Exam 2 Maternity

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for: hemorrhage. infection. urinary retention. thrombophlebitis.

hemorrhage. Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta.

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: hydralazine. magnesium sulfate bolus . diazepam. calcium gluconate.

hydralazine Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: bleeding. intense abdominal pain. uterine activity. cramping.

intense abdominal pain. Bleeding may be present in varying degrees for both placental conditions. Pain is absent with placenta previa and may be agonizing with abruptio placentae. Uterine activity may be present with both placental conditions. Cramping is a form of uterine activity that may be present in both placental conditions.

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: eclamptic seizure. rupture of the uterus. placenta previa. placental abruption. Correct

placental abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption.

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if: blood pressure is reduced to prepregnant baseline. seizures do not occur. deep tendon reflexes become hypotonic. diuresis reduces fluid retention.

seizures do not occur. A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication. Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.

List the time span in lunar months, calendar months, weeks, and days that indicates the appropriate length for a normal pregnancy

10 lunar months, 9 calendar months, 40 weeks, 280 days

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? _____.

3-1-0-1-0 Using the GPTAL system, this woman's gravidity and parity information is calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time) T: Number of pregnancies carried to term (she has one stillborn) P: Number of pregnancies that resulted in a preterm birth (she has none) A: Abortions or miscarriages before the period of viability (she has had one) L: Number of children born who are currently living (she has no living children)

A pregnant woman is the mother of two children. Her first pregnancy ended in a still birth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman's current obstetric history, the nurse would record ____________________________.

4-1-2-0-2 Gravida (the first number) is 4 since this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and would be described as: 4T: 1 = Term birth at 41 weeks of gestation (son) 4P: 2 = Preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) 4A: 0 = Abortion: none occurred 4L: 2 = Living children: her son and her daughter

The nurse should teach a pregnant woman that which substances are teratogens? (Select all that apply) A. Cigarette smoke Correct B. Isotretinoin (Retin A) Correct C. Vitamin C D. Salicylic acid E. Rubella

A. Cigarette smoke B. Isotretinoin (Retin A) E. Rubella Vitamin C and salicylic acid are not known teratogens.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? A. Doppler blood flow analysis B. Contraction stress test (CST) C. Amniocentesis D. Daily fetal movement counts

A. Doppler blood flow analysis Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? (Select all that apply.) A. Dried beans B. Seeds C. Peanut butter D. Bagel E. Eggs Correct

A. Dried beans B. Seeds C. Peanut butter E. Eggs All of the foods listed except a bagel provide protein. A bagel is an example of a whole grain food, not protein.

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as the: A. Hegar sign. B. McDonald sign. C. Chadwick sign. D. Goodell sign.

A. Hegar sign. At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign indicates a fast-food restaurant. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy

Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes? A. Heroin B. Alcohol C. Phencyclidine palmitate (PCP) D. Cocaine The opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Possible effects on pregnancy include preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. Alcohol is not an opiate. PCP is not an opiate. Cocaine is not an opiate.

A. Heroin The opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Possible effects on pregnancy include preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. Alcohol is not an opiate. PCP is not an opiate. Cocaine is not an opiate.

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. The nurse should assess which specific lab result? A. Indirect Coombs test B. Hemoglobin level C. hCG level D. Maternal serum alpha-fetoprotein (MSAFP) The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for NTDs in pregnancy

A. Indirect Coombs test The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for NTDs in pregnancy

A maternity nurse should be aware of which fact about the amniotic fluid? A. It serves as a source of oral fluid and as a repository for waste from the fetus. B. The volume remains about the same throughout the term of a healthy pregnancy. C. A volume of less than 300 mL is associated with gastrointestinal malformations. D. A volume of more than 2 L is associated with fetal renal abnormalities.

A. It serves as a source of oral fluid and as a repository for waste from the fetus. Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

The nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function? A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics B. Prepare the woman for delivery by cesarean section since this is the recommended delivery method to sustain hemodynamics C. Encourage the woman to avoid the use of narcotics or epidural regional analgesia since this alters cardiac function D. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling

A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics The side-lying position with the head and shoulders elevated helps to facilitate hemodynamics during labor. A vaginal delivery is the preferred method of delivery for a woman with cardiac disease as it sustains hemodynamics better than a cesarean section. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated with a woman with heart disease. The use of the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow. Awarded 0.0 points out of 1.0 possible points.

A nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function? A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. B. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics. C. Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. D. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. The side-lying position with the head and shoulders elevated helps facilitate hemodynamics during labor. A vaginal delivery is the preferred method for a woman with cardiac disease because it sustains hemodynamics better than a cesarean section. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated with a woman with heart disease. Epidural anesthesia for labor is preferred. (Easterling and Stout, 2012). Using the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow.

