Antepartum: 100 QUESTIONS

54. The RM who is assessing a G2 P1 palpates the fundal height at the level of the umbilicus. The midwife concludes that the fetus is equal to which of the following gestational ages? a. 12 weeks b. 20 weeks c. 28 weeks d. 36 weeks

ANS: b a. At 12 weeks' gestation, the fundus should be felt at the level of the symphysis pubis. b. The fundus at the level of the umbilicus indicates 20 weeks' gestation. In this question, the fact that this patient is a multigravida is not relevant. Uterine growth should be consistent for both primigravidas and multigravidas. c. At 28 weeks' gestation, the fundus should be felt 8 cm above the level of the umbilicus. d. At 36 weeks' gestation, the fundus should be felt at the xiphoid process. ...

32. Folic acid supplementation during pregnancy is to: a. Improve the bone density of pregnant women b. Decrease the incidence of neural tube defects in the fetus c. Decrease the incidence of Down syndrome in the fetus. d. Improve calcium uptake in pregnant women

ANS: b a. Folic acid is not related to bone density. b. Correct. The use of folic acid has decreased the incidence of neural tube defects by 50%. c. The use of folic acid is not associated with a reduction in Down syndrome. d. Folic acid is not related to calcium uptake in women. ...

47. While performing Leopold's maneuvers on a woman in early labor, the midwife palpates a flat area in the fundal region, a hard round mass on the left side, a soft round mass on the right side, and small parts just above the symphysis. The midwife concludes which of the following? a. The fetal position is right occiput posterior. b. The fetal attitude is flexed. c. The fetal presentation is scapular. d. The fetal lie is vertical.

ANS: c a. This is a shoulder presentation. b. It is not possible to determine whether the attitude is flexed or not when doing Leopold's maneuvers. c. This is a shoulder presentation. d. The lie is transverse or horizontal.

61. The clinic midwife talks with Suzy, a pregnant woman at 9 weeks' gestation who has just learned of her pregnancy. Suzy's nausea and vomiting are most likely caused by (select all that apply): a. Increased levels of estrogen b. Increased levels of progesterone c. An altered carbohydrate metabolism d. Increased levels of human chorionic gonadotropin

ANS: c, d Nausea and vomiting during the first trimester most likely are related to rising levels of human chorionic gonadotropin (hCG) and altered carbohydrate metabolism. Changes in taste and smell, due to alterations in the oral and nasal mucosa, can further aggravate the gastrointestinal discomfort.

70. The clinic midwife explains to Margaret, a newly diagnosed pregnant woman at 10 weeks' gestation, that her rubella titer indicates that she is not immune. Margaret should be advised to (select all that apply): a. Avoid contact with all children b. Be retested in 3 months c. Receive the rubella vaccine postpartum d. Report signs or symptoms of fever, runny nose, and generalized red rash to the health-care provider

ANS: c, d Testing for rubella (German measles) is not necessary as titers are reliable indicators of immunity. Rubella (German measles) is one of the most commonly recognized viral infections known to cause congenital problems. If a woman contracts rubella during the first 12 weeks of pregnancy, the fetus has a 90% chance of being adversely affected. A maternity patient who is not immune to rubella should be offered the rubella immunization following childbirth, ideally prior to hospital discharge. The patient should report signs or symptoms of rubella during pregnancy to her health-care provider. It is not realistic for a woman to avoid contact with all children. ...

33. The positive signs of pregnancy are: a. All physiological and anatomical changes of pregnancy b. All subjective signs of pregnancy c. All those physiological changes perceived by the woman herself. d. The objective signs of pregnancy that can only be attributed to the fetus

ANS: d a. Physiological and anatomical changes of pregnancy are presumptive signs of pregnancy. b. All subjective signs of pregnancy are the probable signs of pregnancy. c. All those physiological changes perceived by the woman herself are presumptive signs of pregnancy. d. Correct. Positive signs of pregnancy are the objective signs of pregnancy that can only be attributed to the fetus, such as fetal heart tones.

97. Fill in the blanks. The midwife knows that __________, which is the eating of nonnutritive substances, is a common __________.

ANS: pica; eating disorder Pica, the consumption of nonnutritive substances or food, is a common eating disorder that can affect pregnancy. Substances that are most often ingested include clay, dirt, cornstarch, and ice.

90. Fill in the blanks. The midwife monitors the blood pressure and assesses a woman's urine at each prenatal visit to assess for signs or symptoms of __________. A previous history or the presence of a __________ are also risk factors.

ANS: preeclampsia; new partner A previous history of preeclampsia increases the woman's likelihood of a recurrence during subsequent pregnancies. If a woman did not experience preeclampsia with previous pregnancies but has a new partner for her current pregnancy, her risk of developing preeclampsia is similar to that of a woman who is pregnant for the first time. Although preeclampsia is a systemic disorder that occurs only during pregnancy, it is generally recognized by two classic symptoms: elevated blood pressure and proteinuria.

96. Fill in the blanks. The clinic midwife understands that the physiological changes of pregnancy include vascular relaxation from the effects of __________ and impaired venous circulation from pressure exerted by the enlarged uterus, predisposing the pregnant woman to __________.

ANS: progesterone; varicose veins Progesterone results in vascular relaxation which combined with impaired venous return increases the incidence of varicose veins in pregnant women.

Fill-in-the-Blank 87. During the prenatal class, the midwife describes factors that may initiate the process of labor. One of these factors is the production of __________, which are found in the uterine __________ and are released from the __________ at term as it softens and dilates.

ANS: prostaglandins; decidua or lining; cervix Prostaglandins are lipid substances found in high concentrations in the female reproductive tract and in the uterine decidua during pregnancy. Their exact function in pregnancy is unknown, although they may maintain a reduced placental vascular resistance. A decrease in prostaglandin levels may contribute to hypertension and preeclampsia. At term, an increased release of prostaglandins from the cervix as it softens and dilates may contribute to the onset of labor. ...

94. Fill in the blanks. The clinic midwife describes to the student midwife that __________ is excessive saliva production in pregnancy. This condition is most likely caused by increased __________ levels.

ANS: ptyalism; hormone Ptyalism, or excessive salivation, can be quite distressing for the pregnant woman who must frequently wipe her mouth or spit into a cup. Although the cause of ptyalism is unknown, it is most likely related to increased hormone levels. ...

93. Fill in the blanks. The prenatal nurse cautions a pregnant woman about Caesar salad consumption during pregnancy or any source of __________ or __________ milk.

ANS: raw eggs; unpasteurized A word of caution should be provided by health-care providers to pregnant women with regard to microbial food-borne illness. Raw, or unpasteurized, milk as well as partially cooked eggs and foods containing raw or partially cooked eggs should be avoided.

92. Fill in the blanks. The midwife describes the need for __________ and __________ screening at the first antenatal visit. If the pregnant woman is not immune, she will be counseled to avoid contact with young children who have a rash and could be infectious.

ANS: rubella; varicella Some of the routine maternal laboratory tests screen for childhood diseases that are known to cause congenital anomalies or other pregnancy complications if contracted during early pregnancy. When contracted during the first trimester, rubella causes a number of fetal deformities. Varicella (chickenpox) is another common childhood disease that may cause problems in the developing embryo and fetus. Therefore, all pregnant women are screened for rubella and varicella.

123. Which of the following complications can be potentially life threatening and can occur in a client receiving a tocolytic agent? 1. diabetic ketoacidosis 2. hyperemesis gravidarum 3. pulmonary edema 4. sickle cell anemia

Answer 3. pulmonary edema Tocolytics are used to stop labor contractions. The most common adverse effect associated with the use of these drugs is pulmonary edema. Clients who dont have diabetes dont need to be observed for diabetic ketoacidosis. Hyperemesis gravidium doesnt result from tocolytic use. Sickle cell anemia is an inherited genetic condition and doesnt develop spontaneously

124. Which of the following rationales best explains why a pregnant client should lie on her left side when resting or sleeping in the later stages of pregnancy? 1. to facilitate digestion 2. to facilitate bladder emptying 3. to prevent compression of vena cava 4. to avoid fetal anomalies

Answer 3. to prevent compression of vena cava The weight of the preg uterus is sufficiently heavy to compress the vena cava, which could impair blood flow to the uterus, possibly decreasing oxygen to the fetus. The side lying position hasn't been shown to prevent fetal anomalies nor bladder emptying and or digestion ...

