Test Bank for Foundations of Maternal Newborn and Womens Health Nursing 7th Edition By Murra

Test Bank for Foundations of Maternal Newborn and

Womens Health Nursing 7th Edition By Murray

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Chapter 07: Antepartum Assessment, Care, and Education
Foundations of Maternal-Newborn & Women’s Health Nursing, 7th Edition

MULTIPLE CHOICE

1. Which suggestion is most helpful for the pregnant patient who is experiencing heartburn?
a. Drink plenty of fluids at bedtime.
b. Eat only three meals a day so the stomach is empty between meals.
c. Drink coffee or orange juice immediately on arising in the morning.
d. Use Tums or Rolaids to obtain relief, as directed by the health care provider.
ANS: D
Antacids high in calcium (e.g., Tums, Rolaids) can provide temporary relief. Fluids
overstretch the stomach and may precipitate reflux when lying down. Instruct the patient to
eat five or six small meals per day rather than three full meals. Coffee and orange juice
stimulate acid formation in the stomach and may need to be eliminated from the diet.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Implementation

MSC: Patient Needs: Physiologic Integrity

2. What is the rationale for a woman in her first trimester of pregnancy to expect to visit her
health care provider every 4 weeks?
a. Problems can be eliminated.
b. She develops trust in the health care team.
c. Her questions about labor can be answered.
d. The conditions of the expectant mother and fetus can be monitored.
ANS: D
This routine allows for monitoring maternal health and fetal growth and ensures that problems
will be identified early. All problems cannot be eliminated because of prenatal visits;
however, they can be identified early. Developing a trusting relationship should be established
during these visits, but that is not the primary reason. Most women do not have questions
concerning labor until the last trimester of the pregnancy.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Health Promotion and Maintenance

3. Which advice to the patient is one of the most effective methods for preventing venous stasis?
a. Sit with the legs crossed.
b. Rest often with the feet elevated.
c. Sleep with the foot of the bed elevated.
d. Wear elastic stockings in the afternoon.
ANS: B
Elevating the feet and legs improves venous return and prevents venous stasis. Sitting with the
legs crossed will decrease circulation in the legs and increase venous stasis. Elevating the legs
at night may cause pressure on the diaphragm and increase breathing problems. Elastic
stockings should be applied before lowering the legs in the morning.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Planning

MSC: Patient Needs: Physiologic Integrity
4. What is the gravida and para for a patient who delivered triplets 2 years ago and is now
pregnant again?
a. 2, 3
b. 1, 2
c. 2, 1
d. 1, 3
ANS: C
She has had two pregnancies (gravida 2); para refers to the outcome of the pregnancy rather
than the number of infants from that pregnancy. She is pregnant now, so that would make her
a gravida 2. She is para 1 because she had one pregnancy that progressed to the age of
viability.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Health Promotion and Maintenance

5. A patient, gravida 2, para 1, comes for a prenatal visit at 20 weeks of gestation. Her fundus is
palpated 3 cm below the umbilicus. This finding is
a. appropriate for gestational age.
b. a sign of impending complications.
c. lower than normal for gestational age.
d. higher than normal for gestational age.
ANS: C
By 20 weeks, the fundus should reach the umbilicus. The fundus should be at the umbilicus at
20 weeks, so 3 cm below the umbilicus is an inappropriate height and needs further
assessment. This is lower than expected at this date. It may be a complication, but it may also
be because of incorrect dating of the pregnancy.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Health Promotion and Maintenance

6. Which complaint made by a patient at 35 weeks of gestation requires additional assessment?

a. Abdominal pain
b. Ankle edema in the afternoon
c. Backache with prolonged standing
d. Shortness of breath when climbing stairs
ANS: A
Abdominal pain at 35 weeks gestation may indicate preeclampsia, or abruptio placentae.
Ankle edema in the afternoon is a normal finding at this stage of the pregnancy. Backaches
while standing is a normal finding in the later stages of pregnancy. Shortness of breath is an
expected finding at 35 weeks.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Physiologic Integrity

