Solution Manual for Introduction to Maternity and Pediatric Nursing, 6th Edition

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Study Guide Answer Key Chapter 1 1
Study Guide Answer Key
1
chapter
1
Learning Activities
1. c, h, d, i, j, b, g, f, e, a
2. a. Obstetricians
b. Family practice physicians
c. Certified nurse-midwives
3. f, d, i, e, g, b, j, a, h, c
4. a. American College of Nurse-Midwives
b. Association of Women’s Health, Obstetric,
and Neonatal Nurses
c. Division of Maternal Nursing within the
American Nurses Association
5. a. Provides funds for maternity care
b. Increases access to health care for under-
privileged women
c. Designed to improve education of pre-
school children
d. Provides contraceptive information
e. Provides supplemental food and education
for the poor
f. Enables employees to take 12 weeks of
unpaid leave but retain benefits and pay
status for newborns or ill family members
g. Establishes minimum working ages and
led to national minimum standards for
child labor and enforcement of these
standards
h. Provides support and public education of
handicapped children
i. Provides a national clearinghouse for miss-
ing children
6. Hospital stays for births in the 1950s were usu-
ally one week. Today, an uncomplicated case
requires only 2 days. Follow-up of the well
newborn occurs within 2 weeks and a nurse
may make visits to the home if a discharged
mother or infant is at high risk. Implications
for nurses might include the need for good
organization of care based on research rather
than tradition, identification of risk factors that
may lengthen the stay for the mother and/or
infant, and teaching early after birth to help
parents best care for themselves and their
infant. Teaching often involves other family
members such as grandparents or siblings as
well. (Student should describe their thoughts
how these changes are likely to affect nurses.)
7. Natural childbirth movement made parents
aware of their need to become educated and
involved. Preparation for childbirth such as
Lamaze classes and La Leche League became
accepted. Parents questioned routine use
of anesthesia and restrictive policies such
as exclusion of fathers from birth. Today, a
father’s attendance at birth, open visiting for
other children and family, and extended con-
tact with the newborn are encouraged.
8. Technological advances and emergence of
pediatric specialties enable survival of many
infants and children who would not have sur-
vived in the past. Specialized care for prema-
ture infants, specialized pediatric cardiology
care, and pediatric specialties such as pediatric
surgery and pediatric psychiatry are now
available. Laboratories are equipped to test
pediatric specimens to identify biochemical
or chromosomal abnormalities. Identification
of genetic risk and related counseling is more
important.
9. The number of chronically ill and disabled
children is growing. Some are dependent
on specialized equipment such as monitors
or ventilators. Parents must be educated in
performing technical skills once reserved for
the hospital, such as tracheotomy or central
venous line care. The need for respite care for
parents grows as the number of these children
increases.
10. See Box 1-4 on p. 11 in the textbook.
11. a. Assessment
b. Diagnosis
c. Outcomes identification
d. Planning
e. Implementation
f. Evaluation
12. NIC and NOC consist of standardized lan-
guage for nursing interventions and outcomes.
Standardization helps improve quality of care,
reduce costs, enable research, and promote

2 Study Guide Answer Key Chapter 1
reimbursement for nursing services. Coding
the interventions and outcomes improves qual-
ity of research and direct reimbursement for
services.
13. Critical thinking is the use of basic standards
of care combined with data obtained by assess-
ment of the specific patient. It is purposeful,
goal-directed thinking based on scientific evi-
dence rather than assumptions or memoriza-
tion. Critical thinking involves reflection and
integration of information to arrive at a conclu-
sion or judgment.
14. Healthy People 2020 updates the 2010 objec-
tives is a statement of national health promo-
tion and disease prevention objectives. It is a
vision statement to achieve a nation of more
healthy people. The report identifies objectives
designed to use health care knowledge and
technology developed in the twentieth century
to improve health and quality of life.
Review Questions
1. Answer: 2
Rationale: Because the nurse must handle
equipment, dressings, and patient care activi-
ties, both with and without gloves, consistent
hand hygiene reduces the number of resident
bacteria that can be transmitted to others who
may not be resistant to infection.
2. Answer: 3
Rationale: Most nurses can identify major cul-
tural groups that reside in the area where they
work. Patients and their families appreciate the
extra attention to incorporate cultural needs
into other nursing care.
3. Answer: 3
Rationale: Because statistics examine trends in
large groups of people, they can help evaluate
the quality of care, including prenatal care.
4. Answer: 4
Rationale: The CNM is an advanced-practice
nurse with special training in providing care
to the childbearing woman. The CNM works
under protocols that specify under what condi-
tions that medical care must be sought for the
woman.
5. Answer: 3
Rationale: The nursing process helps nurses
individualize care for all patients, both well
and ill.
6. Answer: 2
Rationale: Clinical pathways provide “targets”
for expected progress along a time line and
are often collaborative, using skills of multiple
professionals. When the patient “falls off” the
expected course, a variance occurs.
Applying Knowledge
Answers will vary.