111. A 21y.o. client has been diagnosed with hydatidiform mole. Which of the following factors is considered a risk factor for developing hydatidiform mole? 1. age in 20s or 30s 2. high in SES 3. Primigravida 4. Prior molar pregnancy

Answer 4 is correct. Previous molar gestation increases risk for developing subsequent molar gestation by 4-5 times. Adolescents and women ages 40+ are at increased risk for molar pregs. MULTIGRAVIDAS, esp women with prior preg loss, and women with LOWER SES are at increased risk for this problem ...

24. What is the current recommendation for VBACs? 1. Informed consent does not require discussing the possible risk of perinatal infant death 2. The risk of VBAC is slightly higher than a repeat C-section. 3. The rate of perinatal infant death is 3.4 per 10,000. 4. Informed consent is essential for any woman undergoing a trial of labor after C-section (TOLAC).

Answer 4.

120. Which of the following doses of Rh immune globulin RhoGAM is appropriate for a pregnant client at 28 weeks gestation? 1. 50 mcg in a sensitized client 2. 50 mcg in an unsensitized client 3. 300 mcg in a sensitized client 4. 300 mcg in a unsensitized client

Answer 4. 300 mcg in a unsensitized client An Rh negative unsensitized woman should be given 300 mcg of RhoGAM at 28 weeks after an indirect Coombs test is done to verify that sensitization hasn't occurred. For a 1st trimester abortion or ectopic pregnancy, 50 mcg of RhoGAM is given (120mcg of WinRHO).

122. Which of the following factors would contribute to a high risk pregnancy? 1. Blood type O positive 2. first pregnancy at age 33y.o. 3. Hx of allergy to honey bee pollen 4. Hx of insulin dependent DM

Answer :4. a woman w/ a hx of diabetes has an increased risk for perinatal complications, including HTN, preeclampsia, and neonatal hypoglycemia. The age of 33 years w/out other risk factors doesn't increase risk, nor does type O positive blood or environmental allergens. ...

20. Shoes with low, broad heels, plus a good posture will prevent which prenatal discomfort? A. Backache B. Vertigo C. Leg cramps D. Nausea

Answer A. Backache usually occurs in the lumbar area and becomes more problematic as the uterus enlarges. The pregnant woman in her third trimester usually assumes a lordotic posture to maintain balance causing an exaggeration of the lumbar curvature. Low broad heels provide the pregnant woman with a good support.

53. A midwife working in a prenatal clinic is caring for a woman who asks advice on foods that are high in vitamin C because "I hate oranges." The nurse states that 1 cup of which of the following raw foods will meet the patient's daily vitamin C needs? a. Strawberries b. Asparagus c. Lettuce d. Cucumber

Answer A. a. Strawberries are an excellent source of vitamin C. b. Although asparagus has some vitamin C, it is not an excellent source. c. Iceberg lettuce is a poor source of vitamin C d. Cucumber is a poor source of vitamin C.

15. Which of the following findings in a pregnant individual would be consistent with a pregnancy of two months duration? A. Weight gain of 6-10 lbs. and presence of striae gravidarum B. Fullness of the breast and urinary frequency C. Braxton Hicks contractions and quickening D. Increased respiratory rate and ballottement

Answer B. Fullness of the breast is due to the increased amount of progesterone in pregnancy. The urinary frequency is caused by the compression of the urinary bladder by the gravid uterus which is still within the pelvic cavity during the first trimester.

22. Fundal height at 23 weeks gestation should be? 22-24 in 22-24 cm 24-26 cm 24-26 in Answer B. The fundus should grow 1 cm per week.

Answer B. The fundus should grow 1 cm per week.

8. In Leopold's maneuver step # 3 you palpated a hard round movable mass at the supra pubic area. The correct interpretation is that the mass palpated is: A. The buttocks because the presentation is breech. B. The mass palpated is the head. C. The mass is the fetal back. D. The mass palpated is the fetal

Answer B. When the mass palpated is hard round and movable, it is the fetal head.

133. Which of the following terms is used to describe the thinning and shortening of the cervix that occurs just before and during labor? 1. Ballottement 2. Dilation 3. Effacement 4. Muliparous

Answer: 3. Effacement Effacement is cervical shortening and thinning while dilation is widening of the cervix Both facilitate opening the cervix in prep for delivery. Ballottement is the ability of another individual to move the fetus by externally manipulating the maternal abdomen. A ballotable fetus hasn't yet engaged in the maternal pelvis. Multiparous refers to a woman who has had previous live births.

130. Which of the following conditions isn't diagnosed by abdominal US during the prenatal period? 1. fetal presentation 2. fetal heart activity 3. maternal diabetes 4. amniotic fluid volume

Answer: 3. maternal diabetes abdominal US evals fetal presentation, fetal heart activity, amniotic fluid volume although it may show increased amnitoic flud, thus helping to diagnose maternal diabetes, it isnt used for that purpose.

23. What is true about VBAC (vaginal birth after C-section)? 1. The use of oxytocin is contraindicated. 2. The success rate of VBAC is approximately 50 percent. 3. Cytotec (Misoprostol) is the preferred agent if induction or augmentation is needed. 4. Uterine dehiscence and rupture are rare complications, occurring less than 1 to 2 percent of the time.

Answer: 4

72. Presumptive signs of pregnancy include (select all that apply): a. Nausea b. Fatigue c. Ballottement d. Amenorrhea

ANS: a, b, d Nausea and vomiting, fatigue, and amenorrhea are all common during pregnancy and are the presumptive signs of pregnancy. Ballottement is a probably sign, noted during a vaginal exam.

117. A client is being admitted to the antepartum unit for hypovolemia secondary to hyperemesis gravidarum. WHich of the following factors predisposes a client to the development of this? 1. trophoblastic disease 2. maternal age > 35 y.o. 3. malnourished or underweight clients 4. low levels of HCG

1. Trophoblastic disease It's associated w/ hyperemesis gravidarum obesity and maternal age younger than 20 y.o. are risk factors too. High levels of estrogen HCG have also been associated with the development.

17. A midwife is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The RM tells the client to: a. Avoid wearing a bra b. Wash the nipples and areola area daily with soap, and massage the breasts with lotion. c. Wear tight-fitting blouses or dresses to provide support d. Wash the breasts with warm water and keep them dry

12. ANSWER D. The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort (especially on test days, even if you're not pregnant.)

112. A 21 y.o. arrives to the ER with c/o cramping abdominal pain and mild vaginal bleeding. Pelvic exam shows a left adnexal mass that's tender when palpated. Culdocentesis shows blood in the culdesac. This client probably has which of the following conditions? 1. Abruptio placentae 2. Ecoptic pregnancy 3. Hydatidiform mole 4. Pelvic Inflammatory Disease

2. Ecoptic pregnancy most ecoptic pregnancies dont appear as obvious life threatening med emergencies. THey must be considered in any sexually active woman of childbearing age who c/o menstrual irregularity, cramping abdominal pain, and mild vaginal bleeding. PID, abruptio placentae and hydatidiform moles wont show blood in the cul de sac ...

110. A person who's 36 weeks pregnant comes into the labor delivery unit with mild contracts. Which of the following complications should the midwife watch out for when the client informs her that they have placenta previa. 1. Sudden rupture of membranes 2. Emesis 3. Fever 4. Vaginal Bleeding

4. Vaginal bleeding

Term: 98. Passive movement of the unengaged fetus

ANS: Ballottement

46. The RM is providing prenatal teaching to a group of diverse pregnant women. One woman, who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy. The midwife explains that the most significant risk to the fetus is: a. Respiratory distress at birth b. Severe neonatal anemia c. Low neonatal birth weight d. Neonatal hyperbilirubinemia

ANS: C a. Respiratory distress is not the most significant risk to the fetus unless the fetus is also premature. b. Severe neonatal anemia is not associated with pregnancies complicated by cigarette smoking. c. Low neonatal birth weight is the most common complication seen in pregnancies complicated by cigarette smoking. d. Neonatal hyperbilirubinemia is not associated with pregnancies complicated by cigarette smoking.

