Answers and Rationale – Community Health Nursing and Care of the Mother and Child

Answers and Rationale – Community Health
Nursing and Care of the Mother and Child

1. Answer: (A) Inevitable
Rationale: An inevitable abortion is termination
of pregnancy that cannot be prevented.
Moderate to severe bleeding with mild
cramping and cervical dilation would be noted
in this type of abortion.

2. Answer: (B) History of syphilis
Rationale: Maternal infections such as syphilis,
toxoplasmosis, and rubella are causes of
spontaneous abortion.

3. Answer: (C) Monitoring apical pulse
Rationale: Nursing care for the client with a
possible ectopic pregnancy is focused on
preventing or identifying hypovolemic shock
and controlling pain. An elevated pulse rate is
an indicator of shock.

4. Answer: (B) Increased caloric intake
Rationale: Glucose crosses the placenta, but
insulin does not. High fetal demands for
glucose, combined with the insulin resistance
caused by hormonal changes in the last half of
pregnancy can result in elevation of maternal
blood glucose levels. This increases the
mother’s demand for insulin and is referred to
as the diabetogenic effect of pregnancy.

5. Answer: (A) Excessive fetal activity.
Rationale: The most common signs and
symptoms of hydatidiform mole includes
elevated levels of human chorionic
gonadotropin, vaginal bleeding, larger than
normal uterus for gestational age, failure to
detect fetal heart activity even with sensitive
instruments, excessive nausea and vomiting,
and early development of pregnancy-induced
hypertension. Fetal activity would not be noted.

6. Answer: (B) Absent patellar reflexes
Rationale: Absence of patellar reflexes is an
indicator of hypermagnesemia, which requires
administration of calcium gluconate.

7. Answer: (C) Presenting part in 2 cm below the
plane of the ischial spines.
Rationale: Fetus at station plus two indicates
that the presenting part is 2 cm below the
plane of the ischial spines.

8. Answer: (A) Contractions every 1 ½ minutes
lasting 70-80 seconds.
Rationale: Contractions every 1 ½ minutes
lasting 70-80 seconds, is indicative of
hyperstimulation of the uterus, which could
result in injury to the mother and the fetus if
Pitocin is not discontinued.

9. Answer: (C) EKG tracings
Rationale: A potential side effect of calcium
gluconate administration is cardiac arrest.
Continuous monitoring of cardiac activity (EKG)
throught administration of calcium gluconate is
an essential part of care.

10. Answer: (D) First low transverse caesarean was
for breech position. Fetus in this pregnancy is in
a vertex presentation.
Rationale: This type of client has no obstetrical
indication for a caesarean section as she did
with her first caesarean delivery.

11. Answer: (A) Talk to the mother first and then to
the toddler.
Rationale: When dealing with a crying toddler,
the best approach is to talk to the mother and
ignore the toddler first. This approach helps the
toddler get used to the nurse before she
attempts any procedures. It also gives the
toddler an opportunity to see that the mother
trusts the nurse.

12. Answer: (D) Place the infant’s arms in soft
elbow restraints.
Rationale: Soft restraints from the upper arm to
the wrist prevent the infant from touching her
lip but allow him to hold a favorite item such as
a blanket. Because they could damage the
operative site, such as objects as pacifiers,
suction catheters, and small spoons shouldn’t
be placed in a baby’s mouth after cleft repair. A
baby in a prone position may rub her face on
the sheets and traumatize the operative site.
The suture line should be cleaned gently to
prevent infection, which could interfere with
healing and damage the cosmetic appearance
of the repair.

13. Answer: (B) Allow the infant to rest before
feeding.
Rationale: Because feeding requires so much
energy, an infant with heart failure should rest
before feeding.

14. Answer: (C) Iron-rich formula only.
Rationale: The infants at age 5 months should
receive iron-rich formula and that they
shouldn’t receive solid food, even baby food
until age 6 months.