7. A gravida 1 patient at 32 weeks of gestation reports that she has severe lower back pain. What
should the nurse’s assessment include?
a. Palpation of the lumbar spine
b. Exercise pattern and duration
 c. Observation of posture and body mechanics
d. Ability to sleep for at least 6 hours uninterrupted
ANS: C
Correct posture and body mechanics can reduce lower back pain caused by increasing
lordosis. Pregnancy should not cause alterations in the spine. Any assessment for
malformation should be done early in pregnancy. Certain exercises can help relieve back pain.
Rest is important for overall well-being; however, the primary concern related to back pain is
a thorough evaluation of posture and body mechanics.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Health Promotion and Maintenance

8. Which laboratory result would be a cause for concern if exhibited by a patient at her first
prenatal visit during the second month of her pregnancy?
a. Rubella titer, 1:6
b. Platelets, 300,000/mm3
c. White blood cell count, 6000/mm3
d. Hematocrit 38%, hemoglobin 13 g/dL
ANS: A
A rubella titer of less than 1:8 indicates a lack of immunity to rubella, a viral infection that has
the potential to cause teratogenic effects on fetal development. Arrangements should be made
to administer the rubella vaccine after birth during the postpartum period because
administration of rubella, a live vaccine, would be contraindicated during pregnancy. Women
receiving the vaccine during the postpartum period should be cautioned to avoid pregnancy
for 3 months. The lab values for WBCs, platelets, and hematocrit/hemoglobin are within the
expected range for pregnant women.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Physiologic Integrity

9. A patient in her third trimester of pregnancy is asking about safe travel. Which statement
should the nurse provide regarding safe travel during pregnancy?
a. “Only travel by car during pregnancy.”
b. “Avoid use of the seat belt during the third trimester.”
c. “You can travel by plane until your 38th week of gestation.”
d. “If you are traveling by car stop to walk every 1 to 2 hours.”
ANS: D
Car travel is safe during normal pregnancies. Suggest that the woman stop to walk every 1 to
2 hours so she can empty her bladder. Walking also helps decrease the risk of thrombosis that
is elevated during pregnancy. Seat belts should be worn throughout the pregnancy. Instruct the
woman to fasten the seat belt snugly, with the lap belt under her abdomen and across her
thighs and the shoulder belt in a diagonal position across her chest and above the bulge of her
uterus. Travel by plane is generally safe up to 36 weeks if there are no complications of the
pregnancy, so only traveling by car is an inaccurate statement.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Health Promotion and Maintenance

10. When a pregnant woman develops ptyalism, which guidance should the nurse provide?
 a. Chew gum or suck on lozenges between meals.
b. Eat nutritious meals that provide adequate amounts of essential vitamins and
minerals.
c. Take short walks to stimulate circulation in the legs and elevate the legs
periodically.
d. Use pillows to support the abdomen and back during sleep.
ANS: A
Some women experience ptyalism, or excessive salivation. The cause of ptyalism may be
decreased swallowing associated with nausea or stimulation of the salivary glands by the
ingestion of starch. Small frequent meals and use of chewing gum and oral lozenges offer
limited relief for some women. All other options include recommendations for pregnant
women; however, they do not address ptyalism.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Implementation

MSC: Patient Needs: Physiologic Integrity: Basic Care and Comfort

11. When documenting a patient encounter, which term will the nurse use to describe the woman
who is in the 28th week of her first pregnancy?
a. Multigravida
b. Multipara
c. Nullipara
d. Primigravida
ANS: D
A primigravida is a woman pregnant for the first time. A multigravida has been pregnant more
than once. A nullipara is a woman who has never been pregnant or has not completed a
pregnancy of 20 weeks or more. A primipara has delivered one pregnancy of at least 20
weeks. A multipara has delivered two or more pregnancies of at least 20 weeks.