34. During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate action would be to: a. Order an EKG. b. Consult for this abnormal finding immediately. c. Teach the pregnant person to avoid lying on their back and to rise slowly because of supine hypotension. d. Order a non-stress test (NST) to assess fetal well-being.

ANS: C a. This is a normal occurrence in pregnancy and does not indicate pathology. The probable cause of the problem is supine hypotension. b. This is a normal finding that does not warrant immediate consult with an OB. c. Correct. Teaching the client to avoid lying on her back because of occlusion of the vena cava with the gravid uterus causes supine hypotension syndrome. d. Antenatal testing is not indicated with supine hypotension.

35. Blood volume expansion during pregnancy leads to: a. Iron-deficiency anemia b. Maternal iron stores being insufficient to meet the demands for iron in fetal development c. Plasma fibrin increase of 40% and fibrinogen increase of 50% d. Physiological anemia of pregnancy

ANS: D a. Iron-deficiency anemia is treated with iron supplementation. Iron-deficiency anemia is defined as hemoglobin of less than 11 g/dL and hematocrit less than 33%. b. Maternal iron stores that are insufficient to meet the demands for iron in fetal development result in iron-deficiency anemia. c. Hypercoagulation that occurs during pregnancy is to decrease the risk of postpartum hemorrhage. These changes taking place are not related to blood volume expansion. d. Correct. Physiological anemia of pregnancy, also referred to as pseudo-anemia of pregnancy, is due to hemodilution. The increase in plasma volume is relatively larger than the increase in RBCs that results in decreased hemoglobin and hematocrit values. ...

Term: 107. Nosebleeds

ANS: Epistaxis

Term: 102. Lesions at the gum line that bleed easily

ANS: Epulis gravidarum

85. T/F. The midwife explains that ptyalism is a condition more acute than the normal nausea and vomiting of pregnancy and is often associated with dehydration, hypokalemia, and weight loss.

ANS: False Hyperemesis gravidarum is a pregnancy-related condition characterized by persistent, continuous, severe nausea and vomiting, often accompanied by dry retching. Hyperemesis gravidarum results in weight loss and fluid and electrolyte imbalance. Ptyalism is an excessive production of saliva.

Term for: 100. Curvature of the lower spine

ANS: Lordosis

Term: 103. Anterior convexity of the lumbar spine

ANS: Lumbar lordosis

Term: 106. Severe itching due to stasis of bile in the liver

ANS: Pruritis gravidarum

Term: 104. Increased saliva production

ANS: Ptyalism

Term: 105. Reflux of the stomach contents into the esophagus

ANS: Pyrosis

Term: 101. Stretch marks

ANS: Striae gravidarum

83. T/F. The clinic midwife knows that every time a person of childbearing age comes into the office for a health maintenance visit, they should be counseled about the benefits of daily folic acid supplementation.

ANS: True Because of the strong connection between folic acid deficiency and the subsequent development of neural tube defects, all women of childbearing age should take a folic acid supplement of at least 400 mcg/day.

82. T/F. Sam, a pregnant client at 30 weeks' gestation, has their vital signs assessed during a routine prenatal visit. Sam's blood pressure has remained at 110/70 for the last few visits, and their pulse rate has increased from 70 to 80 beats per minute. These findings would be considered normal at this time in pregnancy.

ANS: True During the first trimester, blood pressure normally remains the same as prepregnancy levels but then gradually decreases up to around 20 weeks' of gestation. After 20 weeks, the vascular volume expands and the blood pressure increases to reach prepregnant levels by term.

81. T/F. The clinic midwife speaks with the student midwife prior to the physical examination of a pregnant woman who is 32 weeks' gestation. The clinic RM explains that the heart sounds heard in pregnancy are usually S1 and S3 with a possible murmur related to increased cardiac output.

ANS: True Exaggerated first and third heart sounds and systolic murmurs are common findings during pregnancy. The murmurs are usually asymptomatic and require no treatment.

84. T/F. The midwife recommends strengthening exercises during pregnancy, as this can improve posture and increase energy levels.

ANS: True Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy, which include weight gain and postural changes. Muscle strengthening exercises also help to decrease the risk of ligament and joint injury. ...

52. A RM who is discussing serving sizes of foods with a new prenatal patient would state that which of the following is equal to 1 (one) serving from the dairy food group? a.. 1 cup low-fat milk b. ½ cup vanilla yogurt c. ½ cup cottage cheese d.. 1 ounce cream cheese

ANS: a a. 1 cup of any milk (e.g., whole milk, skim milk, buttermilk, chocolate milk) is equal to 1 serving size from the dairy group. b. 1 cup of yogurt is equal to 1 serving size from the dairy group. c. 1 ½ cup of cottage cheese is equal to 1 serving size from the dairy group. d. Cream cheese is not included in the dairy group. It is a fat product.

56. The clinic midwife includes screening for domestic violence in the first prenatal visit for all patients. An appropriate question would be: a. This is something that we ask everyone. Do you feel safe in your current living environment and relationships? b. This is something we ask everyone. Do you have any abuse in your life right now? c. Is your partner threatening or harming you in any way right now? d. I need to ask you, do you feel safe from abuse right now?

ANS: a a. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home and whether they have been hurt physically, emotionally, or sexually by a past or present partner. b. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients. c. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home and whether they have been hurt physically, emotionally, or sexually by a past or present partner. d. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home rather than asking if they have any abuse, as women may define abuse differently than care providers.

42. The RM uses Leopold maneuvers to determine the fetal lie, presentation, and position. The midwife's hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the: a. First maneuver b. Second maneuver c. Third maneuver d. Fourth maneuver

ANS: a a. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver determines which fetal body part (e.g., head or buttocks) occupies the uterine fundus. The examiner faces the patient's head and places the hands on the abdomen, using the palmar surface of the hands to gently palpate the fundal region of the uterus. The buttocks feel soft, broad, and poorly defined and move with the trunk. The fetal head feels firm and round and moves independently of the trunk. b. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. c. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. d. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario.

45. Lina is an 18-year-old woman at 20 weeks' gestation. This is her first pregnancy. Lina is complaining of fatigue and listlessness. Her vital signs are within a normal range: BP = 118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina's fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The midwife's best approach to care at this visit is to: a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week. b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry. c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks' gestation). d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including the risk of gestational diabetes.

ANS: a a. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the midwife's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. To facilitate this process, it is the midwife's responsibility to gather more information on the woman's dietary practices through a food diary.

48. A midwife is reviewing diet with a pregnant woman in her second trimester. Which of the following foods should the nurse advise the patient to avoid consuming during her pregnancy? a. Brie cheese b. Bartlett pears c. Sweet potatoes d. Grilled lamb

ANS: a a. Soft cheese may harbor Listeria. The patient should avoid consuming uncooked soft cheese. b. A pear is an excellent food for a pregnant woman to consume. c. Sweet potatoes are an excellent food for a pregnant woman to consume. d. Grilled lamb is an excellent food for a pregnant woman to consume, although it should be well cooked.

50. A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm above the symphysis. She denies experiencing quickening. Which of the following conclusions made by the RM is correct? a. The woman is experiencing a normal pregnancy. b. The woman may be having difficulty accepting this pregnancy. c. The woman must see a nutritionist as soon as possible. d. The woman will likely miscarry the conceptus.

ANS: a a. The patient is experiencing a normal pregnancy. b. Quickening is not felt until 16 to 20 weeks' gestation. c. There is no apparent need for a nutritionist to see this patient. d. There is no indication in the scenario that this patient is at high risk for a miscarriage.

