Maternal Test 1 TB questions

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be: a.Negative. b.Positive. c.Satisfactory. d.Unsatisfactory.

ANS: A Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative. A positive CST indicates the presence of repetitive later FHR decelerations. Satisfactory and unsatisfactory are not applicable terms.

A pregnant patient would like to know a good food source of calcium other than dairy products. Your best answer is: a.Legumes b.Yellow vegetables c.Lean meat d.Whole grains

ANS: A Although dairy products contain the greatest amount of calcium, it also is found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Yellow vegetables are rich in vitamin A. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium.

The most important reason for evaluating the pattern of weight gain in pregnancy is to: a.Prevent excessive adipose tissue deposits b.Identify potential nutritional problems or complications of pregnancy c.Assess the need to limit caloric intake in obese women d.Determine cultural influences on the woman's diet

ANS: B Maternal and fetal risks in pregnancy are increased when the mother is significantly overweight. Excessive adipose tissue may occur with excess weight gain; however, this is not the reason for monitoring the weight gain pattern. It is important to monitor the pattern of weight gain to identify complications. The pattern of weight gain is not influenced by cultural influences.

A maternity nurse should be aware of which fact about the amniotic fluid? a.It serves as a source of oral fluid and 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.

ANS: A Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, 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.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned that during and after tennis matches this woman consumes: 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.

ANS: A 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. The woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

Nurses should be aware that the biophysical profile (BPP): a.Is an accurate indicator of impending fetal death. b.Is a compilation of health risk factors of the mother during the later stages of pregnancy. c.Consists of a Doppler blood flow analysis and an amniotic fluid index. d.Involves an invasive form of ultrasound examination.

ANS: A An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.

A newly pregnant patient visits her provider's office for the first prenatal appointment. To estimate accurate weight gain throughout the pregnancy, the nurse will be evaluating the appropriateness of weight for height using the body mass index (BMI). The patient weighs 51 kg and is 1.57 m tall. The BMI is: ___________________

ANS: 20.7 BMI = weight divided by height squared. BMI = 51 kg/(1.57m)2, or 20.7. Prepregnant BMI can be classified into the following categories: <18.5, underweight or low; 18.5-24.9, normal; 25-29.9 overweight or high; and >30, obese

A woman asks the nurse, "What protects my baby's umbilical cord from being squashed while the baby's inside of me?" The nurse's best response is: a."Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby." b."Your baby's umbilical floats around in blood anyway." c."You don't need to worry about things like that." d."The umbilical cord is a group of blood vessels that are very well protected by the placenta."

ANS: A "Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby" is the most appropriate response. "Your baby's umbilical floats around in blood anyway" is inaccurate. "You don't need to worry about things like that" is an inappropriate response. It negates the client's need for teaching and discounts her feelings. The placenta does not protect the umbilical cord. The cord is protected by the surrounding Wharton jelly.

Identify a goal of a patient with the following nursing diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to diet choices inadequate to meet nutrient requirements of pregnancy. a.Gain a total of 30 lb. b.Take daily supplements consistently. c.Decrease intake of snack foods. d.Increase intake of complex carbohydrates.

ANS: A A weight gain of 30 lb is one indication that the patient has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this patient. It does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be a problem and should be assessed; however, assessing weight gain is the best method of monitoring nutritional intake for this pregnant patient. Increasing the intake of complex carbohydrates is important for this patient, but monitoring the weight gain should be the end goal.

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. c.Diabetes mellitus. d.Down syndrome.

ANS: B Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Spina bifida, diabetes mellitus, and Down syndrome are not associated with inadequate maternal weight gain.

A client asks her nurse, "My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?" The best response by the nurse is: a."Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby." b."Your placenta isn't working properly, and your baby is in danger." c."This means that we will need to perform an amniocentesis to detect if you have any placental damage." d."Don't worry about it. Everything is fine."

ANS: A An accurate and appropriate response is, "Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby." Although "Your placenta isn't working properly, and your baby is in danger" may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the client. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. The response "Don't worry about it. Everything is fine" is not appropriate and discredits the client's concerns.

A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time? a.Ultrasound examination b.Maternal serum alpha-fetoprotein (MSAFP) screening c.Amniocentesis d.Nonstress test (NST)

ANS: A An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. It is too early in the pregnancy to perform MSAFP screening, amniocentesis, or NST. MSAFP screening is performed at 16 to 18 weeks of gestation, followed by amniocentesis if MSAFP levels are abnormal or if fetal/maternal anomalies are detected. NST is performed to assess fetal well-being in the third trimester.

A key finding from the Human Genome Project is: a.Approximately 20,000 genes make up the genome. 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 clients in the future.

ANS: A 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.

The nurse caring for the laboring woman should know that meconium is produced by: a.Fetal intestines. b.Fetal kidneys. c.Amniotic fluid. d.The placenta.

ANS: A As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium.

Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment: a.Has no known contraindications. b.Has fewer false-positive results. c.Is more sensitive in detecting fetal compromise. d.Is slightly more expensive.

ANS: A CST has several contraindications. NST has a high rate of false-positive results, is less sensitive than the CST, and is relatively inexpensive.

Which statement regarding acronyms in nutrition is accurate? a.Dietary reference intakes (DRIs) consist of recommended dietary allowances (RDAs), adequate intakes (AIs), and upper limits (ULs). b.RDAs are the same as ULs except with better data. c.AIs offer guidelines for avoiding excessive amounts of nutrients. d.They all refer to green leafy vegetables, whole grains, and fruit.

ANS: A DRIs consist of RDAs, AIs, and ULs. AIs are similar to RDAs except that they deal with nutrients about which data are insufficient for certainty (RDA status). ULs are guidelines for avoiding excesses of nutrients for which excess is toxic. Green leafy vegetables, whole grains, and fruit are important, but they are not the whole nutritional story.

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. 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.

ANS: A 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.

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 other tool would be useful in confirming the diagnosis? a.Doppler blood flow analysis b.Contraction stress test (CST) c.Amniocentesis d.Daily fetal movement counts

ANS: A 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, CST is not performed on a woman whose fetus is preterm. Indications for amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and 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.

Which nutritional recommendation about fluids is accurate? a.A woman's daily intake should be eight to ten glasses (2.3 L) of water, milk, or juice. b.Coffee should be limited to no more than two cups, but tea and cocoa can be consumed without worry. c.Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns. d.Water with fluoride is especially encouraged because it reduces the child's risk of tooth decay.

ANS: A Eight to ten glasses is the standard for fluids; however, they should be the right fluids. All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or drunk only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus; however, mothers with phenylketonuria should avoid aspartame. No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay.

The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by: a.Contact between maternal blood and fetal capillaries within the chorionic villi. b.Interaction of maternal and fetal pH levels within the endometrial vessels. c.A mixture of maternal and fetal blood within the intervillous spaces. d.Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries.

ANS: A Fetal capillaries within the chorionic villi are bathed with oxygen-rich and nutrient-rich maternal blood within the intervillous spaces. The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. Maternal and fetal blood do not normally mix. Maternal carbon dioxide does not enter into the fetal circulation.

Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that: a.Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. b.Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. c.Identical twins are more common in white families. d.Fraternal twins are same gender, usually male.

ANS: A If the parents-to-be are older and have taken fertility drugs, they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference; fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender. Identical twins are the same gender.

The nurse is assessing the knowledge of new parents with a child born with maple syrup urine disease (MSUD). This is an autosomal recessive inherited disorder, which means that: a.Both genes of a pair must be abnormal for the disorder to be expressed. b.Only one copy of the abnormal gene is required for the disorder to be expressed. c.The disorder occurs in males and heterozygous females. d.The disorder is carried on the X chromosome.

ANS: A MSUD is a type of autosomal recessive inheritance disorder in which both genes of a pair must be abnormal for the disorder to be expressed. MSUD is not an X-linked dominant or recessive disorder or an autosomal dominant inheritance disorder.

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a.Multiple-marker screening b.Lecithin/sphingomyelin (L/S) ratio c.Biophysical profile d.Type and crossmatch of maternal and fetal serum

ANS: A Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. The L/S ratio is used to determine fetal lung maturity. A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. The blood type and crossmatch would not predict chromosomal defects in the fetus.

With regard to prenatal genetic testing, nurses should be aware that: a.Maternal serum screening can determine whether a pregnant woman is at risk of carrying a fetus with Down syndrome. b.Carrier screening tests look for gene mutations of people already showing symptoms of a disease. c.Predisposition testing predicts with near certainty that symptoms will appear. d.Presymptomatic testing is used to predict the likelihood of breast cancer.

ANS: A Maternal serum screening identifies the risk for the neural tube defect and the specific chromosome abnormality involved in Down syndrome. Carriers of some diseases, such as sickle cell disease, do not display symptoms. Predisposition testing determines susceptibility, such as for breast cancer. presymptomatic testing indicates that symptoms are certain to appear if the gene is present.

Which nutrient's recommended dietary allowance (RDA) is higher during lactation than during pregnancy? a.Energy (kcal) b.Iron c.Vitamin A d.Folic acid

ANS: A Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater than nonpregnant needs.

The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping: a.In a side-lying position. b.On her back with a pillow under her knees. c.With the head of the bed elevated. d.On her abdomen.

ANS: A Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women find lying on her abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.

A new mother asks the nurse about the "white substance" covering her infant. The nurse explains that the purpose of vernix caseosa is to: a.Protect the fetal skin from amniotic fluid. b.Promote normal peripheral nervous system development. c.Allow transport of oxygen and nutrients across the amnion. d.Regulate fetal temperature.