A pregnant woman is being examined by the nurse in the outpatient obstetric clinic. The nurse suspects systemic lupus erythematosus (SLE) after revealing which symptoms? (Select all that apply.) A. Muscle aches B. Hyperactivity C. Weight changes D. Fever E. Hypotension

A. Muscle aches C. Weight changes D. Fever Fatigue, rather than hyperactivity is a common sign of SLE. Hypotension is not a characteristic sign of SLE. Common symptoms, including myalgias, fatigue, weight change, and fevers, occur in nearly all women with SLE at some time during the course of the disease. Although a diagnosis of SLE is suspected based on clinical signs and symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. As is the case with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the MOST important? A. Several glasses of fluid B. Extra protein sources, such as peanut butter C. Salty foods to replace lost sodium D. Easily digested sources of carbohydrate

A. Several glasses of fluid If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise

Which statements about multifetal pregnancy are most appropriate? (Select all that apply.) A. The expectant mother often develops anemia because the fetuses have a greater demand for iron. Correct B. Twin pregnancies come to term with the same frequency as single pregnancies. C. The mother should be counseled to increase her nutritional intake and gain more weight. Correct D. Backache and varicose veins are often more pronounced. Correct E. Spontaneous rupture of membranes before term is uncommon.

A. The expectant mother often develops anemia because the fetuses have a greater demand for iron. C. The mother should be counseled to increase her nutritional intake and gain more weight. D. Backache and varicose veins are often more pronounced. A woman with a multifetal pregnancy often develops anemia due to the increased demands of two fetuses. This should be monitored closely throughout her pregnancy. Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. The client may need nutrition counseling to ensure that she gains more weight than what is needed for a singleton birth. The considerable uterine distention is likely to cause backache and leg varicosities. Maternal support hose should be recommended. Spontaneous rupture of membranes before term is common.

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? (Select all that apply.) A. Underweight women should gain 12.5 to 18 kg. Correct B. Obese women should gain at least 7 to 11.5 kg. Correct C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. Correct D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. E. Normal weight women should gain 11.5 to 16 kg.

A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 to 11.5 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. E. Normal weight women should gain 11.5 to 16 kg. Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. Normal weight women should gain 11.5 to 16kg.

Thalassemia is a relatively common anemia in which: A. an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). Correct B. RBCs have a normal life span but are sickled in shape. C. folate deficiency occurs. D. there are inadequate levels of vitamin B12 .

A. an insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). Thalassemia is a hereditary disorder that involves the abnormal synthesis of the á or â chains of hemoglobin. An insufficient amount of hemoglobin is produced to fill the RBCs. This is the underlying description for sickle cell anemia. Folate deficiency is the most common cause of megaloblastic anemias during pregnancy. B12 deficiency must also be considered if the pregnant woman presents with anemia.

A key finding from the Human Genome Project is: A. approximately 20,000 to 25,000 genes make up the genome. Correct B. all human beings are 80.99% identical at the DNA level. C. human genes produce only one protein per gene; other mammals produce three proteins per gene. D. single-gene testing will become a standardized test for all pregnant women in the future. Incorrect

A. approximately 20,000 to 25,000 genes make up the genome. Approximately 20,500 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single-gene testing (e.g., alpha-fetoprotein) is already standardized for prenatal care.

With regard to protein in the diet of pregnant women, nurses should be aware that: A. many protein-rich foods are also good sources of calcium, iron, and b vitamins. Correct B. many women need to increase their protein intake during pregnancy. C. as with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. D. high-protein supplements can be used without risk by women on macrobiotic diets.

A. many protein-rich foods are also good sources of calcium, iron, and b vitamins. Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for: (Select all that apply.) A. miscarriage. B. macrosomia. C. gestational hypertension. D. placental abruption. E. stillbirth.

A. miscarriage. C. gestational hypertension. D. placental abruption. E. stillbirth. Hypothyroidism is often associated with both infertility and an increased risk of miscarriage. Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm. These outcomes can be improved with early diagnosis and treatment. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism. Placental abruption and stillbirth are risks associated with hypothyroidism.

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that: A. prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. Correct B. the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. C. killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. D. no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus

A. prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: A. primipara. B. primigravida. C. multipara. D. nulligravida

A. primipara. A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.

When planning a diet with a pregnant woman, the nurse's FIRST action would be to: A. review the woman's current dietary intake. B. teach the woman about the food pyramid. C. caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. D. instruct the woman to limit the intake of fatty foods.

A. review the woman's current dietary intake. Reviewing the woman's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required. These are correct actions on the part of the nurse, but the first action should be to assess the patient's current dietary pattern and practices since instruction should be geared to what she already knows and does.

Most of the genetic tests now offered in clinical practice are tests for: A. single-gene disorders. B. carrier screening. C. predictive values. D. predispositional testing

A. single-gene disorders. Most tests now offered are tests for single-gene disorders in clients with clinical symptoms or who have a family history of a genetic disease. Carrier screening is used to identify individuals who have a gene mutation for a genetic condition but do not display symptoms. Predictive testing is used only to clarify the genetic status of asymptomatic family members. Predispositional testing differs from the other types of genetic screening in that a positive result does not indicate a 100% chance of developing the condition.

