NUR1025C Exam 3 Possible Questions
1. Induced abortion is the purposeful interruption of a pregnancy before 20 weeks of gestation. (Spontaneous
abortion or miscarriage is discussed in Chapter 12.) If the abortion is performed at the woman's request, the
term elective abortion is usually used; if performed for reasons of maternal or fetal health or disease, the term
therapeutic abortion applies. Many factors contribute to a woman's decision to have an abortion. Indications
include (1) preservation of the life or health of the mother, (2) genetic disorders of the fetus, (3) rape or incest,
and (4) the pregnant woman's request. The control of birth, dealing as it does with human sexuality and the
question of life and death, is one of the most emotional components of health care. It has been the most
controversial social issue in the last half of the twentieth century and continues to be so today. Regulations
exist to protect the mother from the complications of abortion.
Second-Trimester Abortion
Because the great majority of induced abortions in the United States occur in the first trimester, only about
10% are performed in the second trimester. Second-trimester abortion is associated with more complications
and costs than first-trimester abortions. Dilation and evacuation (D&E) accounts for almost all procedures
performed in the United States. In general medical administration of second-trimester abortions involves the
same drugs (misoprostol and mifepristone) used in medical termination of pregnancy during the first trimester.
The D&E procedure is generally preferred by patients because it is less expensive and better tolerated than
medical abortion during the second trimester (Fritz and Speroff, 2011b).
Dilation and Evacuation
D&E can be performed at any point up to 20 weeks of gestation, although it is more often performed between
13 and 16 weeks (Paul and Stein, 2011). The cervix requires more dilation because the products of conception
are larger. Often laminaria are inserted several hours or several days before the procedure, or misoprostol can
be applied to the cervix to soften the tissue. The procedure is similar to that of vaginal aspiration, except that a
larger cannula is used and other instruments may be needed to remove the fetus and placenta. Nursing care
includes monitoring vital signs, providing emotional support, administering analgesics, and postoperative
monitoring. Disadvantages of D&E include possible long-term harmful effects on the cervix.
The woman who has an induced abortion should be given clear instructions to return immediately to the
health care facility or emergency department for any of the following symptoms:
• Fever greater than 38° C (100.4° F)
• Chills
• Bleeding greater than two saturated pads in 2 hours or heavy bleeding lasting a few days
• Foul-smelling vaginal discharge
• Severe abdominal pain, cramping, or backache
• Abdominal tenderness (when pressure applied)
A woman who is 10 weeks pregnant is being counseled by the nurse regarding her upcoming elective abortion.
What information should the nurse provide?
A. "A local anesthetic will be injected into your vagina."
B. "The exact name of the procedure is dilation and extraction."
C. "They may use a seaweed product to dilate your cervix."
D. "You won't need to have any cervical dilation at all."
Vacuum aspiration is the most common method for surgical abortion for pregnancies up to 12 weeks'
gestation. After 7 weeks, cervical dilation is often accomplished with laminaria, a dried seaweed product. For a
pregnancy that is 5-7 weeks' gestation, no dilation is needed. A local anesthetic is injected into the cervix in
women who are between 8 and 12 weeks' gestation because of the need for mechanical dilation. A dilation
and extraction is the term for abortions performed during the second trimester.
,A doctor performs an abortion on a woman who is unable to carry a fetus to term because of a severe risk to
her health. What is the term for this type of abortion?
A) Spontaneous abortion
B) Elective abortion
C) Therapeutic abortion
D) Legal abortion
A therapeutic abortion is performed for medical reasons while elective abortion is undertaken for personal
reasons. Both are legal under legally appropriate circumstances. A spontaneous abortion results from natural
causes.
What is the priority nursing intervention for the client who has had an incomplete abortion?
a. Methylergonovine (Methergine), 0.2 mg IM
b. Preoperative teaching for surgery
c. Insertion of IV line for fluid replacement
d. Positioning of client in left side-lying position
Initial treatment of an incomplete abortion should be focused on stabilizing the client’s cardiovascular state.
Methylergonovine would be administered after surgical treatment, preoperative teaching is not a priority until
the client is stabilized, and the left side-lying position provides no benefit to the client in this situation.