Study Guide Answer Key Chapter 2 1
Study Guide Answer Key
1
chapter
2
Learning Activities
1. Puberty
2. a. 10, 16
b. penis, testes
3. a. breast development
b. 2–2.5
4. a. Boys: taller; more muscular; pubic, axillary,
chest, and facial hair; deeper voice
b. Girls: broader hips; breast development;
pubic and axillary hair
5. c, f, h, b, g, e, a, d
6. See Figure 2-1 on p. 21.
7. a. seminiferous tubules
b. Leydig’s cells
8. a. Increases muscle mass and strength
b. Promotes growth of long bones
c. Increases BMR
d. Enhances red blood cell production
e. Enlarges vocal cords
f. Encourages male distribution of body hair
9. See Figure 2-2 on p. 23.
10. g
l, q, r
p
d
c, h
i
k
j
f
m
o
a
b, e
n
11. See Figures 2-3 and 2-4 on pp. 23-24.
12. See Figure 2-6 on p. 26.
13. See Figure 2-7 on p. 27.
14. b, d, c, a
15. b, a, e, c, d
16. a. FSH (follicle-stimulating hormone) is pro-
duced in the anterior pituitary gland and
stimulates the maturation of an ovarian
follicle.
b. LH (luteinizing hormone) is produced in
the anterior pituitary gland and stimulates
final maturation of the follicle and release
of its ovum.
c and d. Estrogen and progesterone are pro-
duced in the corpus luteum and cause
buildup of the endometrium to nourish a
fertilized ovum if it arrives. If no fertilized
ovum arrives, the corpus luteum degener-
ates and levels of estrogen and progester-
one fall, causing the next menstrual cycle.
Review Questions
1. Answer: 3
Rationale: Although the female growth spurt
begins earlier than the male’s, it also ends
sooner, limiting the girl’s mature height. Tes-
tosterone is the primary male hormone. Girls
begin puberty earlier, but they end it sooner
than boys. Onset of puberty initiates the
growth spurt rather than stopping it. Estrogen
and progesterone, which increase as the girl
matures, eventually stop her growth in height.
2. Answer: 2
Rationale: Although most sperm are released
in semen with ejaculation, some semen is often
secreted before ejaculation and can fertilize a
waiting ovum. Although ejaculation can occur
at any time, the penis becomes flaccid after
ejaculation, preventing penetration. Sperm
are added to the seminal fluid by contractions
of the vas deferens before ejaculation. Semen
typically enters the urethra shortly before
ejaculation.
3. Answer: 3
Rationale: The endometrium is the inner muco-
sal layer that responds to cyclic hormonal
changes during the menstrual cycle and also
receives the fertilized ovum when it implants.
The parametrium is the outer serosal layer and
the myometrium is the middle muscular layer.

