OB week 1 ch 4

81. Verbalizing someone else's wishes if he or she is unable to do so

ANS: Advocacy Refer To: Chapter 2

61. Severe itching due to stasis of bile in the liver

ANS: Pruritis gravidarum Refer To: Glossary

14. Lina is an 18-year-old woman at 20 weeks' gestation. This is her first pregnancy. Lina is complaining of fatigue and listlessness. Her vital signs are within a normal range: BP = 118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina's fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The perinatal nurse's best approach to care at this visit is to: a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week. b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry. c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks' gestation). d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including the risk of gestational diabetes.

...ANS: a Feedback a. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. To facilitate this process, it is the nurse's responsibility to gather more information on the woman's dietary practices through a food diary. b. Nutrition and weight management play an essential role in the development of a healthy pregnancy. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. c. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices, not just inform the patient of expected normal weight gain. d. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices.

20. A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm above the symphysis. She denies experiencing quickening. Which of the following nursing conclusions made by the nurse is correct? a. The woman is experiencing a normal pregnancy. b. The woman may be having difficulty accepting this pregnancy. c. The woman must see a nutritionist as soon as possible. d. The woman will likely miscarry the conceptus.

ANS: a a. The patient is experiencing a normal pregnancy . b. Quickening is not felt until 16 to 20 weeks' gestation. c. There is no apparent need for a nutritionist to see this patient. d. There is no indication in the scenario that this patient is at high risk for a miscarriage.

82. Absence of menses

ANS: Amenorrhea Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

16. The nurse is providing prenatal teaching to a group of diverse pregnant women. One woman, who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy. The nurse explains that the most significant risk to the fetus is: a. Respiratory distress at birth b. Severe neonatal anemia c. Low neonatal birth weight d. Neonatal hyperbilirubinemia

ANS: C Feedback a. Respiratory distress is not the most significant risk to the fetus unless the fetus is also premature. b. Severe neonatal anemia is not associated with pregnancies complicated by cigarette smoking. c. Low neonatal birth weight is the most common complication seen in pregnancies complicated by cigarette smoking. d. Neonatal hyperbilirubinemia is not associated with pregnancies complicated by cigarette smoking.

62. Nosebleeds

ANS: Epistaxis Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

57. Lesions at the gum line that bleed easily

ANS: Epulis gravidarum Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

67. The perinatal nurse explains to the new nurse that ptyalism is a condition more acute than the normal nausea and vomiting of pregnancy and is often associated with dehydration, hypokalemia, and weight loss.

ANS: False ANS: False Hyperemesis gravidarum is a pregnancy-related condition characterized by persistent, continuous, severe nausea and vomiting, often accompanied by dry retching. Hyperemesis gravidarum results in weight loss and fluid and electrolyte imbalance. Ptyalism is an excessive production of saliva.

83. Curvature of the spine

ANS: Lordosis Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

58. Anterior convexity of the lumbar spine

ANS: Lumbar lordosis Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

59. Increased saliva production

ANS: Ptyalism Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

60. Reflux of the stomach contents into the esophagus

ANS: Pyrosis Refer To: Glossary

47. An overweight or obese pre-pregnancy weight increases the risk for which poor maternal outcomes? (Select all that apply.) a. Preeclampsia b. Hemorrhage c. Difficult delivery d. Vaginal infections

ANS: a, b, c Being overweight or obese can substantially increase perinatal risk; however, no data support an increase in vaginal infections for the obese pregnant population.

35. The clinic nurse discusses normal bladder function in pregnancy with a 22-year-old pregnant woman who is now in her 29th gestational week. The nurse explains that at this time in pregnancy, it is normal to experience (select all that apply): a. Urinary frequency b. Urinary urgency c. Nocturia d. Incontinence

ANS: a, b, c During pregnancy, the bladder, a pelvic organ, is compressed by the weight of the growing uterus. The added pressure, along with progesterone-induced relaxation of the urethra and sphincter musculature, leads to urinary urgency, frequency, and nocturia. Incontinence of urine is not a normal change during pregnancy.

84. Stretch marks

ANS: Striae gravidarum Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

65. The clinic nurse knows that every time a woman of childbearing age comes in to the office for a health maintenance visit, she should be counseled about the benefits of daily folic acid supplementation.

