Module 1 Ch 12-15

2. Low-income women may have deficient diets because of lack of financial resources and nutritional education. Simple carbohydrate foods are less expensive than other, more nutritious foods items. The diet may be high in calories but low in vitamins and minerals. A referral to ___________ may be helpful.

ANS: WIC The WIC program is administered by the USDA to provide nutritional assessment, counseling, and education to low-income women and children up to age 5 years who are at nutritional risk. The program also provides food vouchers for items such as milk, cheese, eggs, fruits, vegetables and whole grains. Eligibility is based on an income of 185% of the federal property level or less. Women are eligible for WIC during pregnancy and for 6 months after if formula feeding and for one year if breast-feeding.

1. While providing care to a patient early in pregnancy, the nurse learns that the patient consumes alcohol almost daily. Drinking alcohol during pregnancy has been associated with a condition known as _______________________ in the infant and should be avoided.

ANS: fetal alcohol syndrome Alcohol interferes with the absorption and use of protein, thiamine, folic acid, and zinc. It also impairs metabolism and often takes the place of food in the mother's diet. Vitamin and mineral supplementation is usually necessary for women who consumed alcohol before pregnancy because nutrient stores may be depleted.

1. A woman who is 36 weeks pregnant reports to the labor and delivery triage area expressing concerns that her baby "is not moving." Along with a nonstress test (NST) the nurse might also use ______________ to determine fetal well-being.

ANS: vibroacoustic stimulation Also referred to as VAS or acoustic stimulation, the vibroacoustic stimulator (similar to an electronic larynx) is applied to the maternal abdomen over the area of the fetal head. Vibration and sound are emitted for up to 3 seconds and may be repeated. A fetus near term responds by increasing the number of gross body movements, which can be easily seen and felt. The procedure can confirm reassuring NST findings and shorten the length of time necessary to obtain NST data.

23. Which nutritional recommendation about fluids is accurate? a. A woman's daily intake should be 8-10 cups b. Coffee should be limited to no more than 2 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 Feedback A 8-10 cups is the standard for fluids; however, they should be the right fluids. B All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or should be drunk only in limited amounts. C Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria (PKU) should avoid aspartame. D No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay. However, it still helps the mother.

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

11. 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 Feedback 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. B Yellow vegetables are rich in vitamin A. C Lean meats are rich in protein and phosphorus. D Whole grains are rich in zinc and magnesium.

18. Prenatal testing for the human immunodeficiency virus (HIV) is recommended for which women? a. All women, regardless of risk factors b. A woman who has had more than one sexual partner c. A woman who has had a sexually transmitted infection d. A woman who is monogamous with her partner

ANS: A Feedback A An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. B All women should be tested for HIV, although this patient is at increased risk of contracting the disease. C Regardless of past sexual history, all women should have an HIV test completed prenatally. D Although this patient is apparently monogamous, an HIV test is still recommended.

1. A pregnant woman's mother is worried that her daughter is not "big enough" at 20 weeks. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. What should the nurse report to the woman and her mother? a. "The body of the uterus is at the belly button level, just where it should be at this time." b. "You're right. We'll inform the practitioner immediately." c. "When you come for next month's appointment, we'll check you again to make sure that the baby is growing." d. "Lightening has occurred, so the fundal height is lower than expected."

ANS: A Feedback A At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks of gestation is located at the level of the umbilicus. B This is incorrect information. At 20 weeks the uterus should be at the umbilical level. C By avoiding the direction question, this might increase the anxiety of both the mother and grandmother. D The descent of the fetal head (lightening) occurs in late pregnancy.

22. A gravida patient at 32 weeks of gestation reports that she has severe lower back pain. The nurse's assessment should include a. Observation of posture and body mechanics b. Palpation of the lumbar spine c. Exercise pattern and duration d. Ability to sleep for at least 6 hours uninterrupted

ANS: A Feedback A Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis. B Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in the pregnancy. C Certain exercises can help relieve back pain. D Rest is important for well-being, but the main concern with back pain is to assess posture and body mechanics.

3. The nurse providing care for the pregnant woman understands that a factor indicating the need for fetal diagnostic procedures is a. Maternal diabetes b. Maternal age older than 30 years c. Previous infant more than 3000 g at birth d. Weight gain of 25 pounds

ANS: A Feedback A Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion. B A maternal age greater than 35 years is an indication for testing. C Having had another infant weighing greater than 4000 g at birth is an indication for testing. D Excessive weight gain is an indication for testing. Normal weight gain is 15 to 35 pounds.

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

17. A patient notices that the doctor writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. The nurse's best response is a. "It refers to the bluish color of the cervix in pregnancy." b. "It means the cervix is softening." c. "The doctor was able to flex the uterus against the cervix." d. "That refers to a positive sign of pregnancy."

ANS: A Feedback A Increased vascularity of the pelvic organs during pregnancy results in the bluish color of the cervix, vagina, and labia, called Chadwick's sign. B Softening of the cervix is Goodell's sign. C The softening of the lower segment of the uterus (Hegar's sign) can allow the uterus to be flexed against the cervix. D Chadwick's sign is a probable indication of pregnancy.

2. 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 Feedback 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. B The L/S ratio is used to determine fetal lung maturity. C A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. D The blood type and crossmatch will not predict chromosomal defects in the fetus.