2 Study Guide Answer Key Chapter 2
4. Answer: 3
Rationale: The linea terminalis is at the level
of the sacroiliac joint to the front iliopubic
prominence (front of the pelvis). The obstetric
conjugate is a diameter from the upper part of
the symphysis pubis to the sacral promontory
and is estimated from the diagonal conjugate
because it cannot be directly measured. These
diameters are measured at the inlet, but are not
the dividing line of the true from the false pel-
vis. The bi-ischial is a diameter of the outlet, at
the lower end of the true pelvis.
5. Answer: 3
Rationale: The anteroposterior diameter of
the pelvic outlet can enlarge slightly during
childbirth because the coccyx is moveable.
The obstetric conjugate and the right and left
oblique diameters are mostly surrounded
by non-movable bone and are therefore less
flexible.
6. Answer: 1
Rationale: Adequate sperm production
requires a temperature slightly lower than the
rest of the body. The scrotum is a skin pouch
that allows the testes to be suspended slightly
away from the body. The epididymis and vas
deferens carry sperm from the testes to the ure-
thra. The testes manufacture sperm and secrete
testosterone. Contraction of muscles of the
prostate gland and seminal vesicles contribute
to the flow and motility of sperm and rhythmic
contractions of penile erectile tissues aid in
ejaculation
7. Answer: 3
Rationale: Alveoli contain milk-secreting cells.
Lactiferous ducts carry milk from the alveoli
to the nipples. Montgomery’s glands secrete a
substance to lubricate and protect the nipple
during breastfeeding. The nipple is at the cen-
ter of each breast and is where milk is ejected
through its pores.
8. Answer: 2
Rationale: Blood is trapped within the penis as
penile arteries relax. It becomes engorged with
blood and an erection occurs. Muscles attached
to the penis do not contribute to erection. Tes-
tosterone levels play a part in the male sex act,
but do not fall in response to stimulation. The
prostate gland primarily functions to contrib-
ute its secretion to the seminal fluid.
9. Answer: 4
Rationale: Breast size is unrelated to the ability
to produce milk because fatty tissues cause size
differences. The number of alveoli is similar
in women, regardless of whether their breasts
are small or large. Hormones of pregnancy do
cause growth in breast tissue, but this does not
make the difference in a woman’s ability to
nurse.
10. Answer: 2
Rationale: The middle of the three muscle lay-
ers of the uterus has a figure-8 design. The
circular muscles of the inner myometrium
form sphincters where the fallopian tubes
enter the uterus and at the internal opening
of the cervix. Longitudinal muscles form the
outer muscular layer and expel the infant dur-
ing labor. Oblique muscles do not exist in the
myometrium.
11. Answer: 4
Rationale: Much of the endometrium is shed
during menstruation, and it is thinnest at the
end of the menstrual period. The endometrium
is thickest at ovulation, to prepare for a fertil-
ized ovum. The endometrium remains thick if
a fertilized ovum implants, but begins breaking
down a few days after menstruation if none is
present.
Thinking Critically
1. You can reassure your niece that early cycles
are often irregular and the young girl often
does not ovulate. Regular cycles are usually
established within 6 months to 2 years of the
first period.
2. The vagina normally cleanses itself and main-
tains a slightly acidic pH. Douching washes
away these acidic secretions, and antibiotics
can alter its self-cleansing activity. The nurse
can explain these factors to the woman to
discourage her from douching except when
ordered by her health care practitioner.
Applying Knowledge
Answers will vary.

Study Guide Answer Key Chapter 3 1
Study Guide Answer Key
1
chapter
3
Learning Activities
1. b, g, a, c, d, f, e
2. a. 4
b. 22, x, y
3. a. 1
b. 22, x
4. a. 24
b. 5
5. a. boy
b. girl
c. The woman does not have a direct genetic
influence over the gender of the baby
because she only contributes an X chro-
mosome. However, the pH (acidity or
alkalinity) of her reproductive tract and
her estrogen levels may affect the survival
of the X-bearing and Y-bearing sperm
differently and their speed of movement
through her cervix and fallopian tubes.
6. a. fallopian tube
b. upper, posterior
7. a, i, d, b, h, f, g, c, e, j
8. 1,000
9. a. Maintains an even temperature
b. prevents adherence of the amniotic sac to
the fetal skin
c. allows symmetrical growth
d. allows buoyancy and fetal movement
e. cushions the fetus and umbilical cord from
injury
10. yolk sac, liver, spleen, bone marrow
11. a. fetal respiration
b. fetal nutrition
c. fetal excretion
d. endocrine gland
12. a. i. Maintains uterine lining
ii. Reduces uterine contractions
iii. Prepares milk-producing tissue of
breasts for lactation
iv. Stimulates testes of the male to pro-
duce testosterone needed for develop-
ment of the male reproductive tract
b. i. Stimulates uterine growth
ii. Increases blood flow to uterine vessels
iii. Stimulates ducts of breasts to prepare
for lactation