ANS: True Because of the strong connection between folic acid deficiency and the subsequent development of neural tube defects, all women of childbearing age should take a folic acid supplement of at least 400 mcg/day.

64. Cecilia, a pregnant woman at 30 weeks' gestation, has her vital signs assessed during a routine prenatal visit. Cecilia's blood pressure has remained at 110/70 for the last few visits, and her pulse rate has increased from 70 to 80 beats per minute. These findings would be considered normal at this time in pregnancy.

ANS: True During the first trimester, blood pressure normally remains the same as prepregnancy levels but then gradually decreases up to around 20 weeks' of gestation. After 20 weeks, the vascular volume expands and the blood pressure increases to reach prepregnant levels by term.

The clinic nurse speaks with the student nurse prior to the physical examination of a pregnant woman who is 32 weeks' gestation. The clinic nurse explains that the heart sounds heard in pregnancy are usually S1 and S3 with a possible murmur related to increased cardiac output.

ANS: True Exaggerated first and third heart sounds and systolic murmurs are common findings during pregnancy. The murmurs are usually asymptomatic and require no treatment.

66. The perinatal nurse recommends strengthening exercises during pregnancy, as this can improve posture and increase energy levels.

ANS: True Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy, which include weight gain and postural changes. Muscle strengthening exercises also help to decrease the risk of ligament and joint injury.

6. A woman presents to the prenatal clinic at 30 weeks' gestation reporting dysuria, frequency, and urgency with urination. Appropriate nursing actions include: a. Obtain clean-catch urine to assess for a possible urinary tract infection. b. Reassure the woman that the signs are normal urinary changes in the third trimester. c. Teach the woman to decrease fluid intake to manage these symptoms. d. Perform a Leopold's maneuver to assess fetal position and station.

ANS: a Feedback a. Correct. Dysuria, frequency, and urgency with urination are signs and symptoms of a urinary tract infection, necessitating further assessment and testing. b. These are abnormal urinary symptoms in the third trimester. c. Pregnant women need to increase their fluid intake during pregnancy, and dysuria and urgency are abnormal. d. Assessment of fetal position and station is not an appropriate response to reported signs and symptoms of a urinary tract infection. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

27. A nurse working in a prenatal clinic is caring for a woman who asks advice on foods that are high in vitamin C because "I hate oranges." The nurse states that 1 cup of which of the following raw foods will meet the patient's daily vitamin C needs? a. Strawberries b. Asparagus c. Iceberg lettuce d. Cucumber

ANS: a Feedback a. Strawberries are an excellent source of vitamin C. b. Although asparagus has some vitamin C, it is not an excellent source. c. Iceberg lettuce is a poor source of vitamin C. d. Cucumber is a poor source of vitamin C. KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive Level: Knowledge | Content Area: Health and Wellness | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

7. The clinic nurse talks with the newly diagnosed pregnant woman about the nausea that the woman is experiencing in this pregnancy. The clinic nurse suggests eating __________ meals more often, remaining __________ after eating, and the using __________ techniques.

ANS: smaller; upright; relaxation Nausea is often one of the first symptoms of pregnancy experienced. Nurses can suggest strategies to help offset the nausea, such as the avoidance of "trigger foods" (foods that cause nausea from sight or smell) and tight clothing that constricts the abdomen. The use of relaxation techniques (i.e., slow, deep breathing, mental imagery) can also help to decrease nausea. Other techniques that are often helpful include consuming plain, dry crackers or sucking on peppermint candy before arising; adhering to small, frequent meals; and remaining in an upright position after eating.

29. A nurse who is discussing serving sizes of foods with a new prenatal patient would state that which of the following is equal to 1 (one) serving from the dairy food group? a.. 1 cup low-fat milk b. 1⁄2 cup vanilla yogurt c. 1⁄2 cup cottage cheese d.. 1 ounce cream cheese

a.. 1 cup low-fat milk ANS: a Feedback a. 1 cup of any milk (e.g., whole milk, skim milk, buttermilk, chocolate milk) is equal to 1 serving size from the dairy group. b. 1 cup of yogurt is equal to 1 serving size from the dairy group. c. 1 1⁄2 cup of cottage cheese is equal to 1 serving size from the dairy group. d. Cream cheese is not included in the dairy group. It is a fat product. KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive Level: Comprehension | Content Area: Antepartum Care; Basic Care and Comfort: Nutrition | Client Need: Health Promotion and Maintenance; Physiological Integrity: Basic Care and Comfort | Difficulty Level: Easy