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

22. After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so that 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 Feedback 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. B Iron intake prevents anemia. C Calcium intake is needed for fetal bone and tooth development. D Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

1. Which part of the mature sperm contains the male chromosomes? a. The head of the sperm b. The middle portion of the sperm c. X-bearing sperm d. The tail of the sperm

ANS: A Feedback A The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. B The middle portion of the sperm supplies energy for the tail's whip-like action. C If an X-bearing sperm fertilizes the ovum, the baby will be female. D The tail of the sperm helps propel the sperm toward the ovum.

20. The various systems and organs develop at different stages. Which statement is accurate? a. The cardiovascular system is the first organ system to function in the developing human. b. Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks. c. The body changes from straight to C-shaped at 8 weeks. d. The gastrointestinal system is mature at 32 weeks.

ANS: A Feedback A The heart is developmentally complete by the end of the embryonic stage. B Hematopoiesis begins in the liver during the 6th week. C The body becomes C-shaped at 21 weeks. D The gastrointestinal system is complete at 36 weeks.

17. The recommended diet for pregnancy differs from the recommended diet for lactation, because a. Lactating women require more calories and protein. b. Pregnant women need more calcium. c. Lactating women require fewer vitamins. d. Pregnant women require more iron and protein.

ANS: A Feedback A The lactating woman needs 200 calories and 5 g of protein more than the pregnant woman. B Calcium needs are the same for pregnancy and lactation. C Vitamin needs are higher during pregnancy and lactation. D Protein requirements are higher during lactation.

20. The multiple marker screen is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A Feedback A The maternal serum level of alpha-fetoprotein is used to screen for Trisomy 18 or 21, neural tube defects, and other chromosomal anomalies. B The quadruple marker test does not detect this fetal anomaly. Additional testing, such as ultrasonography would be required to diagnose diaphragmatic hernia. C Congenital cardiac abnormality would most likely be identified during an ultrasound examination. D The quadruple marker test would not detect anencephaly.

1. 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 Feedback 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. B Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. C This score is within normal range, and no further testing is required at this time. D The results of the biophysical profile are usually available immediately after the procedure is performed.

2. One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered within normal limits? a. Two arteries and one vein b. Two arteries and two veins c. Two veins and one artery d. One artery and one vein

ANS: A Feedback A The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. B This option is abnormal and may indicate other anomalies. C Any option other than two arteries and one vein is considered abnormal and requires further assessment. D The presence of one umbilical artery is considered an abnormal finding. This infant would require further assessment for other anomalies.

1. Congenital disorders refer to those 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 be knowledgeable regarding known human teratogens, which include (select all that apply) a. Infections b. Radiation c. Maternal conditions d. Drugs e. Chemicals

ANS: A, B, C, D Feedback Correct Exposure to radiation and a number of infections may result in profound congenital deformities. These include varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and PKU 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. Incorrect Coffee is not considered a teratogen.

1. Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week-gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be necessary to determine which of the following? Select all that apply. a. Multifetal gestation b. Bicornate uterus c. Presence and location of pregnancy (intrauterine or elsewhere) d. Amniotic fluid volume e. Presence of ovarian cysts

ANS: A, B, C, E Feedback Correct All of these conditions can be determined by transvaginal ultrasound in the first trimester of pregnancy. This procedure is also used for estimating gestational age, confirming fetal viability, identifying fetal abnormalities or chromosomal defects, and identifying the maternal abnormalities mentioned, as well as fibroids. Incorrect Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.

2. 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 Feedback Correct 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 a number of growth factors. Incorrect 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.

2. Percutaneous umbilical cord sampling (PUBS), also called cordocentesis, involves the aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy. Major indications include (select all that apply) a. Rh disease b. Fetal well-being c. Infection d. Lung maturity e. Karyotyping

ANS: A, C, E Feedback Correct These are all indications for PUBS. Another indication is for diagnosis or disorders that require fetal blood for testing. Although used to develop a karyotype (chromosome evaluation) other DNA analysis techniques might also be utilized. Incorrect NST or BPP are used to determination fetal well-being. An amniocentesis is done in order to determine lung maturity.

8. The breastfeeding woman whose recommended prepregnant caloric intake was 2000 calories per day needs how many calories per day to meet her current needs? a. 2300 b. 2500 c. 2750 d. 3000

ANS: B Feedback A 2300 calories is not enough calories to meet her needs. B The increase for a breastfeeding mother is 500 calories above her recommended prepregnant caloric intake. C 2750 calories may be too many calories and may lead to weight gain. D 3000 calories is too many for this mother and will lead to weight gain.

13. Which pregnant adolescent is most at risk for a nutritional deficit during pregnancy? a. A 15-year-old of normal height and weight b. A 17-year-old who is 10 pounds underweight c. A 16-year-old who is 10 pounds overweight d. A 16-year-old of normal height and weight

ANS: B Feedback A A 15-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency. B The adolescent who is pregnant and underweight is most at risk, because she is already deficient in nutrition and must now supply the nutritional intake for both herself and her fetus. C An overweight pregnant teen is at risk for deficiency, but is not at the highest risk. Being underweight is the most risky because she is already deficient. D A 16-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency.

13. A woman's last menstrual period was June 10. Her estimated date of delivery (EDD) is a. April 7 b. March 17 c. March 27 d. April 17

ANS: B Feedback A April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days. B To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17). C March is the correct month, but instead of adding 7 days, 17 days were added. D April 17 is subtracting 2 months instead of 3 months.