2. Travel is not contraindicated for low risk pregnant women. Women with high risk pregnancies are advised to
avoid long-distance travel after fetal viability has been reached to avert the economic and psychologic
consequences of giving birth to a preterm infant far from home. Travel to areas where medical care is poor,
water is untreated, or malaria is prevalent should be avoided if possible. Women who contemplate foreign
travel should be aware that many health insurance carriers do not cover birth in a foreign setting or even
hospitalization for preterm labor. In addition, vaccinations for foreign travel may be contraindicated during
pregnancy.
Pregnant women who travel long distances should schedule periods of activity and rest. While sitting, the
woman can practice deep breathing, foot circling, and alternately contracting and relaxing different muscle
groups. She should avoid becoming fatigued. Although travel in itself is not a cause of adverse outcomes such
as miscarriage or preterm labor, certain precautions are recommended when traveling in a car. For example,
women riding in a car should wear automobile restraints and stop to walk every hour.
A pregnant client in the 21st week of pregnancy is planning a vacation with family and asks which method of
travel she should use. How should the nurse respond?
1. “Travel by bus.”
2. “Fly on an airplane.”
3. “Take an automobile.”
4. “Do not travel this late in the pregnancy.”
1. Traveling by bus is similar to traveling by automobile, which does not allow for frequent enough ambulation.
2. As pregnancy progresses, long-distance trips are best taken by plane. 3. Automobile travel does not allow for
frequent enough ambulation. 4. It is not necessary to cease travel altogether.
A client in her third trimester of pregnancy is asking about safe travel. Which statement should the nurse give
about 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.”
,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 travelling by car is an inaccurate statement.
A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling
during pregnancy, which statement indicates that the teaching was successful?
A) “I'll sit in a window seat so I can focus on the sky to help relax me.”
B) “I won't drink too much fluid so I don't have to urinate so often.”
C) “I'll get up and walk around the airplane about every 2 hours.”
D) “I'll do some upper arm stretches while sitting in my seat.”
3. Some concern has been raised over the safety of various immunization practices during pregnancy.
Immunization with live or attenuated live virus or live bacterial vaccines is generally contraindicated during
pregnancy (CDC, 2013). Live virus vaccines include those for measles (rubeola and rubella), chickenpox
(varicella), and the Sabin (oral) poliomyelitis vaccine (no longer used in the United States). Human papilloma
virus (HPV) vaccine is not recommended during pregnancy. Vaccines consisting of killed viruses that may be
administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and influenza vaccines
(CDC, 2013).
The Centers for Disease Control and Prevention (CDC, 2013) recommends routine administration of the
tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during each pregnancy. The optimal timing for the
vaccine is between 27 and 36 weeks of gestation. While certainly the optimal timing is 27-36 weeks, a patient
without any vaccines will benefit at any time.
A pregnant client 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 client receive? (Select all
that apply.)
a. Tetanus
b. Varicella
c. Influenza
d. Hepatitis A and B
e. Measles, mumps, rubella (MMR)
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.
A nurse should screen clients of childbearing age for pregnancy as the administration of which of the following
vaccines is contraindicated during pregnancy? Select all that apply.
A) Influenza
B) Varicella
C) Measles
D) Mumps
E) Rubella
The measles, mumps, rubella, and varicella vaccines are contraindicated during pregnancy, especially during
the first trimester, because of the danger for birth defects.
, A pregnant immigrant has an unknown immunization history. When she presents for routine vaccinations,
which will the nurse administer?
a. Hepatitis B
b. Measles
c. Rubella
d. Varicella
In general, immunizations with live virus vaccines (e.g., measles, mumps, rubella, varicella, smallpox) are
contraindicated during pregnancy because they may have teratogenic effects on the fetus. Inactivated vaccines
are safe and can be used in women who have a risk of developing diseases such as tetanus, hepatitis B, and
influenza.
4. Many children and adolescents continue to suffer from inadequately treated pain of all types (Perquin,
Hazebroek-Kampschreur, Hunfeld, et al., 2000). Several research studies suggest that the undertreatment of
pain in children is related to inconsistent practice in pain assessment, administration of analgesics at
subtherapeutic levels, prolonged intervals between medications (Jacob and Puntillo, 2000), and lack of
systematic monitoring and evaluation of relief (Jacob, Miaskowski, Savedra, et al., 2003a, 2003b; Jacob and
Mueller, 2008). Optimal pain management begins with thorough assessment, which guides the selection of
treatments. Acute pain assessment is easier to perform than complex pain that may be chronic, recurrent, or
persistent. Nurses across the board tend to underestimate the pain level for children and adults.