The nurse has decided to implement the Centering Pregnancy model for prenatal care instead of the conventional antenatal care. which is the focus of this model of care? Select all that apply. 1. The nurse spends more time dealing with the complications of pregnancy. 2. The nurse will be better able to take responsibility for the clients' health. 3. The clients will be spending more time with the nurse in antenatal care. 4. More social support will be available for clients. 5. The clients will get one-on-one prenatal care

Answer: 3,4 Option 1: The focus will be on normalcy of pregnancy. Option 2: The focus is to promote individual responsibility for health in pregnancy. Option 3: The focus is to increase the time the clients spend in antenatal care. Option 4: The focus is to provide more social support for clients in antenatal care. Option 5: The focus is on having a small group of women to meet with the nurse.

28. The nurse notes each of the following findings in a woman at 10 weeks' gestation. Which of the findings would enable the nurse to tell the woman that she is probably pregnant? a. Fetal heart rate via Doppler b. Positive pregnancy test c. Positive ultrasound assessment d. Absence of menstrual period

b. Positive pregnancy test ANS: b Feedback a. A fetal heart rate is a positive sign of pregnancy. b. A positive pregnancy test is a probable sign of pregnancy. It is not a positive sign because the hormone tested for—human chorionic gonadatropin (hCG)—may be being produced by, for example, a hydatidiform mole. c. A positive ultrasound is a positive sign of pregnancy. d. Amenorrhea is a presumptive sign of pregnancy. KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Comprehension | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

31. A patient at 28 weeks' gestation was last seen in the prenatal clinic at 24 weeks' gestation. Which of the following changes should the nurse bring to the attention of the Certified Nurse Midwife? a. Weight change from 128 pounds to 132 pounds b. Pulse change from 88 bpm to 92 bpm c. Blood pressure change from 110/70 to 140/90 d. Respiratory change from 16 rpm to 20 rpm

c. Blood pressure change from 110/70 to 140/90 ANS: c Feedback a. A weight change of approximately 4 pounds in 4 weeks is normal in the second and third trimesters of pregnancy. b. This pulse rate change is within normal limits. c. A blood pressure elevation to 140/90 is a sign of mild preeclampsia. d. This respiratory rate change is within normal limits.

80. Passive movement of the unengaged fetus

ANS: Ballottement Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

71. The clinic nurse promotes a diet rich in vitamin __________ during the third trimester to prevent the possibility of __________ rupture of the membranes.

ANS: C; premature Low levels of vitamin C may predispose women to premature rupture of membranes. As the cellular availability of vitamin C decreases, the rate of degradation of cervical collagen increases. With decreased collagen, the cervix more easily ripens, prompting effacement and dilatation.

Physiologic changes that occur in the renal system during pregnancy predispose the pregnant woman to urinary tract infections (UTIs). Symptoms of a UTI include (select all that apply) : a. Dysuria b. Hematuria c. Urgency d. Delayed urination

ANS: a, b, c Urinary tract infection (UTI) symptoms include dysuria, hematuria, and urgency.

A mother who had a stillbirth 2 months ago stated that she has been trying to get pregnant. The nurse determines that she may be at risk for iron-deficiency anemia. Which advice would the nurse give to this woman? 1. "Take iron supplements." 2. "Continue taking megadoses of vitamins and minerals." 3. "Increase your intake of calcium and magnesium." 4. "Take Folic acid 0.6mg once per day."

Answer: 1 Option 1: Taking iron supplements will replace the iron stores she lost in the recent pregnancy. Option 2: Taking megadoses of vitamins and minerals may be toxic to the anticipated pregnancy. Option 3: Taking calcium and magnesium contributes to bone health, and does not reduce the risk for iron-deficiency anemia. Option 4: Taking Folic acid 0.6mg once per day reduces the risk for neural tube defects, not iron- deficiency anemia.