DIF: Cognitive Level: Knowledge OBJ: Nursing Process Step: Implementation

MSC: Patient Needs: Health Promotion and Maintenance

12. You are performing assessments for an obstetric patient who is 5 months pregnant with her
third child. Which finding would cause you to suspect that the patient was at risk?
a. Patient states that she doesn’t feel any Braxton Hicks contractions like she had in
her prior pregnancies.
b. Fundal height is below the umbilicus.
c. Cervical changes, such as Goodell’s sign and Chadwick’s sign, are present.
d. She has increased vaginal secretions.
ANS: B
Based on gestational age (20 weeks), the fundal height should be at the umbilicus. This
finding is abnormal and warrants further investigation about potential risk. With subsequent
pregnancies, multiparas may not perceive Braxton Hicks contractions as being evident
compared with their initial pregnancy. Cervical changes such as Goodell’s and Chadwick’s
signs should be present and are considered a normal finding. Increased vaginal secretions are
normal during pregnancy as a result of increased vascularity.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Physiologic Integrity: Reduction of Risk Potential
13. Determine the obstetric history of a patient in her fifth pregnancy who has had two
spontaneous abortions in the first trimester, one infant at 32 weeks’ gestation, and one infant
at 38 weeks’ gestation.
a. G5 T1 P2 A2 L 2
b. G5 T1 P1 A1 L2
c. G5 T0 P2 A2 L2
d. G5 T1 P1 A2 L2
ANS: D
This patient is in her fifth pregnancy, which is G5, she had one viable term infant (between 38
and 42 weeks’ gestation), which is T1, she had one viable preterm infant (between 20 and 37
weeks’ gestation), which is P1, two spontaneous abortions (before 20 weeks’ gestation),
which is A2, and she has two living children, which is L2.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Analysis

MSC: Patient Needs: Health Promotion and Maintenance

14. Use Nägele’s rule to determine the EDD (estimated day of birth) for a patient whose last
menstrual period started on April 12.
a. February 19
b. January 19
c. January 21
d. February 7
ANS: B
Nägele’s rule subtracts 3 months from the month of the last menstrual period (month 4 – 3 =
January) and adds 7 days to the day that the last menstrual period started (April 12 + 7 days =
April 19), so the correct answer is January 19 of the following calendar year.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Analysis

MSC: Patient Needs: Health Promotion and Maintenance

15. Which of the patient health behaviors in the first trimester would the nurse identify as a risk
factor in pregnancy?
a. Sexual intercourse two or three times weekly
b. Moderate exercise for 30 minutes daily
c. Working 40 hours a week as a secretary in a travel agency
d. Relaxing in a hot tub for 30 minutes a day, several days a week
ANS: D
Pregnant women should avoid activities that might cause hyperthermia. Maternal
hyperthermia, particularly during the first trimester, may be associated with fetal anomalies.
She should not be in a hot tub for more than 10 minutes at less than 100F. Sexual intercourse
is generally safe for the healthy pregnant woman; moderate exercise during pregnancy can
strengthen muscles, reduce backache and stress, and provide a feeling of well-being; working
during pregnancy is acceptable as long as the woman is not continually on her feet or exposed
to environmental toxins and industrial hazards.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Physiologic Integrity
16. A patient who smokes one pack of cigarettes daily has a positive pregnancy test. The nurse
will explain that smoking during pregnancy increases the risk of which condition?
a. Congenital anomalies
b. Death before or after birth
c. Neonatal hypoglycemia
d. Neonatal withdrawal syndrome
ANS: B
Smoking during pregnancy increases the risk for spontaneous abortion, low birth weight,
abruptio placentae, placenta previa, preterm birth, perinatal mortality, and SIDS. Smoking
does not appear to cause congenital anomalies, hypoglycemia, or withdrawal syndrome.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Implementation

MSC: Patient Needs: Physiologic Integrity: Reduction of Risk Potential

17. A patient with an IUD in place has a positive pregnancy test. When planning care, the nurse
will base decisions on which anticipated action?
a. A therapeutic abortion will need to be scheduled since fetal damage is inevitable.
b. Hormonal analyses will be done to determine the underlying cause of the
false-positive test result.
c. The IUD will need to be removed to avoid complications such as miscarriage or
infection.
d. The IUD will need to remain in place to avoid injuring the fetus.
ANS: C
Pregnancy with an intrauterine device (IUD) in place is unusual; however, it can occur and
cause complications such as spontaneous abortion and infection. A therapeutic abortion is not
indicated unless infection occurs.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Planning

