Chapter 9 - Antepartum Nursing Assessment

A woman gave birth last week to a fetus at 18 weeks' gestation after her first pregnancy. She is in the clinic for follow-up, and notices that her chart states she has had one abortion. The patient is upset over the use of this word. How can the nurse best explain this terminology to the patient? 1. "Abortion is the medical term for all pregnancies that end before 20 weeks." 2. "Abortion is the word we use when someone has miscarried." 3. "Abortion is how we label babies born in the second trimester." 4. "Abortion is what we call all babies who are born dead."

Correct Answer: 1 Rationale 1: Abortions are fetal losses prior to the onset of the third trimester, and include elective induced (medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages. Rationale 2: This explanation is only partially correct. Rationale 3: This explanation is only partially correct. Rationale 4: This is not a true statement.

The nurse is explaining to a new prenatal patient that the certified nurse-midwife will perform clinical pelvimetry as a part of the pelvic exam. The nurse knows that teaching has been successful when the patient states, "The certified nurse-midwife will perform this examination because: 1. "It will help us know how big a baby I can deliver vaginally." 2. "Doing this exam is a part of prenatal care at this clinic." 3. "My sister had both of her babies by cesarean." 4. "I am pregnant with my first child."

Correct Answer: 1 Rationale 1: Clinical pelvimetry is an estimate of the diameter of the pelvis the baby fits through during birth. The estimated size of the pelvis helps estimate what size fetus the patient can deliver vaginally. Rationale 2: Although this is a true statement, the estimation of the pelvis size is a better indication of the patient's understanding. Rationale 3: Knowing that the patient's sister had her babies by cesarean would not indicate that the patient understood the teaching. Rationale 4: Clinical pelvimetry is done with the first pregnancy, but the patient's stating that this is her first child does not indicate that the patient understood the teaching.

The nurse at the prenatal clinic has four calls to return. Which phone call should the nurse return first? 1. Primip at 32 weeks, reports headache and blurred vision. 2. Multip at 18 weeks, reports no fetal movement this pregnancy. 3. Primip at 16 weeks, reports increased urinary frequency. 4. Multip at 40 weeks, reports sudden gush of fluid and contractions.

Correct Answer: 1 Rationale 1: Headache and blurred vision are signs of preeclampsia, which is potentially life-threatening for both mother and fetus. This patient has top priority. Rationale 2: Fetal movement should be felt by 19-20 weeks. Multips sometimes feel fetal movement prior to 19 weeks, but the lack of fetal movement prior to 20 weeks is considered normal. This patient is a lower priority. Rationale 3: Increased urinary frequency is common during pregnancy as the increased size of the uterus puts pressure on the urinary bladder. Rationale 4: A term patient who is experiencing contractions and a sudden gush of fluid is in labor. Although laboring patients should be in contact with their provider for advice on when to go to the hospital, labor at term is an expected finding. This patient is a lower priority.

While completing the medical and surgical history during the initial prenatal visit, the 16-year-old primigravida interrupts with "Why are you asking me all these questions? What difference does it make?" Which statement would best answer the patient's questions? "We ask these questions: 1. "To detect anything that happened in your past that might affect the pregnancy." 2. "To see whether you can have prenatal visits less often than most patients do." 3. "To make sure that our paperwork and records are complete and up to date." 4. "To look for any health problems in the past that might affect your parenting."

Correct Answer: 1 Rationale 1: The medical and surgical histories of a new prenatal patient must be accurate and complete to detect conditions that might be exacerbated during pregnancy or delivery, to ensure safety of both the mother and the fetus. Rationale 2: Prenatal visits follow a set schedule for normal patients without complications. Rationale 3: Paperwork is a lower priority than is patient care. Rationale 4: The psychological history of a patient, not the medical or surgical history, can indicate potential problems with parenting.