A nurse is attending to two pregnant clients. The first client was assessed as "early term." The second was assessed as "full term." In order for the nurse to make such assessments, how mature are the clients' pregnancies? 1. The first client is between 37 0/7 weeks and 38 6/7 weeks. The second client is between 39 0/7 weeks and 40 6/7 weeks. 2. The first client is between 41 0/7 weeks and 41 6/7 weeks. The second client is between 42 0/7 weeks and beyond. 3. The first client is between 39 0/7 weeks and 40 6/7 weeks. The second client is between 37 0/7 weeks and 38 6/7 weeks. 4. The first client is between 42 0/7 weeks and beyond. The second client is between 41 0/7 weeks and 41 6/7 weeks.

Answer: 1 Option 1: A client who is between 37 0/7 and 38 6/7 weeks gestation is classified as early term. A client who is between 39 0/7 through 40 6/7 weeks gestation is classified as full term. Option 2: A client who is between 41 0/7 and 41 6/7 weeks gestation is classified as late term. A client who is between 42 0/7 weeks gestation and beyond is classified as post term. Option 3: A client who is between 39 0/7 through 40 6/7 weeks gestation is classified as full term. A client between 37 0/7 and 38 6/7 weeks gestation is classified as early term. Option 4: A client who is between 42 0/7 weeks gestation and beyond is classified as post term. A client who is between 41 0/7 weeks and 41 6/7 weeks gestation is classified as late term.

At her 14-week prenatal appointment, the client reports experiencing a moderate amount of white vaginal discharge. Which teaching would the nurse provide? 1. Wear a panty-liner and change it often. 2. Use a vaginal douche to cleanse the vagina of discharge. 3. Change the type of bath soap she is using. 4. Explain that the loss of the mucus plug is normal.

Answer: 1 Option 1: An increase of estrogen during pregnancy causes leukorrhea. The client can wear a panty-liner to keep her undergarments dry. It should be changed regularly to prevent bacterial growth. Option 2: Douching is not recommended during pregnancy, as it alters vaginal pH. Vaginal pH during pregnancy is naturally more acidic to prevent bacterial growth. Option 3: While some women are sensitive to soaps with lots of dye or perfumes, it should not cause vaginal discharge. Option 4: The loss of the mucus plug is a sign of impending labor. This is not a normal occurrence at 14 weeks gestation.

A nurse is caring for a 16-week pregnant client whose obstetrical history includes 5-year-old twins born at 38 weeks gestation and an abortion at 24-weeks after the twins were born. How would the nurse document the client's obstetrical status? 1. G3P2 2. G3P3 3. G2P3 4. G3P4

Answer: 1 Option 1: Client has 3 pregnancies, a term delivery of twins counted as 1 para and an abortion at 24-weeks counted as another para. Gravida and Para (G/P) is a two-digit system to denote pregnancy and birth history. While Gravida refers to the total number of times a woman has been pregnant, Para refers to the number of births after 20-week gestation whether live or stillbirth. Option 2: Client has 3 pregnancies, a term delivery of twins counted as 1 para and a stillbirth at 24-weeks counted as another para. The current pregnancy is not counted until delivery after 20 weeks of gestation. Option 3: Client has 3 pregnancies not two. The current pregnancy, the twins, and the stillbirth delivery. Option 4: Client is para 2 not 4. Current pregnancy is not counted, the twins are counted as 1 para plus the stillbirth delivery at 24-weeks.

A pregnant client at term visits the clinic and tells the nurse that she is feeling tired all the time. A review of her laboratory results show that her hematocrit level is low. The nurse documented "Fatigue" in the client's health records. Which recommendations by the nurse is correct? 1. "Eat iron-rich foods, ask for assistance from family, and get adequate rest." 2. "Wear loose fitting clothes, elevate legs when sitting, and position yourself on your side when lying." 3. "Maintain adequate hydration, rise slowly from sitting to standing, and avoid lying on your back." 4. "Avoid lying on your back, keep your feet moving when standing, and avoid standing for prolonged periods."

Answer: 1 Option 1: Eating iron-rich foods, asking for assistance from family, and getting adequate rest are relief measures for a pregnant client who is fatigued. Option 2: Wearing loose fitting clothes, elevating legs when sitting, and lying on the side are relief measures for a pregnant client with dependent edema in the lower extremities. Option 3: Maintaining adequate hydration, rising slowly from sitting to standing, and avoiding lying on dorsal are relief measures for a pregnant client who has headaches and syncope. Option 4: Avoid lying on dorsal, keeping moving when standing, and avoiding standing for prolonged periods are relief measures for a pregnant client who has orthostatic hypotension.