ANS: A Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system is dependent on nutritional intake of the mother. The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange. The amniotic fluid aids in maintaining fetal temperature.

After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy? a."Protein will help my baby grow." b."Eating protein will prevent me from becoming anemic." c."Eating protein will make my baby have strong teeth after he is born." d."Eating protein will prevent me from being diabetic."

ANS: A Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

To help a woman reduce the severity of nausea caused by morning sickness, the nurse might suggest that she: a.Try a tart food or drink such as lemonade or salty foods such as potato chips. b.Drink plenty of fluids early in the day. c.her teeth immediately after eating. d.Never snack before bedtime.

ANS: A Some women can tolerate tart or salty foods when they are nauseous. The woman should avoid drinking too much when nausea is most likely, but she should make up the fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.

The nurse must be cognizant that an individual's genetic makeup is known as his or her: a.Genotype. b.Phenotype. c.Karyotype. d.Chromotype.

ANS: A The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individual's genotype. The karyotype is a pictorial analysis of the number, form, and size of an individual's chromosomes. Genotype refers to an individual's genetic makeup.

A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is: a."The test results are within normal limits." b."Immediate delivery by cesarean birth is being considered." c."Further testing will be performed to determine the meaning of this score." d."An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery."

ANS: A The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.

Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. The nurse or midwife should refer a client to a registered dietitian for in-depth nutritional counseling in the following situations (Select all that apply). a.Preexisting or gestational illness such as diabetes b.Ethnic or cultural food patterns c.Obesity d.Vegetarian diet e.Allergy to tree nuts

ANS: A, B, C, D The nurse should be especially aware that conditions such as diabetes can require in-depth dietary planning and evaluation. To prevent issues with hypoglycemia and hyperglycemia and an increased risk for perinatal morbidity and mortality, this patient would benefit from a referral to a dietitian. Consultation with a dietitian may ensure that cultural food beliefs are congruent with modern knowledge of fetal development and that adjustments can be made to ensure that all nutritional needs are met. The obese pregnant patient may be under the misapprehension that because of her excess weight little or no weight gain is necessary. According to the Institute of Medicine, a client with a body mass index in the obese range should gain at least 7 kg to ensure a healthy outcome. This patient may require in-depth counseling on optimal food choices. The vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimal combination of amino acids and protein intake is achieved. Very strict vegetarians (vegans) who consume only plant products may also require vitamin B and mineral supplementation. A patient with a food allergy would not alter that component of her diet during pregnancy; therefore, no additional consultation is necessary.

Congenital disorders refer to conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, she should understand the significance of exposure to known human teratogens. These include(Select all that apply): a.Infections. b.Radiation. c.Maternal conditions. d.Drugs. e.Chemicals.

ANS: A, B, C, D, E Exposure to radiation and numerous infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, cytomegalovirus, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics as well as chemicals, including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities.

Which congenital malformations result from multifactorial inheritance (Select all that apply)? a.Cleft lip b.Congenital heart disease c.Cri du chat syndrome d.Anencephaly e.Pyloric stenosis

ANS: A, B, D, E All these congenital malformations are associated with multifactorial inheritance. Cri du chat syndrome is related to a chromosome deletion.

Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (select all that apply) a.Human chorionic gonadotropin (hCG) b.Insulin c.Estrogen d.Progesterone e.Testosterone

ANS: A, C, D hCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman's uterus and breasts; cause growth of the ductal system in the breasts; and, as term approaches, play a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT, hCA, and numerous growth factors. Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures.

To prevent gastrointestinal upset, clients should be instructed to take iron supplements: a.On a full stomach. b.At bedtime. c.After eating a meal. d.With milk.

ANS: B Clients should be instructed to take iron supplements at bedtime. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.

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 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.

ANS: B A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

Which statement made by a lactating woman would lead the nurse to believe that the woman might have lactose intolerance? a."I always have heartburn after I drink milk." b."If I drink more than a cup of milk, I usually have abdominal cramps and bloating." c."Drinking milk usually makes me break out in hives." d."Sometimes I notice that I have bad breath after I drink a cup of milk."

ANS: B Abdominal cramps and bloating are consistent with lactose intolerance. One problem that can interfere with milk consumption is lactose intolerance, which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. Milk consumption may cause abdominal cramping, bloating, and diarrhea people who are lactose intolerant, although many affected individuals can tolerate small amounts of milk without symptoms.

In teaching the pregnant adolescent about nutrition, the nurse should: a.Emphasize the need to eliminate common teen snack foods because they are too high in fat and sodium. b.Determine the weight gain needed to meet adolescent growth and add 35 lb. c.Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value. d.Realize that most adolescents are unwilling to make dietary changes during pregnancy.

ANS: B Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Changes in the diet should be kept at a minimum. Snack foods can be included in moderation, and other foods can be added to make up for the lost nutrients. Eliminating fast foods would make the adolescent appear different to her peers. The patient should be taught to choose foods that add needed nutrients. Adolescents are willing to make changes; however, they still have the need to be similar to their peers.