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2 Study Guide Answer Key Chapter 3
17.
Characteristic Monozygotic Dizygotic
a. Same sex or different? Always same sex May or may not be same sex
b. Number of fertilized ova 1 2
c. Number of placentas 1 (varies according to when the
twinning occurred after con-
ception but most often a single
placenta)
2 (although placentas may be
fused)
d. Number of membranes Also varies according to when
the twinning occurred, but usu-
ally one amnion and two chori-
ons
Two amnions and two chorions
e. Number of umbilical cords 2 2
Review Questions
1. Answer: 1
Rationale: Genes are the smallest units of
heredity and are located on chromosomes.
The zygote is the developing baby for the first
2 weeks after conception. These structures,
located in the placenta, are where the develop-
ing baby exchanges oxygen, carbon dioxide,
and waste products. Somatic cells are non-
reproductive, or body cells.
2. Answer: 2
Rationale: The embryonic yolk sac produces
erythrocytes until six weeks after conception,
at which time the liver performs this function,
followed by the bone marrow. The placenta
uses fetal blood cells to deliver oxygen and
nutrition to the fetus and to remove fetal waste
products.
3. Answer: 2
Rationale: The chorion is the outer fetal mem-
brane. The amnion is the inner membrane that
extends across the placenta and umbilical cord.
Vernix is fetal skin covering.
4. Answer: 1
Rationale: Umbilical vessels are coiled within
the umbilical cord. Wharton’s jelly allows them
to stretch, yet keeps them from being easily
compressed with fetal movement.
5. Answer: 2
Rationale: Only a small amount of blood goes
into the fetal lungs to nourish them while they
develop. Most blood goes from the right atrium
to the left atrium through the foramen ovale,
thus bypassing the lungs. The ductus venosus
allows most blood from the placenta to bypass
the liver. The umbilical vein and umbilical
artery are structures within the umbilical cord
that carry blood from the body to the placenta
and return it to the body after oxygenation and
removal of wastes.
6. Answer: 2
Rationale: Because the umbilical arteries carry
blood from the fetus to the placenta, most of
its oxygen and nutrients have been consumed
and it carries blood having a high concentra-
tion of fetal wastes. The umbilical vein carries
blood with the highest concentration because
it is returning from the placenta. The ductus

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Study Guide Answer Key Chapter 3 3
10. Answer: 2
Rationale: One of progesterone’s effects is to
reduce uterine contractions that would other-
wise tend to occur with stretching by the grow-
ing baby. Spontaneous abortion is likely if there
is insufficient progesterone to quiet the uterus.
Release of multiple ova would result from
development and release of two or more of
these gametes and is not controlled by proges-
terone. Human chorionic gonadotropin (hCG)
signals the corpus luteum to persist and con-
tinue production of estrogen and progesterone.
Maternal and fetal blood do not normally mix
before birth.
11. Answer: 4
Rationale: Fraternal (dizygotic) twins occur
when two ova are released and each is fertil-
ized by a different sperm.
12. Answer: 1
Rationale: Identical twins are of the same sex
because they have the same genetic composi-
tion, including sex chromosomes. Although a
couple may have more than one set of dizy-
gotic twins and each set may have one child of
each sex, it occurs by chance.
Thinking Critically
1. For a contraceptive technique such as natural
family planning to be successful, one or more
techniques help the woman to predict a likely
time of ovulation. The woman must have an
idea of about when her menstrual periods usu-
ally begin and understand that ovulation, or
her fertile period, occurs about 14 days before
the onset of the next menstrual period, or in the
middle of a 28-day cycle. Sperm may live up to
5 days after ejaculation. The couple wishing to
use natural family planning uses these facts to
avoid intercourse near the time of ovulation.
2. The communication should include facts that
the father’s sperm has a 50% chance of pro-
ducing a boy or a girl. However, female fac-
tors such as the pH of her reproductive tract
and estrogen levels also influence how long
X-bearing or Y-bearing sperm survive and their
speed of movement toward the ovum.
Applying Knowledge
Answers will vary.