7. A woman is 16 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, but you can't feel it yet." d. "Some babies are quiet, and you don't feel them move."

ANS: B Feedback A Because this is her first pregnancy, movement is felt toward the later part of the 17 to 20 weeks. This statement may be alarming to the woman. B Maternal perception of fetal movement usually begins 17 to 20 weeks after conception. C This is a true statement. The fetus's movements are not strong enough to be felt until 17 to 20 weeks; however, this statement does not answer the concern of the woman. D Fetal movement should be felt by 17 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary.

9. A number of cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman during pregnancy? a. Cardiac output rises by 25% b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production

ANS: B Feedback A Cardiac output increases by 50% with half of this rise occurring in the first 8 weeks gestation. B The pulse increases about 15 to 20 beats/min, which persists to term. C In the first trimester, blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. D Production of RBCs accelerates during pregnancy.

16. 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 Feedback A Changes in the diet should be kept at a minimum, and snacks should be included. Snack foods can be in included in moderation and other foods added to make up for the lost nutrients. 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. C Eliminating fast foods will make her appear different to her peers. She should be taught to choose foods that add needed nutrients. D Adolescents are willing to make changes; however, they still have the need to be like their peers.

9. 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 Feedback A Excessive adipose tissue may occur with excess weight gain, but it is not the reason for monitoring the weight gain pattern. B Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. C It is important to monitor the pattern of weight gain for developing complications. D The pattern of weight gain is not influenced by cultural influences.

6. Which statement related to changes in the breasts during pregnancy is the most accurate? a. During the early weeks of pregnancy there is decreased sensitivity. b. Nipples and areolae become more pigmented. c. Montgomery tubercles are no longer visible around the nipples. d. Venous congestion of the breasts is more visible in the multiparous woman.

ANS: B Feedback A Fullness, heightened sensitivity, tingling and heaviness of the breasts occur in the early weeks of gestation in response to increased levels of estrogen and progesterone. B Nipples and areolae become more pigmented, and the nipples become more erectile and may express colostrum. C Montgomery tubercles may be seen around the nipples. These sebaceous glands may have a protective role in that they keep the nipples lubricated for breastfeeding. D Venous congestion in the breasts is more obvious in primigravidas.

15. A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

ANS: B Feedback A Gastric motility decreases during pregnancy. B Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. C Glucose levels decrease in the first trimester. D Gastric secretions do decrease, but this is not the main cause of nausea and vomiting.

5. The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine if the fetus has a. Hemophilia b. A neural tube defect c. Sickle cell anemia d. A normal lecithin/sphingomyelin (L/S) ratio

ANS: B Feedback A Hemophilia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. B An open neural tube allows a high level of AFP to seep into the amniotic fluid and enter the maternal serum. C Sickle cell is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. D L/S ratios are determined with an amniocentesis and is usually done in the third trimester.

25. Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish will adequately supply the recommended amount of protein for the 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 patient in determining which fish is safe to consume includes a. Canned white tuna as a preferred choice b. Avoiding shark, swordfish, and mackerel c. Treating fish caught in local waterways as the safest d. Avoiding high levels of mercury in salmon and shrimp

ANS: B Feedback A High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the patient in understanding the differences between numerous sources of this product. A pregnant patient can eat as much as 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. B As a precaution the pregnant patient should avoid eating all of these as well as the less common tilefish. C This is a common misconception. 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. D Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish. The pregnant patient may eat up to 12 ounces per week.

5. The upper uterus is the best place for the fertilized ovum to implant because it is here that the a. Placenta attaches most firmly b. Developing baby is best nourished c. Uterine endometrium is softer d. Maternal blood flow is lower

ANS: B Feedback A If the placenta attaches too deeply, it does not easily detach after birth. B The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimal nourishment of the fetus. C Softness is not a concern with implantation; attachment and nourishment are the major concerns. D The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus.

10. Physiologic anemia often occurs during pregnancy as a result of a. Inadequate intake of iron b. Dilution of hemoglobin concentration c. The fetus establishing iron stores d. Decreased production of erythrocytes

ANS: B Feedback A Inadequate intake of iron may lead to true anemia. B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. C If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. D There is an increased production of erythrocytes during pregnancy.

21. To prevent GI upset, patients 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 Feedback A Iron supplements are best absorbed if they are taken when the stomach is empty. B Taking iron supplements at bedtime may reduce GI upset. C Iron supplements are best absorbed if they are taken when the stomach is empty. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals. D 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.

12. A patient is sent from the physician's office for assessment because of too little amniotic fluid. The nurse is aware that oligohydramnios can result in a. Excessive fetal urine secretion b. Newborn respiratory distress c. Central nervous system abnormality d. Gastrointestinal blockage

ANS: B Feedback A Oligohydramnios may be caused by a decreased in urine secretion. B Because an abnormally small amount of amniotic fluid restricts normal lung development, the infant may have inadequate respiratory function after birth, when the placenta no longer performs respiratory function. C Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality. D Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid.

14. Oogenesis, the process of egg formation, begins during fetal life in the female. Which statement related to ovum formation is correct? a. Two million primary oocytes will mature. b. At birth, all ova are contained in the female's ovaries. c. The oocytes complete their division during fetal life. d. Monthly, at least two oocytes mature.

ANS: B Feedback A Only 400 to 500 ova will mature during the approximately 35 years of a woman's reproductive life. B All of the cells that may undergo meiosis in a woman's lifetime are contained in the ovaries at birth. C The primary oocytes begin their first meiotic division during fetal life but remain suspended until puberty. D Every month, one primary oocyte matures and completes meiotic division yielding two unequal cells.