A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" The best answer is: a."A baby's sex is determined as soon as conception occurs." b."The baby has developed enough that we can determine the sex by examining the genitals through ultrasound." c."Boys and girls look alike until about 20 weeks after conception, and then they begin to look different." d."It might be possible to determine your baby's sex, but the external organs look very similar right now."

ANS: B Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.

With regard to chromosome abnormalities, 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 chromosome structure. d.Unbalanced translocation results in a mild abnormality that the child will outgrow.

ANS: B Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation. Chromosome abnormalities occur in less than 1% of newborns. 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.

Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish adequately supply the recommended amount of protein for a pregnant woman. Many patients are concerned about the increased levels of mercury in fish and may be afraid to include this source of nutrients in their diet. Sound advice by the nurse to assist the client in determining which fish is safe to consume would include: a.Canned white tuna is a preferred choice. b.Avoid shark, swordfish, and mackerel. c.Fish caught in local waterways are the safest. d.Salmon and shrimp contain high levels of mercury.

ANS: B As a precaution, the pregnant patient should avoid eating all of these and the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the client in understanding the differences between numerous sources of this product. A pregnant client can 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. It is a common misconception that fish caught in local waterways are the safest. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, these fish sources should be avoided, limited to less than 6 ounces, or the only fish consumed that week. Commercially caught fish that are low in mercury include salmon, shrimp, pollock, or catfish.

In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as: a.Anxiety and altered family relationships. b.Denial of insurance benefits. c.High false-positive results associated with genetic testing. d.Ethnic and socioeconomic disparity associated with genetic testing.

ANS: B Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Anxiety and altered family relationships, high false-positive results, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing.

In the first trimester, ultrasonography can be used to gain information on: a.Amniotic fluid volume. b.Location of Gestational sacs c.Placental location and maturity. d.Cervical length.

ANS: B During the first trimester, ultrasound examination is performed to obtain information regarding the number, size, and location of gestatials sacs; the presence or absence of fetal cardiac and body movements; the presences or absence of uterine abnormalities (e.g., bicornuate uterus or fibroids) or adnexal masses (e.g., ovarian cysts or an ectopic pregnancy); and pregnancy dating.

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.

ANS: B Eating small, frequent meals is the correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated, but should compensate by drinking fluids at other times. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried and other fatty foods.

Maternal serum alpha-fetoprotein (MSAFP) screening indicates an elevated level. MSAFP screening is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus? a.Percutaneous umbilical blood sampling (PUBS) b.Ultrasound for fetal anomalies c.Biophysical profile (BPP) for fetal well-being d.Amniocentesis for genetic anomalies

ANS: B If MSAFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect, repeated MSAFP screening, ultrasound examination, and possibly amniocentesis. Indications for use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. BPP is a method of assessing fetal well-being in the third trimester. Before amniocentesis is considered, the client first would have an ultrasound for direct visualization of the fetus.

A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is: a."You should have felt the baby move by now." b."Within the next month, you should start to feel fluttering sensations." c."The baby is moving; however, you can't feel it yet." d."Some babies are quiet, and you don't feel them move."

ANS: B Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating that "you should have felt the baby move by now" is incorrect and may be alarming to the patient. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary.

Maternal nutritional status is an especially significant factor of the many factors that influence the outcome of pregnancy because: a.It is very difficult to adjust because of people's ingrained eating habits. b.It is an important preventive measure for a variety of problems. c.Women love obsessing about their weight and diets. d.A woman's preconception weight becomes irrelevant.

ANS: B Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach.

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring client with diabetes mellitus, the nurse is aware that she is at a greater risk for: a.Oligohydramnios. b.Polyhydramnios. c.Postterm pregnancy. d.Chromosomal abnormalities.

ANS: B Polyhydramnios (amniotic fluid >2000 mL) is 10 times more likely to occur in diabetic compared with nondiabetic pregnancies. Polyhydramnios puts the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage. Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the client at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age older than 35 and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities.

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? a.Ultrasound for fetal anomalies b.Biophysical profile (BPP) c.Maternal serum alpha-fetoprotein (MSAFP) screening d.Percutaneous umbilical blood sampling (PUBS)

ANS: B Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have been performed earlier in the pregnancy. It is too late in the pregnancy to perform MSAFP screening. Also, MSAFP screening does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of a fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

A man's wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as: a.Occurrence risk. b.Recurrence risk. c.Predictive testing. d.Predisposition testing.

ANS: B The couple already has a child with a genetic disease so they will be given a recurrence risk test. If a couple has not yet had children but are known to be at risk for having children with a genetic disease, they are given an occurrence risk test. Predictive testing is used to clarify the genetic status of an asymptomatic family member. Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing.