15. Answer: (D) 10 months
Rationale: A 10 month old infant can sit alone
and understands object permanence, so he
would look for the hidden toy. At age 4 to 6
months, infants can’t sit securely alone. At age
8 months, infants can sit securely alone but
cannot understand the permanence of objects.

16. Answer: (D) Public health nursing focuses on
preventive, not curative, services.
Rationale: The catchments area in PHN consists
of a residential community, many of whom are
well individuals who have greater need for
preventive rather than curative services.

17. Answer: (B) Efficiency
Rationale: Efficiency is determining whether the
goals were attained at the least possible cost.

18. Answer: (D) Rural Health Unit
Rationale: R.A. 7160 devolved basic health
services to local government units (LGU’s ). The
public health nurse is an employee of the LGU.

19. Answer: (A) Mayor
Rationale: The local executive serves as the
chairman of the Municipal Health Board.

20. Answer: (A) 1
Rationale: Each rural health midwife is given a
population assignment of about 5,000.

21. Answer: (B) Health education and community
organizing are necessary in providing
community health services. Rationale: The
community health nurse develops the health
capability of people through health education
and community organizing activities.

22. Answer: (B) Measles
Rationale: Presidential Proclamation No. 4 is on
the Ligtas Tigdas Program

23. Answer: (D) Core group formation
Rationale: In core group formation, the nurse is
able to transfer the technology of community
organizing to the potential or informal
community leaders through a training program.

24. Answer: (D) To maximize the community’s
resources in dealing with health problems.
Rationale: Community organizing is a
developmental service, with the goal of
developing the people’s self-reliance in dealing
with community health problems. A, B and C
are objectives of contributory objectives to this
goal.

25. Answer: (D) Terminal
Rationale: Tertiary prevention involves
rehabilitation, prevention of permanent
disability and disability limitations appropriate
for convalescents, the disabled, complicated
cases and the terminally ill (those in the
terminal stage of a disease).

26. Answer: (A) Intrauterine fetal death.
Rationale: Intrauterine fetal death, abruptio
placentae, septic shock, and amniotic fluid
embolism may trigger normal clotting
mechanisms; if clotting factors are depleted,
DIC may occur. Placenta accreta, dysfunctional
labor, and premature rupture of the
membranes aren't associated with DIC.

27. Answer: (C) 120 to 160 beats/minute
Rationale: A rate of 120 to 160 beats/minute in
the fetal heart appropriate for filling the heart
with blood and pumping it out to the system.

28. Answer: (A) Change the diaper more often.
Rationale: Decreasing the amount of time the
skin comes contact with wet soiled diapers will
help heal the irritation.

29. Answer: (D) Endocardial cushion defect
Rationale: Endocardial cushion defects are seen
most in children with Down syndrome,
asplenia, or polysplenia.

30. Answer: (B) Decreased urine output
Rationale: Decreased urine output may occur in
clients receiving I.V. magnesium and should be
monitored closely to keep urine output at
greater than 30 ml/hour, because magnesium is
excreted through the kidneys and can easily
accumulate to toxic levels.

31. Answer: (A) Menorrhagia
Rationale: Menorrhagia is an excessive
menstrual period.

32. Answer: (C) Blood typing
Rationale: Blood type would be a critical value
to have because the risk of blood loss is always
a potential complication during the labor and
delivery process. Approximately 40% of a
woman’s cardiac output is delivered to the
uterus, therefore, blood loss can occur quite
rapidly in the event of uncontrolled bleeding.

33. Answer: (D) Physiologic anemia
Rationale: Hemoglobin values and hematocrit
decrease during pregnancy as the increase in
plasma volume exceeds the increase in red
blood cell production.

34. Answer: (D) A 2 year old infant with stridorous
breath sounds, sitting up in his mother’s arms
and drooling.
Rationale: The infant with the airway
emergency should be treated first, because of
the risk of epiglottitis.