A pregnant client with four living children, one preterm infant, and one abortion visits the clinic. How is the nurse expected to record the client's data? 1. G 6 T 3 P 1 A 1 L 4 2. G 5 T 2 P 1 A 1 L 4 3. G 4 T 4 P 1 A 1 L 4 4. G 3 T 1 P 1 A 1 L 4

Answer: 1 Option 1: G 6 T 3 P 1 A 1 L 4 means that this is the sixth pregnancy; three infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive Option 2: G 5 T 2 P 1 A 1 L 4 means that this is the fifth pregnancy; two infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive Option 3: T 4 G 4 P 1 A 1 L 4 means that this is the fourth pregnancy; four infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive. Option 4: G 3 T 1 P 1 A 1 L 4 means that this is the third pregnancy; one infant was born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive

A woman who is planning to get pregnant started 0.4 mg/day of folic acid. She visited her primary physician and the dose was later increased to 0.8 mg/day because she had an infant with neural tube defect (NTD). The stock volume for folic acid is 0.4 mg. The nurse is expected to instruct the woman to take _____ tablets per day? Fill in the blank.

Answer: 2 Correct Feedback The nurse would have to calculate the number of tablets the client should take: 0.8 mg ÷ 0.4 mg x 1 = 2 tablets per day.

A nurse reads the client's history and physical, which lists the GTPAL as 3-1-1-0-2. How would the nurse interpret this? 1. The client has been pregnant three times, delivered once at term, once at preterm, and has two living children. 2. The client has been pregnant three times, delivered once at term, once at preterm, and had one miscarriage. She now has two living children. 3. The client has been pregnant three times, had one set of twins, one delivery after 20 weeks, and two children are living. 4. The client has been pregnant three times, had one therapeutic abortion, one delivery after 20 weeks, no miscarriages, and two living children.

Answer: 1 Option 1: Gravidity refers to the number of times the woman has been pregnant. Term deliveries (which include early, full, late, and post term gestations) are counted under "T." Preterm deliveries are counted under "P." The "A" stands for abortion, which includes therapeutic/induced and spontaneous. The "L" includes living children. Option 2: According to the GTPAL, the client has had no miscarriages. This would be denoted under the "A" category, which states zero. Option 3: The "T" and "P" in GTPAL stand for term and preterm, not twins and para. Option 4: The "T" in GTPAL stands for term. If the client had an abortion, it would be denoted under the "A" column.

The nurse obtains a fundal height measurement of 32 cm on a client experiencing a healthy, low-risk pregnancy. How does the nurse interpret this measurement? 1. The client is approximately 32-week gestation. 2. The weight of the fetus is approximately 3200 grams. 3. The amniotic fluid volume is 3.2 cm. 4. The distance from the fundus to the xiphoid process is 32 cm.

Answer: 1 Option 1: In a normally growing singleton pregnancy, the fundal height in centimeters should be approximately the same as the gestational age in weeks, give or take 2 weeks. Option 2: Fetal weight cannot be determined through fundal height measurement. A gross estimate can be determined by ultrasound. Option 3: An accurate determination of amniotic fluid volume is obtained through ultrasound imaging, not fundal height measurement. Option 4: Fundal height is measured as the distance from the symphysis pubis to the top of the fundus.

A multiparous client asks the nurse what she can do to help with leaking urine when she coughs or sneezes. Which intervention would the nurse recommend? 1. Perform Kegel exercises 2. See a urology specialist for surgery 3. Empty her bladder every hour 4. Obtain a specimen for urinalysis

Answer: 1 Option 1: Kegel exercises promote pelvic floor muscle strength and decrease the risk of urinary incontinence. Option 2: Urine leaking in a multiparous client is a common problem. Simple, less invasive interventions, such as Kegel exercises, should be encouraged before surgical intervention Option 3: Urinating hourly would be inconvenient to the client. Small amounts of urine contained in the bladder may still leak if pelvic floor muscles are weak. Option 4: Symptoms of urinary tract infection include frequency, urgency, and pain while urinating. These symptoms were not included in the question stem.