The nurse is seeing prenatal patients in the clinic. Which patient is exhibiting expected findings? 1. Primip at 12 weeks with fetal heart tones heard by Doppler fetoscope 2. Multip at 22 weeks who reports no fetal movement felt yet 3. Primip at 26 weeks with fundal height of 30 cm 4. Multip at 12 weeks reports bright red vaginal bleeding.

Correct Answer: 1 Rationale 1: This is an expected finding because fetal heart tones should be heard by 12 weeks using an ultrasonic Doppler fetoscope. Rationale 2: A multip at 22 weeks who reports no fetal movement is an abnormal finding. Fetal movement should be felt by 20 weeks. Rationale 3: A primip at 26 weeks with fundal height of 30 cm is an abnormal finding. Beginning in the second trimester, the fundal height should correlate with weeks of gestation; thus, at 26 weeks' gestation, the fundal height should be about 26 cm. Rationale 4: This is an abnormal finding. Bright red bleeding during pregnancy is never normal.

During the initial prenatal visit, the nurse obtains a weight of 42 kg (92.4 lbs). The nurse must further assess the patient for information about: Select all that apply. 1. Eating habits. 2. Foods regularly eaten. 3. Income limitations. 4. Blood pressure and pulse rate. 5. Weight loss during pregnancy.

Correct Answer: 1,2,3 Rationale 1: null Rationale 2: null Rationale 3: null Rationale 4: The blood pressure and pulse are important, but are not part of the assessment made in relation to height and weight. Rationale 5: Weight loss is not a recommendation based on height and weight; the nurse would recommend an amount of weight to gain.

A pregnant patient calls the clinic nurse to say she is worried about symptoms she is experiencing. The nurse advises the patient to come immediately to the clinic because of reported: Select all that apply. 1. Vaginal bleeding. 2. Abdominal pain. 3. Constipation. 4. Epigastric pain. 5. null

Correct Answer: 1,2,4 Rationale 1: Vaginal bleeding can indicate abruptio placentae, placenta previa, or lesions of cervix or vagina, or it can be "bloody show," and requires the patient be seen. Rationale 2: Abdominal pain can signal premature labor or abruptio placentae, and requires the patient to be seen. Rationale 3: Constipation is not a warning sign of an alteration of pregnancy. Rationale 4: Epigastric pain must be evaluated, as it can indicate preeclampsia or ischemia in a major abdominal vessel. Rationale 5: null

A pregnant patient at 30 weeks' gestation has had a steady rise in blood pressure. She is now 20 mmHg above her systolic baseline. The nurse advises her to immediately report: Select all that apply. 1. Dizziness. 2. Even a small amount of dependent edema. 3. Spots before her eyes. 4. Persistent nausea and vomiting. 5. Vaginal spotting.

Correct Answer: 1,3 Rationale 1: Dizziness can be a sign of hypertension or preeclampsia, and should be reported immediately. Rationale 2: A small amount of dependent edema is expected, especially in the last weeks of pregnancy. Rationale 3: Spots before the eyes can be a sign of hypertension or preeclampsia, and should be reported immediately. Rationale 4: Persistent nausea and vomiting would occur early in the pregnancy. Rationale 5: Vaginal spotting is a danger sign, but it is not related to the increased blood pressure.

During a patient's initial prenatal visit, the nurse must assess and document the patient's current medical history, including: Select all that apply. 1. Body mass index. 2. Infections before the last menstrual period. 3. Homeopathic or herbal medication use. 4. ABO type and Rh factor. 5. History of previous pregnancies.

Correct Answer: 1,3,4 Rationale 1: The body mass index is an important part of the current medical history to be assessed and documented. Rationale 2: Infections are important, but should be documented in the current medical history only if they have occurred since the last menstrual period. Rationale 3: Homeopathic and herbal medication use is important for the nurse to assess and document in the current medical history. Rationale 4: The ABO (blood type) must be assessed and documented in the current medical history, as must the Rh factor. Rationale 5: Although previous pregnancies are important information, they are not part of the current medical history.