35. Answer: (A) Placenta previa
Rationale: Placenta previa with painless vaginal
bleeding.

36. Answer: (D) Early in the morning
Rationale: Based on the nurse’s knowledge of
microbiology, the specimen should be collected
early in the morning. The rationale for this
timing is that, because the female worm lays
eggs at night around the perineal area, the first
bowel movement of the day will yield the best
results. The specific type of stool specimen
used in the diagnosis of pinworms is called the
tape test.

37. Answer: (A) Irritability and seizures
Rationale: Lead poisoning primarily affects the
CNS, causing increased intracranial pressure.
This condition results in irritability and changes
in level of consciousness, as well as seizure
disorders, hyperactivity, and learning
disabilities.

38. Answer: (D) “I really need to use the diaphragm
and jelly most during the middle of my
menstrual cycle”.
Rationale: The woman must understand that,
although the “fertile” period is approximately
mid-cycle, hormonal variations do occur and
can result in early or late ovulation. To be
effective, the diaphragm should be inserted
before every intercourse.

39. Answer: (C) Restlessness
Rationale: In a child, restlessness is the earliest
sign of hypoxia. Late signs of hypoxia in a child
are associated with a change in color, such as
pallor or cyanosis.

40. Answer: (B) Walk one step ahead, with the
child’s hand on the nurse’s elbow.
Rationale: This procedure is generally
recommended to follow in guiding a person
who is blind.

41. Answer: (A) Loud, machinery-like murmur.
Rationale: A loud, machinery-like murmur is a
characteristic finding associated with patent
ductus arteriosus.

42. Answer: (C) More oxygen, and the newborn’s
metabolic rate increases.
Rationale: When cold, the infant requires more
oxygen and there is an increase in metabolic
rate. Non-shievering thermogenesis is a
complex process that increases the metabolic
rate and rate of oxygen consumption,
therefore, the newborn increase heat
production.

43. Answer: (D) Voided
Rationale: Before administering potassium I.V.
to any client, the nurse must first check that the
client’s kidneys are functioning and that the
client is voiding. If the client is not voiding, the
nurse should withhold the potassium and notify
the physician.

44. Answer: (c) Laundry detergent
Rationale: Eczema or dermatitis is an allergic
skin reaction caused by an offending allergen.
The topical allergen that is the most common
causative factor is laundry detergent.

45. Answer: (A) 6 inches
Rationale: This distance allows for easy flow of
the formula by gravity, but the flow will be slow
enough not to overload the stomach too
rapidly.

46. Answer: (A) The older one gets, the more
susceptible he becomes to the complications of
chicken pox.
Rationale: Chicken pox is usually more severe in
adults than in children. Complications, such as
pneumonia, are higher in incidence in adults.

47. Answer: (D) Consult a physician who may give
them rubella immunoglobulin.
Rationale: Rubella vaccine is made up of
attenuated German measles viruses. This is
contraindicated in pregnancy. Immune globulin,
a specific prophylactic against German measles,
may be given to pregnant women.

48. Answer: (A) Contact tracing
Rationale: Contact tracing is the most practical
and reliable method of finding possible sources
of person-to-person transmitted infections,
such as sexually transmitted diseases.

49. Answer: (D) Leptospirosis
Rationale: Leptospirosis is transmitted through
contact with the skin or mucous membrane
with water or moist soil contaminated with
urine of infected animals, like rats.

50. Answer: (B) Cholera
Rationale: Passage of profuse watery stools is
the major symptom of cholera. Both amebic
and bacillary dysentery are characterized by the
presence of blood and/or mucus in the stools.
Giardiasis is characterized by fat malabsorption
and, therefore, steatorrhea.

51. Answer: (A) Hemophilus influenzae
Rationale: Hemophilus meningitis is unusual
over the age of 5 years. In developing countries,
the peak incidence is in children less than 6
months of age. Morbillivirus is the etiology of
measles. Streptococcus pneumonia and
Neisseria meningitidis may cause meningitis,
but age distribution is not specific in young
children.