The nurse is educating a 32-weeks-pregnant client on how to perform kick counts. Which statement by the client would indicate a need for further teaching? 1. "I will perform the kick counts at a different time every day." 2. "I should call my doctor right away if the baby is not moving as much as usual." 3. "It is normal for the baby to move about 10 times or more in 2 hours." 4. "A kick, flutter, or roll counts as movements."

Answer: 1 Option 1: Kick counts should be performed at the same time every day. Option 2: Decreased or absent fetal movement is a sign of hypoxia and should be reported immediately. Option 3: Feeling 10 movements or more in 2 hours is considered reassuring. Option 4: Kicks, flutters, swishes, and rolls are all considered types of fetal movement that should be counted by the mother.

The nurse is planning care for a group of clients. Which client would need to receive Rho (D) Immune Globulin (RhoGAM)? 1. A client whose blood type is O-negative 2. A client whose white blood cell count was below normal 3. A client with an autoimmune disorder 4. A client whose blood type is O-positive

Answer: 1 Option 1: RhoGAM is given to women who have Rh-negative blood to prevent isoimmunization. Option 2: RhoGAM does not increase white blood cell count or provide immunity to disease. Option 3: RhoGAM does not provide immunity to disease or alter the symptoms of an autoimmune disorder. Option 4: RhoGAM is not needed in women with Rh-positive blood. There are no Rh-antibodies to perceive the fetus as foreign tissue.

A client in her second trimester presented at the clinic with a history of vaginal bleeding. She has no history of trauma. Which condition in the client's history would assist the nurse to determine the cause for the bleeding? Select all that apply. 1. Friable cervix 2. Placenta previa 3. Urinary frequency 4. Hyperemesis gravidarum 5. Absence of fetal movement

Answer: 1,2 Option 1: Vaginal bleeding may indicate a friable cervix. Option 2: Vaginal bleeding may indicate placenta previa. Option 3: Urinary frequency is an indication of a urinary tract infection. Option 4: Prolonged nausea and vomiting indicates possible hyperemesis gravidarum. Option 5: Absence of fetal movement may be an indication of fetal distress.

A woman visits the clinic and states that she has missed four menstrual periods and is unsure if she is pregnant. The nurse informs her that a ballottement test will be done to diagnose pregnancy. How can a ballottement test assist the nurse in confirming a pregnancy? 1. Softening of the cervix and vagina 2. Softening of the lower uterine segment 3. Brownish pigmentation over the client's forehead 4. Bluish-purplish coloration of the vaginal mucosa 5. A dark line that runs from the umbilicus to the pubis

Answer: 1,2,4 Option 1: Goodell's sign is the softening of the cervix and vagina, which are probable signs that may not be obvious to the woman. Option 2: Hegar's sign is the softening of the lower uterine segment, and is a probable sign that may not be obvious to the woman. Option 3: Brownish pigmentation over the client's forehead is a probable sign that the woman would have observed. Option 4: Chadwick's sign is the bluish-purplish coloration of the vaginal mucosa that can be seen by the nurse, and not the woman. Option 5: Linea nigra is the dark line that runs from the umbilicus to the pubis, and is a probable sign that the woman would have observed.

A pregnant woman asked the nurse why her home is being assessed for the Aedes albopictus mosquitoes. The nurse responded by saying, "I intentionally assessed your home because you are pregnant." Which other reason given by the nurse is correct? Select all that apply. 1. "Your spouse has the Zika virus and can transmit it to you during sexual intercourse." 2. "You have been non-compliant with the vaccination to prevent Zika virus infection." 3. "You have been reporting fever, rash, headache, and muscle pain for the past week." 4. "We do not want the Zika virus to increase the growth of your baby too much." 5. "The Zika virus is an infection that is spread by infected Aedes albopictus mosquitos."

Answer: 1,3,5 Option 1: The Zika virus can be sexually transmitted from an infected partner. Option 2: There is no vaccine to prevent the Zika virus. Option 3: Some symptoms of the Zika virus are fever, rash, headache, and muscle pain. These symptoms can last up to a week. Option 4: The Zika virus impairs fetal growth. Option 5: The Zika virus is an infection spread by infected Aedes albopictus mosquitos.