8. The maternity nurse understands that vascular volume increases 40% to 60% during pregnancy to a. Compensate for decreased renal plasma flow. b. Provide adequate perfusion of the placenta. c. Eliminate metabolic wastes of the mother. d. Prevent maternal and fetal dehydration.

ANS: B Feedback A Renal plasma flow increases during pregnancy. B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. C Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. D This is not the primary reason for the increase in volume.

21. Which complaint by a patient at 35 weeks of gestation requires additional assessment? a. Shortness of breath when climbing stairs b. Abdominal pain c. Ankle edema in the afternoon d. Backache with prolonged standing

ANS: B Feedback A Shortness of breath is an expected finding by 35 weeks. B Abdominal pain may indicate preterm labor or placental abruption. C Ankle edema in the afternoon is a normal finding at this stage of pregnancy. D Backaches while standing is a normal finding during the later stages of pregnancy.

13. The purpose of initiating contractions in a CST is to a. Determine the degree of fetal activity. b. Apply a stressful stimulus to the fetus. c. Identifying fetal acceleration patterns. d. Increase placental blood flow.

ANS: B Feedback A The NST and biophysical profiles look at fetal movements. B The CST involves recording the response of the FHR to stress induced by uterine contractions. C The NST looks at fetal heart accelerations with fetal movements. D The CST records the fetal response to stress. It does not increase placental blood flow.

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

4. Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria in the urine d. Ketones in the urine

ANS: B Feedback A The presence of protein could indicate kidney disease or preeclampsia. B Small amounts of glucose may indicate "physiologic spilling." C Urinary tract infections are associated with bacteria in the urine. D An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

15. A patient who is in week 28 of gestation is concerned about her weight gain of 17 lb. The nurse's best response is a. "You should try to decrease your amount of weight gain for the next 12 weeks." b. "You have gained an appropriate amount for the number of weeks of your pregnancy." c. "You should not gain any more weight until you reach the third trimester." d. "You have not gained enough weight for the number of weeks of your pregnancy."

ANS: B Feedback A The woman has gained the appropriate amount of weight. It would be inappropriate to have her decrease her weight gain. B A woman in her 28th week of gestation should have gained between 17 and 20 lb. The normal pattern of weight gain is 2 to 3 lb total in the first trimester (by 13 weeks) and 1 lb per week after that. C Weight gain needs to be consistent during the last part of the pregnancy and should not be suppressed. D She has gained an appropriate amount of weight and should not increase the weight gain.

9. 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 a soapsuds enema. d. Perform an abdominal prep.

ANS: B Feedback A The woman needs a full bladder in order to elevate the uterus; therefore being NPO is not appropriate. 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. C A soapsuds enema is not necessary for this procedure. D An abdominal prep is not necessary for this procedure.

15. In many settings, nurses may perform nonstress tests (NST), conduct an initial assessment of the woman and begin necessary interventions for nonreassuring results. These nursing procedures are accomplished after additional education and training under established protocols. Which nursing action is necessary when preparing the patient for the NST? a. Position the woman on her left side. b. Be certain that the woman is seated comfortably in a reclining chair. c. Encourage the woman to drink one liter of water prior to the test. d. Place conduction gel on the woman's abdomen with one belt.

ANS: B Feedback A The woman should be seating in a reclining chair or in semi-Fowler position if on a bed or stretcher. B To correctly position the pregnant patient for an NST, the nurse should place the woman in a reclining chair or in semi-Fowler position with a lateral tilt. will optimize uterine perfusion and prevent supine hypotension. C This is the appropriate preparation for abdominal ultrasonography. Caregivers sometimes suggest that the women drink juice in order to increase her glucose level and stimulate fetal movement. Although this practice is common, research has not proven it effective. D Conduction gel should be applied along with two belts. One belt has a Doppler transducer to detect the fetal heart rate. The other belt has a tocodynamometer to detect fetal movement or uterine contractions.

20. Which statement made by a lactating woman leads 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 Feedback A The woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn. B 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 in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. C A woman who breaks out in hives after consuming milk is more likely to have a milk allergy. D This woman should be advise to simply brush her teeth after consuming dairy products.

10. 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 approximately 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 Feedback A This is a true statement, but the external genitalia are similar in appearance until approximately the 12th week. B Although gender is determined at conception, the external genitalia of males and females look similar through the 9th week. By the 12th week, the external genitalia are distinguishable as male or female. C The external genitalia are similar in appearance until approximately 12 weeks, not 20 weeks. D The external genitalia are different at approximately week 12.

1. Eating disorders include anorexia nervosa and bulimia. Many women with anorexia have amenorrhea and do not become pregnant where as women with bulimia or subclinical anorexia may become pregnant. These condition conditions are associated with (select all that apply) a. Food cravings b. Low birth weight c. Food aversions d. Electrolyte imbalance e. Small for gestational age infants

ANS: B, D, E Feedback Correct These conditions are associated with electrolyte imbalance, low birth weight, and small for gestational age infants. All women should be asked about eating disorders and nurses should watch for behaviors that may indicate disordered eating. Some women eat normally during pregnancy for the sake of the fetus, but others continue their previous dysfunctional eating patterns during pregnancy or in the early postpartum period. Incorrect Food cravings and aversions are normal for most women during pregnancy. Women may have a strong preference or strong dislike for certain foods. They're generally not harmful, and some, like aversion to alcohol, may be beneficial.

