Maternity Exam 2

A nurse is reviewing the clinical diagnosis of ectopic pregnancy. Which location should the nurse identify as being the most common location for this occurrence? a. Fimbriae. b. Ampulla. c. Uterine fundus. d. Cervical os.

b. Ampulla.

How would the nurse docuement a woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability? a. Primipara b. Multipara c. Nulligravida d. Primigravida

a. Primipara

A group of maternity nurses are providing education to pregnant clients about changes in blood pressure. What information should the nurses include? a. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy. b. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. c. 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. d. 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.

a. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that: a. Dietary management involves distributing nutrient requirements over three meals and two or three snacks. b. Dietary modifications and insulin are both required for adequate treatment. c. Glucose levels are monitored by testing urine four times a day and at bedtime. d. Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin.

a. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

A nurse is examining a client who has been admitted for possible ectopic pregnancy who is approximately 8 weeks pregnant. Which finding if observed by the nurse would be a priority concern? a. Ecchymosis noted around umbilicus b. No FHT heard via Doppler c. Blood pressure 100/80 d. Scant vaginal bleeding noted on peri pad

a. Ecchymosis noted around umbilicus

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: a. Fetal movement palpated by the nurse-midwife. b. Braxton Hicks contractions. c. Quickening. d. A positive pregnancy test result.

a. Fetal movement palpated by the nurse-midwife.

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

a. In a side-lying position.

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. Which finding would the nurse identify as indicating that the treatment is successful? a. Seizures do not occur. b. Diuresis reduces fluid retention. c. Blood pressure is reduced to prepregnant baseline. d. Deep tendon reflexes become hypotonic.

a. Seizures do not occur.

A nurse providing care to a woman in labor should be aware that cesarean birth: a. Is performed primarily for the benefit of the fetus. b. Can be either elected or refused by women as their absolute legal right. c. Is declining in frequency in the United States. d. Is more likely to be performed in the poor in public hospitals who do not receive the nurse counseling that wealthier clients do.

a. Is performed primarily for the benefit of the fetus.

A nurse is caring for a pregnant client in labor using tocolytic therapy. Which statement should the nurse identify as correct? a. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. b. There are no important maternal (as opposed to fetal) contraindications. c. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. d. If pulmonary edema develops while the client is receiving tocolytics, IV fluids should be given.

a. Its most important function is to afford the opportunity to administer antenatal glucocorticoids.

A nurse is reviewing barriers to prenatal care. What type of cultural concern should the nurse identify as being the most likely deterrent? a. Modesty b. Ignorance c. Belief that physicians are evil d. Religion

a. Modesty

A maternity nurse's role is to help guide a woman's acceptance of pregnancy. What information should the maternity nurse understand related to potential effects of maternal feeling as they relate to acceptance of pregnancy? a. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. b. Ambivalent feelings during pregnancy are usually seen only in emotionally immature or very young mothers. c. Nonacceptance of the pregnancy very often equates to rejection of the child. d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth.

a. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.

A client has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse s plan of care after the procedure? (Select all that apply.) Select all that apply. a. Observe the client for possible uterine contractions. b. Perform a minicatheterization to obtain a urine specimen to assess for bleeding. c. Perform ultrasound to determine fetal positioning. d. Administer RhoGAM to the client if she is Rh negative.

a. Observe the client for possible uterine contractions. d. Administer RhoGAM to the client if she is Rh negative.

A nurse is reviewing clinical diagnoses of preeclampsia and eclampsia. Which statement should the nurse be aware of? a. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain. b. Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters. c. The causes of preeclampsia and eclampsia are well documented. d. Severe preeclampsia is defined as preeclampsia plus proteinuria.

a. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain.

A client who is pregnant already has Type 2 diabetes with a hemoglobin A1c value of 7. The nurse would categorize this client as having: a. Pregestational diabetes mellitus. b. Insulin-dependent diabetes complicated by pregnancy. c. Gestational diabetes. d. Non-insulin-dependent diabetes with complications.

a. Pregestational diabetes mellitus.