MSC: Patient Needs: Physiologic Integrity: Reduction of Risk Potential

18. The health care provider reports that the primigravida’s fundus can be palpated at the
umbilicus. Which priority question will the nurse include in the patient’s assessment?
a. “Have you noticed that it is easier for you to breathe now?”
b. “Would you like to hear the baby’s heartbeat for the first time?”
c. “Have you felt a fluttering sensation in your lower pelvic area yet?”
d. “Have you recently developed any unusual cravings, such as for chalk or dirt?”
ANS: C
Quickening is the first maternal sensation of fetal movement and is often described as a
fluttering sensation. Quickening is detected at approximately 20 weeks in the primigravida
and as early as 16 weeks in the multigravida. The fundus is at the umbilicus at 20 weeks’
gestation. Lightening is associated with descent of the fetal head into the maternal pelvis and
is associated with improved lung expansion. Lightening occurs approximately 2 weeks before
birth in the primipara. Fetal heart tones can be detected by Doppler as early as 9 to 12 weeks
of gestation. Pica is the craving for nonnutritive substances such as chalk, dirt, clay, or sand. It
can develop at any time during pregnancy. It can be associated with malnutrition and the
health care provider should monitor the patient’s hematocrit/hemoglobin, zinc, and iron
levels.
 DIF: Cognitive Level: Application OBJ: Nursing Process Step: Analysis
MSC: Patient Needs: Health Promotion and Maintenance

19. The nurse is scheduling the next appointment for a healthy primigravida currently at 28 weeks
gestation. When will the nurse schedule the next prenatal visit?
a. 1 week
b. 2 weeks
c. 3 weeks
d. 4 weeks
ANS: B
From 29 to 36 weeks, routine prenatal assessment is every 2 weeks. If the pregnancy is high
risk, the patient will see the health care provider more frequently.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Implementation

MSC: Patient Needs: Health Promotion and Maintenance

20. Which information is covered by early pregnancy classes offered in the first and second
trimesters?
a. Methods of pain relief
b. The phases and stages of labor
c. Coping with common discomforts of pregnancy
d. Prebirth and postbirth care of a patient having a cesarean birth
ANS: C
Early pregnancy classes focus on the first two trimesters and cover information on adapting to
pregnancy, dealing with early discomforts, and understanding what to expect in the months
ahead. Methods of pain relief are discussed in a childbirth preparation class. The phases and
stages of labor are usually covered in a childbirth preparation class. Cesarean birth preparation
classes discuss prebirth and postbirth of a patient having a cesarean birth.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Health Promotion and Maintenance

21. Which is the method of childbirth that helps prevent the fear-tension-pain cycle by using slow
abdominal breathing in early labor and rapid chest breathing in advanced labor?
a. Bradley
b. Lamaze
c. Leboyer
d. Dick-Read
ANS: D
The Dick-Read method helps prevent the fear-tension-pain cycle by using slow abdominal
breathing in early labor and rapid chest breathing in advanced labor. The Lamaze method
involves concentration and conditioning to help the woman respond to contractions with
relaxation to decrease pain. Viewing childbirth as a traumatic experience, the Leboyer method
uses decreased light and noise to help the newborn adapt to extrauterine life more easily. The
Bradley method teaches women to use abdominal muscles to increase relaxation and breath
control; it emphasizes avoidance of all medications and interventions.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Health Promotion and Maintenance
22. Which type of cutaneous stimulation involves massage of the abdomen?
a. Imagery
b. Effleurage
c. Mental stimulation
d. Thermal stimulation
ANS: B
Effleurage is massage usually performed on the abdomen during contractions. Imagery
exercises enhance relaxation by teaching the woman to imagine herself in a relaxing setting.
Mental stimulation is a group of methods to decrease pain by increasing mental stimulation.
Thermal stimulation decreases pain by using applications of heat and cold.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Physiologic Integrity