10. 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. 26 d. 30

ANS: C Feedback A 5 g will not be enough to meet her protein needs during pregnancy. B 10 g will not be enough extra protein to meet her needs during pregnancy. C The recommended intake of protein for the pregnant woman is 71 g. D 30 g is more than is necessary and will add extra calories.

8. During a centering pregnancy group meeting, the nurse teaches patients that the fetal period is best described as one of a. Development of basic organ systems b. Resistance of organs to damage from external agents c. Maturation of organ systems d. Development of placental oxygen-carbon dioxide exchange

ANS: C Feedback A Basic organ systems are developed during the embryonic period. B The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant the organs will be. The greatest risk is when the organs are developing. C During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. D The placental system is complete by week 12, but that is not the best description of the fetal period.

12. A woman is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Her gravida and para are a. Gravida 3 para 2 b. Gravida 4 para 3 c. Gravida 4 para 2 d. Gravida 3 para 3

ANS: C Feedback A Because she is currently pregnant, she is classified as a gravida 4; the pregnancy that was terminated at 8 weeks is classified as an abortion. B Gravida 4 is correct, but she is a para 2. The pregnancy that was terminated at 8 weeks is classified as an abortion. C She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion. D Since she is currently pregnant, she is classified as a gravida 4, not a 3. The para is correct.

7. Alterations in hormonal balance and mechanical stretching are responsible for several changes in the integumentary system during pregnancy. Stretch marks often occur on the abdomen and breasts. These are referred to as a. Chloasma b. Linea nigra c. Striae gravidarum d. Angiomas

ANS: C Feedback A Chloasma is a facial melasma also known as the "mask of pregnancy." This condition is manifested by a blotchy, hyperpigmentation of the skin over the cheeks, nose and forehead especially in dark complexioned women. B Linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus in the midline. C Striae gravidarum or stretch marks appear in 50% to 90% of pregnant women during the second half of pregnancy. They most often occur on the breasts and abdomen. This integumentary alteration is the result of separation within the underlying connective (collagen) tissue. D Angiomas and other changes also may appear.

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

ANS: C Feedback A Depending upon the woman's food choices this diet may be adequate in calcium. B Protein needs can be sufficiently met by a vegetarian diet. 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. D The nurse should be more concerned with the woman's intake of vitamin B12 due to her dietary restrictions. Folic acid needs can be met by enriched bread products.

14. A woman in her first trimester of pregnancy can expect to visit her physician every 4 weeks so that a. She develops trust in the health care team. b. Her questions about labor can be answered. c. The condition of the expectant mother and fetus can be monitored. d. Problems can be eliminated.

ANS: C Feedback A Developing a trusting relationship should be established during these visits, but that is not the primary reason. B Most women do not have questions concerning labor until the last trimester of the pregnancy. C This routine allows monitoring of maternal health and fetal growth and ensures that problems will be identified early. D All problems cannot be eliminated because of prenatal visits, but they can be identified.

16. One of the most effective methods for preventing venous stasis is to a. Wear elastic stockings in the afternoons. b. Sleep with the foot of the bed elevated. c. Rest often with the feet elevated. d. Sit with the legs crossed.

ANS: C Feedback A Elastic stockings should be applied before lowering the legs in the morning. B Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. C Elevating the feet and legs improves venous return and prevents venous stasis. D Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis.

11. What is the purpose of amniocentesis for the patient hospitalized at 34 weeks with pregnancy-induced hypertension? a. Identification of abnormal fetal cells b. Detection of metabolic disorders c. Determination of fetal lung maturity d. Identification of sex of the fetus

ANS: C Feedback A Identification of abnormal cells is done during the early portion of the pregnancy. B The test is done in the early portion of the pregnancy if the metabolic disorder is genetic. C During the third trimester, amniocentesis is most often performed to determine fetal lung maturity. In pregnancy-induced hypertension, preterm delivery may be necessary because of changes in placental perfusion. D Amniocentesis is done early in the pregnancy to do genetic studies and determine the sex.

5. Which suggestion is appropriate for the pregnant woman who is experiencing nausea and vomiting? a. Eat only three meals a day so the stomach is empty between meals. b. Drink plenty of fluids with each meal. c. Eat dry crackers or toast before arising in the morning. d. Drink coffee or orange juice immediately on arising in the morning.

ANS: C Feedback A Instruct the woman to eat five to six small meals rather than three full meals per day. Nausea is more intense when the stomach is empty. B Fluids should be taken separately from meals. Fluids overstretch the stomach and may precipitate vomiting. C This will assist with the symptoms of morning sickness. It is also important for the woman to arise slowly. D Coffee and orange juice stimulate acid formation in the stomach. It is best to suggest eating dry carbohydrates when rising in the morning.

6. While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling can be performed during pregnancy as early as _____ weeks. a. 4 b. 8 c. 10 d. 12

ANS: C Feedback A It is too early to perform this test at 4 weeks. B It is too early to perform this test at 8 weeks. C Fetal villus tissue can be obtained as early as 10 weeks of gestation and analyzed directly for chromosomal or genetic abnormalities. D The test should be performed at 13 weeks, but it can be done as early as 10 weeks.