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Study Guide Answer Key Chapter 4 1
Study Guide Answer Key
1
chapter
4
Learning Activities
1. a, c, g, d, e, b, f
2. g, a, c, f, d, b, e
3. b, h, c, e, a, l, g, i, d, j, k, f
4. a. Human chorionic gonadotropin (hCG)
b. urine, blood
5. a. i. 7.5 cm x 5 cm x 2.5 cm to a size large
enough to house the fetus, placenta,
and amniotic fluid
ii. 60 g to 1,000 g
iii. 10 mL to 5,000 mL
b. Bluish discoloration, softening; secretion of
mucus to form a mucous plug
c. Do not produce ova; corpus luteum per-
sists and secretes hormones to maintain the
pregnancy until the placenta takes over
d. Blood supply increases; mucosa thickens;
rugae become prominent; connective tis-
sue softens; vaginal pH becomes more
acidic; secretions have higher amounts of
glycogen
6. a. Change to prepare for breastfeeding; dark-
ening of the areolae; secretions of Mont-
gomery’s tubercles
b. Respirations deepen to increase oxygen
and carbon dioxide exchange; oxygen
intake increases about 15%; upward pres-
sure against the diaphragm (about 4 cm, or
1.6 inches); flaring of the rib cage, increas-
ing chest circumference about 6 cm (2.4
inches); nasal stuffiness, nosebleeds, and a
deeper voice
c. Increase in blood volume; pseudoanemia;
increased cardiac output; higher pulse rate;
prone to supine hypotension and ortho-
static hypotension; palpitations
d. Increased salivary secretions (ptyalism);
bleeding of the mouth tissue; increased
appetite and thirst; reduced gastric acidity;
slowed stomach emptying and intestinal
peristalsis; heartburn (pyrosis); tendency
to gestational diabetes; pruritus due to
increased retention of bile salts
e. Increased glomerular filtration rate; ten-
dency for glucosuria and proteinuria;
water retention; increased ureter diameter
and bladder capacity with risk for urinary
stasis and urinary tract infection
f. Skin pigment darkens; striae; increased
sweat and sebaceous gland activity; spider
nevi; palmar redness; backaches; waddling
gait with softening of the joints
7. a. 25 to 35 pounds (11.5 to 16 kilograms)
b. 28 to 40 pounds (12.5 to 18 kilograms)
c. 11 to 25 pounds (5 to 11.5 kilograms)
d. 11 to 20 pounds (5 to 9 kilograms)
8. 300

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2 Study Guide Answer Key Chapter 4
better choices at fast-food restaurants so
she can fit in and still have adequate nutri-
tion. Give her positive feedback for making
good choices.
b. Take lactase as a tablet or liquid in dairy
products; fermented dairy products such
as aged cheese, buttermilk, and yogurt;
enriched cereals; legumes, nuts, dried
fruits, broccoli, green leafy vegetables;
canned salmon and sardines with bones
11. a. Eat dry toast or crackers before getting
out of bed in the morning; drink fluids
between meals instead of with meals; eat
small, frequent meals; avoid fried, greasy,
or spicy foods and foods with strong odors
such as cabbage and onions
b. Bathe or shower daily, wear loose-fitting
cotton panties, do not douche unless
ordered, wipe from front to back
c. Try to get 8-10 hours of sleep each night;
nap during the day; and use measures such
as relaxation techniques, meditation, or
change of scenery
d. Correct posture; wear low-heeled shoes;
squat to pick up objects; support arms, feet,
and back when sitting; perform exercises
(tailor sitting, shoulder circling, pelvic
rock)
e. Drink at least 8 glasses of water daily
(exclude coffee, tea, and carbonated drinks
from the total), add high-fiber foods to
diet, limit cheese if this is constipating,
limit sweets, consult health care provider
if iron supplement causes constipation for
possible change, exercise (such as a brisk
1-mile walk), keep a regular time for bowel
movements, take laxatives or enemas only
if specifically directed
f. Avoid constricting clothing or crossing legs
at knees, elevate legs when sitting, apply
support hose/elastic stockings before get-
ting up each morning, avoid prolonged
standing
g. Anesthetic ointments, witch hazel pads,
rectal suppositories, sitz baths, avoid
constipation
h. Small frequent meals, avoiding fatty foods,
reduce smoking and caffeine, sit upright,
deep breathe and take sips of water, use
antacids as recommended by health care
provider
i. Keep upper torso elevated when resting,
avoid exertion, use saline nasal drops or
humidifier for nasal stuffiness
j. Extend leg with knee straight and flex foot,
stand and apply pressure to extend mus-