A nurse is evaluating several obstetric clients for their risk for cervical insufficiency. Which client would the nurse consider to be at greatest risk? a. Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the pregnancy b. Grandmultip who has previously had all vaginal deliveries without a problem c. Multip who had her previous delivery via C section due to cephalopelvic disproportion (CPD) d. Primipara

a. Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the pregnancy

A nurse is working with a pregnant client. Which behavior if observed by the nurse indicates that a woman is "seeking safe passage" for herself and her infant? a. She keeps all prenatal appointments. b. She "eats for two." c. She wears only low-heeled shoes. d. She drives her car slowly.

a. She keeps all prenatal appointments.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding would indicate to the nurse that preterm labor is occurring? a. The cervix is effacing and dilated to 2 cm. b. Fetal fibronectin is present in vaginal secretions. c. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. d. Estriol is not found in maternal saliva.

a. The cervix is effacing and dilated to 2 cm.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. Which finding does the nurse identify? a. The lungs are mature. b. The fetus is at risk for Down syndrome. c. The woman is at high risk for developing preterm labor. d. Meconium is present in the amniotic fluid.

a. The lungs are mature. Presence of pulmonary surfactants and surface-active phospholipids help to determine fetal lung maturity

Diabetes in pregnancy puts the fetus at risk in several ways. Which statement should the nurse identify as being correct? a. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. b. At birth, the neonate of a diabetic mother is no longer in any greater risk. c. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. d. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern.

a. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

The nurse is reviewing danger signs of pregnancy with a client who is 32 weeks pregnant. What information should the nurse tell the client to observe for? a. Edema in the ankles and feet at the end of the day b. Alteration in the pattern of fetal movement c. Constipation d. Heart palpitations

b. Alteration in the pattern of fetal movement

A nurse is providing instruction for an obstetrical client to perform a daily fetal movement count (DFMC). Which instructions should the nurse include in the plan of care? (Select all that apply.) Select all that apply. a. The fetal alarm signal is reached when there are no fetal movements noted for 5 hours. b. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. c. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. d. The client can monitor fetal activity once daily for a 60-minute period and note activity.

b. Count all fetal movements in a 12-hour period daily until 10 c. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. d. The client can monitor fetal activity once daily for a 60-minute period and note activity.

A nurse is reviewing care for pregnant women. Which clinical diagnosis would the nurse identify as being the most common medical complication of pregnancy? a. Hemorrhagic complications. b. Hypertension. c. Infections. d. Hyperemesis gravidarum.

b. Hypertension.

A group of student nurses are reviewing human chorionic gonadotropin (hCG) levels as it relates to pregnancy. Which finding if observed by the student nurses would indicate a potential problem? a. Expected peak between 60 and 70 days into the pregnancy b. Increased plasma levels in correlation to expected gestational age c. Increase in levels 7 to 8 days after implantation d. Decrease in plasma levels at the end of pregnancy

b. Increased plasma levels in correlation to expected gestational age A substantial increase in plasma levels that is inconsistent with gestational age indicates presence of genetic disorders and/or malformations and as such should warrant further investigation.

A nurse is reviewing cardiovascular system changes that occur during pregnancy. Which finding would the nurse consider to be 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

An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. How should the nurse respond? a. Intercourse is safe until the third trimester. b. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present. c. Safer-sex practices should be used once the membranes rupture. d. Intercourse should be avoided if any spotting from the vagina occurs afterward.

b. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

A nurse is reviewing the complication of HELLP syndrome. Which finding should the nurse be aware of? a. It can be diagnosed by a nurse alert to its symptoms. b. Is characterized by hemolysis, elevated liver enzymes, and low platelets. c. It is a mild form of preeclampsia. d. Is associated with preterm labor but not perinatal mortality.

b. Is characterized by hemolysis, elevated liver enzymes, and low platelets.

A nurse providing care for an antepartum woman receiving a contraction stress test (CST). Which statement should the nurse identify as being accurate? a. Sometimes uses vibroacoustic stimulation. b. Is considered to have a negative result if no late decelerations are observed with the contractions. c. Is more effective than nonstress test (NST) if the membranes have already been ruptured. d. Is an invasive test; however, contractions are stimulated.

b. Is considered to have a negative result if no late decelerations are observed with the contractions.

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 to every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. What complication should the nurse suspect? a. Eclamptic seizure. b. Placental abruption. c. Placenta previa. d. Rupture of the uterus.

b. Placental abruption.

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. Which intervention would the nurse identify as being appropriate for this type of abortion? a. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month. b. Prepare the woman for an ultrasound and blood work. c. Put the woman on bed rest for at least 1 week and reevaluate. d. Prepare the woman for a dilation and curettage (D&C).

b. Prepare the woman for an ultrasound and blood work.