23. What does a birth plan help the parents accomplish?

a. Avoidance of an episiotomy
b. Determining the outcome of the birth
c. Assuming complete control of the situation
d. Taking an active part in planning the birth experience
ANS: D
The birth plan helps the woman and her partner look at the available options and plan the birth
experience to meet their personal needs. A birth plan cannot dictate the need for or avoidance
of an episiotomy. The outcome of the birth is not an absolute determinant. A birth plan does
not assume complete control of the situation; it allows for expanding communication. Parents
who prepare a birth plan should be educated that flexibility is essential as each labor and
delivery is unique and may present unexpected complications.

DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Health Promotion and Maintenance

24. A relaxation technique that can be used during the childbirth experience to decrease maternal
pain perception is
a. using increased environmental stimulation as a method of distraction.
b. restricting family and friends from visiting during the labor period to keep the
patient focused on breathing techniques.
c. medicating the patient frequently to reduce pain perception.
d. assisting the patient in breathing methods aimed at taking control of pain
perception based on the contraction pattern.
ANS: D
Relaxation techniques are aimed at incorporating mind and body activities to maintain control
over pain. Additional environmental stimuli may have the opposite effect and increase patient
anxiety, which will affect pain perception. Restricting visitors may have the opposite effect,
leading to increased anxiety because of isolation. Medicating a patient may not decrease pain
perception but may place the patient at risk for adverse reactions and/or complications of
pregnancy related to medications.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Planning

MSC: Patient Needs: Psychosocial Integrity: Therapeutic Communication
25. Which technique would provide the best pain relief for a pregnant woman with an occiput
posterior position?
a. Neuromuscular disassociation
b. Effleurage
c. Psychoprophylaxis
d. Sacral pressure
ANS: D
The use of sacral pressure may provide relief for patients who are experiencing back labor.
The presentation of the fetus in a posterior position indicates this. Neuromuscular dissociation
is used as a conditioned response to affect pain relief based on the mother tensing one group
of muscles and focusing on releasing tension in the rest of her body. Effleurage is the process
of using circular massage to effect pain relief. Psychoprophylaxis is another name for the
Lamaze method of prepared childbirth.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Planning

MSC: Patient Needs: Psychosocial Integrity: Sensory Perceptual Alterations

26. The labor nurse is reviewing breathing techniques with a primiparous patient admitted for
induction of labor. When is the best time to encourage the laboring patient to use slow, deep
chest breathing with contractions?
a. During labor, when she can no longer talk through contractions
b. During the first stage of labor, when the contractions are 3 to 4 minutes apart
c. Between contractions, during the transitional phase of the first stage of labor
d. Between her efforts to push to facilitate relaxation between contractions
ANS: A
Focused breathing techniques should not be used in labor until they are actually needed,
which is usually when the woman can no longer walk and talk during a contraction. If
breathing techniques are used too early, the woman tends to move through the different
techniques too quickly, and she may stop using them. In addition, the use of the more complex
breathing patterns in latent labor may increase fatigue. Women should be encouraged to adapt
the techniques to their own comfort and needs. Breathing deeply between contractions or
pushing can increase the possibility of carbon dioxide retention and make the patient dizzy.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Planning

MSC: Patient Needs: Health Promotion and Maintenance

27. In a prenatal education class, the nurse is reviewing the importance of using relaxation
techniques during labor. Which patient statement will the nurse need to correct?
a. “We will practice relaxation techniques only in a quiet setting so I can focus.”
b. “Relaxation is important during labor because it will help me conserve my
energy.”
c. “If I relax in between contractions, my baby will get more oxygen during labor.”
d. “My partner and I will practice relaxation throughout the remainder of my
pregnancy.”
ANS: A
 Relaxation exercises must be practiced frequently to be useful during labor. Couples begin
practice sessions in a quiet, comfortable setting. Later, they practice in other places that
simulate the noise and unfamiliar setting of the hospital. The ability to relax during labor is an
important component of coping effectively with childbirth. Relaxation conserves energy,
decreases oxygen use, and enhances other pain relief techniques. Women learn exercises to
help them recognize and release tension. The labor partner assists the woman by providing
feedback during exercise sessions and labor.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Evaluation