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Study Guide Answer Key Chapter 4 3
Rationale: A pregnant woman should have a
minimum of 30 mg/day of iron; 30-60 mg/
day supplementation provides added iron
for increased erythrocytes. Milk provides cal-
cium but little iron (it also interferes with iron
absorption). Meat and grains provide adequate
protein primarily. 18 mg of iron is inadequate
for pregnancy.
6. Answer: 4
Rationale: Varicose veins become more promi-
nent and uncomfortable when the pressure
within them increases with blood pooling.
Elevating the legs allows blood to return more
readily to the heart rather than pooling in the
legs. Warm packs may be comforting, but do
not address the problem of blood pooling.
Prolonged sitting, like prolonged standing, can
worsen varicosities unless the legs are elevated.
7. Answer: 2
Rationale: Early and regular prenatal care can
identify risk factors or complications early,
when they are more readily treated. Prena-
tal care itself does not reduce labor pain.
Improved long-term nutrition may begin dur-
ing pregnancy, but this is not the overall goal
of prenatal care. Prenatal care teaches a woman
how to safely deal with pregnancy discomforts,
but this is too narrow for a primary goal.
8. Answer: 4
Rationale: Meat provides high-quality iron;
dark green vegetables also contain iron. Citrus
and melons provide primarily vitamin C. Dairy
products provide primarily calcium. Dried
beans, potatoes, and legumes provide folic acid
and the beans provide inexpensive protein.
9. Answer: 4
Rationale: Adequate folic acid intake from
conception has been shown to reduce the inci-
dence of neural tube defects. Iron supports
blood volume expansion. Nausea and vomit-
ing are often relieved by dry carbohydrates,
but not specifically folic acid. Calcium is not
depleted from maternal teeth.
10. Answer: 2
Rationale: The ultimate goal should be to gain
the minimum desired weight.
11. Answer: 2
Rationale: Dietary relief of constipation is best,
with addition of fiber and fluids. Laxatives
are not routinely recommended. Extra fluids,
rather than less, are appropriate to soften the
stool. Delaying defecation may worsen consti-

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4 Study Guide Answer Key Chapter 4
Thinking Critically
1. 39 weeks
2. October 14th of the previous year.
3. a. Late menses is a presumptive symptom
because irregular or absent menses are
common for early puberty, lower than
normal weight, metabolic or endocrine
dysfunction, chronic disease, anorexia,
premature menopause, or emotional
problems.
b. Breast tenderness is a common, but only
presumptive, symptom along with other
breast changes such as striae or pigment
changes.
c. “Getting fat” might describe overall weight
gain or abdominal enlargement, a
probable sign of a growing fetus. Urinary
frequency is a presumptive sign.
d. A nurse cannot know if the previous
pregnancy test done by the girl was done
properly. A repeat test done properly will
provide a probable sign of pregnancy if
positive.
Applying Knowledge
Answers will vary.

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Study Guide Answer Key Chapter 5 1
Study Guide Answer Key
1
chapter
5
Learning Activities
1. b, f, e, d, a, c
2. Maintain adequate intake and output.
Avoid cooking odors.
Carbohydrates are best tolerated.
Drink liquids between meals.
Eat frequently in small quantities.
Sit upright after meals to reduce gastric reflux.
Keep visual reminders of nausea, such as eme-
sis basins, out of sight.
Provide emotional support.
3. h, b, a, e, f, g, c, d
4. a. Report increased bleeding.
b. Report temperature of 38° C (100.4° F) or
higher.
c. Take iron supplement as recommended to
correct anemia.
d. Resume sexual activity as directed.
e. Return to physician for checkup and con-
traceptive information and emphasize that
pregnancy can occur before the first men-
strual period.
5. fallopian tube
6. hypovolemic shock secondary to blood loss
7. a. Bleeding, possibly accompanied by
cramping, that varies from spotting to
hemorrhage
b. Larger than usual
c. Absent fetal heart activity
d. Early and severe hyperemesis gravidarum
e. Elevated, with other signs of pregnancy-
related hypertension
f. hCG levels higher than expected for
gestation
g. “Snowstorm” appearance on ultrasound
h. Increased risk for choriocarcinoma if all
abnormal tissue is not removed
8. a. Within 2–3 cm of the cervical opening, but
not covering any part of it
b. Partially covering the cervical opening
c. Totally covering the cervical opening