A maternity nurse is working with a father of a pregnant client to assist with acceptance of the pregnancy and preparation for childbirth. What should the nurse understand related to the father's role in pregnancy? a. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. b.The father goes through three phases of acceptance of his own. c. Typically men remain ambivalent about fatherhood right up to the birth of their child. d. The father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth.

b. The father goes through three phases of acceptance of his own.

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The nurse bases the anticipated plan of care for this woman as it relates to a probable diagnosis of which type of spontaneous abortion? a. Incomplete b. Threatened c. Septic d. Inevitable

b. Threatened

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool should the nurse identify as being appropriate to assess the pregnancy? a. Biophysical profile b. Transvaginal ultrasound c. Amniocentesis d. Maternal serum alpha-fetoprotein (MSAFP)

b. Transvaginal ultrasound

A nurse is providing instructions for a nonstress test (NST) to a woman who is at 36 weeks of gestation. Which statement by the client indicates a correct understanding of the nurse's instructions? a. "This test will help to determine whether the baby has Down syndrome or a neural tube defect." b. "I will need to have a full bladder for the test to be done accurately." c. "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." d. "I should have my husband drive me home after the test because I may be nauseated."

c. "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

A nurse is assessing a pregnant woman at 10 weeks of gestation who jogs three or four times per week. The client expresses concern about the effect of exercise on the fetus. How should the nurse respond? a. "You don't need to modify your exercising any time during your pregnancy." b. "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." d. "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."

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. How would the nurse document her gravidity and parity according to the GTPAL system? a. 2-1-0-1-0 b. 2-0-0-1-1 c. 3-1-0-1-0 d. 3-0-1-1-0

c. 3-1-0-1-0

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

c. Administration of blood

A nurse is reviewing assessments used to determine gestational age. When timeframe should the nurse identify as being the best to establish gestational age based on ultrasound? a. At term b. 36 weeks c. Between 14 and 22 weeks d. 8 weeks

c. Between 14 and 22 weeks

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. How should the nurse document this finding? a. Chadwick sign. b. McDonald sign. c. Hegar sign. d. Goodell sign.

c. Hegar sign. The Chadwick sign is a blue-violet cervix caused by increased vascularity; it is seen around the fourth week of gestation. Softening of the cervical tip, which may be observed around the sixth week of pregnancy, is called the Goodell sign.

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. Which complication should the nurse anticipate as the being the greatest risk for thie client? a. Thrombophlebitis. b. Infection. c. Hemorrhage. d. Urinary retention.

c. Hemorrhage.

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. Which physician order should the nurse anticipate? a. Diazepam. b. Calcium gluconate. c. Hydralazine. d. Magnesium sulfate bolus.

c. Hydralazine.

A group of nurses are discussing the strengths and limitations of various biochemical assessments during pregnancy. Which statement should the nurses indicate as correct? a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b. Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. c. MSAFP is a screening tool only; it identifies candidates for more definitive procedures. d. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects.

c. MSAFP is a screening tool only; it identifies candidates for more definitive procedures. d. Screening for maternal serum alpha-fetoprotein

A nurse is reviewing the concept of fetal growth. Which finding should the nurse identify as being within normal range of development? a. Lungs take shape by 8 weeks. b. Heart starts beating at 12 weeks. c. Main blood vessels form by 8 weeks. d. Brain configuration is complete by 8 weeks.

c. Main blood vessels form by 8 weeks. Heart starts beating at 4 weeks, lungs at 12, and brain at 12

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. What does the nurse identify as the primary goal of her treatment? a. Restore the woman's ability to take and retain oral fluid and foods. b. Reduce emotional distress by encouraging the woman to discuss her feelings. c. Reverse fluid, electrolyte, and acid-base imbalances. d. Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours.

c. Reverse fluid, electrolyte, and acid-base imbalances.

Which information should the nurse provide to the woman who wants to have a nurse-midwife provide obstetric care? a. She will have to give birth at home. b. She must see an obstetrician as well as the midwife during pregnancy. c. She must be having a low-risk pregnancy. d. She will not be able to have epidural analgesia for labor pain.

c. She must be having a low-risk pregnancy.