3. The purpose of the ovum's zona pellucida is to a. Make a pathway for more than one sperm to reach the ovum. b. Allow the 46 chromosomes from each gamete to merge. c. Prevent multiple sperm from fertilizing the ovum. d. Stimulate the ovum to begin mitotic cell division.

ANS: C Feedback A Once one sperm has entered the ovum, the zona pellucida changes to prevent other sperm from entering. B Each gamete (sperm and ovum) has only 23 chromosomes. There will be 46 chromosomes when they merge. C Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. D Mitotic cell division begins when the nuclei of the sperm and ovum unite.

19. To relieve a leg cramp, the patient should be instructed to a. Massage the affected muscle. b. Stretch and point the toe. c. Dorsiflex the foot. d. Apply a warm pack.

ANS: C Feedback A Since she is prone to blood clots in the legs, massaging the affected leg muscle is contraindicated. B Pointing the toes will contract the muscle and not relieve the pain. C Dorsiflexion of the foot stretches the leg muscle and relieves the painful muscle contraction. D Warm packs can be used to relax the muscle, but more immediate relief is necessary, such as dorsiflexion of the foot.

3. To increase the absorption of iron in a pregnant woman, the iron preparation should be given with a. Milk b. Tea c. Orange juice d. Coffee

ANS: C Feedback A The calcium and phosphorus in milk decrease iron absorption. B Tannin in the tea reduces the absorption of iron. C A vitamin C source may increase the absorption of iron. D A decreased intake of caffeine is recommended in pregnancy.

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

7. The nurse's role in diagnostic testing is to provide a. Advice to the couple b. Assistance with decision-making c. Information about the tests d. Reassurance about fetal safety

ANS: C Feedback A The nurse's role is to inform, not to advise. B Decision making should always lie with the couple involved. The nurse should provide information so that the couple can make an informed decision. C The nurse should provide the couple with all necessary information about a procedure so that the couple can make an informed decision. D Ensuring fetal safety is not possible with all of the diagnostic testing. To offer this is to give false reassurance to the parents. The nurse can inform the couple about potential problems so they can make an informed decision.

16. 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 Feedback A These milestones would not be completed by 20 weeks of gestation. B These milestones in human development will not be completed at 24 weeks of gestation. C These are all milestones that occur at 28 weeks. D These specific milestones will be reached as early as 28 weeks, not 30 weeks of gestation.

14. Which response by the nurse is most appropriate to this statement: "This test isn't my idea, but my husband insists"? a. "Don't worry. Everything will be fine." b. "Why don't you want to have this test?" c. "You're concerned about having this test?" d. "It's your decision."

ANS: C Feedback A This is false reassurance and does not deal with the concerns expressed by the woman. B The woman may not be able to answer "why" questions. It may also make her defensive. C The nurse should clarify the statement and assist the patient in exploring her feelings about the test. D This is a closed statement and does not encourage the woman to express her feelings.

7. 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 Feedback A This is termed lactose intolerance. B Pica may produce iron deficiency anemia if proper nutrition is decreased. 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. D Pica is not related to anorexia and vomiting.

17. Ultrasonography is an important and safe technique used in antepartum surveillance. It provides critical information related to fetal activity, gestational age and fetal well-being. Which statement regarding ultrasonography during pregnancy is most accurate? a. Ultrasonography uses infrared technology to create an image. b. Ultrasonography is only utilized as an adjunct to more invasive tests. c. Ultrasonography is not harmful to the fetus. d. Ultrasonography is not a component of biophysical profile testing.

ANS: C Feedback A Ultrasonography uses sound waves to create an image. B As an adjunct to more invasive tests, ultrasonography can provide visual guidance for increased safety. It can be done as a standalone test. C Most women look forward to the results of this test, which causes no harm to the fetus. D Ultrasonography is a component of biophysical profile testing.

4. Health teaching during routine prenatal care includes providing patients with the recommended weight gain during pregnancy. For a woman with a single fetus who begins pregnancy at a normal weight, this amount is _____ lb. a. 10 to 15 b. 15 to 20 c. 37 to 50 d. 28 to 40

ANS: D Feedback A A 10-lb weight gain is not sufficient to meet the needs of the pregnancy. B A 15- to 20-lb weight gain is recommended for women who are overweight before the pregnancy. C A 37- to 50-lb weight gain is recommended for women who are carrying twins. When women with a multifetal pregnancy gain the recommended amount of weight, they are less likely to deliver prior to 32 weeks and infants are more likely to weigh more than 2500 gm. D A weight gain of 28 to 40 lb is believed to reduce intrauterine growth retardation that may result from inadequate nutrition and also allows variations in individual needs. No precise weight gain is appropriate for every woman.

1. 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 Feedback A A higher weight gain in twin gestations may help prevent low birth weights. B Adolescents need to gain weight toward the higher acceptable range, which will provide for their own growth as well as for fetal growth. C In the past women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found. 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 prior to conception in order to achieve the best pregnancy outcomes.

12. An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed a. Nonreactive b. Positive c. Negative d. Reactive

ANS: D Feedback A A nonreactive result means that the heart rate did not accelerate during fetal movement. B A positive result is not used with an NST. The CST uses positive as a result term. C A negative result is not used with an NST. The CST uses negative as a result term. D The NST is reactive (normal) when two or more FHR accelerations of at least 15 bpm (each with a duration of at least 15 seconds) occur in a 20-minute period.