52. Answer: (B) Buccal mucosa
Rationale: Koplik’s spot may be seen on the
mucosa of the mouth or the throat.

53. Answer: (A) 3 seconds
Rationale: Adequate blood supply to the area
allows the return of the color of the nailbed
within 3 seconds.

54. Answer: (B) Severe dehydration
Rationale: The order of priority in the
management of severe dehydration is as
follows: intravenous fluid therapy, referral to a
facility where IV fluids can be initiated within 30
minutes, Oresol or nasogastric tube. When the
foregoing measures are not possible or
effective, then urgent referral to the hospital is
done.

55. Answer: (A) 45 infants
Rationale: To estimate the number of infants,
multiply total population by 3%.
56. Answer: (A) DPT
Rationale: DPT is sensitive to freezing. The
appropriate storage temperature of DPT is 2 to
8° C only. OPV and measles vaccine are highly
sensitive to heat and require freezing. MMR is
not an immunization in the Expanded Program
on Immunization.

57. Answer: (C) Proper use of sanitary toilets
Rationale: The ova of the parasite get out of the
human body together with feces. Cutting the
cycle at this stage is the most effective way of
preventing the spread of the disease to
susceptible hosts.

58. Answer: (D) 5 skin lesions, positive slit skin
smear
Rationale: A multibacillary leprosy case is one
who has a positive slit skin smear and at least 5
skin lesions.

59. Answer: (C) Thickened painful nerves
Rationale: The lesion of leprosy is not macular.
It is characterized by a change in skin color
(either reddish or whitish) and loss of sensation,
sweating and hair growth over the lesion.
Inability to close the eyelids (lagophthalmos)
and sinking of the nosebridge are late
symptoms.

60. Answer: (B) Ask where the family resides.
Rationale: Because malaria is endemic, the first
question to determine malaria risk is where the
client’s family resides. If the area of residence is
not a known endemic area, ask if the child had
traveled within the past 6 months, where she
was brought and whether she stayed overnight
in that area.
61. Answer: (A) Inability to drink
Rationale: A sick child aged 2 months to 5 years
must be referred urgently to a hospital if
he/she has one or more of the following signs:
not able to feed or drink, vomits everything,
convulsions, abnormally sleepy or difficult to
awaken.

62. Answer: (A) Refer the child urgently to a
hospital for confinement.
Rationale: “Baggy pants” is a sign of severe
marasmus. The best management is urgent
referral to a hospital.

63. Answer: (D) Let the child rest for 10 minutes
then continue giving Oresol more slowly.
Rationale: If the child vomits persistently, that
is, he vomits everything that he takes in, he has
to be referred urgently to a hospital. Otherwise,
vomiting is managed by letting the child rest for
10 minutes and then continuing with Oresol
administration. Teach the mother to give Oresol
more slowly.

64. Answer: (B) Some dehydration
Rationale: Using the assessment guidelines of
IMCI, a child (2 months to 5 years old) with
diarrhea is classified as having SOME
DEHYDRATION if he shows 2 or more of the
following signs: restless or irritable, sunken
eyes, the skin goes back slow after a skin pinch.

65. Answer: (C) Normal
Rationale: In IMCI, a respiratory rate of
50/minute or more is fast breathing for an
infant aged 2 to 12 months.

66. Answer: (A) 1 year
Rationale: The baby will have passive natural
immunity by placental transfer of antibodies.
The mother will have active artificial immunity
lasting for about 10 years. 5 doses will give the
mother lifetime protection.

67. Answer: (B) 4 hours
Rationale: While the unused portion of other
biologicals in EPI may be given until the end of
the day, only BCG is discarded 4 hours after
reconstitution. This is why BCG immunization is
scheduled only in the morning.

68. Answer: (B) 6 months
Rationale: After 6 months, the baby’s nutrient
needs, especially the baby’s iron requirement,
can no longer be provided by mother’s milk
alone.