Prior to the patient undergoing amniocentesis, the most appropriate nursing intervention is to: A: administer RhoD immunoglobulin. B. send the patient for a computed tomography (CT) scan before the procedure. C. assure the mother that short-term radiation exposure is not harmful to the fetus. D. administer anticoagulant.

A: administer RhoD immunoglobulin. Because of the possibility of fetomaternal hemorrhage, administering RhoD immunoglobulin to the woman who is Rh negative is standard practice after an amniocentesis. Anticoagulants are not administered before amniocentesis as this would increase the risk of bleeding when the needle is inserted transabdominally. A CT is not required before amniocentesis, because the procedure is ultrasound guided. The mother is not exposed to radiation during amniocentesis.

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? Administration of blood Preparation of the woman for invasive hemodynamic monitoring Restriction of intravascular fluids Administration of steroids

Administration of blood Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding. Management of DIC includes volume replacement, not volume restriction. Steroids are not indicated for the management of DIC.

The emergency department nurse is assessing a pregnant trauma victim who just arrived at the hospital. What are the nurse's MOST appropriate actions? (Select all that apply.) Place the patient in a supine position. Assess for point of maximal impulse at fourth intercostal space. Collect urine for urinalysis and culture. Frequent vital sign monitoring. Assist with ambulation to decrease risk of thrombosis.

Assess for point of maximal impulse at fourth intercostal space. Collect urine for urinalysis and culture. Frequent vital sign monitoring. Passive regurgitation may occur if patient is supine, leading to high risk for aspiration. Placental perfusion is decreased when the patient is in a supine position as well. The heart is displaced upward and to the left in pregnant patients. During pregnancy, there is dilation of the ureters and urethra, and the bladder is displaced forward placing the pregnant trauma patient at higher risk for urinary stasis, infection, and bladder trauma. The trauma patient can suffer blood loss and other complications, necessitating frequent monitoring of vital signs. While the pregnant patient is at risk for thrombus formation, the patient must be cleared by the health care provider before ambulating. The pregnant trauma patient is at higher risk for pelvic fracture, and therefore this condition must be ruled out first as well.

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? A. "Many women imagine what their baby is like." B. "A baby in utero does respond to the mother's voice." C. "You'll need to ask the doctor if the baby can hear yet." D. "Thinking that your baby hears will help you bond with the baby."

B. "A baby in utero does respond to the mother's voice." Although this statement is accurate, it is not the most appropriate response. Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice. This statement is not appropriate. The mother should be instructed that her fetus can hear at 24 weeks and can respond to the sound of her voice. The statement is not appropriate. It gives the impression that her baby cannot hear her. It also belittles the mother's interpretation of her fetus's behaviors

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: A. a pound a week throughout pregnancy. B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. Correct C. a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. D. a total of 25 to 35 lbs.

B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. A pound a week is not the correct guideline during pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/wk during the second and third trimesters. These are not accurate guidelines for weight gain during pregnancy. The total is correct, but the pattern needs to be explained.

If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner's first pregnancy? A. Views pregnancy with pride as a confirmation of his virility B. Consistently changes the subject when the topic of the fetus/newborn is raised C. Expresses concern that he might faint at the birth of his baby D. Experiences nausea and fatigue, along with his partner, during the first trimester

B. Consistently changes the subject when the topic of the fetus/newborn is raised This is an expected view for an expectant father. Persistent refusal to talk about the fetus-newborn may be a sign of a problem and should be assessed further. This is an expected feeling for an expectant father. This is an expected finding with expectant fathers.

What best describes the pattern of genetic transmission known as autosomal recessive inheritance? A. Disorders in which the abnormal gene for the trait is expressed even when the other member of the pair is normal B. Disorders in which both genes of a pair must be abnormal for the disorder to be expressed C. Disorders in which a single gene controls the particular trait D. Disorders in which the abnormal gene is carried on the X chromosome

B. Disorders in which both genes of a pair must be abnormal for the disorder to be expressed Autosomal dominant inheritance occurs when the abnormal gene for the trait is expressed, even when the other member of the pair is normal, such as Huntington disease or Marfan syndrome. An autosomal recessive inheritance disorder occurs when both genes of the pair are abnormal, such as phenylketonuria or sickle cell anemia. Disorders in which a single gene controls the particular trait describe the unifactorial inheritance. X-linked recessive inheritance occurs when the abnormal gene is carried on the X chromosome, such as hemophilia or Duchenne muscular dystrophy

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? A. Less audible heart sounds (S1 , S2 ) B. Increased pulse rate C. Increased blood pressure D. Decreased red blood cell (RBC) production

B. Increased pulse rate Splitting of S1 and S2 is more audible. Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. In the first trimester blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

What is an indicator for performing a contraction stress test? A. Increased fetal movement and small for gestational age B. Maternal diabetes mellitus and postmaturity C. Adolescent pregnancy and poor prenatal care D. History of preterm labor and intrauterine growth restriction

B. Maternal diabetes mellitus and postmaturity Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Although adolescent pregnancy and poor prenatal care are risk factors of poor fetal outcomes, they are not indicators for performing a contraction stress test. Intrauterine growth restriction is an indicator; but history of a previous stillbirth, not preterm labor, is the other indicator.