Traditionally assessment measures are defined as behavioral measures, physiologic measures, and measures of
self-reports. These measures predominantly address the domain of pain intensity. The behavioral measures of
pain (for infants and children younger than 4 years; Table 30-1) and self-reports of pain (for children 4 years
and older; Table 30-2) have been developed, validated, and widely used. Self-report measures are not
sufficiently valid for children below 3 years of age because many are not able to accurately self-report their
pain. Distress behaviors such as vocalization, facial expression, and body movement have been associated with
pain (Figs. 30-1 and 30-2; Box 30-1). These behaviors are helpful in evaluating pain in infants and children with
limited communication skills. However, discriminating between pain behaviors and reactions from other
sources of distress such as hunger, anxiety, or other types of discomfort is not always easy. These factors
decrease the specificity and sensitivity of behavioral measures (see Table 30-1).
Behavioral assessment is useful for measuring pain in infants and preverbal children who do not have the
language skills to communicate that they are in pain or in children with mental clouding and confusion that
limit their ability to communicate meaningfully. Behavior provides important information that cannot be
obtained from self-report. Behavioral assessment may provide a more complete picture of the total pain
experience when administered in conjunction with a subjective self-report measure. However, behavioral pain
scales may be more time-consuming than self-reports. These measures depend on a trained observer to watch
and record children's behaviors such as vocalization, facial expression, and body movements that suggest
discomfort. Behaviors are assigned numbers from 0 to 4 to represent different intensities of distress. Scores are
added to determine the child's pain rating.
Unrelieved pain may lead to potential long-term physiologic, psychosocial, and behavioral consequences
(Goldschneider and Anand, 2003; Weisman, Bernstein, and Schechter, 1998). Management of pain should be a
priority for all clinicians.
Which additional nursing intervention(s) would be effective with pain management in the pediatric
population? (Select all that apply.)
a. Provide diversional activities such as coloring, puzzles, and games.
b. Allow uninterrupted sleep and rest.
c. Perform hygiene measures.
d. Encourage parental participation with caregiving to diminish the child’s anxiety.
1. Induced abortion is the purposeful interruption of a pregnancy before 20 weeks of gestation. (Spontaneous
abortion or miscarriage is discussed in Chapter 12.) If the abortion is performed at the woman's request, the
term elective abortion is usually used; if performed for reasons of maternal or fetal health or disease, the term
therapeutic abortion applies. Many factors contribute to a woman's decision to have an abortion. Indications
include (1) preservation of the life or health of the mother, (2) genetic disorders of the fetus, (3) rape or incest,
and (4) the pregnant woman's request. The control of birth, dealing as it does with human sexuality and the
question of life and death, is one of the most emotional components of health care. It has been the most
controversial social issue in the last half of the twentieth century and continues to be so today. Regulations
exist to protect the mother from the complications of abortion.
Second-Trimester Abortion
Because the great majority of induced abortions in the United States occur in the first trimester, only about
10% are performed in the second trimester. Second-trimester abortion is associated with more complications
and costs than first-trimester abortions. Dilation and evacuation (D&E) accounts for almost all procedures
performed in the United States. In general medical administration of second-trimester abortions involves the
same drugs (misoprostol and mifepristone) used in medical termination of pregnancy during the first trimester.
The D&E procedure is generally preferred by patients because it is less expensive and better tolerated than
medical abortion during the second trimester (Fritz and Speroff, 2011b).
Dilation and Evacuation
D&E can be performed at any point up to 20 weeks of gestation, although it is more often performed between
13 and 16 weeks (Paul and Stein, 2011). The cervix requires more dilation because the products of conception
are larger. Often laminaria are inserted several hours or several days before the procedure, or misoprostol can
be applied to the cervix to soften the tissue. The procedure is similar to that of vaginal aspiration, except that a
larger cannula is used and other instruments may be needed to remove the fetus and placenta. Nursing care
includes monitoring vital signs, providing emotional support, administering analgesics, and postoperative
monitoring. Disadvantages of D&E include possible long-term harmful effects on the cervix.