69. Answer: (C) 24 weeks
Rationale: At approximately 23 to 24 weeks’
gestation, the lungs are developed enough to
sometimes maintain extrauterine life. The lungs
are the most immature system during the
gestation period. Medical care for premature
labor begins much earlier (aggressively at 21
weeks’ gestation)

70. Answer: (B) Sudden infant death syndrome
(SIDS)
Rationale: Supine positioning is recommended
to reduce the risk of SIDS in infancy. The risk of
aspiration is slightly increased with the supine
position. Suffocation would be less likely with
an infant supine than prone and the position
for GER requires the head of the bed to be
elevated.

71. Answer: (C) Decreased temperature
Rationale: Temperature instability, especially
when it results in a low temperature in the
neonate, may be a sign of infection. The
neonate’s color often changes with an infection
process but generally becomes ashen or
mottled. The neonate with an infection will
usually show a decrease in activity level or
lethargy.

72. Answer: (D) Polycythemia probably due to
chronic fetal hypoxia
Rationale: The small-for-gestation neonate is at
risk for developing polycythemia during the
transitional period in an attempt to decrease
hypoxia. The neonates are also at increased risk
for developing hypoglycemia and hypothermia
due to decreased glycogen stores.

73. Answer: (C) Desquamation of the epidermis
Rationale: Postdate fetuses lose the vernix
caseosa, and the epidermis may become
desquamated. These neonates are usually very
alert. Lanugo is missing in the postdate
neonate.

74. Answer: (C) Respiratory depression
Rationale: Magnesium sulfate crosses the
placenta and adverse neonatal effects are
respiratory depression, hypotonia, and
bradycardia. The serum blood sugar isn’t
affected by magnesium sulfate. The neonate
would be floppy, not jittery.

75. Answer: (C) Respiratory rate 40 to 60
breaths/minute
Rationale: A respiratory rate 40 to 60
breaths/minute is normal for a neonate during
the transitional period. Nasal flaring,
respiratory rate more than 60 breaths/minute,
and audible grunting are signs of respiratory
distress.

76. Answer: (C) Keep the cord dry and open to air
Rationale: Keeping the cord dry and open to air
helps reduce infection and hastens drying.
Infants aren’t given tub bath but are sponged
off until the cord falls off. Petroleum jelly
prevents the cord from drying and encourages
infection. Peroxide could be painful and isn’t
recommended.

77. Answer: (B) Conjunctival hemorrhage
Rationale: Conjunctival hemorrhages are
commonly seen in neonates secondary to the
cranial pressure applied during the birth
process. Bulging fontanelles are a sign of
intracranial pressure. Simian creases are
present in 40% of the neonates with trisomy 21.
Cystic hygroma is a neck mass that can affect
the airway.

78. Answer: (B) To assess for prolapsed cord
Rationale: After a client has an amniotomy, the
nurse should assure that the cord isn't
prolapsed and that the baby tolerated the
procedure well. The most effective way to do
this is to check the fetal heart rate. Fetal wellbeing
is assessed via a nonstress test. Fetal
position is determined by vaginal examination.
Artificial rupture of membranes doesn't
indicate an imminent delivery.

79. Answer: (D) The parents’ interactions with each
other.
Rationale: Parental interaction will provide the
nurse with a good assessment of the stability of
the family's home life but it has no indication
for parental bonding. Willingness to touch and
hold the newborn, expressing interest about
the newborn's size, and indicating a desire to
see the newborn are behaviors indicating
parental bonding.

80. Answer: (B) Instructing the client to use two or
more peripads to cushion the area
Rationale: Using two or more peripads would
do little to reduce the pain or promote perineal
healing. Cold applications, sitz baths, and Kegel
exercises are important measures when the
client has a fourth-degree laceration.

81. Answer: (C) “What is your expected due date?”
Rationale: When obtaining the history of a
client who may be in labor, the nurse's highest
priority is to determine her current status,
particularly her due date, gravidity, and parity.
Gravidity and parity affect the duration of labor
and the potential for labor complications. Later,
the nurse should ask about chronic illnesses,
allergies, and support persons.