39. A 26-year-old client at 29 weeks' gestation experienced epigastric pain following the consumption of a large meal of fried fish and onion rings. The pain resolved a few hours later. The most likely diagnosis for this symptom is: a. Cholelithiasis b. Influenza c. Urinary tract infection d. Indigestion

ANS: a a. The progesterone-induced prolonged emptying time of bile from the gallbladder, combined with elevated blood cholesterol levels, may predispose the pregnant woman to gallstone formation (cholelithiasis). Pain in the epigastric region following ingestion of a high-fat meal constitutes the major symptom of these conditions. The pain is self-limiting and usually resolves within 2 hours. b. The symptoms described are not associated with influenza. c. The symptoms described are not associated with urinary tract infection. d. Prolonged emptying time of bile from the gallbladder, combined with elevated blood cholesterol levels, make cholelithiasis a more probable diagnosis than indigestion.

68. Asking the pregnant client about their use of recreational drugs is an essential component of the prenatal history. Harmful fetal effects that may occur from recreational drugs include (select all that apply): a. Miscarriage/spontaneous abortion b. Low birth weight c. Macrosomia d. Post-term labor/birth

ANS: a, b Illegal or recreational drug use can have a number of detrimental effects on maternal and fetal health, including spontaneous abortion, low birth weight, placental abruption, and preterm labor.

69. At her first prenatal appointment in the clinic with an RM, Tracy has appropriate questions for her potential health-care provider that include (select all that apply): a. Complementary and alternative methods used during labor and birth b. An opportunity to meet other providers in the practice c. Beliefs and practices concerning an episiotomy and an epidural anesthetic d. Whether the midwife will be continually available for support during labor

ANS: a, b, c A woman's journey through the pregnancy experience can have long-term effects on her self-perception and self-concept. Therefore, it is especially important that the patient choose a care provider and group with whom she can openly relate and who shares the same philosophical views on the management of pregnancy. At the first prenatal visit, it is not common to explore whether the midwife will be continually available for support during labor.

71. An overweight or obese pre-pregnancy weight increases the risk for which poor maternal outcomes? (Select all that apply.) a. Preeclampsia b. Hemorrhage c. Difficult delivery d. Vaginal infections

ANS: a, b, c Being overweight or obese can substantially increase perinatal risk; however, no data support an increase in vaginal infections for the obese pregnant population.

64. The clinic midwife describes the respiratory system changes common to pregnancy to the new nurse. These changes include (select all that apply): a. An increased tidal volume b. A decreased airway resistance c. An increased chest circumference d. An increased airway resistance

ANS: a, b, c During pregnancy, a number of changes occur to meet the woman's increased oxygen requirements. The tidal volume (amount of air breathed in each minute) increases 30% to 40%. The enlarging uterus creates an upward pressure that elevates the diaphragm and increases the subcostal angle. The chest circumference may increase by as much as 6 centimeters, and airway resistance decreases. Although the "up and down" capacity of diaphragmatic movement is reduced, lateral movement of the chest and intercostal muscles accommodates for this loss of movement and keeps pulmonary functions stable. There is no increase in airway resistance during pregnancy.

59. The clinic midwife discusses normal bladder function in pregnancy with a 22-year-old pregnant woman who is now in her 29th gestational week. The RM explains that at this time in pregnancy, it is normal to experience (select all that apply): a. Urinary frequency b. Urinary urgency c. Nocturia d. Incontinence

ANS: a, b, c During pregnancy, the bladder, a pelvic organ, is compressed by the weight of the growing uterus. The added pressure, along with progesterone-induced relaxation of the urethra and sphincter musculature, leads to urinary urgency, frequency, and nocturia. Incontinence of urine is not a normal change during pregnancy.

66. The clinic midwife describes possible interventions for the pregnant woman who is experiencing pain and numbness in her wrists. The nurse suggests (select all that apply): a. Elevating the arms and wrists at night b. Reassessment during the postpartum period c. The use of "cock splints" to prevent wrist flexion d. Massaging the hands and wrists with alcohol

ANS: a, b, c Edema from vascular permeability can lead to a collection of fluid in the wrist that puts pressure on the median nerve lying beneath the carpal ligament, leading to carpal tunnel syndrome. Elevation of the hands at night may help to reduce the edema. Occasionally, a woman may need to wear a "cock splint" to prevent the wrist from flexing. Reassessment in the postpartum period is indicated because although carpal tunnel syndrome usually subsides after the pregnancy has ended, some women may require surgical treatment if symptoms persist. Massaging the hands and wrists with alcohol does not improve pain and numbness.

73. Physiologic changes that occur in the renal system during pregnancy predispose the pregnant person to urinary tract infections (UTIs). Symptoms of a UTI include (select all that apply): a. Dysuria b. Hematuria c. Urgency d. Delayed urination

ANS: a, b, c Urinary tract infection (UTI) symptoms include dysuria, hematuria, and urgency.

76. Jorgina is a 24-year-old pregnant woman at 26 weeks' gestation. This is Jorgina's third pregnancy, and her obstetrical history includes one full-term birth, one preterm birth, and two living children. Today Jorgina arrives at the clinic with complaints of fatigue, insomnia, and backache. She reports that she is a nurse on an oncology unit and is worried about continuing with working her 12-hour shifts. The midwife identifies concerns in Jorgina's history and work environment including (select all that apply): a. Risk of preterm birth b. Presence of chemotherapeutic agents c. Requirement for heavy lifting d. History of diabetes

ANS: a, b, c Women who are currently experiencing pregnancy complications and those who have a history of pregnancy complications (such as history of preterm birth) or other preexisting health disorders may be required to reduce their hours or stop working. The potential for maternal exposure to toxic substances such as chemotherapeutic agents, lead, and ionizing radiation (found in laboratories and health-care facilities); heavy lifting; and use of heavy machinery and other hazardous equipment should prompt reassignment to a different work area. If reassignment is not possible, Jorgina may need to stop working until the pregnancy has been completed. In this scenario there is no history of diabetes.

58. A preceptor teaches the student midwife about the physiological changes in pregnancy that most often contribute to the increased incidence of urinary tract infections. These changes include (select all that apply): a. Relaxation of the smooth muscle of the urinary sphincter b. Relaxation of the smooth muscle of the bladder c. Inadequate emptying of the bladder d. Increased incidence of bacteriuria

ANS: a, b, c, d Ascension of bacteria into the bladder can cause asymptomatic bacteriuria (ASB), or urinary tract infections (UTIs). These infections occur more frequently in pregnancy due to relaxation of the smooth muscle of the bladder and urinary sphincter and inadequate emptying of the bladder, changes that allow bacterial ascent into the bladder.

62. The clinic midwife encourages all pregnant women to increase their water intake to at least 8 to 10 glasses per day in order to (select all that apply): a. Decrease the risk of constipation b. Decrease the risk of bile stasis c. Decrease their feelings of fatigue d. Decrease the risk of urinary tract infections

ANS: a, b, c, d Patients should be encouraged to drink at least 8 to 10 glasses of water each day and empty their bladders at least every 2 to 3 hours and immediately after intercourse. These measures will help prevent stasis of urine and the bacterial contamination that leads to infection, as well as constipation. Some women experience symptoms of fatigue that can be alleviated by remaining adequately hydrated.

79. During the initial antenatal visit, the clinic midwife asks questions about nutritional intake. Specific questions should include information pertaining to (select all that apply): a. Preferred foods b. The presence of cravings c. Use of herbal supplements d. Aversions to certain foods and odors

ANS: a, b, c, d The nurse should obtain a nutritional history on all pregnant patients and patients of childbearing age to gain specific information related to the pregnancy, including foods that are preferred while pregnant (which may provide information about cultural and environmental dietary factors), special diets (which will assist the nurse in planning for education or interventions for risk factors associated with dietary practices), cravings or aversions to specific foods, and use of herbal supplements.