The nurse is explaining clinical pelvimetry to a patient. The nurse explains that the anteroposterior diameters consist of the: Select all that apply. 1. Diagonal conjugate. 2. Transverse diameter. 3. Conjugata vera. 4. Obstetric conjugate. 5. Oblique diameter.

Correct Answer: 1,3,4 Rationale 1: The diagonal conjugate is a part of the anteroposterior diameter measurement. Rationale 2: The transverse diameter is another pelvic measurement. Rationale 3: The conjugata vera is a part of the anteroposterior diameter measurement. Rationale 4: The obstetric conjugate is a part of the anteroposterior diameter measurement. Rationale 5: The oblique diameter is another separate pelvic measurement.

The nurse in the OB-GYN clinic is working with a patient who is seeking her initial prenatal visit. The nurse will use the acronym TPAL to document the patient's number of: Select all that apply. 1. Term infants born. 2. Children living in the home. 3. Pregnancies ending in abortion. 4. Preterm infants born. 5. Pregnancies that occurred.

Correct Answer: 1,3,4 Rationale 1: null Rationale 2: L: number of currently living children to whom the woman has given birth, not the number in the home Rationale 3: A: number of pregnancies ending in either spontaneous or therapeutic abortion Rationale 4: null Rationale 5: The documentation will not be of just any pregnancy, but descriptive of that pregnancy.

The nurse seeing a patient at 28 weeks' gestation explains that a 1-hour glucose screen must be done, and that normal results are: Note: Credit will be given only if all correct and no incorrect choices are selected. Standard Text: Select all that apply. 1. 135 mg/dl. 2. 120 mg/dl. 3. 155 mg/dl. 4. 130 mg/dl. 5. 140 mg/dl.

Correct Answer: 1,4,5 Rationale 1: 135 mg/dl is considered a normal result, depending upon the lab. Rationale 2: 120 mg/dl is a low blood sugar result. Rationale 3: 155 mg/dl is an abnormally high blood sugar result. Rationale 4: 130 mg/dl is considered a normal result, depending upon the lab. Rationale 5: 140 mg/dl is considered a normal result, depending upon the lab.

The nurse begins a prenatal assessment on a 25-year-old primigravida at 20 weeks' gestation and immediately contacts the healthcare provider because of which finding? 1. Pulse 88/minute 2. Respirations 30/minute 3. Temperature 37.4° C (99.3° F) 4. Blood pressure 134/82

Correct Answer: 2 Rationale 1: A slight increase in pulse is an expected finding during pregnancy due to the increased oxygen consumption to support fetal metabolism. Rationale 2: Tachypnea is not a normal finding, and requires medical care. Rationale 3: A slightly higher temperature is an expected finding during pregnancy due to the increased oxygen consumption to support fetal metabolism. Rationale 4: A blood pressure of 134/82 is within normal limits.

A nurse examining a prenatal patient recognizes that a lag in progression of measurements of fundal height from month to month and week to week could signal: 1. Twin pregnancy. 2. Intrauterine growth restriction. 3. Polyhydramnios. 4. Breech position.

Correct Answer: 2 Rationale 1: A sudden increase in fundal height could indicate twins or polyhydramnios (excessive amount of amniotic fluid). Rationale 2: A lag in progression of measurements of fundal height from month to month and week to week could signal intrauterine growth restriction (IUGR). Rationale 3: A sudden increase in fundal height could indicate twins or polyhydramnios (excessive amount of amniotic fluid). Rationale 4: Breech position would still have a normal fundal height measurement.

The nurse is assessing a primiparous patient who indicates that her religion is Judaism. This information is important for the nurse to assess because: 1. Religious and cultural background can impact what a patient eats during pregnancy. 2. It provides a baseline from which to ask questions about the patient's religious and cultural background. 3. Knowing the patient's beliefs and behaviors regarding pregnancy is important. 4. Patients sometimes encounter problems in their pregnancies based on what religion they practice.