82. Answer: (D) Aspirate the neonate’s nose and
mouth with a bulb syringe.
Rationale: The nurse's first action should be to
clear the neonate's airway with a bulb syringe.
After the airway is clear and the neonate's color
improves, the nurse should comfort and calm
the neonate. If the problem recurs or the
neonate's color doesn't improve readily, the
nurse should notify the physician.
Administering oxygen when the airway isn't
clear would be ineffective.

83. Answer: (C) Conducting a bedside ultrasound
for an amniotic fluid index.
Rationale: It isn't within a nurse's scope of
practice to perform and interpret a bedside
ultrasound under these conditions and without
specialized training. Observing for pooling of
straw-colored fluid, checking vaginal discharge
with nitrazine paper, and observing for flakes of
vernix are appropriate assessments for
determining whether a client has ruptured
membranes.

84. Answer: (C) Monitor partial pressure of oxygen
(Pao2) levels.
Rationale: Monitoring PaO2 levels and reducing
the oxygen concentration to keep PaO2 within
normal limits reduces the risk of retinopathy of
prematurity in a premature infant receiving
oxygen. Covering the infant's eyes and
humidifying the oxygen don't reduce the risk of
retinopathy of prematurity. Because cooling
increases the risk of acidosis, the infant should
be kept warm so that his respiratory distress
isn't aggravated.

85. Answer: (A) 110 to 130 calories per kg.
Rationale: Calories per kg is the accepted way
of determined appropriate nutritional intake
for a newborn. The recommended calorie
requirement is 110 to 130 calories per kg of
newborn body weight. This level will maintain a
consistent blood glucose level and provide
enough calories for continued growth and
development.

86. Answer: (C) 30 to 32 weeks
Rationale: Individual twins usually grow at the
same rate as singletons until 30 to 32 weeks’
gestation, then twins don’t’ gain weight as
rapidly as singletons of the same gestational
age. The placenta can no longer keep pace with
the nutritional requirements of both fetuses
after 32 weeks, so there’s some growth
retardation in twins if they remain in utero at
38 to 40 weeks.

87. Answer: (A) conjoined twins
Rationale: The type of placenta that develops in
monozygotic twins depends on the time at
which cleavage of the ovum occurs. Cleavage in
conjoined twins occurs more than 13 days after
fertilization. Cleavage that occurs less than 3
day after fertilization results in diamniotic
dicchorionic twins. Cleavage that occurs
between days 3 and 8 results in diamniotic
monochorionic twins. Cleavage that occurs
between days 8 to 13 result in monoamniotic
monochorionic twins.

88. Answer: (D) Ultrasound
Rationale: Once the mother and the fetus are
stabilized, ultrasound evaluation of the
placenta should be done to determine the
cause of the bleeding. Amniocentesis is
contraindicated in placenta previa. A digital or
speculum examination shouldn’t be done as
this may lead to severe bleeding or
hemorrhage. External fetal monitoring won’t
detect a placenta previa, although it will detect
fetal distress, which may result from blood loss
or placenta separation.

89. Answer: (A) Increased tidal volume
Rationale: A pregnant client breathes deeper,
which increases the tidal volume of gas moved
in and out of the respiratory tract with each
breath. The expiratory volume and residual
volume decrease as the pregnancy progresses.
The inspiratory capacity increases during
pregnancy. The increased oxygen consumption
in the pregnant client is 15% to 20% greater
than in the nonpregnant state.

90. Answer: (A) Diet
Rationale: Clients with gestational diabetes are
usually managed by diet alone to control their
glucose intolerance. Oral hypoglycemic drugs
are contraindicated in pregnancy. Long-acting
insulin usually isn’t needed for blood glucose
control in the client with gestational diabetes.