75. Interventions for low back pain during pregnancy should include (select all that apply): a. Utilizing proper body mechanics b. Applying ice or heat to affected area c. Avoiding pelvic rock and pelvic tilt d. Using additional pillows for support during sleep

ANS: a, b, d Interventions for back pain during pregnancy include utilizing proper body mechanics, applying heat or ice to the area, using additional pillows during sleep, and not avoiding pelvic rock/tilt, but encouraging pelvic rock/tilt.

57. An 18-year-old woman at 23 weeks' gestation tells the midwife that she has fainted two times. The midwife teaches about the warning signs that often precede syncope so that she can sit or lie down to prevent personal injury. Warning signs include (select all that apply): a. Sweating b. Nausea c. Chills d. Yawning

ANS: a, b, d Sweating is a warning sign that often precedes syncope. Syncope (a trandient loss of consciousness and postural tone with spontaneous recovery) during pregnancy is frequently attributed to orthostatic hypotension or inferior vena cava compression by the gravid uterus. Nausea and yawning are warning signs that often precede syncope. Lightheadedness, sweating, nausea, yawning, and feelings of warmth are warning signs that often precede syncope. Chills are not a warning sign that often precede syncope.

63. The RM examines the thyroid gland as part of the physical examination of Savannah, a pregnant woman who is now at 16 weeks' gestation. The perinatal nurse informs Savannah that during pregnancy (select all that apply): a. Increased size of the thyroid gland is normal b. Increased function of the thyroid gland is normal c. Decreased function of the thyroid gland is normal d. The thyroid gland will return to its normal size and function during the postpartal period

ANS: a, b, d The thyroid gland changes in size and activity during pregnancy. Enlargement is caused by increased circulation from the progesterone-induced effects on the vessel walls, and by estrogen-induced hyperplasia of the glandular tissue. The thyroid gland increases not decreases in size and activity during pregnancy. The thyroid gland returns to normal size and activity postpartum.

78. Teera is a 22-year-old woman who is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. Teera is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. The RM discusses Teera's diet with her as she may be deficient in (select all that apply): a. Iron b. Magnesium c. Zinc d. Vitamin B12

ANS: a, c Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork and have adequate intake of magnesium. Pregnant women who adhere to this diet may consume inadequate amounts of iron and zinc. Because strict vegetarians (vegans) consume only plant products, their diets are deficient in vitamin B12, found only in foods of animal origin.

77. The clinic midwife is assessing the complete blood count results for Kim-Ly, a 23-year-old pregnant woman. Kim-Ly's hemoglobin is 98 g/dL. This laboratory finding places Kim-Ly's pregnancy at risk for (select all that apply): a. Preterm birth b. Placental abruption c. Intrauterine growth restriction d. Thrombocytopenia

ANS: a, c True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The blood's decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction (IUGR) and preterm birth. There is not a risk factor for abruption or thrombocytopenia.

65. The clinic nurse teaches the new nurse about pregnancy-induced blood clotting changes. The nurse explains that a pregnant woman is at risk for venous thrombosis due to (select all that apply): a. Increased fibrinogen volume b. Increased blood factor V c. Increased blood factor X d. Venous stasis

ANS: a, c, d Although the platelet cell count does not change significantly during pregnancy, fibrinogen volume has been shown to increase by as much as 50%. This alteration leads to an increase in the sedimentation rate. Blood factors VII, VIII, IX, and X are also increased, and this change causes hypercoagulability. The hypercoagulability state, coupled with venous stasis (poor blood return from the lower extremities) places the pregnant woman at an increased risk for venous thrombosis, embolism, and, when complications are present, disseminated intravascular coagulation (DIC). Blood factor V does not increase.

74. Urinary tract infection (UTI) prevention measures during pregnancy include counseling the pregnant individual to (select all that apply): a. Delay urination until bladder is full b. Limit hydration c. Wipe from front to back d. Urinate after intercourse

ANS: a, c, d Anticipatory guidance for urinary tract infection prevention includes delaying urination, wipe front to back, and maintaining adequate hydration.

80. The RM talks to the prenatal class attendees about guidelines for exercise in pregnancy. Recommended guidelines include (select all that apply): a. Stopping if the person is tired b. Bouncing and slowly arching the back c. Increasing fluid intake throughout the physical activity d. Maintaining the ability to walk and talk during exercise

ANS: a, c, d Women should adhere to some basic safety guidelines when formulating their exercise program, including monitoring the breathing rate and ensuring that the ability to walk and talk comfortably is maintained during physical activity, stopping exercise when the woman becomes tired, and maintaining adequate fluid intake. Pregnant women should avoid exercises that can cause any degree of trauma to the abdomen or those that include rigorous bouncing, arching of the back, or bending beyond a 45-degree angle. ...

67. The clinic midwife advocates for smoking cessation during pregnancy. Potential harmful effects of prenatal tobacco use include (select all that apply): a. Preterm birth b. Gestational hypertension c. Gestational diabetes d. Low birth weight

ANS: a, d Nurses can help to improve the fetal environment by educating women about the dangers of direct and passive smoking during pregnancy. Effects of tobacco use during pregnancy are well documented and predispose to premature rupture of the membranes, preterm labor, placental abruption, placenta previa, and infants who are low birth weight or small for gestational age (SGA). Gestational hypertension and diabetes are not associated with smoking during pregnancy.

51. The RM notes each of the following findings in a woman at 10 weeks' gestation. Which of the findings would enable the midwife to tell the woman that she is probably pregnant? a. Fetal heart rate via Doppler b. Positive pregnancy test c. Positive ultrasound assessment d. Absence of menstrual period

ANS: b a. A fetal heart rate is a positive sign of pregnancy. b. A positive pregnancy test is a probable sign of pregnancy. It is not a positive sign because the hormone tested for—human chorionic gonadatropin (hCG)—may be being produced by, for example, a hydatidiform mole. c. A positive ultrasound is a positive sign of pregnancy. d. Amenorrhea is a presumptive sign of pregnancy.

36. Intimate partner violence (IPV) against women consists of actual or threatened physical or sexual violence and psychological and emotional abuse. Screening for IPV during pregnancy is recommended for : a. Pregnant individuals with a history of domestic violence b. All pregnant individuals c. All low-income pregnant people d. Pregnant adolescents

ANS: b a. Intimate partner violence is underreported by women, necessitating universal screening. b. Correct. AWHONN advocates for universal screening for domestic violence for all pregnant women. Homicide is the most likely cause of death for pregnant or recently pregnant women, and a significant portion of those homicides are committed by their intimate partners. One in six pregnant women reported physical or sexual abuse during pregnancy, seriously impacting maternal and fetal health and infant birth weight. c. IPV crosses all ethnic, racial, religious, and socioeconomic levels. d. IPV crosses all ethnic, racial, religious, and socioeconomic levels.

43. The RM talks with Kathy about her possible pregnancy. Kathy has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. These symptoms are best described as: a. Positive signs of pregnancy b. Presumptive signs of pregnancy c. Probable signs of pregnancy d. Possible signs of pregnancy

ANS: b a. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements palpated by the examiner. b. Presumptive signs of pregnancy include amenorrhea, nausea and vomiting, frequent urination, breast tenderness, perception of fetal movement, skin changes, and fatigue. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements palpated by the examiner. c. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement. d. Possible signs of pregnancy may vary widely.

40. The RM reviews the complete blood count results for a 30-year-old client who is now 33 weeks' gestation. Tamara's hemoglobin value is 112 g/dL, and her hematocrit is 38%. The RM interprets these findings as: a. Normal adult values b. Normal pregnancy values for the third trimester c. Increased adult values d. Increased values for 33 weeks' gestation

ANS: b a. The values are low normal for adults but represent normal findings for pregnant women. b. During pregnancy the woman's hematocrit values may appear low due to the increase in total plasma volume (on average, 50%). Because the plasma volume is greater than the increase in erythrocytes (30%), the hematocrit decreases by about 7%. This alteration is termed "physiologic anemia of pregnancy," or "pseudo-anemia." The hemodilution effect is most apparent at 32 to 34 weeks. The mean acceptable hemoglobin level in pregnancy is 11 to 12 g/dL of blood. c. The values are not increased; they are low normal for adults but represent normal findings for pregnant women. d. The values are not increased; they are low normal for adults but represent normal findings for pregnant women.