A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure in a restaurant. The nurse expects which health care provider orders to be included in the plan of care? (Select all that apply.) A. valproate (Depakote). B. Serum lab levels of medications. C. Abdominal ultrasounds. D. Prenatal vitamins with vitamin D. E. carbamazepine (Tegretol).

B. Serum lab levels of medications. C. Abdominal ultrasounds. D. Prenatal vitamins with vitamin D. Carbamazepine (Tegretol) and valproate (Depakote) should be avoided if possible during pregnancy, especially during the first trimester, because their use is associated with NTDs in the fetus. Checking lab levels of medications, performing abdominal ultrasounds to assess fetal growth, and taking prenatal vitamins with vitamin D are all expected interventions for a pregnant woman diagnosed with epilepsy.

A nonstress test (NST) is ordered on a pregnant women at 37 weeks gestation. What are the most appropriate teaching points to include when explaining the procedure to the patient? (Select all that apply) A. After 20 minutes, a nonreactive reading indicates the test is complete. B. Vibroacoustic stimulation may be used during the test. Correct C. Drinking orange juice before the test is appropriate. Correct D. A needle biopsy may be needed to stimulate contractions. E. Two sensors are placed on the abdomen to measure contractions and fetal heart tones. Correct

B. Vibroacoustic stimulation may be used during the test. C. Drinking orange juice before the test is appropriate. E.Two sensors are placed on the abdomen to measure contractions and fetal heart tones. A nonreactive test requires further evaluation. The testing period is often extended, usually for an additional 20 minutes, with the expectation that the fetal sleep state will change and the test will become reactive. During this time vibroacoustic stimulation (see later discussion) may be used to stimulate fetal activity. Vibroacoustic stimulation is often used to stimulate fetal activity if the initial NST result is nonreactive and thus hopefully shortens the time required to complete the test (Greenberg, Druzin, and Gabbe, 2012). Care providers sometimes suggest that the woman drink orange juice or be given glucose to increase her blood sugar level and thereby stimulate fetal movements. Although this practice is common, there is no evidence that it increases fetal activity (Greenberg, Druzin, and Gabbe, 2012). A needle biopsy is not part of a NST. The FHR is recorded with a Doppler transducer, and a tocodynamometer is applied to detect uterine contractions or fetal movements. The tracing is observed for signs of fetal activity and a concurrent acceleration of FHR.

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: A. a sleepy, sedated affect. B. a respiratory rate of 10 breaths/min. C. deep tendon reflexes of 2+. D. absent ankle clonus.

B. a respiratory rate of 10 breaths/min. Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated. A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Deep tendon reflexes of 2+ are a normal finding. Absent ankle clonus is a normal finding.

With regard to abnormalities of chromosomes, nurses should be aware that: A. they occur in approximately 10% of newborns. B. abnormalities of number are the leading cause of pregnancy loss. C. down syndrome is a result of an abnormal chromosomal structure. D. unbalanced translocation results in a mild abnormality that the child will outgrow

B. abnormalities of number are the leading cause of pregnancy loss. Chromosomal abnormalities occur in less than 1% of newborns. Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects.

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: A. constipation. B. alteration in the pattern of fetal movement. C. heart palpitations. D. edema in the ankles and feet at the end of the day

B. alteration in the pattern of fetal movement. Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Heart palpitations are a normal change related to pregnancy. This is most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.

When assessing the fetal heart rate (FHR) of a woman at 30 weeks of gestation, the nurse counts a rate of 82 beats/min. Initially the nurse should: A. recognize that the rate is within normal limits and record it. B. assess the woman's radial pulse. C. notify the physician. D. allow the woman to hear the heartbeat.

B. assess the woman's radial pulse. The expected FHR is 120 to 160 beats/min. The nurse may have inadvertently counted the uterine souffle, the beatlike sound of blood flowing through the uterine blood vessels, which corresponds to the mother's heartbeat. The physician should be notified if the FHR is confirmed to be 82 beats/min. Allow the woman to hear the heart beat as soon as a full assessment is made

From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks: A. in the first trimester. B. between 24 to 36 weeks of gestation. C. during the last 4 weeks of pregnancy. D. immediately postpartum. Women often have few symptoms of asthma during the first trimester. The severity of symptoms peaks between 24 and 36 weeks of gestation. Asthma appears to be associated with intrauterine growth restriction and preterm birth. During the last 4 weeks of pregnancy symptoms often subside. The period between 24 and 36 weeks of pregnancy is associated with the greatest severity of symptoms. Issues have often resolved by the time the woman delivers.

B. between 24 to 36 weeks of gestation. Women often have few symptoms of asthma during the first trimester. The severity of symptoms peaks between 24 and 36 weeks of gestation. Asthma appears to be associated with intrauterine growth restriction and preterm birth. During the last 4 weeks of pregnancy symptoms often subside. The period between 24 and 36 weeks of pregnancy is associated with the greatest severity of symptoms. Issues have often resolved by the time the woman delivers.