13. When explaining twin conception, the nurse points out that dizygotic twins develop from a. A single fertilized ovum and are always of the same sex b. A single fertilized ovum and may be the same sex or different sexes c. Two fertilized ova and are the same sex d. Two fertilized ova and may be the same sex or different sexes

ANS: D Feedback A A single fertilized ovum that produces twins is called monozygotic. B Monozygotic twins are always the same sex. C Dizygotic twins are from two fertilized ova and may or may not be the same sex. D Dizygotic twins are two different zygotes, each conceived from a single ovum and a single sperm. They may be both male, both female, or one male and one female.

8. Which diagnostic test evaluates the effect of fetal movement on fetal heart activity? a. Contraction stress test (CST) b. Sonography c. Biophysical profile d. Nonstress test (NST)

ANS: D Feedback A CST evaluates the fetal reaction to contractions. B Sonographic examinations visualize the fetus and are done for various reasons. C The biophysical profile evaluates fetal status using many variables. D An NST evaluates the ability of the fetal heart to accelerate either spontaneously or in association with fetal movement.

16. Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended between 10 and 12 weeks of gestation in order to give parents time to consider options. c. Percutaneous umbilical blood sampling (PUBS) is one of the multiple marker screen tests for Down syndrome. d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

ANS: D Feedback A CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. B MSAFP screening is recommended for all pregnant women. C Screening is recommended between 15 and 20 weeks of gestation. Abnormal findings give parents time to have additional tests done. D This is correct, MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.

5. 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 Feedback A Chicken is an excellent source of protein, but it is poor in folates. B Cheese is an excellent source of calcium, but it is poor in folates. C Potatoes contain carbohydrates and vitamins and minerals, but are poor in folates. D Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans.

4. When is the best time to determine gestational age based on biparietal diameter through ultrasound? a. 4 to 6 weeks b. 5 to 7 weeks c. 7 to 10 weeks d. 12 to 20 weeks

ANS: D Feedback A During this time frame, the gestational age is determined by measuring the crown-rump length. B During this time frame, the gestational age is determined by measuring the crown-rump length. C During this time frame, the gestational age is determined by measuring the crown-rump length. D The biparietal diameter, a method of assessing gestational age during the last half of pregnancy, is most accurate from 12 to 20 weeks.

12. 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 Feedback A Evaluating a patient's weight gain during pregnancy should be included for all patients, not just for those who are culturally different. B The socioeconomic status of the patient may alter the nutritional intake, but not the cultural influence. C Teaching the food groups to the patient should come after assessing food preferences. 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.

11. While assessing her patient, what does the nurse interpret as a positive sign of pregnancy? a. Fetal movement felt by the woman b. Amenorrhea c. Breast changes d. Visualization of fetus by ultrasound

ANS: D Feedback A Fetal movement is a presumptive sign of pregnancy. B Amenorrhea is a presumptive sign of pregnancy. C Breast changes are a presumptive sign of pregnancy. D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner.

10. The major advantage of chorionic villus sampling (CVS) over amniocentesis is that it a. Is not an invasive procedure b. Does not require hospitalization c. Has less risk of spontaneous abortion d. Is performed earlier in pregnancy

ANS: D Feedback A It is an invasive procedure. B The woman does have to be in a hospital setting for the fetus and her to be properly assessed during and after the procedure. C The risk of an abortion is at the same level for both procedures. D CVS is performed between 10 and 13 weeks of gestation, providing earlier results than amniocentesis.

18. The most basic information a maternity nurse should have concerning conception is 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 Feedback A Ova are considered fertile for approximately 24 hours after ovulation. B Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. C Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed. D After implantation, the endometrium is called the decidua.

2. While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D Feedback A Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. B The arm should be supported at the same level of the heart. C The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension. D Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension.

18. The traditional diet of Asian women includes little meat or dairy products and may be low in calcium and iron. The nurse can help the woman increase her intake of these foods by a. Emphasizing the need for increased milk intake during pregnancy b. Suggesting she eat more "hot" foods during pregnancy c. Telling her husband that she must increase her intake of fruits and vegetables for the baby's sake d. Suggesting she eat more tofu, bok choy, and broccoli

ANS: D Feedback A Since milk products are not part of the of this woman's diet, it should be respected and other alternatives offered. Also, lactose intolerance is common. B Pregnancy is considered "hot"; therefore the woman would eat "cold" foods. C Fruits and vegetables are "cold" foods and included in the diet. In family dynamics, however, the husband does not dictate to the wife in this culture. D The diet should be improved by increasing foods acceptable to the woman. These foods are common in the Asian diet and are good sources of calcium and iron.

6. One danger in using nonfood supplementation of nutrients is a. Increased absorption of all vitamins b. Development of pregnancy-induced hypertension (PIH) c. Increased caloric intake d. Toxic effects on the fetus

ANS: D Feedback A Supplements do not have better absorption than natural vitamins and minerals. B There is no relationship between supplements and PIH. C Supplements do not contain calories. D The use of supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some nutrients have been shown to cause fetal defects.

15. Between 6 and 10 days after conception, the trophoblast secretes enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered. This is termed implantation. Tiny projections then develop out of the trophoblast and extend into the endometrium. These projections are referred to as a. Decidua basalis b. Decidua capsularis c. Decidua vera d. Chorionic villi

ANS: D Feedback A The deciduas basalis is the portion of the endometrium where the chorionic villi tap into the maternal blood vessels. B The deciduas capsularis is the portion of the endometrium that covers the blastocyst. C The portion of the endometrium that lines the rest of the uterus is called deciduas vera. D These villi are vascular processes that obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood.