60. A 32-year-old woman now at 32 weeks' gestation is complaining of right-sided sharp abdominal pain. The client is examined by the clinic midwife and given information about abdominal discomfort in pregnancy. She is also instructed to seek immediate attention if she (select all that apply): a. Has heartburn b. Has chills or a fever c. Feels decreased fetal movements d. Has increased abdominal pain

ANS: b, c, d Heartburn is a common discomfort throughout pregnancy. Because the appendix is pushed upward and posterior by the gravid uterus, the typical location of pain is not a reliable indicator for a ruptured appendix during pregnancy. The pain should gradually subside, but if it persists or is accompanied by fever, a change in bowel habits, or decreased fetal movement, the patient should promptly contact her medical provider.

91. Fill in the blanks. The midwife is aware of the importance of chlamydia screening during pregnancy. Chlamydia transmission to the infant at __________ may result in __________.

ANS: birth; ophthalmia neonatorum Chlamydia trachomatis is a bacteria that causes infection that is prevalent in sexually active populations, especially those in the under-25 age group. Complications of chlamydia infections include salpingitis, pelvic inflammatory disease, infertility, ectopic pregnancy, premature rupture of the membranes, and preterm birth. Transmission to the neonate may occur during birth and results in ophthalmia neonatorum and chlamydial neonatal pneumonia.

55. A patient at 28 weeks' gestation was last seen in the prenatal clinic at 24 weeks' gestation. Which of the following changes should the nurse bring to the attention of the RM? a. Weight change from 128 pounds to 132 pounds b. Pulse change from 88 bpm to 92 bpm c. Blood pressure change from 110/70 to 140/90 d. Respiratory change from 16 rpm to 20 rpm

ANS: c Feedback a. A weight change of approximately 4 pounds in 4 weeks is normal in the second and third trimesters of pregnancy. b. This pulse rate change is within normal limits. c. A blood pressure elevation to 140/90 is a sign of mild preeclampsia. d. This respiratory rate change is within normal limits.

49. The midwife is working in a prenatal clinic caring for a patient at 14 weeks' gestation, G2 P1001. Which of the following findings should the midwife note a significant? a. Body mass index of 23 b. Blood pressure of 100/60 c. Hematocrit of 29% d. Pulse rate of 76 bpm

ANS: c a. A body mass index of 23 is normal. b. A blood pressure of 100/60 is normal. c. A hematocrit of 29% indicates that the patient is anemic. The nurse should highlight the finding for the nurse-midwife. d. A pulse rate of 76 bpm is a normal rate.

41. A midwife is aware that the pregnant woman's blood volume increases by: a. 20% to 25% b. 30% to 35% c. 40% to 45% d. 50% to 55%

ANS: c a. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not 20% to 25%. b. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45, not 30% to 35%. c. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45% and is primarily due to an increase in plasma and erythrocyte volume. Additional erythrocytes, needed because of the extra oxygen requirements of the maternal and placental tissue, ensure an adequate supply of oxygen to the fetus. The elevation in erythrocyte volume remains constant during pregnancy. d. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not as high as 50% to 55%.

95. Fill in the blanks. The clinic nurse talks with the newly-pregnant woman about the nausea that they are experiencing in this pregnancy. The clinic midwife suggests eating __________ meals more often, remaining __________ after eating, and the using __________ techniques.

ANS: smaller; upright; relaxation Nausea is often one of the first symptoms of pregnancy experienced. Nurses can suggest strategies to help offset the nausea, such as the avoidance of "trigger foods" (foods that cause nausea from sight or smell) and tight clothing that constricts the abdomen. The use of relaxation techniques (i.e., slow, deep breathing, mental imagery) can also help to decrease nausea. Other techniques that are often helpful include consuming plain, dry crackers or sucking on peppermint candy before arising; adhering to small, frequent meals; and remaining in an upright position after eating.

88. Fill in the blanks. The midwife describes common complaints of pregnancy to the prenatal class attendees. Nasal __________, medically termed "__________ of pregnancy," is caused by increased levels of estrogen and progesterone.

ANS: stuffiness; rhinitis Nasal stuffiness and congestion (rhinitis of pregnancy) are common complaints during pregnancy. The nurse should educate the patient about these normal changes and offer reassurance. Increasing oral fluid intake helps to keep the mucus thin and easier to mobilize.

13. A midwife is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The midwife checks the client for which specific signs of Preeclampsia (select all that apply)? a. Elevated blood pressure b. Negative urinary protein c. Facial edema d. Increased respirations

ANSWER A and C. The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia.

3. A midwife is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy. a. Uterine enlargement b. Fetal heart rate detected by nonelectric device c. Outline of the fetus via radiography or ultrasound d. Chadwick's sign e. Braxton Hicks contractions f. Ballottement

ANSWER A, D, E, and F. The probable signs of pregnancy include uterine enlargement, Hegar's sign (softening and thinning of the uterine segment that occurs at week 6), Goodell's sign (softening of the cervix that occurs at the beginning of the 2nd month), Chadwick's sign (bluish coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at week 6), ballottement (rebounding of the fetus against the examiners fingers of palpation), Braxton Hicks contractions and a positive pregnancy test measuring for hCG. Positive signs of pregnancy include fetal heart rate detected by electronic device (Doppler) at 10-12 weeks and by nonelectronic device (fetoscope) at 20 weeks gestation, active fetal movements palpable by the examiner, and an outline of the fetus via radiography or ultrasound.

4. A midwife is reviewing the record of a client who has just been told that a pregnancy test is positive there is documentation of the presence of a Goodell's sign. The midwife determines this sign indicates: a. A softening of the cervix b. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus. c. The presence of hCG in the urine d. The presence of fetal movement

ANSWER A. In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell's sign.

11. A pregnant client calls the clinic and tells the midwife that she is experiencing leg cramps and is awakened by the cramps at night. To provide relief from the leg cramps, the midwife tells the client to: a. Dorsiflex the foot while extending the knee when the cramps occur b. Dorsiflex the foot while flexing the knee when the cramps occur c. Plantar flex the foot while flexing the knee when the cramps occur d. Plantar flex the foot while extending the knee when the cramps occur.

ANSWER A. Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping.

30. In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must: a. Administer RhIg within 72 hours b. Make certain she receives RhIg on her first clinic visit c. Not give RhIg, since it is not used with the birth of a stillborn d. Make certain the client does not receive RhIg, since the gestation only lasted 12 weeks.

ANSWER A. RhIg is given within 72 hours postpartum if the client has not been sensitized already. RhoGam: 50mcg if <12 wks, 300mcg if ≥12 wks WinRho: 120mcg

31. A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A midwife monitors for complications associated with the diagnosis and assesses the client for: a. Any bleeding, such as in the gums, petechiae, and purpura. b. Enlargement of the breasts c. Periods of fetal movement followed by quiet periods d. Complaints of feeling hot when the room is cool

ANSWER A. Severe Preeclampsia can trigger disseminated intravascular coagulation (DIC; remember the Peds lecture?) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.

26. A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the RM instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education? a. "I will maintain strict bedrest throughout the remainder of pregnancy. b. "I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding." c. "I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." d. "I will watch for the evidence of the passage of tissue."

ANSWER A. Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.

18. A midwife is providing instructions to a group of pregnant clients regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions? a. "I need to cook meat thoroughly." b. "I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat." c. "I need to drink unpasteurized milk only." d. "I need to avoid contact with materials that are possibly contaminated with cat feces."

ANSWER C. All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption, and avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sand boxes, and garden soil.

28. A midwife implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education? a. "I need to stay on the diabetic diet." b. "I will perform glucose monitoring at home." c. "I need to avoid exercise because of the negative effects of insulin production." d. "I need to be aware of any infections and report signs of infection immediately to my health care provider."

ANSWER C. Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood glucose level.