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2 Study Guide Answer Key Chapter 5
9.
Placenta Previa Abruptio Placentae
a. Pain No unusual pain Bleeding is accompanied by pain
b. Characteristics
of bleeding
Bright red, obvious Often concealed behind placenta, with
little external bleeding
c. Fetal ane-
mia and/or
hypoxia
Fetus may lose some blood as vessels
are disrupted with cervical dilation and
effacement; maternal hypovolemia may
reduce oxygen delivery to the fetus
Some blood behind placenta is often
fetal blood; maternal hypovolemia may
reduce oxygen delivery to the fetus
d. Consistency of
the uterus
No unusual contractions or irritability Frequent cramp-like contractions
e. Blood
coagulation
No blood clotting abnormalities are
expected
DIC may occur due to large clot behind
placenta with consumption of clotting
factors
f. Risk for
postpartum
hemorrhage
Higher because lower uterus does not
have as much muscle to compress open
vessels
Higher because injured muscle at
placenta site may not contract as well
g. Risk for
postpartum
infection
Higher because placenta is implanted
near vagina and organisms can easily
ascend and infect it
Higher because injured tissue is more
susceptible to microbial invasion
10. Signs that suggest a possible seizure include:
a. Abdominal and/or epigastric pain (related
to liver edema, ischemia, and necrosis;
precedes seizure; abruptio placentae is also
more likely and may be cause of pain)
b. Persistent vomiting (may occur with
hyperemesis gravidarum, but may also be
caused by same mechanisms noted above)
c. Edema of face and hands (large excess of
tissue fluid, although edema is not essen-

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Study Guide Answer Key Chapter 5 3
g. Pulmonary edema (movement of fluid
from vessels to lung tissue [severe])
h. Epigastric pain or nausea (liver edema,
ischemia, and necrosis [severe])
i. Lab studies (liver enzymes elevated
because of decreased circulation, edema,
and small hemorrhages [severe]); coagula-
tion abnormalities due to low platelet lev-
els and accumulation of platelets at sites of
vessel damage [severe]
15. Reduces blood flow to mother’s skeletal mus-
cles, making more available to her vital organs
and for perfusion of the placenta
16. a. Reduce central nervous system irritability
to prevent seizures
b. Urine output <30 mL/hour, depression or
loss of deep tendon reflexes, respiratory
depression, serum levels above 8 mg/dL,
observation for uterine atony after birth
c. Calcium gluconate
d. 4–8 mg/dL
17. a. negative; positive
b. Rh immune globulin (RhoGAM or
HypRho-D)
c. i. 28 weeks of gestation
ii.

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4 Study Guide Answer Key Chapter 5
b. use a latex condom
c. avoid oral sex
36. Incomplete bladder emptying due to pressure
on the bladder and reduced motility of the ure-
ters; retained urine becomes more alkaline and
favors growth of microorganisms.
37. a. Clean the vaginal-perineal area in a front-
to-back direction.
b. Drink at least eight glasses of liquids each
day, excluding caffeinated ones. Cranberry
juice makes the urine more acidic and less
favorable to bacterial growth.
c. Urinate before and after intercourse; use a
water-soluble lubricant to reduce irritation.
38. Standard precautions to reduce spread by
contact
Safe food and water supply to ensure adequate
nutrition and hydration
Safe air supply to reduce further transmission
Vaccines or antibiotics if benefits outweigh
risks to fetus
39. a. Growth retardation, facial abnormalities,
mental retardation
b. Avoid alcohol intake from conception.
40. e, f, i, c, a, b, g, h, d
41. The physician or nurse-midwife will prescribe
the drug that is least harmful yet is therapeutic
for her condition and will prescribe it in the
lowest possible effective dose and at the best
time(s) to take the drug. A pharmacist or phy-
sician who prescribed the drug may also be
consulted.
42. a. Increased risk for spontaneous abortion
(miscarriage), stillbirth, low birthweight
baby
b. Late prenatal care
c. Increased risk for homicide
43. Late or erratic prenatal care; injuries in various
stages of healing; old fractures; tendency to
minimize injury or its severity; assumption of
responsibility for the trauma. The abuser may
be extremely attentive after a battering episode.
Review Questions
1. Answer: 2
Rationale: The placenta secretes substances
(estrogen, progesterone, insulinase) that
decrease the effectiveness of insulin or break
it down more quickly. This action makes more

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Solution Manual for Introduction to Maternity and Pediatric Nursing, 6th Edition

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