4. While teaching an early pregnancy class, the nurse explains that the morula is a a. Fertilized ovum before mitosis begins b. Flattened disc-shaped layer of cells within a fluid-filled sphere c. Double layer of cells that becomes the placenta d. Solid ball composed of the first cells formed after fertilization

ANS: D Feedback A The fertilized ovum is called the zygote. B This is the embryonic disc. It will develop into the baby. C The placenta is formed from two layers of cells: the trophoblast, which is the other portion of the fertilized ovum, and the deciduas, which is the portion of the uterus where implantation occurs. D The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization.

6. 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 Feedback A The intestines remain within the umbilical cord only until approximately week 10. B Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity. All the intestines are within the abdominal cavity around week 10. C Blood supply is adequate in all areas. Intestines stay in the umbilical cord for approximately 10 weeks because they are growing faster than the abdomen. 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, the abdomen is large enough to contain them.

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

3. A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. What is the correct interpretation of these symptoms by the practitioner? a. These conditions are abnormal. Refer the patient to an ear, nose, and throat specialist. b. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

ANS: D Feedback A The patient should be reassured that these symptoms are within normal limits. No referral is needed at this time. B Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. C Progesterone affects relaxation of the smooth muscles in the respiratory tract. D As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy.

23. A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse? a. "My husband and I have agreed that my sister will be my coach since he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is OK." b. "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." c. "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." d. "We do not want the fetal monitor used during labor, since it will interfere with movement and doing effleurage."

ANS: D Feedback A This is an acceptable request for a laboring woman. B Using breathing techniques to alleviate pain is a realistic part of a birth plan. C Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation. D Since monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low risk pregnancy and as long as labor is progressing normally. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative.

24. 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 Feedback A Zinc is vital to good maternity and fetal health and is 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. B Vitamin D is vital to good maternity and fetal health and is 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. C Folic acid is vital to good maternity and fetal health and is 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. D Zinc, vitamin D, and folic acid are vital to good maternity 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.

2. The evidence regarding the effects of caffeine on nutrition during pregnancy is conflicting and more research is needed. Until the time when there is more evidence on the effect of caffeine on the fetus, caffeine intake during pregnancy should be limited to 400 mg per day. Is this statement true or false?

ANS: F Caffeine intake should be limited to less than 200 mg per day. The nurse should discuss usual sources of caffeine with the patient. A 6-oz cup of brewed coffee contains about 103 mg, tea contains 36 mg, Cola beverages contain 35-50 mg/12 ounces and cocoa contain 4 mg/6 oz. Caffeine changes calcium, thiamine, and iron absorption or excretion.

2. The nurse is precepting a student who asks about fetal circulation. The nurse explains that the fetal circulatory shunts are still required after birth. Is this statement true or false?

ANS: False Fetal circulatory shunts are not needed after birth because the infant oxygenates blood in the lungs, metabolizes substances in the liver, and stops circulating blood to the placenta. As the infant breathes, blood flow to the lungs increases, pressure in the right-sided heart falls, and the foramen ovale closes.

2. Very fine hairs, called __________, appear first on the fetus's eyebrows and upper lip at 12 weeks of gestation. By 20 weeks, they cover the entire body. By 28 weeks, the scalp hair is longer than these fine hairs, which thin and may disappear by term gestation.

ANS: Lanugo By 20 weeks of gestation, the eyelashes, eyebrows, and scalp hair also begin to grow.

1. The nurse has instructed the pregnant patient to self-assess movement of her fetus by doing "kick counts." The nurse knows that the woman has had effective learning when she states "Two or three times a day I will be sure that my baby moves at least three times in an hour." Is this statement true or false?

ANS: T The other method of self-assessment for fetal well-being is referred to as the "count to 10." The woman is taught to perceive at least 10 fetal movements within a 12 hour period of time. However, maternal reporting of atypical changes in fetal activity has shown to be as valid as counting and documentation.

1. Food continues to be the best source of nutrients for the pregnant patient. The exceptions are iron and folic acid, which may not be obtained in adequate amounts through normal food intake. Is this statement true or false?

ANS: T Vitamin and mineral supplements are not necessary, despite the fact that most prenatal providers order prenatal vitamins. Expectant mothers who are vegetarians, lactose-intolerant, or have special problems with nutrient absorption may need supplements other than iron and folic acid. A dietary assessment will determine a woman's actual needs. The nurse must carefully consider the patient's age, cultural background, and knowledge of nutrition when providing teaching regarding her diet.

1. When teaching contraception, the nurse must be able to effectively communicate the nuances of conception. An ovum has the capacity to be fertilized for only 24 hours, whereas a sperm may remain fertile for up to 80 hours. Is this statement true or false?

ANS: True Most sperm survive for no more than 1 or 2 days, although a few will remain fertile in the female reproductive tract for up to 80 hours. Conception requires correct timing for fertilization to occur. This information is important whether the patient is seeking to become pregnant or prevent pregnancy.

1. The ability of the fetus to survive outside the uterus is called ___________.

ANS: Viability In the past, the earliest age at which fetal survival could be expected was 28 weeks after conception. With modern technology and advancements in maternal and neonatal care, viability is now possible at 20 weeks after conception (22 weeks after last menstrual period [LMP], fetal weight of 500 g or more).