91. Answer: (D) Seizure
Rationale: The anticonvulsant mechanism of
magnesium is believes to depress seizure foci in
the brain and peripheral neuromuscular
blockade. Hypomagnesemia isn’t a
complication of preeclampsia. Antihypertensive
drug other than magnesium are preferred for
sustained hypertension. Magnesium doesn’t
help prevent hemorrhage in preeclamptic
clients.

92. Answer: (C) I.V. fluids
Rationale: A sickle cell crisis during pregnancy is
usually managed by exchange transfusion
oxygen, and L.V. Fluids. The client usually needs
a stronger analgesic than acetaminophen to
control the pain of a crisis. Antihypertensive
drugs usually aren’t necessary. Diuretic
wouldn’t be used unless fluid overload resulted.

93. Answer: (A) Calcium gluconate (Kalcinate)
Rationale: Calcium gluconate is the antidote for
magnesium toxicity. Ten milliliters of 10%
calcium gluconate is given L.V. push over 3 to 5
minutes. Hydralazine is given for sustained
elevated blood pressure in preeclamptic clients.
Rho (D) immune globulin is given to women
with Rh-negative blood to prevent antibody
formation from RH-positive conceptions.
Naloxone is used to correct narcotic toxicity.

94. Answer: (B) An indurated wheal over 10 mm in
diameter appears in 48 to 72 hours.
Rationale: A positive PPD result would be an
indurated wheal over 10 mm in diameter that
appears in 48 to 72 hours. The area must be a
raised wheal, not a flat circumcised area to be
considered positive.

95. Answer: (C) Pyelonephritis
Rationale The symptoms indicate acute
pyelonephritis, a serious condition in a
pregnant client. UTI symptoms include dysuria,
urgency, frequency, and suprapubic
tenderness. Asymptomatic bacteriuria doesn’t
cause symptoms. Bacterial vaginosis causes
milky white vaginal discharge but no systemic
symptoms.

96. Answer: (B) Rh-positive fetal blood crosses into
maternal blood, stimulating maternal
antibodies.
Rationale: Rh isoimmunization occurs when Rhpositive
fetal blood cells cross into the maternal
circulation and stimulate maternal antibody
production. In subsequent pregnancies with Rhpositive
fetuses, maternal antibodies may cross
back into the fetal circulation and destroy the
fetal blood cells.

97. Answer: (C) Supine position
Rationale: The supine position causes
compression of the client's aorta and inferior
vena cava by the fetus. This, in turn, inhibits
maternal circulation, leading to maternal
hypotension and, ultimately, fetal hypoxia. The
other positions promote comfort and aid labor
progress. For instance, the lateral, or side-lying,
position improves maternal and fetal
circulation, enhances comfort, increases
maternal relaxation, reduces muscle tension,
and eliminates pressure points. The squatting
position promotes comfort by taking advantage
of gravity. The standing position also takes
advantage of gravity and aligns the fetus with
the pelvic angle.
98. Answer: (B) Irritability and poor sucking.
Rationale: Neonates of heroin-addicted
mothers are physically dependent on the drug
and experience withdrawal when the drug is no
longer supplied. Signs of heroin withdrawal
include irritability, poor sucking, and
restlessness. Lethargy isn't associated with
neonatal heroin addiction. A flattened nose,
small eyes, and thin lips are seen in infants with
fetal alcohol syndrome. Heroin use during
pregnancy hasn't been linked to specific
congenital anomalies.

99. Answer: (A) 7th to 9th day postpartum
Rationale: The normal involutional process
returns the uterus to the pelvic cavity in 7 to 9
days. A significant involutional complication is
the failure of the uterus to return to the pelvic
cavity within the prescribed time period. This is
known as subinvolution.

100. Answer: (B) Uterine atony
Rationale: Multiple fetuses, extended labor
stimulation with oxytocin, and traumatic
delivery commonly are associated with uterine
atony, which may lead to postpartum
hemorrhage. Uterine inversion may precede or
follow delivery and commonly results from
apparent excessive traction on the umbilical
cord and attempts to deliver the placenta
manually. Uterine involution and some uterine
discomfort are normal after delivery.