A woman has been diagnosed with a high risk pregnancy. She and her husband come into the office in a very anxious state. She seems to be coping by withdrawing from the discussion, showing declining interest. The nurse can best help the couple by: a.Telling her that the physician will isolate the problem with more tests. b.Encouraging her and urging her to continue with childbirth classes. c.Becoming assertive and laying out the decisions the couple needs to make. d.Downplaying her risks by citing success rate studies.

ANS: B The nurse can best help the woman and her husband regain a sense of control in their lives by providing support and encouragement (including active involvement in preparations and classes). The nurse can try to present opportunities for the couple to make as many choices as possible in prenatal care.

As relates to the structure and function of the placenta, the maternity nurse should be aware that: a.As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b.As one of its early functions, the placenta acts as an endocrine gland. c.The placenta is able to keep out most potentially toxic substances such as cigarette smoke to which the mother is exposed. d.Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B The placenta produces four hormones necessary to maintain the pregnancy. The placenta widens until week 20 and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.

You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant? a.Disturbed body image b.Interrupted family processes c.Anxiety d.Risk for injury

ANS: B This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Women commonly experience "body image disturbances in the postpartum period"; however, this is unrelated to giving birth to a child with Down syndrome. The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family. "Risk for injury" is not an applicable nursing diagnosis.

Which nursing intervention is necessary before a second-trimester transabdominal ultrasound? a.Place the woman NPO for 12 hours. b.Instruct the woman to drink 1 to 2 quarts of water. c.Administer an enema. d.Perform an abdominal preparation.

ANS: B When the uterus is still in the pelvis, visualization may be difficult. It is necessary to perform the test when the woman has a full bladder, which provides a "window" through which the uterus and its contents can be viewed. The woman needs a full bladder to elevate the uterus; therefore being NPO is not appropriate. Neither an enema nor an abdominal preparation is necessary for this procedure.

At 35 weeks of pregnancy a woman experiences preterm labor. Tocolytics are administered and she is placed on bed rest, but she continues to experience regular uterine contractions, and her cervix is beginning to dilate and efface. What would be an important test for fetal well-being at this time? a.Percutaneous umbilical blood sampling (PUBS) b.Ultrasound for fetal size c.Amniocentesis for fetal lung maturity d.Nonstress test (NST)

ANS: C Amniocentesis would be performed to assess fetal lung maturity in the event of a preterm birth. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of a fetus with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. Typically, fetal size is determined by ultrasound during the second trimester and is not indicated in this scenario. NST measures the fetal response to fetal movement in a noncontracting mother.

A pregnant woman at 25 weeks' gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a."That must have been a coincidence; babies can't respond like that." b."The fetus is demonstrating the aural reflex." c."Babies respond to sound starting at about 24 weeks of gestation." d."Let me know if it happens again; we need to report that to your midwife."

ANS: C "Babies respond to sound starting at about 24 weeks of gestation" is an accurate statement. "That must have been a coincidence; babies can't respond like that" is inaccurate. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The statement, "Let me know if it happens again; we need to report that to your midwife" is not appropriate; it gives the impression that something is wrong.

The measurement of lecithin in relation to sphingomyelin (L/S ratio) is used to determine fetal lung maturity. Which ratio reflects maturity of the lungs? a. 1.4:1 b. 1.8:1 c. 2:1 d. 1:1

ANS: C A ratio of 2:1 indicates a two-to-one ratio of L/S, an indicator of lung maturity. Ratios of 1.4:1, 1.8:1, and 1:1 indicate immaturity of the fetal lungs.

With regard to the development of the respiratory system, maternity nurses should be understand that: a.The respiratory system does not begin developing until after the embryonic stage. b.The infant's lungs are considered mature when the lecithin/sphingomyelin (L/S) ratio is 1:1, at about 32 weeks. c.Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. d.Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks.

ANS: C A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and accelerates lung maturity. Development of the respiratory system begins during the embryonic phase and continues into childhood. The infant's lungs are mature when the L/S ratio is 2:1, at about 35 weeks. Lung movements have been seen on ultrasound scans at 11 weeks.

While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at: a. 4 weeks b. 8 weeks c. 10 weeks d. 14 weeks

ANS: C CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, the risk of limb reduction is no greater than in the general population.

With regard to amniocentesis, nurses should be aware that: a.Because of new imaging techniques, amniocentesis is now possible in the first trimester. b.Despite the use of ultrasound, complications still occur in the mother or infant in 5% to 10% of cases. c.The shake test, or bubble stability test, is a quick means of determining fetal maturity. d.The presence of meconium in the amniotic fluid is always cause for concern.

ANS: C Diluted fluid is mixed with ethanol and shaken. After 15 minutes, the bubbles tell the story. Amniocentesis is possible after the fourteenth week of pregnancy when the uterus becomes an abdominal organ. Complications occur in less than 1% of cases; many have been minimized or eliminated through the use of ultrasound. Meconium in the amniotic fluid before the beginning of labor is not usually a problem.