The woman who has an induced abortion should be given clear instructions to return immediately to the
health care facility or emergency department for any of the following symptoms:
• Fever greater than 38° C (100.4° F)
• Chills
• Bleeding greater than two saturated pads in 2 hours or heavy bleeding lasting a few days
• Foul-smelling vaginal discharge
• Severe abdominal pain, cramping, or backache
• Abdominal tenderness (when pressure applied)
A woman who is 10 weeks pregnant is being counseled by the nurse regarding her upcoming elective abortion.
What information should the nurse provide?
A. "A local anesthetic will be injected into your vagina."
B. "The exact name of the procedure is dilation and extraction."
C. "They may use a seaweed product to dilate your cervix."
D. "You won't need to have any cervical dilation at all."
Vacuum aspiration is the most common method for surgical abortion for pregnancies up to 12 weeks'
gestation. After 7 weeks, cervical dilation is often accomplished with laminaria, a dried seaweed product. For a
pregnancy that is 5-7 weeks' gestation, no dilation is needed. A local anesthetic is injected into the cervix in
women who are between 8 and 12 weeks' gestation because of the need for mechanical dilation. A dilation
and extraction is the term for abortions performed during the second trimester.
,A doctor performs an abortion on a woman who is unable to carry a fetus to term because of a severe risk to
her health. What is the term for this type of abortion?
A) Spontaneous abortion
B) Elective abortion
C) Therapeutic abortion
D) Legal abortion
A therapeutic abortion is performed for medical reasons while elective abortion is undertaken for personal
reasons. Both are legal under legally appropriate circumstances. A spontaneous abortion results from natural
causes.
What is the priority nursing intervention for the client who has had an incomplete abortion?
a. Methylergonovine (Methergine), 0.2 mg IM
b. Preoperative teaching for surgery
c. Insertion of IV line for fluid replacement
d. Positioning of client in left side-lying position
Initial treatment of an incomplete abortion should be focused on stabilizing the client’s cardiovascular state.
Methylergonovine would be administered after surgical treatment, preoperative teaching is not a priority until
the client is stabilized, and the left side-lying position provides no benefit to the client in this situation.
2. Travel is not contraindicated for low risk pregnant women. Women with high risk pregnancies are advised to
avoid long-distance travel after fetal viability has been reached to avert the economic and psychologic
consequences of giving birth to a preterm infant far from home. Travel to areas where medical care is poor,
water is untreated, or malaria is prevalent should be avoided if possible. Women who contemplate foreign
travel should be aware that many health insurance carriers do not cover birth in a foreign setting or even
hospitalization for preterm labor. In addition, vaccinations for foreign travel may be contraindicated during
pregnancy.
Pregnant women who travel long distances should schedule periods of activity and rest. While sitting, the
woman can practice deep breathing, foot circling, and alternately contracting and relaxing different muscle
groups. She should avoid becoming fatigued. Although travel in itself is not a cause of adverse outcomes such
as miscarriage or preterm labor, certain precautions are recommended when traveling in a car. For example,
women riding in a car should wear automobile restraints and stop to walk every hour.
A pregnant client in the 21st week of pregnancy is planning a vacation with family and asks which method of
travel she should use. How should the nurse respond?
1. “Travel by bus.”
2. “Fly on an airplane.”
3. “Take an automobile.”
4. “Do not travel this late in the pregnancy.”
1. Traveling by bus is similar to traveling by automobile, which does not allow for frequent enough ambulation.
2. As pregnancy progresses, long-distance trips are best taken by plane. 3. Automobile travel does not allow for
frequent enough ambulation. 4. It is not necessary to cease travel altogether.
A client in her third trimester of pregnancy is asking about safe travel. Which statement should the nurse give
about 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.”
,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 travelling by car is an inaccurate statement.
A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling
during pregnancy, which statement indicates that the teaching was successful?
A) “I'll sit in a window seat so I can focus on the sky to help relax me.”
B) “I won't drink too much fluid so I don't have to urinate so often.”
C) “I'll get up and walk around the airplane about every 2 hours.”
D) “I'll do some upper arm stretches while sitting in my seat.”
3. Some concern has been raised over the safety of various immunization practices during pregnancy.
Immunization with live or attenuated live virus or live bacterial vaccines is generally contraindicated during
pregnancy (CDC, 2013). Live virus vaccines include those for measles (rubeola and rubella), chickenpox
(varicella), and the Sabin (oral) poliomyelitis vaccine (no longer used in the United States). Human papilloma
virus (HPV) vaccine is not recommended during pregnancy. Vaccines consisting of killed viruses that may be
administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and influenza vaccines
(CDC, 2013).