With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. the mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. C. critical iron and folic acid levels must be maintained. D. lactating women can go back to their prepregnant calorie intake.

B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: A. orthopnea. B. decreasing energy levels. C. moist frequent cough and frothy sputum. D. crackles (rales) at the bases of the lungs on auscultation.

B. decreasing energy levels. Orthopnea is a finding that appears later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. Decreasing energy level (fatigue) is an early finding of heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, and during the first 48 hours following birth. A moist, frequent cough appears later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema. Crackles and rales appear later when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema.

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. drink warm fluids with each of her meals. B. eat a high-protein snack before going to bed. Correct C. keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. schedule three meals and one midafternoon snack a day

B. eat a high-protein snack before going to bed. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

A pregnant woman experiencing nausea and vomiting should: A. drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. B. eat small, frequent meals (every 2 to 3 hours). C. increase her intake of high-fat foods to keep the stomach full and coated. D. limit fluid intake throughout the day.

B. eat small, frequent meals (every 2 to 3 hours). A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated. This is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse's instructions if she states that a positive sign of pregnancy is: A. a positive pregnancy test. B. fetal movement palpated by the nurse-midwife. C. Braxton Hicks contractions. D. quickening.

B. fetal movement palpated by the nurse-midwife. A positive pregnancy test is a probable sign of pregnancy. Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. Braxton Hicks contractions are a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. spina bifida. B. intrauterine growth restriction. Correct C. diabetes mellitus. D. Down syndrome.

B. intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: A. with good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. B. the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. C. infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. D. at birth, the neonate of a diabetic mother is no longer at any greater risk. Even with good control, sudden and unexplained stillbirth remains a major concern. Congenital malformations account for 30% to 50% of perinatal deaths. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

B. the most important cause of perinatal loss in diabetic pregnancy is congenital malformations. Even with good control, sudden and unexplained stillbirth remains a major concern. Congenital malformations account for 30% to 50% of perinatal deaths. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities.

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman would indicate a correct understanding of the discharge instructions? A. "I will not experience mood swings since I was only at 10 weeks of gestation." B. "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." C. "I should eat foods that are high in iron and protein to help my body heal." Correct D. "I should expect the bleeding to be heavy and bright red for at least 1 week."

C. "I should eat foods that are high in iron and protein to help my body heal." After a miscarriage a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped and should avoid pregnancy for 2 months. A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider.

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Your best response is: A. "Karyotyping will reveal if the baby's lungs are mature." B. "Karyotyping will reveal if your baby will develop normally." C. "Karyotyping will provide information about the gender of the baby, and the number and structure of the chromosomes." D. "Karyotyping will detect any physical deformities the baby has."

C. "Karyotyping will provide information about the gender of the baby, and the number and structure of the chromosomes." The lecithin/sphingomyelin ratio, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Karyotyping provides genetic information, such as gender and chromosomal structure. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? A. "We don't really know when such defects occur." B. "It depends on what caused the defect." C. "They occur between the third and fifth weeks of development." D. "They usually occur in the first 2 weeks of development

C. "They occur between the third and fifth weeks of development." This is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. This is an inaccurate statement

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's BEST response would be: A. "This is normal behavior and should begin to subside by the second trimester." B. "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know." C. "This is called emotional liability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." D. "You seem impatient with her. Perhaps this is precipitating her behavior."

C. "This is called emotional liability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." Although this statement is appropriate, it does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. This is the most appropriate response since it gives an explanation and a time frame for when the mood swings may stop. This statement is judgmental and not appropriate.

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: A. "You don't need to modify your exercising any time during your pregnancy." B. "Stop exercising, because it will harm the fetus." C. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." D. "Jogging is too hard on your joints; switch to walking now."

C. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Typically, running should be replaced with walking around the seventh month of pregnancy. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.

Which hematocrit (Hct) and hemoglobin (Hgb) results represent(s) the lowest acceptable values for a woman in the third trimester of pregnancy? A. 38% Hct; 14 g/dL Hgb B. 35% Hct; 13 g/dL Hgb C. 33% Hct; 11 g/dL Hgb D. 32% Hct; 10.5 g/dL Hgb

C. 33% Hct; 11 g/dL Hgb This is within normal limits in the nonpregnant woman. This is within normal limits for a nonpregnant woman. Represents the lowest acceptable value during the first and the third trimesters. This represents the lowest acceptable value for the second trimester when the hemodilution effect of blood volume expansion is at its peak.

The student nurse is giving a presentation about milestones in embryonic development. Which information should he or she include? A. At 8 weeks of gestation, primary lung and urethral buds appear. B. At 12 weeks of gestation, the vagina is open or the testes are in position for descent into the scrotum. C. At 20 weeks of age, the vernix caseosa and lanugo appear. D. At 24 weeks of age, the skin is smooth, and subcutaneous fat is beginning to collect.