Correct Answer: 2 Rationale 1: Although this can be true, much more than diet is impacted by religious and cultural background. Rationale 2: This is the best explanation because not all people interpret or live out their religious or cultural backgrounds the same way. It is imperative to avoid stereotyping patients. The nurse must use the information from the patient's background as an educated starting point from which to base further questions. Rationale 3: It is true that knowing the patient's beliefs and behaviors regarding pregnancy is important, but this answer does not include the logical consequences of knowing this information. The nurse must use the information from the patient's background as an educated starting point from which to base further questions. Rationale 4: How a patient observes her religion occasionally will cause problems with pregnancy, but this not the most important reason for obtaining this information.

The nurse working in an outpatient obstetric clinic assesses four primigravida patients. Which patient findings would the nurse tell the physician about? 1. 17 weeks' gestation and denies feeling fetal movement. 2. 24 weeks' gestation and fundal height is at the umbilicus. 3. 27 weeks' gestation and complains of excess salivation. 4. 34 weeks' gestation and complains of hemorrhoidal pain.

Correct Answer: 2 Rationale 1: It is most common for pregnant patients to feel fetal movement between 17 and 20 weeks. Rationale 2: The fundal height at 24 weeks should be 24 cm. The fundal height is usually at the umbilicus at 20-22 weeks. Rationale 3: Excess salivation is a usual finding in pregnancy. Rationale 4: Hemorrhoids are common in pregnant women.

The nurse receives a phone call from a patient who claims she is pregnant. The patient reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What would the patient's estimated date of delivery (EDD) be? 1. Nov. 13 2. Jan. 17 3. Jan. 10 4. Dec. 3

Correct Answer: 2 Rationale 1: Nov. 13 is not correct according to Nagele's rule. Rationale 2: The due date is Jan. 17. Nagele's rule is to add 7 days to the last menstrual period and subtract 3 months. The last menstrual period is April 10; therefore Jan. 17 is the EDD. Rationale 3: Jan. 10 is not correct according to Nagele's rule. Rationale 4: Dec. 3 is not correct according to Nagele's rule.

The prenatal clinic nurse is designing a new prenatal intake information form for pregnant patients. Which question is best to include on this form? 1. Where was the father of the baby born? 2. Do genetic diseases run in the family of the baby's father? 3. What is the name of the baby's father? 4. Are you married to the father of the baby?

Correct Answer: 2 Rationale 1: The father's place of birth is not important information to include about the pregnancy. Rationale 2: This question has the highest priority because it gets at the physiologic issue of inheritable genetic diseases that might directly impact the baby. Rationale 3: Although it is helpful for the nurse to know the name of the baby's father to include him in the prenatal care, this is psychosocial information. Rationale 4: Although the marital status of the patient might have cultural significance, this is psychosocial information.

A 25-year-old primigravida is at 20 weeks' gestation. The nurse takes her vital signs and notifies the healthcare provider immediately because of which finding? 1. Pulse 88/minute 2. Rhonchi in both bases 3. Temperature 37.4°C (99.3°F) 4. Blood pressure 130/78

Correct Answer: 2 Rationale 1: The pulse will increase 10-15 beats/minute during pregnancy, with 60-90 beats/minute being the normal range. Rationale 2: Any adventitious breath sounds are abnormal. Rationale 3: Temperature norms in pregnancy are slightly higher due to fetal metabolism: 36.2-37.6°C (98-99.6°F). Rationale 4: A blood pressure lower than 135/85 is considered normal.

The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi present on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take based on these findings? 1. Document the findings on the prenatal chart. 2. Have the physician see the patient today. 3. Instruct the patient to avoid direct sunlight. 4. Analyze previous thyroid hormone lab results.