12. A midwifery instructor asks a student midwife who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term? a. "It is the irregular, painless contractions that occur throughout pregnancy." b. "It is the soft blowing sound that can be heard when the uterus is auscultated." c. "It is the fetal movement that is felt by the mother." d. "It is the thinning of the lower uterine segment."

ANSWER C. Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar's sign.

129. During the last 6 weeks of gestation, which of the following tests isn't used to determine fetal well-being? 1. BPP 2. NST 3. Maternal blood count 4. FM count

Answer 3. Maternal Blood count - evaluates maternal, not fetal well being BPP - uses US to eval fetal body movements, breathing movements, muscle tone, reactive fetal cardiac rate, amniotic fluid volume NST - evals the FHR for accels during FM FM - counts are used during the last trimester to obtain a rough index of fetal health - the number of FM are counted at diff times throughout the day and then charted to detect any change in overall activity over a number of days

Term: 99. Absence of menses

Amenorrhea

114. Which of the following changes in respiratory functioning during pregnancy is considered normal? 1. increased tidal volume 2. increases expiratory volume 3. decreased inspiratory capacity 4. decreased oxygen consumption.

Answer 1. A pregnant client breathes deeper, which increases the tidal volume of gas moved in and out of the respiratory tract w/ each breath.The expiratory volume and residual volume DECREASE as the preg. Progresses. The inspiratory capacity INCREASES during preg. The increases oxygen consumption in the preg client is 15-20% greater than in the nonpreg state

113. A client, 34 weeks pregnant, arrives at the ER with SEVERE abdominal pain, uterine tenderness and an increased uterine tone. The client denies vaginal bleeding. The external fetal monitor shows fetal distress with severe, variable decels. The client most likely has which of the following? 1. Abruptio Placentae 2. Ectopic Pregnancy 3.Molar Pregnancy 4. Placenta Previa

Answer 1. Abruptio placentae Aclient w/ severe abruptio placentae will often have SEVERE abdominal pain. The uterus will have increased tone w/ little to no return to resting tone btw/ contractions. The fetus will start to show signs of distress, with decels in the HR or even fetal death w/ large placental separation. Placenta previa usually involves PAINLESS vaginal bleeding w/out UCs. A molar preg. generally would be detected before 34 weeks gestation. An ecoptic preg. which usually occurs in the FALLOPIAN TUBES, would rupture well before 34 weeks gestation.

127. Which of the following is best to monitor a fetus of a client with insulin-dependent diabetes in her 3rd trimester 1. US exam weekly 2. NST 2x/week 3. Daily contraction stress test at 32 weeks 4. monitoring fetal activity by client weekly

Answer 2. NST is the preferred antepartum HR screening test for pregnant clients with diabetes. NSTs should be done at least 2x per week staring at 32 weeks gestation, as fetal deaths in clients w/ diabetes have been noted within 1 week of a reactive NST. US should be done ever 4-6 weeks to monitor fetal growth. CST wouldnt be initiated at 32 weeks Maternal fetal activity monitoring should be done daily

125. Because uteroplacental circulation is compromised in clients with preeclampsia, a NST is performed to detect which conditions? 1. Anemia 2. Fetal well being 3. IUGR 4. Oligohydramnios

Answer 2. An NST is based on the theory that a healthy fetus will have transient fetal heart rate accelerations with fetal movement. A fetus with compromised uteroplacental circulation usually won't have these accelerations, which indicate a nonreactive NST. Serial US will detect IUGR and oligohydramnios in a fetus. An NST can't detect anemia in a fetus.

126. A client is 33 weeks pregnant and has had diabetes since she was 21. When checking her fasting plasma glucose (FPG) level, which values indicate the client's diabetes was controlled. 1. 5.2 mmolL 2. 3.5 mmol/L 3. 7.6 mmol/L 4. 7.0 mmol/L

Answer 2. Recommended fasting blood sugar levels in pregnant clients w/ dm are ≤5.3 mmol/L A fasting blood sugar level of 3.5 mmol/L (≤4.0 mmol/L) is low and may result in hypoglyecemia A PG level below 7.8 mmol/L is recommended for 1 hour postprandial values A FPG level above 6.8 mmol/L in a pregnant client indicates hyperglycemia

116. A 21 y.o. client, 6 weeks pregnant, is diagnosed with hyperemesis gravidum. This excessive vomiting during pregnancy will often result in which of the following? 1. bowel perforation 2. electrolyte imbalance 3. miscarriage 4. PIH

Answer 2. Excessive vomiting in clients with hyperemesis grav often causes weight loss / fluid and electrolyte, acid base imbalance. PIH and bowel perforation aren't related to hyperemesis gravidum. The effects of hyperemesis gravidarum on the fetus depend on the severity of the disorder. Clients w/ severe hyperemis gravidarum may have low birth weight infant, but the disorder isn't life threatening to the fetus

119. Rh isoimmunization in a pregnant client develops during which conditions? 1. Rh positive maternal blood crosses into fetal blood, stimulating fetal antibodies. 2. Rh positive fetal blood crosses into maternal blood, stimulating maternal antibodies. 3. Rh Negative fetal blood crosses into maternal blood, stimulating maternal antibodies. 4. Rh negative maternal blood crosses into fetal blood, stimulating fetal antibodies.

Answer 2. Rh positive fetal blood crosses into maternal blood, stimulating maternal antibodies. Rh isoimmunization occurs when Rh positive fetal blood cells cross into the maternal circulation and stimulate maternal antibody production. In subsequent pregnancies w/ Rh positive fetuses, maternal antibodies may cross back into the fetal circulation and destroy fetal blood cells.

128. Which drug would the nurse choose to utilize as an antagonist for magnesium sulfate? 1. Oxytocin 2. Terbutaline 3. Calcium gluconate 4. Narcan

Answer 3. Calcium gluconate should be kept at the bedside while a client is recieivng mag sulfate infusion. If magnesium toxicity occurs, calcium gluconate is admined as an antidote Oxytocin is the synthetic form of the naturally occurring pituitary hormone used to initiate or augment UCs Terbutaline is a beta2 adrenergic agonist that may be used to relax smooth muscle of the uterus, esp for PTL and uterine hyperstimulation Naloxone is an opiate antagonist admin to reverse resp distress

115. Which of the following conditions is common in pregnant clients in the 2nd trimester of preg? 1. mastitis 2. metabolic alkalosis 3. physiologic anemia 4. respiratory acidosis

Answer 3. Hgb and Hct values DECREASE during preg as the INCREASE in plasma volume exceeds the increase in RBC production. Alterations in acid-base balance during pregnancy result in a state of resp. alkalosis, compensated by mild metabolic acidosis. Mastitis is an infection in the breast characterized by a swollen tender breast and flu like Sx. this condition is most freq. seen in breast feeding clients.

29. A midwife visits a pregnant client who has a diagnosis of mild preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the preeclampsia? a. Blood pressure reading is at the prenatal baseline b. Urinary output has increased c. The client complains of a headache and blurred vision d. Dependent edema has resolved

Answer 3. If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening Preeclampsia.

121. A client hospitalized for premature labor tells the midwife she's having occasional contractions. Which of the following interventions would be the most appropriate? 1. Teach the client the possible complications of premature birth. 2. Tell the clients to walk to see if she can get rid of the contractions. 3. Encourage her to empty her bladder and drink plenty of fluids, IV fluids 4. Notify anesthesia for immediate epidural placement to relieve the pain associated with contractions.

Answer 3. Encourage her to empty her bladder and drink plenty of fluids, IV fluids An empty bladder and adequate hydration may help decrease or stop labor contractions. Walking may encourage contractions to become stronger. Teaching the potential complications is likely to increase the clients anxiety rather than relax her It would be inappropriate to call anesthesia

38. At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse and tells you shyly that she wants to maintain a sexual relationship with her partner. The best response is to: a. Reassure woman/couple of normalcy of response. b. Suggest alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse c. Recommend cessation of intercourse until after delivery due to advanced gestation.