C. At 20 weeks of age, the vernix caseosa and lanugo appear The primary lung and urethral buds appear at 6 weeks of gestation. The vagina is open or the testes are in position for descent into the scrotum at 16 weeks. Two milestones that occur at 20 weeks are the appearance of the vernix caseosa and lanugo. The appearance of smooth skin occurs at 28 weeks, and subcutaneous fat begins to collect at 30 to 31 weeks.

A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she: A. Wiggles and points her toes during the cramp. B. Applies cold compresses to the affected leg. C. Extends her leg and dorsiflexes her foot during the cramp. D. Avoids weight bearing on the affected leg during the cramp

C. Extends her leg and dorsiflexes her foot during the cramp. Pointing toes can aggravate rather than relieve the cramp. Application of heat is recommended. Extending the leg and dorsiflexing the foot is the appropriate relief for a leg cramp. Bearing weight on the affected leg can help to relieve the leg cramp, so it should not be avoided.

Which presumptive signs (felt by the woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause? A. Amenorrhea: stress, endocrine problems B. Quickening: gas, peristalsis C. Goodell sign: cervical polyps D. Chadwick sign: pelvic congestion

C. Goodell sign: cervical polyps Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Goodell sign might be the result of pelvic congestion, not polyps. Chadwick sign might be the result of pelvic congestion.

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C. Iron and folate Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Zinc sometimes is supplemented. Most women get enough calcium.

During pregnancy, alcohol withdrawal may be treated using: A. disulfiram (Antabuse). B. corticosteroids. C. benzodiazepines. D. aminophylline.

C. benzodiazepines. Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids are not used to treat alcohol withdrawal. Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Aminophylline is not used to treat alcohol withdrawal.

A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: A. tell the couple they need to have an abortion within 2 to 3 weeks. B. explain that the fetus has a 50% chance of having the disorder. C. discuss options with the couple, including amniocentesis to determine whether the fetus is affected. D. refer the couple to a psychologist for emotional support

C. discuss options with the couple, including amniocentesis to determine whether the fetus is affected. The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counselor is the best source for determining genetic probability ratios. Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected. The couple eventually may need emotional support, but the status of the pregnancy must be determined first.

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST): A. sometimes uses vibroacoustic stimulation. B. is an invasive test; however, contractions are stimulated. C. is considered negative if no late decelerations are observed with the contractions. D. is more effective than nonstress test (NST) if the membranes have already been ruptured.

C. is considered negative if no late decelerations are observed with the contractions. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by IV oxytocin but not if by nipple stimulation. No late decelerations indicate a positive CST. CST is contraindicated if the membranes have ruptured.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates: A. the fetus is at risk for Down syndrome. B. the woman is at high risk for developing preterm labor. C. lung maturity. D. meconium is present in the amniotic fluid.

C. lung maturity. The presence of surface-active phospholipids is not an indication of Down syndrome. This result reveals the fetal lungs are mature and in no way indicates risk for preterm labor. The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. Meconium should not be present in the amniotic fluid.

Maternal and neonatal risks associated with gestational diabetes mellitus are: A. maternal premature rupture of membranes and neonatal sepsis. B. maternal hyperemesis and neonatal low birth weight. C. maternal preeclampsia and fetal macrosomia. D. maternal placenta previa and fetal prematurity.

C. maternal preeclampsia and fetal macrosomia. Premature rupture of membranes and neonatal sepsis are not risks associated with gestational diabetes. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Placental previa and subsequent prematurity of the neonate are not risks associated with gestational diabetes.

During the first trimester the pregnant woman would be most motivated to learn about: A. fetal development. B. impact of a new baby on family members. C. measures to reduce nausea and fatigue so she can feel better. D. location of childbirth preparation and breastfeeding classes

C. measures to reduce nausea and fatigue so she can feel better. Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement. Impact of a new baby on the family would be appropriate topics for the second trimester when the fetus becomes "real" as its movements are felt and its heartbeat heard. During this trimester a woman works on the task of, "I am going to have a baby." During the first trimester a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse tells her: A. "Because you're in your second trimester, there's no problem with having one drink with dinner." B. "One drink every night is too much. One drink three times a week should be fine." C. "Because you're in your second trimester, you can drink as much as you like." D. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."

D. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy." Regardless of which trimester the woman has reached, no amount of alcohol during pregnancy has been deemed safe for the fetus. Neither one drink per night nor three drinks per week is a safe recommendation. Although the first trimester is a crucial period of fetal development, pregnant women of all gestations are counseled to eliminate all alcohol from their diet. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test? A. "I will need to have a full bladder for the test to be done accurately." B. "I should have my husband drive me home after the test because I may be nauseous." C. "This test will help to determine if the baby has Down syndrome or a neural tube defect." D."This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

D. "This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." An ultrasound is the test that requires a full bladder. An amniocentesis would be the test that a pregnant woman should be driven home afterward. A maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome. The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements.

Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? A. Radioimmunoassay B. Radioreceptor assay C. Latex agglutination test D. Enzyme-linked immunosorbent assay (ELISA

D. Enzyme-linked immunosorbent assay (ELISA) The radioimmunoassay tests for the summit of hCG in serum or urine samples. This test must be performed in the laboratory. The radioreceptor assay is a serum test that measures the ability of a blood sample to inhibit the binding of hCG to receptors. The latex agglutination test in no way determines pregnancy. Rather, it is done to detect specific antigens and antibodies. OTC pregnancy tests use ELISA for its one-step, accurate results.

If exhibited by a pregnant woman, what represents a positive sign of pregnancy? A. Morning sickness B. Quickening C. Positive pregnancy test D. Fetal heartbeat auscultated with Doppler/fetoscope

D. Fetal heartbeat auscultated with Doppler/fetoscope Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy; subjective findings are suggestive but not diagnostic of pregnancy. Other probable signs include changes in integument, enlargement of the uterus, and Chadwick sign. A positive pregnancy test is still considered to be a probable sign of pregnancy (objective findings are more suggestive but not yet diagnostic of pregnancy) since error can occur in performing the test or in rare cases human chorionic gonadotropin (hCG) may be detected in the urine of nonpregnant women. Chances of error are less likely to occur today since pregnancy tests used are easy to perform and are very sensitive to the presence of the hCG associated with pregnancy. Detection of a fetal heartbeat, palpation of fetal movements and parts by an examiner, and detection of an embryo/fetus with sonographic examination would be positive signs diagnostic of pregnancy

The health care provider has ordered a magnetic resonance imaging (MRI) study to be done on a pregnant patient to evaluate fetal structure and growth. The nurse should include which instructions when preparing the patient for this test? (Select all that apply.) A. A lead apron must be worn during the test. B. A full bladder is required prior to the test. C. An intravenous line must be inserted before the test. D. Jewelry must be removed before the test.

D. Jewelry must be removed before the test. Magnetic resonance imaging (MRI) is a noninvasive radiologic technique used for obstetric and gynecologic diagnosis. Similar to computed tomography (CT), MRI provides excellent pictures of soft tissue. Unlike CT, ionizing radiation is not used. Therefore vascular structures within the body can be visualized and evaluated without injecting an iodinated contrast medium, thus eliminating any known biologic risk. Similar to sonography, MRI is noninvasive and can provide images in multiple planes, but no interference occurs from skeletal, fatty, or gas-filled structures, and imaging of deep pelvic structures does not require a full bladder. The woman is placed on a table in the supine position and moved into the bore of the main magnet, which is similar in appearance to a CT scanner. Depending on the reason for the study, the procedure may take from 20 to 60 minutes, during which time the woman must be perfectly still except for short respites.

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: A. chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. B. screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. C. percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. D. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

D. MSAFP is a screening tool only; it identifies candidates for more definitive procedures. CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for Down syndrome. This is correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.

What laboratory results would be a cause for concern if exhibited by a woman at her first prenatal visit during the second month of her pregnancy? A. Hematocrit 38%, hemoglobin 13 g/dL B. White blood cell count 6000/mm3 C. Platelets 300,000/mm3 D. Rubella titer 1:6

D. Rubella titer 1:6 This is a normal laboratory value in the pregnant woman. This is a normal laboratory value in the pregnant woman. This is a normal laboratory value in the pregnant woman. A rubella titer of less than 1:10 indicates a lack of immunity to rubella, a viral infection that has the potential to cause teratogenic effects on fetal development. Arrangements should be made to administer the rubella vaccine after birth during the postpartum period since administration of rubella, a live vaccine, would be contraindicated during pregnancy. Women receiving the vaccine during the postpartum period should be cautioned to avoid pregnancy for 3 months.

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? A. This weight gain indicates possible gestational hypertension. B.This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). C.This weight gain cannot be evaluated until the woman has been observed for several more weeks. D.The woman's weight gain is appropriate for this stage of pregnancy.

D. The woman's weight gain is appropriate for this stage of pregnancy. During the first trimester, the average total weight gain is only 1 to 2.5 kg.The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy. This woman's BMI is within the normal range.

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? A. Biophysical profile B. Amniocentesis C. Maternal serum alpha-fetoprotein (MSAFP) D. Transvaginal ultrasound Correct

D. Transvaginal ultrasound A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal). An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: A. euglycemia. B. rheumatic fever. C. pneumonia. D. cardiac decompensation. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation. Symptoms of cardiac decompensation may appear abruptly or gradually.

D. cardiac decompensation. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation. Symptoms of cardiac decompensation may appear abruptly or gradually.

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that: A. a blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. B. shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. C. the systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. D. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy.

D. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy. The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases. This compression also leads to varicose veins in the legs and vulva.

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. iron absorption is inhibited by a diet rich in vitamin C. iron supplements are permissible for children in small doses. D. constipation is common with iron supplements.