A pregnant woman at 21 weeks of gestation has an elevated blood pressure of 140/98. Past medical history reveals that the woman has been treated for hypertension. On the basis of this information, the nurse would classify this client as having: a. Gestational hypertension. b. Chronic hypertension. c. Superimposed preeclampsia. d. Preeclampsia.

c. Superimposed preeclampsia

A group of student nurses are reiviewing length for a normal pregnancy. Which time span should the student nurse identify as being appropriate? a. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days b. 9 calendar months, 10 lunar months, 42 weeks, 294 days c. 9 calendar months, 38 weeks, 266 days d. 10 lunar months, 9 calendar months, 40 weeks, 280 days

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

A nurse is monitoring lab results for a client in the third trimester of pregancy. Which hematocrit (HCT) and hemoglobin (HGB) results should the nurse identify as being the lowest acceptable value? a. 32% HCT; 10.5 g/dL HGB b. 35% HCT; 13 g/dL HGB c. 38% HCT; 14 g/dL HGB d. 33% HCT; 11 g/dL HGB

d. 33% HCT; 11 g/dL HGB

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. Which assessment finding if observed by the nurse would indicate a concern? a. Deep tendon reflexes of 2+. b. A sleepy, sedated affect. c. Absence of ankle clonus. d. A respiratory rate of 10 breaths/min.

d. A respiratory rate of 10 breaths/min.

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. Amount of insulin required prenatally. c. Number of years since diabetes was diagnosed. d. Degree of glycemic control during pregnancy.

d. Degree of glycemic control during pregnancy.

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 the nurse identify as being another tool to help confirm the diagnosis? a. Daily fetal movement counts b. Amniocentesis c. Contraction stress test (CST) d. Doppler blood flow analysis

d. Doppler blood flow analysis

A nurse is reviewing categories of high risk pregnancy. Which of the options listed here should the nurse not include? a. Psychosocial b. Environmental c. Biophysical d. Geographic

d. Geographic

A nurse is reviewing clinical manifestations between abruptio placentae and placenta previa. Which finding should the nurse identifying as being the most significant difference between the two? a. Cramping. b. Bleeding. c. Uterine activity. d. Intense abdominal pain.

d. Intense abdominal pain.

A nurse is reviewing physiological concepts related to amniotic fluid. Which statement should the nurse identify as being accurate? a. A volume of more than 2 L is associated with fetal renal abnormalities. 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. It serves as a source of oral fluid and as a repository for waste from the fetus.

d. It serves as a source of oral fluid and as a repository for waste from the fetus.

A nurse is reviewing lab results for a client diagnosed with preeclampsia. Which laboratory values would the nurse expect to be present? (Select all that apply.) Select all that apply. a. Hemoglobin 8g/dL c. Burr cells d. LDH 100 units/L c. Platelet count of 75,000 e. BUN 25 mg/dL

d. LDH 100 units/L c. Platelet count of 75,000 e. BUN 25 mg/dL

A nurse is reviewing clinical indications for a contraction stress test(CST). What should the nurse identify as being an appropriate indicator for this test? a. History of preterm labor and intrauterine growth restriction b. Adolescent pregnancy and poor prenatal care c. Increased fetal movement and small for gestational age d. Maternal diabetes mellitus and postmaturity

d. Maternal diabetes mellitus and postmaturity Decreased fetal movement, Intrauterine growth restriction are indicators; history of a previous stillbirth, not preterm labor, is another indicator.

A nurse is assessing a client at 42 weeks of gestation. Which finding, if noted by the nurse requires more assessment? a. Cervix dilated 2 cm and 50% effaced b. Score of 8 on the biophysical profile c. Fetal heart rate of 116 beats/min d. One fetal movement noted in 1 hour of assessment by the mother

d. One fetal movement noted in 1 hour of assessment by the mother

A nurse is monitoring a client's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding if observed by the nurse would indicate a cause for concern? a. DTRs response has been noted at 1+ since onset of therapy b. Client reports no pain upon examination of DTRs by nurse c. Bilateral DTRs noted at 2+ d. Positive clonus response elicited unilaterally

d. Positive clonus response elicited unilaterally

A pregnant client is experiencing some integumentary changes and is concerned that they may represent abnormal findings. Which of the following findings should the nurse provide to the client that would be considered "normal abnormal" findings during pregnancy so that she should not be alarmed? (Select all that apply.) Select all that apply. a. Superficial thrombophlebitis b. Facial edema c. Allodynia d. Vascular spiders e. Melasma f. Linea nigra

d. Vascular spiders e. Melasma f. Linea nigra