The Centers for Disease Control and Prevention (CDC, 2013) recommends routine administration of the
tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during each pregnancy. The optimal timing for the
vaccine is between 27 and 36 weeks of gestation. While certainly the optimal timing is 27-36 weeks, a patient
without any vaccines will benefit at any time.
A pregnant client 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 client receive? (Select all
that apply.)
a. Tetanus
b. Varicella
c. Influenza
d. Hepatitis A and B
e. Measles, mumps, rubella (MMR)
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.
A nurse should screen clients of childbearing age for pregnancy as the administration of which of the following
vaccines is contraindicated during pregnancy? Select all that apply.
A) Influenza
B) Varicella
C) Measles
D) Mumps
E) Rubella
The measles, mumps, rubella, and varicella vaccines are contraindicated during pregnancy, especially during
the first trimester, because of the danger for birth defects.
, A pregnant immigrant has an unknown immunization history. When she presents for routine vaccinations,
which will the nurse administer?
a. Hepatitis B
b. Measles
c. Rubella
d. Varicella
In general, immunizations with live virus vaccines (e.g., measles, mumps, rubella, varicella, smallpox) are
contraindicated during pregnancy because they may have teratogenic effects on the fetus. Inactivated vaccines
are safe and can be used in women who have a risk of developing diseases such as tetanus, hepatitis B, and
influenza.
4. Many children and adolescents continue to suffer from inadequately treated pain of all types (Perquin,
Hazebroek-Kampschreur, Hunfeld, et al., 2000). Several research studies suggest that the undertreatment of
pain in children is related to inconsistent practice in pain assessment, administration of analgesics at
subtherapeutic levels, prolonged intervals between medications (Jacob and Puntillo, 2000), and lack of
systematic monitoring and evaluation of relief (Jacob, Miaskowski, Savedra, et al., 2003a, 2003b; Jacob and
Mueller, 2008). Optimal pain management begins with thorough assessment, which guides the selection of
treatments. Acute pain assessment is easier to perform than complex pain that may be chronic, recurrent, or
persistent. Nurses across the board tend to underestimate the pain level for children and adults.
Traditionally assessment measures are defined as behavioral measures, physiologic measures, and measures of
self-reports. These measures predominantly address the domain of pain intensity. The behavioral measures of
pain (for infants and children younger than 4 years; Table 30-1) and self-reports of pain (for children 4 years
and older; Table 30-2) have been developed, validated, and widely used. Self-report measures are not
sufficiently valid for children below 3 years of age because many are not able to accurately self-report their
pain. Distress behaviors such as vocalization, facial expression, and body movement have been associated with
pain (Figs. 30-1 and 30-2; Box 30-1). These behaviors are helpful in evaluating pain in infants and children with
limited communication skills. However, discriminating between pain behaviors and reactions from other
sources of distress such as hunger, anxiety, or other types of discomfort is not always easy. These factors
decrease the specificity and sensitivity of behavioral measures (see Table 30-1).
Behavioral assessment is useful for measuring pain in infants and preverbal children who do not have the
language skills to communicate that they are in pain or in children with mental clouding and confusion that
limit their ability to communicate meaningfully. Behavior provides important information that cannot be
obtained from self-report. Behavioral assessment may provide a more complete picture of the total pain
experience when administered in conjunction with a subjective self-report measure. However, behavioral pain
scales may be more time-consuming than self-reports. These measures depend on a trained observer to watch
and record children's behaviors such as vocalization, facial expression, and body movements that suggest
discomfort. Behaviors are assigned numbers from 0 to 4 to represent different intensities of distress. Scores are
added to determine the child's pain rating.
Unrelieved pain may lead to potential long-term physiologic, psychosocial, and behavioral consequences
(Goldschneider and Anand, 2003; Weisman, Bernstein, and Schechter, 1998). Management of pain should be a
priority for all clinicians.
Which additional nursing intervention(s) would be effective with pain management in the pediatric
population? (Select all that apply.)
a. Provide diversional activities such as coloring, puzzles, and games.
b. Allow uninterrupted sleep and rest.
c. Perform hygiene measures.
d. Encourage parental participation with caregiving to diminish the child’s anxiety.