The 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.

ANS: C Genetic testing, including amniocentesis, would need to be performed 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. The couple eventually may need emotional support, but the status of the pregnancy must be determined first.

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

ANS: C Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. 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. Zinc sometimes is supplemented. Most women obtain enough calcium through their regular diet.

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."

ANS: C Karyotyping provides genetic information such as gender and chromosome structure. The L/S, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that: a.Alcohol or cigarette smoke can irritate the fetus into greater activity. b."Kick counts" should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off. c.The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d.Obese mothers familiar with their bodies can assess fetal movement as well as average-size women.

ANS: C No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity ("kick counts") two or three times daily for 60 minutes each time. Obese women have a harder time assessing fetal movement.

In practical terms regarding genetic health care, nurses should be aware that: a.Genetic disorders affect people of all socioeconomic backgrounds, races, and ethnic groups equally. b.Genetic health care is more concerned with populations than individuals. c.The most important of all nursing functions is providing emotional support to the family during counseling. d.Taking genetic histories is the province of large universities and medical centers.

ANS: C Nurses should be prepared to help with various stress reactions from a couple facing the possibility of a genetic disorder. Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups. Genetic health care is highly individualized because treatments are based on the phenotypic responses of the individual. Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.

The labor and delivery nurse is preparing a bariatric patient for an elective cesarean birth. Which piece of "specialized" equipment is unnecessary when providing care for this pregnant woman. a.Extra long surgical instruments b.Wide surgical table c.Temporal thermometer d.Increased diameter blood pressure cuff

ANS: C Obstetricians today are seeing more morbidly obese pregnant women weighing 400, 500, and 600 pounds. To manage their conditions and to meet their logistical needs, a new medical subspecialty "bariatric obstetrics" has arisen. Extra-wide blood pressure cuffs, scales that can accommodate up to 880 pounds, and extra-wide surgical tables designed to hold the weight of these women are used. Special techniques for ultrasound examination and longer surgical instruments for cesarean birth are also required. A temporal thermometer can be used for a pregnant patient of any size.

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."

ANS: C 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. "We don't really know when such defects occur" is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. "They usually occur in the first 2 weeks of development" is an inaccurate statement.

A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won't be affected. What response by the nurse is most accurate? a."Good planning; you need to take advantage of the odds in your favor." b."I think you'd better check with your doctor first." c."You are both carriers, so each baby has a 25% chance of being affected." d."The ultrasound indicates a boy, and boys are not affected by PKU."

ANS: C The chance is one in four that each child produced by this couple will be affected by PKU disorder. This couple still has an increased likelihood of having a child with PKU. Having one child already with PKU does not guarantee that they will not have another. These parents need to discuss their options with their physician. However, an opportune time has presented itself for the couple to receive correct teaching about inherited genetic risks. No correlation exists between gender and inheritance of the disorder because PKU is an autosomal recessive disorder.

While taking a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. This represents a nutritional problem known as: a.Preeclampsia. b.Pyrosis. c.Pica. d.Purging.

ANS: C The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica.

Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), "How does my baby get air inside my uterus?" The correct response is: a."The baby's lungs work in utero to exchange oxygen and carbon dioxide." b."The baby absorbs oxygen from your blood system." c."The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream." d."The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen."

ANS: C The placenta functions by supplying oxygen and excreting carbon dioxide to the maternal bloodstream. The fetal lungs do not function for respiratory gas exchange in utero. The baby does not simply absorb oxygen from a woman's blood system. Blood and gas transport occur through the placenta. The placenta delivers oxygen-rich blood through the umbilical vein and not the artery.

When providing care to the prenatal patient, the nurse understands that pica is defined as: a.Intolerance of milk products b.Iron deficiency anemia c.Ingestion of nonfood substances d.Episodes of anorexia and vomiting

ANS: C The practice of eating substances not normally thought of as food is called pica. Clay or dirt and solid laundry starch are the substances most commonly ingested. Intolerance of milk products is referred to as lactose intolerance. Pica may produce iron deficiency anemia if proper nutrition is decreased. Pica is not related to anorexia and vomiting.

If a patient's normal prepregnancy diet contains 45 g of protein daily, how many more grams of protein should she consume per day during pregnancy? a.5 b.10 c.25 d.30

ANS: C The recommended intake of protein for the pregnant woman is 70 g. Intakes of 5, 10, or 15 g would be inadequate to meet protein needs during pregnancy. A protein intake of 30 g is more than is necessary and would add extra calories.

At approximately _____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. a. 20 b. 24 c. 28 d. 30

ANS: C These milestones human development occur at approximately 28 weeks.

In the past, factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted today. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the following is not one of these categories? a.Biophysical b.Psychosocial c.Geographic d.Environmental

ANS: C This category is correctly referred to as sociodemographic risk. These factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status also are included. Biophysical is one of the broad categories used for determining risk. These include genetic considerations, nutritional status, and medical and obstetric disorders. Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus. Environmental risks are risks that can affect both fertility and fetal development. These include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.