Answer B. a. Although this is a normal response, providing reassurance is not enough. Further intervention is indicated. b. Although shy to discuss this, she wants to maintain a sexual relationship with her partner. Suggesting alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse provides the woman with information to maintain sexual relations. c. She wants to maintain a sexual relationship with her partner, and there are no contraindications to intercourse during a healthy pregnancy.

5. A midwife is performing an assessment of a primapira who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing? a. Consistent increase in fundal height b. Fetal heart rate of 180 BPM c. Braxton hicks contractions d. Quickening

Answer B. The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected.

16. When a pregnant woman experiences leg cramps, the correct intervention to relieve the muscle cramps is: A. Allow the woman to exercise B. Let the woman walk for a while C. Let the woman lie down and dorsiflex the foot towards the knees D. Ask the woman to raise her legs

Answer C. Question 12 Explanation: Leg cramps is caused by the contraction of the gastrocnimeus (leg muscle). Thus, the intervention is to stretch the muscle by dosiflexing the foot of the affected leg towards the knee.

1. During a prenatal visit at 38 weeks, a midwife assesses the fetal heart rate. The midwife determines that the fetal heart rate is normal if which of the following is noted? a. 80 BPM b. 100 BPM c. 150 BPM d. 180 BPM

Answer C. The fetal heart rate depends in gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress.

109. A client telephones the emergency room stating that she thinks that she is in labor. The midwife should tell the client that labor has probably begun when: a. Her contractions are 2 minutes apart. b. She has back pain and a bloody discharge. c. She experiences abdominal pain and frequent urination. d. Her contractions are 4-5 minutes apart.

Answer D is correct. The client should be advised to come to the labor and delivery unit when the contractions are every 5 minutes and consistent. She should also be told to report to the hospital if she experiences rupture of membranes or extreme bleeding. She should not wait until the contractions are every 2 minutes or until she has bloody discharge, so answers A and B are incorrect. Answer C is a vague answer and can be related to a urinary tract infection.

108. The midwife suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic pregnancy? a. Painless vaginal bleeding b. Abdominal cramping c. Throbbing pain in the upper quadrant d. Sudden, stabbing pain in the lower quadrant

Answer D is correct. The signs of an ectopic pregnancy are vague until the fallopian tube ruptures. The client will complain of sudden, stabbing pain in the lower quadrant that radiates down the leg or up into the chest. Painless vaginal bleeding is a sign of placenta previa, abdominal cramping is a sign of labor, and throbbing pain in the upper quadrant is not a sign of an ectopic pregnancy, making answers A, B, and C incorrect. ...

7. In Leopold's maneuver step #1, you palpated a soft broad mass that moves with the rest of the mass. The correct interpretation of this finding is: A. The mass palpated at the fundal part is the head part. B. The presentation is breech. C. The mass palpated is the back D. The mass palpated is the buttocks.

Answer D. The palpated mass is the fetal buttocks since it is broad and soft and moves with the rest of the mass.

6. A midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the midwife implement to test for the presence of ballottement? a. Auscultating for fetal heart sounds b. Palpating the abdomen for fetal movement c. Assessing the cervix for thinning d. Initiating a gentle upward tap on the cervix

Answer D. Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger.

118. Clients with gestational diabetes are usually managed by which of the following therapies? 1. diet 2. long acting insulin 3. oral hypoglycemic drugs 4. oral hypoglycemic drugs/insulin

Answer: 1 Oral hypoglycemics are contraindicated in preg. long acting insulin usually inst needed for blood glucose control in the client with GDM ...

25. You performed the Leopold's maneuvers and found the following: breech presentation, fetal back at the right side of the mother. Based on these findings, you can hear the fetal heart beat (PMI) BEST in which location? 1. Left lower quadrant 2. Right lower quadrant 3. Left upper quadrant 4. Right upper quadrant

Answer: 1 Right lower quadrant. The landmark to look for when looking for PMI is the location of the fetal back in relation to the right or left side of the mother and the presentation, whether cephalic or breech. The best site is the fetal back nearest the head.

21. Which of the following is NOT an indication for a C-section? 1. Prior C section 2. Obstructive lesion in genital tract 3. Leiomyomas of the uterus 4. Pelvic abnormalities

Answer: 1.

132. A woman with a term, uncomplicated pregnancy comes into L&D in early labor saying that she thinks her water broke. Which action should the nurse take? 1. prep the woman for delivery 2. note color, amt and odor of fluid 3. immed contact doctor 4. collect sample of fluid for microbial analysis

Answer: 2. Noting color, amount and odor of the fluid as well as the time of the rupture, will help guide the RM in her next action. There's no need to call the doctor immed or prep the client for delivery if the fluid is clear and delivery isnt imminent. ROM isnt unusual in early stages of labor. Fluid collection for microbe analysis isnt routine and theres no concern for infection/maternal fever.

37. A client presents to the prenatal clinic at 30 weeks' gestation reporting dysuria, frequency, and urgency with urination. Appropriate actions include: a. Obtain clean-catch urine to assess for a possible urinary tract infection. b. Reassure the client that the signs are normal urinary changes in the third trimester. c. Teach the client to decrease fluid intake to manage these symptoms. d. Perform a Leopold's maneuver to assess fetal position and station.

Answer: A a. Correct. Dysuria, frequency, and urgency with urination are signs and symptoms of a urinary tract infection, necessitating further assessment and testing. b. These are abnormal urinary symptoms in the third trimester. c. Pregnant women need to increase their fluid intake during pregnancy, and dysuria and urgency are abnormal. d. Assessment of fetal position and station is not an appropriate response to reported signs and symptoms of a urinary tract infection.

14. In the later part of the 3rd trimester, the pregnant person may experience shortness of breath. This complaint maybe explained as: A. A normal occurrence in pregnancy because the fetus is using more oxygen B. The fundus of the uterus is high pushing the diaphragm upwards C. The woman is having allergic reaction to the pregnancy and its hormones D. The person maybe experiencing complications of pregnancy

Answer: B. From the 32nd week of the pregnancy, the fundus of the enlarged uterus is pushing the respiratory diaphragm upwards. Thus, the lungs have reduced space for expansion consequently reducing the oxygen supply.

89. Fill in the blanks. The midwife promotes a diet rich in vitamin __________ during the third trimester to prevent the possibility of __________ rupture of the membranes.

Answer: C, Premature. Low levels of vitamin C may predispose women to premature rupture of membranes. As the cellular availability of vitamin C decreases, the rate of degradation of cervical collagen increases. With decreased collagen, the cervix more easily ripens, prompting effacement and dilatation.

44. A client presents to a prenatal clinic appointment at 10 weeks' gestation, in the first trimester of pregnancy. Which of the following symptoms would be considered a normal finding at this point in pregnancy? a. Occipital headache b. Urinary frequency c. Diarrhea d. Leg cramps

Answer: b a. Headaches may be benign or, especially if noted after 20 weeks' gestation, may be a symptom of pregnancy-induced hypertension (PIH). b. Urinary frequency is a common complaint of women during their first trimester. c. Diarrhea is rarely seen in pregnancy. Constipation is a common complaint. d. Leg cramps are commonly seen during the second and third trimesters.

131. A client who is 32 weeks pregnant is being monitored in the antepartum unit for PIH. She suddenly complains of continuous abdominal pain and vaginal bleeding. Which of the following internventions should be included in the care of this client? Check all that apply 1. Evaluate V/S 2. Prepare for vaginal delivery 3. Reassure client that she'll be able to continue pregnancy 4. Evaluate FHT 5. Monitor amt of vaginal bleed 6. Monitor I&O

Answers: 1. Evaluate VS 4. Evaluate FHT 5. Monitor amt of vaginal bleed 6. Monitor I&O The clients Sx indicate that she's experiencing abruptio placenta. The nurse must immed eval the moms well being by eval VS, FWB, by auscultation of heart tones, monitoring amt of blood loss and eval the vol status by measuring I&O. After the severity of the abruption has been determined and blood and fluid have been replaced, prompt C-SECTION delivery of the fetus (not vaginal) is indicated if the fetus