MSC: Patient Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. A pregnant patient reports that she works in a long-term care setting and is concerned about
the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are
aware that some immunizations are safe to administer during pregnancy, whereas others are
not. Which vaccines could this patient receive? (Select all that apply.)
a. Tetanus
b. Varicella
c. Influenza
d. Hepatitis A and B
e. Measles, mumps, rubella (MMR)
ANS: A, C, D
Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe
to administer to women who have a risk for contracting or developing the disease.
Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are
contraindicated during pregnancy because of the possible teratogenic effects on the fetus.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Evaluation

MSC: Patient Needs: Health Promotion and Maintenance

2. The nurse is planning care for a patient in her first trimester of pregnancy. The patient is
experiencing nausea and vomiting. Which interventions should the nurse plan to share with
this patient? (Select all that apply.)
a. Suck on hard candy.
b. Take prenatal vitamins in the morning.
c. Try some herbal tea to relieve the nausea.
d. Drink fluids frequently but separate from meals.
e. Eat crackers or dry cereal before arising in the morning.
ANS: A, D, E
A patient experiencing nausea and vomiting should be taught to suck on hard candy, drink
fluids frequently but separately from meals, and eat crackers, dry toast, or dry cereal before
arising in the morning. Prenatal vitamins should be taken at bedtime because they may
increase nausea if taken in the morning. Before taking herbal tea, the patient should check
with her health care provider.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Planning

MSC: Patient Needs: Physiologic Integrity
Test Bank for Foundations of Maternal Newborn and Womens Health Nursing 7th Edition By Murra

3. Which factors contribute to the presence of edema in the pregnant patient? (Select all that
apply.)
a. Diet consisting of processed foods
b. Hemoconcentration
c. Increase in colloid osmotic pressure
d. Last trimester of pregnancy
e. Decreased venous return
ANS: A, D, E
Processed foods, which are high in sodium content, can contribute to edema formation. As the
pregnancy progresses, because of the weight of the uterus, compression takes place, leading to
decreased venous return and an increase in edema formation. A decrease in colloid osmotic
pressure would contribute to edema formation and fluid shifting. Hemodilution would also
lead to edema formation.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment

MSC: Patient Needs: Physiologic Integrity: Physiologic Adaptation

4. The prenatal nurse educator is teaching couples the technique of applying sacral pressure
during labor. Which should be included in the teaching session? (Select all that apply.)
a. The technique can be combined with heat to the area.
b. A jiggling motion should be used while applying the pressure.
c. Tennis balls may be used to apply the pressure to the sacral area.
d. The pressure against the sacrum should be intermittent during the contraction.
e. The hand may be moved slowly or remain positioned directly over the sacrum.
ANS: A, C, E
Sacral pressure can be combined with thermal stimulation to increase effectiveness.
The hand may be moved slowly over the area or remain positioned directly over the sacrum,
but pressure should be continuous and firm throughout the contraction. Care should be taken
not to jiggle the woman, which may be irritating.

DIF: Cognitive Level: Application OBJ: Nursing Process Step: Implementation

MSC: Patient Needs: Physiologic Integrity

COMPLETION

1. Calculate the estimated date of birth (EDD) in October using Nägele’s rule for a patient whose
last normal menstrual period (LNMP) began on January 1. Record your answer as a whole
number. _______

ANS:
8

Nägele’s rule is often used to establish the EDD. This method involves subtracting 3 months
from the date that the LNMP began, adding 7 days, and then correcting the year, if
appropriate. Subtracting 3 months from January 1 gives you the month of October and adding
7 days = October 8.

DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Evaluation

MSC: Patient Needs: Health Promotion and Maintenance

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