Correct Answer: 2 Rationale 1: While all of these findings should be documented on the prenatal chart, additional action is indicated. Rationale 2: Mottling of the skin is indicative of poor oxygenation and a circulation problem. Skin and nail bed pallor can indicate either hypoxia or anemia. These abnormalities must be reported to the physician immediately. Rationale 3: Instructing the patient to avoid direct sunlight is not necessary, but additional action is indicated. Rationale 4: The thyroid gland increases in size during pregnancy due to hyperplasia. Additional action is indicated.

The nurse is seeing a patient who asks about the accuracy of Nagele's rule. The nurse explains that accuracy can be compromised when: Select all that apply. 1. There is a history of regular menses every 28 days. 2. Amenorrhea is present and ovulation occurs with breastfeeding. 3. Oral contraception was discontinued, but no regular menstruation was established. 4. There has been one or months of amenorrhea. 5. There is an accurate date for the last menstrual period.

Correct Answer: 2,3,4 Rationale 1: A woman with a history of regular periods every 28 days will most likely have an accurate due date calculated by Nagele's rule. Rationale 2: Nagele's rule is not always accurate for women who have amenorrhea but are ovulating and conceive while breastfeeding. Rationale 3: Nagele's rule is not always accurate for women who conceive before regular menstruation is established following discontinuation of oral contraceptives or termination of a pregnancy. Rationale 4: Nagele's rule is not always accurate for women with markedly irregular periods that include one or more months of amenorrhea. Rationale 5: When there is an accurate date for the last menstrual period, the due date will be accurate using Nagele's rule.

During the initial prenatal visit, the nurse assesses the history of the father of the child for: Select all that apply. 1. Stability of living conditions. 2. ABO and Rh type. 3. Significant health problems. 4. Nutritional history. 5. Previous or present use of tobacco.

Correct Answer: 2,3,5 Rationale 1: The stability of living conditions for the father will not be assessed at the initial prenatal visit. Rationale 2: The father of the fetus should be assessed for blood type and Rh factor. Rationale 3: The father of the fetus should be assessed for significant health problems. Rationale 4: The nutritional history of the father of the fetus will not be assessed. Rationale 5: The father of the fetus should be assessed for previous or present alcohol intake, drug use, or tobacco use.

A woman comes into the prenatal clinic accompanied by her boyfriend. When asked by the nurse why she is there, the patient looks down, and the boyfriend states, "She says she is pregnant. She constantly complains of feeling tired, and her vomiting is disgusting." What is a priority for the nurse to do at this point? 1. Ask the woman what time of the day her fatigue is more common. 2. Recommend that the woman have a pregnancy test done as soon as possible. 3. Continue the interview of the woman in private. 4. Give the woman suggestions on ways to decrease the vomiting.

Correct Answer: 3 Rationale 1: Asking the woman when her fatigue occurs is not the priority. Rationale 2: Recommending that the woman have a pregnancy test is not the priority. Rationale 3: The nurse should suspect that the woman is in an abusive relationship. The priority is for the nurse to get the patient away from the boyfriend and continue the interview. Rationale 4: Offering suggestions for ways to stop the nausea and vomiting is not the priority.

The nurse in the prenatal clinic is seeing a pregnant 16-year-old for the first time. What comment by the young woman is the most critical for the nurse to address first? 1. "My favorite lunch is burger and fries." 2. "I've been dating my new boyfriend for 2 weeks." 3. "On weekends, we go out and drink a few beers." 4. "I dropped out of school about 3 months ago."

Correct Answer: 3 Rationale 1: Even though a burger and fries are not the healthiest lunch, it is not the most critical statement for the nurse to address. Rationale 2: Although this comment is cause for concern, as it suggests that the patient has many partners, it is not the most important issue. Rationale 3: The nurse responds to this statement because of the danger of fetal alcohol syndrome. Rationale 4: It is important for the patient to finish her education, but her education is not the nurse's first priority to address.