A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this woman's intake of: a.Calcium. b.Protein. c.Vitamin B12. d.Folic acid.

ANS: C This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.

A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this woman's total recommended weight gain during pregnancy should be at least: a.20 kg (44 lb). c.12.5 kg (27.5 lb). b.16 kg (35 lb). d.10 kg (22 lb).

ANS: C This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy. A weight gain of 20 kg would be unhealthy for most women. A weight gain 35 lb is the high end of the range of weight this woman should gain in her pregnancy. A weight gain of 22 lb would be appropriate for an obese woman.

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice: a."Discontinue all contraception now." b."Lose weight so that you can gain more during pregnancy." c."You may take any medications you have been taking regularly." d."Make sure that you include adequate folic acid in your diet."

ANS: D A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A woman's folate or folic acid intake is of particular concern in the periconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception used, discontinuing all contraception may not be appropriate advice. Losing weight is not appropriate advice. Depending on the type of medication the woman is taking, continuing its use may not be appropriate.

Which pregnant woman should restrict her weight gain during pregnancy? a.Woman pregnant with twins b.Woman in early adolescence c.Woman shorter than 62 inches or 157 cm d.Woman who was 20 pounds overweight before pregnancy

ANS: D A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and obese women should be advised to lose weight before conception to achieve the best pregnancy outcomes. A higher weight gain in twin gestations may help prevent low birth weights. Adolescents need to gain weight toward the higher acceptable range, which provides for their own growth as well as for fetal growth. In the past, women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found.

The most basic information a maternity nurse should have concerning conception is that: a.Ova are considered fertile 48 to 72 hours after ovulation. b.Sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours. c.Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d.Implantation in the endometrium occurs 6 to 10 days after conception.

ANS: D After implantation, the endometrium is called the decidua. Ova are considered fertile for about 24 hours after ovulation. Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.

The _____ is/are responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream. a.Decidua basalis b.Blastocyst c.Germ layer d.Chorionic villi

ANS: D Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula. Implantation occurs at this stage. The germ layer is a layer of the blastocyst.

The major source of nutrients in the diet of a pregnant woman should be composed of: a.Simple sugars b.Fats c.Fiber d.Complex carbohydrates

ANS: D Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. Fiber is supplied primarily by complex carbohydrates.

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. c.Iron supplements are permissible for children in small doses. d.Constipation is common with iron supplements.

ANS: D Constipation can be a problem. Milk, coffee, and tea 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.

A pregnant woman's diet may not meet her need for folates. A good source of this nutrient is: a.Chicken b.Cheese c.Potatoes d.Green leafy vegetables

ANS: D Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor in folates. Potatoes contain carbohydrates and vitamins and minerals but are poor in folates.

A woman who is 8 months pregnant asks the nurse, "Does my baby have any antibodies to fight infection?" The most appropriate response by the nurse is: a."Your baby has all the immune globulins necessary: IgG, IgM, and IgA." b."Your baby won't receive any antibodies until he is born and you breastfeed him." c."Your baby does not have any antibodies to fight infection." d."Your baby has IgG and IgM."

ANS: D During the third trimester, the only immune globulins that crosses the placenta, IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM by the end of the first trimester. IgA is not produced by the baby. By the third trimester, the fetus has IgG and IgM. Breastfeeding supplies the baby with IgA. "Your baby does not have any antibodies to fight infection" is an inaccurate statement.

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.

ANS: D 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. 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. In disorders involving maternal ingestion of drugs, subsequent children would be at risk only if the mother continued to take drugs; the rate of risk would be difficult to calculate.

A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman: a.Substitute other calcium sources for milk in her diet. b.Lie down after each meal. c.Reduce the amount of fiber she consumes. d.Eat five small meals daily.

ANS: D Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women and do not alleviate heartburn.

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category? a.Blood pressure, age, BMI b.Drug/alcohol use, age, family history c.Family history, blood pressure, BMI d.Family history, BMI, drug/alcohol abuse

ANS: D Her family history of NTD, low BMI, and substance abuse all are high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which would be a high risk. The woman's drug/alcohol use and family history put her in a high risk category, but her age does not. The woman's family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal.

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.Maternal serum alpha-fetoprotein (MSAFP) screening is recommended only for women at risk for neural tube defects. c.Percutaneous umbilical blood sampling (PUBS) is one of the triple-marker tests for Down syndrome. d.MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

ANS: D MSAFP is a screening tool, not a diagnostic tool. CVS provides 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 screening, not PUBS, is part of the triple-marker tests for Down syndrome.

A pregnant woman's diet history indicates that she likes the following list of foods. The nurse would encourage this woman to consume more of which food to increase her calcium intake? a.Fresh apricots b.Canned clams c.Spaghetti with meat sauce d.Canned sardines

ANS: D Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.