D. constipation is common with iron supplements. These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem.

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: A. mother's age. B. number of years since diabetes was diagnosed. C. amount of insulin required prenatally.

D. degree of glycemic control during pregnancy. Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that: A. oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. B. dietary modifications and insulin are both required for adequate treatment. C. glucose levels are monitored by testing urine 4r times a day and at bedtime. D. dietary management involves distributing nutrient requirements over three meals and two or three snacks. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis.

D. dietary management involves distributing nutrient requirements over three meals and two or three snacks. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis.

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: A. intercourse should be avoided if any spotting from the vagina occurs afterward. B. intercourse is safe until the third trimester. C. safer-sex practices should be used once the membranes rupture. D. intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

D. intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor.

A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with: A. Down syndrome. B. sickle cell anemia. C. cardiac defects. D. open neural tube defects such as spina bifida

D. open neural tube defects such as spina bifida Low levels of MSAFP are associated with Down syndrome. Sickle cell anemia is not detected by the MSAFP. Cardiac defects would not be detected with the MSAFP. A triple marker test determines the levels of MSAFP along with serum levels of estriol and human chorionic gonadotropin; an elevated level is associated with open neural tube defects.

The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that: A. she will have to give birth at home. B. she must see an obstetrician as well as the midwife during pregnancy. C. she will not be able to have epidural analgesia for labor pain. D. she must be having a low-risk pregnancy.

D. she must be having a low-risk pregnancy Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer clients to physicians for complications. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care. This does not imply that medications for pain control are prohibited. Midwives usually see low-risk obstetric clients. Care is often noninterventional with active involvement from the woman and her family. Nurse-midwives must refer clients to physicians for complications

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: A. with a dominant disorder, the likelihood of the second child also having the condition is 100%. B. an autosomal recessive disease carries a one in eight risk of the second child also having the disorder. C. disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. D. the risk factor remains the same no matter how many affected children are already in the family.

D. the risk factor remains the same no matter how many affected children are already in the family. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. Subsequent children would be at risk only if the mother continued to use drugs; the rate of risk would be difficult to calculate. Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family.

A pregnant woman at 32 weeks of gestation complains of feeling dizzy and light-headed while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to: A. assess the woman's blood pressure and pulse. B. have the woman breathe into a paper bag. C. raise the woman's legs. D. turn the woman on her side.

D. turn the woman on her side. Vital signs can be assessed next. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure.

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? (Select all that apply.) Decreased urinary output and irritability Transient headache and +1 proteinuria Ankle clonus and epigastric pain Platelet count of less than 100,000/mm3 and visual problems Seizure activity and hypotension

Decreased urinary output and irritability 4 + Ankle clonus and epigastric pain Platelet count of less than 100,000/mm3 and visual problems Decreased urinary output and irritability are signs of severe eclampsia. Ankle clonus and epigastric pain are signs of severe eclampsia. Platelet count of less than 100,000/mm3 and visual problems are signs of severe preeclampsia. A transient headache and +1 proteinuria are signs of preeclampsia and should be monitored. Seizure activity and hyperreflexia are signs of eclampsia.

A pregnant woman presents to the emergency department complaining of persistent nausea and vomiting. She is diagnosed with hyperemesis gravidarum. The nurse should include which information when teaching about diet for hyperemesis? (Select all that apply.) Eat three larger meals a day. Eat a high-protein snack at bedtime. Ice cream may stay down better than other foods. Avoid ginger tea or sweet drinks. Eat what sounds good to you even if your meals are not well-balanced.

Eat a high-protein snack at bedtime Ice cream may stay down better than other foods. Eat what sounds good to you even if your meals are not well-balanced. The diet for hyperemesis includes: • Avoid an empty stomach. Eat frequently, at least every 2 to 3 hours. Separate liquids from solids and alternate every 2 to 3 hours. • Eat a high-protein snack at bedtime. • Eat dry, bland, low-fat, and high-protein foods. Cold foods may be better tolerated than those served at a warm temperature. • In general eat what sounds good to you rather than trying to balance your meals. • Follow the salty and sweet approach; even so-called junk foods are okay. • Eat protein after sweets. • Dairy products may stay down more easily than other foods. • If you vomit even when your stomach is empty, try sucking on a Popsicle. • Try ginger tea. Peel and finely dice a knuckle-sized piece of ginger and place it in a mug of boiling water. Steep for 5 to 8 minutes and add brown sugar to taste. • Try warm ginger ale (with sugar, not artificial sweetener) or water with a slice of lemon. • Drink liquids from a cup with a lid.

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? Prepare the woman for a dilation and curettage (D&C). Place the woman on bed rest for at least 1 week and reevaluate. Prepare the woman for an ultrasound and blood work.

Prepare the woman for an ultrasound and blood work Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month. D&C is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.

A pregnant woman's last menstrual period began on April 8, 2009, and ended on April 13. Using Nägele's rule, her estimated date of birth would be________.

January 15, 2010. Nägele's rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman's last menstrual period. When this rule is used with April 8, 2009, the estimated date of birth is January 15, 2010.