A nurse is performing an assessment on four patients at 22 weeks' gestation. The nurse reports to the obstetrician that which patient might be carrying twins? 1. The patient who states that she feels "huge" 2. The patient with a weight gain of 15 pounds 3. The patient whose fundal height is 27 cm 4. The patient whose heart rate is 90

Correct Answer: 3 Rationale 1: Most pregnant women complain of feeling huge. Rationale 2: A weight gain of 15 pounds is within normal limits at this stage. Rationale 3: A patient at 22 weeks' gestation with a fundal height of 27 cm could possibly be carrying twins, as the fundal height normally should be at 22 cm at this stage. Rationale 4: A heart rate of 90 is within normal limits for a pregnant woman.

What would the nurse include as part of a routine physical assessment for a second-trimester primiparous patient whose prenatal care began in the first trimester and is ongoing? 1. Measurement of the diagonal conjugate 2. Hepatitis B screening (HBsAg) 3. Fundal height measurement 4. Complete blood count

Correct Answer: 3 Rationale 1: Pelvic measurements are usually done at the initial prenatal appointment. Rationale 2: Hepatitis B screening is done at the initial prenatal appointment. Rationale 3: At each prenatal visit, the blood pressure, pulse, and weight are assessed, and the size of the fundus is measured. Fundal height should be increasing with each prenatal visit. Rationale 4: Complete blood count is done at the initial prenatal appointment.

The patient has delivered her first child at 37 weeks. The nurse would describe this to the patient as what type of delivery? 1. Preterm 2. Postterm 3. Term 4. Near term

Correct Answer: 3 Rationale 1: Preterm births are those that occur between 20 weeks and 37 completed weeks. Rationale 2: Postterm births are those that occur after 42 weeks. Rationale 3: Term births are those that occur from 37 completed weeks of pregnancy to 42 weeks. Rationale 4: Near term is not terminology used to describe birth.

When doing a prenatal assessment of parenting, which comment by a woman would the nurse recognize as needing further investigation? 1. "I have so much to learn about taking care of a baby. I've bought a couple of books already." 2. "When will I be able to feel my baby move?" 3. "I work and have an active social life; I don't see how a baby will change it all that much." 4. "We've already told our parents we're expecting, and our friends and the people at work, too."

Correct Answer: 3 Rationale 1: Wanting to learn about fetal movement and baby care is expected, as is announcing the pregnancy to family and friends. Rationale 2: Wanting to learn about fetal movement and baby care is expected, as is announcing the pregnancy to family and friends. Rationale 3: A newborn requires a great deal of time and care; not anticipating how a baby will change one's life indicates a lack of understanding and knowledge, and presents risk factors for ineffective parenting and postpartum depression. Rationale 4: Announcing the pregnancy to family and friends is expected.

A pregnant patient has a hemoglobin of 10 g/dl and a Hct of 30%. The clinic nurse recognizes the fetus is at risk for: Select all that apply. 1. Macrosomia. 2. Respiratory distress syndrome. 3. Low birth weight. 4. Prematurity. 5. Prenatal mortality.

Correct Answer: 3,4,5 Rationale 1: Macrosomia is associated with diabetes mellitus. Rationale 2: A risk of respiratory distress syndrome is associated with factors other than anemia. Rationale 3: Anemia places the fetus at risk for a low birth weight. Rationale 4: Anemia places the fetus at risk for premature birth. Rationale 5: Anemia places the fetus at risk for fetal death.

The clinic nurse is compiling data for a yearly report. Which patient would be classified as a primigravida? 1. A patient at 18 weeks' gestation who had a spontaneous loss at 12 weeks 2. A patient at 13 weeks' gestation who had an ectopic pregnancy at 8 weeks 3. A patient at 14 weeks' gestation who has a 3-year-old daughter at home 4. A patient at 15 weeks' gestation who has never been pregnant before

Correct Answer: 4 Rationale 1: A pregnant woman who has been pregnant before is called a multigravida. Rationale 2: A pregnant woman who has been pregnant before is called a multigravida. Rationale 3: A pregnant woman who has been pregnant before is called a multigravida. Rationale 4: Primigravida can be broken down into the Latin roots: primi (prime, or first) and gravida (pregnancy).