Some of the embryo's intestines remain within the umbilical cord during the embryonic period because the; a.Umbilical cord is much larger at this time than it will be at the end of pregnancy. b.Intestines begin their development within the umbilical cord. c.Nutrient content of the blood is higher in this location. d.Abdomen is too small to contain all the organs while they are developing.

ANS: D The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas.

Nutrition is one of the most significant factors influencing the outcome of a pregnancy. It is an alterable and important preventive measure for various potential problems, such as low birth weight and prematurity. While completing the physical assessment of the pregnant client, the nurse can evaluate the client's nutritional status by observing a number of physical signs. Which sign would indicate that the client has unmet nutritional needs? a.Normal heart rate, rhythm, and blood pressure b.Bright, clear, shiny eyes c.Alert, responsive, and good endurance d.Edema, tender calves, and tingling

ANS: D The physiologic changes of pregnancy may complicate the interpretation of physical findings. Lower extremity edema often occurs when caloric and protein deficiencies are present; however, it may also be a common physical finding during the third trimester. It is essential that the nurse complete a thorough health history and physical assessment and request further laboratory testing if indicated. A malnourished pregnant patient may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure. A patient receiving adequate nutrition has bright, shiny eyes with no sores and moist, pink membranes. Pale or red membranes, dryness, infection, dull appearance of the cornea, or blue sclerae all are signs of poor nutrition. This client is well nourished. Cachexia, listlessness, and tiring easily would be indications of poor nutritional status.

In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their clients that: a.Both require the woman to have a full bladder. b.The abdominal examination is more useful in the first trimester. c.Initially the transvaginal examination can be painful. d.The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

ANS: D The transvaginal examination allows pelvic anatomy to be evaluated in greater detail and allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty bladder. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither method should be painful, although with the transvaginal examination the woman feels pressure as the probe is moved.

A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time? a.Biophysical profile (BPP) b.Amniocentesis c.Maternal serum alpha-fetoprotein (MSAFP) screening d.Transvaginal ultrasound

ANS: D Ultrasound would be performed at this gestational age for biophysical assessment of the infant. BPP would be a method of biophysical assessment of fetal well-being in the third trimester. Amniocentesis is performed after the fourteenth week of pregnancy. MSAFP screening is performed from week 15 to week 22 of gestation (weeks 16 to 18 are ideal).

To determine the cultural influence on a patient's diet, the nurse should first: a.Evaluate the patient's weight gain during pregnancy b.Assess the socioeconomic status of the patient c.Discuss the four food groups with the patient d.Identify the food preferences and methods of food preparation common to that culture

ANS: D Understanding the patient's food preferences and how she prepares food will assist the nurse in determining whether the patient's culture is adversely affecting her nutritional intake. Evaluation of a patient's weight gain during pregnancy should be included for all patients, not just for patients who are culturally different. The socioeconomic status of the patient may alter the nutritional intake but not the cultural influence. Teaching the food groups to the patient should come after assessing food preferences.

Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the mother? a.Zinc b.Vitamin D c.Folic acid d.Vitamin A

ANS: D Zinc, vitamin D, and folic acid are vital to good maternal and fetal health and are highly unlikely to be consumed in excess. Vitamin A taken in excess causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy.

Pregnant adolescents are at high risk for _____ because of lower body mass indices (BMIs) and "fad" dieting. a.Obesity b.Diabetes c.Low-birth-weight babies d.High-birth-weight babies

Adolescents tend to have lower BMIs because they are still developing and may follow unsafe nutritional practices. In addition, the fetus and still-growing mother appear to compete for nutrients. These factors, along with inadequate weight gain, lend themselves to a higher incidence of low-birth-weight babies. Obesity, diabetes, and high-birth-weight babies are conditions associated with higher BMIs.

Which meal would provide the most absorbable iron? a.Toasted cheese sandwich, celery sticks, tomato slices, and a grape drink b.Oatmeal, whole wheat toast, jelly, and low-fat milk c.Black bean soup, wheat crackers, orange sections, and prunes d.Red beans and rice, cornbread, mixed greens, and decaffeinated tea

Food sources that are rich in iron include liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes, and dried fruits. In addition, the vitamin C in orange sections aids absorption. Dairy products and tea are not sources of iron.

The nurse providing care for the antepartum woman should understand that 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.

No late decelerations is good news. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by intravenous oxytocin but not if by nipple stimulation and is contraindicated if the membranes have ruptured.

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 lb) 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.

The statement "The woman's weight gain is appropriate for this stage of pregnancy" is accurate. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg. Although weight gain does indicate possible gestational hypertension, it does not apply to this patient. 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. Although weight gain does indicate risk for IUGR, this does not apply to this patient. Weight gain should occur at a steady rate throughout the pregnancy. The optimal rate of weight gain also depends on the stage of the pregnancy.