Which third-trimester woman would you suspect might be having difficulty with psychological adjustments to her pregnancy? 1. A woman who says, "Either a boy or a girl will be fine with me." 2. A woman who puts her feet up and listens to some music for 15 minutes when she is feeling too stressed 3. A woman who was a smoker but who has quit at least for the duration of her pregnancy 4. A woman who has not investigated the kind of clothing or feeding methods the baby will need

Correct Answer: 4 Rationale 1: Acceptance of gender is indicative of healthy adaptation to pregnancy. Rationale 2: Using stress reduction techniques are indicative of healthy adaptation to pregnancy. Rationale 3: Quitting smoking is indicative of healthy adaptation to pregnancy. Rationale 4: By the third trimester, the patient should be making plans for obtaining the equipment needed for the newborn (such as clothing), and should have made a decision on a feeding method.

The nurse is assessing a newly pregnant patient. Which finding does the nurse note as a normal psychosocial adjustment in this patient's first trimester? 1. An unlisted telephone number 2. Reluctance to tell the partner of the pregnancy 3. Parental disapproval of the woman's partner 4. Ambivalence about the pregnancy

Correct Answer: 4 Rationale 1: An unlisted telephone number does not indicate psychosocial adjustment. Rationale 2: Reluctance to tell the partner about the pregnancy might indicate that the patient anticipates disapproval, and is not a normal psychosocial adjustment. Rationale 3: Parental disapproval of the patient's partner does not indicate psychosocial adjustment. Rationale 4: Ambivalence toward a pregnancy is a common psychosocial adjustment in early pregnancy.

The primigravida at 22 weeks' gestation has a fundal height palpated slightly below the umbilicus. Which of the following statements would best describe to the patient why she needs to be seen by a physician today? 1. "Your baby is growing too much and getting too big." 2. "Your uterus might have an abnormal shape." 3. "The position of your baby can't be felt." 4. "Your baby might not be growing enough."

Correct Answer: 4 Rationale 1: At 22 weeks' gestation, the fundal height should be at about 22 cm. Rationale 2: Uterine shape can be assessed only with diagnostic imaging techniques such as ultrasound or CT scan. Rationale 3: The position of the baby is not noted until 36 weeks' gestation. Rationale 4: The fundal height at 20 weeks should be about even with the umbilicus. At 22 weeks, the fundus should be above the umbilicus. At 22 weeks' gestation, a fundal height below the umbilicus could indicate fetal death in utero.

The nurse is providing health teaching to a group of women of childbearing age. One woman states that she is a smoker, and asks about the effect on her fetus. The nurse tells her that which fetal complication can occur when the mother smokes? 1. Genetic changes in the fetal reproductive system 2. Extensive central nervous system damage 3. Addiction to the nicotine inhaled from the cigarette 4. Fetal intrauterine growth restriction

Correct Answer: 4 Rationale 1: No genetic changes to the fetal reproductive system are associated with smoking. Rationale 2: Nervous system damage has not been associated with smoking. Rationale 3: There is no evidence that fetal nicotine addiction occurs. Rationale 4: Placentas of women who smoke during pregnancy are smaller, and their babies are smaller because they receive less oxygen.

The nurse is providing guidance for a woman in her second trimester of pregnancy and telling her about some of the signs and symptoms that she might experience. Which statement by the patient indicates that further teaching is necessary? 1. "During the third trimester, I might have frequent urination." 2. "During the third trimester, I might have heartburn." 3. "During the third trimester, I might have back pain." 4. "During the third trimester, I might have a persistent headache."

Correct Answer: 4 Rationale 1: Urinary frequency will usually start around the 20th week. Rationale 2: Heartburn is a common complaint. Rationale 3: Back pain is a common complaint. Rationale 4: A persistent headache is not normal or expected. This could be related to the complication of preeclampsia.