The nurse will be focusing on 'self-care' during a preconception counseling session with women who are seeking to get pregnant. Which advice should the nurse include in the counseling session? Select all that apply. 1. Discontinue the use of herbal supplements before pregnancy. 2. Avoid aerobic and regular weight-bearing exercise before pregnancy. 3. Continue with the same megadoses of vitamins and minerals as prescribed. 4. Ensure that smoke alarms and carbon monoxide detectors are in working order. 5. Maintain optimal oral health and treat any periodontal disease before pregnancy.

Answer: 1,4,5 Option 1: Using herbal supplements is contraindicated during pregnancy. Option 2: Aerobic and regular weight-bearing exercise provide overall body conditioning, help with weight management and can enhance psychological well-being. Option 3: Megadoses of vitamins and minerals may be toxic to the developing fetus. Option 4: Ensuring that smoke alarms and carbon monoxide detectors are in working order is important for safety reasons. Option 5: Maintaining optimal oral health and treating any periodontal disease before pregnancy may prevent preterm birth.

A 19-year-old primigravida client's initial prenatal laboratory results show that she has Rh negative blood. Which action by the nurse is correct? 1. Provide antiretroviral therapy during pregnancy and around the time of delivery. 2. Rescreen the client in the second trimester and give RhoGAM at 28-weeks. 3. Monitor for signs and symptoms of anemia and give the client iron supplements. 4. Request a cytology screening every 3 years.

Answer: 2 Option 1: Antiretroviral therapy during pregnancy and around the time of delivery is for clients who are HIV positive. Option 2: Rescreening the client in second trimester and giving RhoGAM will prevent isoimmunization if the baby's blood is Rh positive. Option 3: Monitoring for signs and symptoms of anemia is done for clients whose Hgb blood volume increases more than their red cell volume, and if so, iron supplements should be given. Option 4: Requesting cytology screening every 3 years is done to assess change in the cervical cells.

The nurse is obtaining a 24-hour diet history from a pregnant client. which food consumed by the client would indicate the need for further teaching by the nurse? 1. Pasteurized milk 2. Alfalfa sprouts 3. Cheddar cheese 4. A cup of coffee

Answer: 2 Option 1: Pasteurized milk is safe to drink. Unpasteurized dairy products should be avoided due to bacterial contamination. Option 2: Raw sprouts of any kind should be avoided during pregnancy. Option 3: Cheddar cheese is safe to eat. Soft cheese, such as brie, camembert, or feta should be avoided. Option 4: Pregnant women should limit caffeine intake to 200mg per day, which is approximately one cup of coffee.

The nurse used Naegele's rule to calculate the expected date of delivery (EDD) for a primigravida whose last menstrual period (LMP) was September 7. How did the nurse arrive at June 14? 1. The nurse subtracted 3 months from September 7 and then added 14 days. 2. The nurse subtracted 3 months from September 7 and then added 7 days. 3. The nurse added 3 months to September 7 and then subtracted 14 days. 4. The nurse added 3 months to September 7 and then subtracted 7 days

Answer: 2 Option 1: Subtracting 3 months from September 7 and then adding 14 days would calculate the EDD to be June 21. Option 2: Using Naegele's rule, the correct calculation to calculate the EDD of June 14 is to subtract 3 months from September 7 and then add 7 days. Option 3: Adding 3 months to September 7 and then subtracting 14 days would calculate the EDD to be November 23. Option 4: Adding 3 months to September 7 and then subtracting 7 days would calculate the EDD to be November 30.

In the clinic, the nurse is discussing the recommendations for standard precaution against Zika virus infection. Which advice by the nurse will help clients avoid exposure to the virus? 1. "Sleep under mosquito nets since the Aedes albopictus mosquitos only bite at night." 2. "Avoid going to communities that have active mosquito transmission of the virus." 3. "The Zika virus may cause negative pregnancy so remember to take your vaccination by the seventh week of your pregnancy." 4. "It is unnecessary to use protection with an infected spouse."

Answer: 2 Option 1: The Aedes albopictus mosquitos bite at night as well as during the daytime. Option 2: The Zika virus has may have negative pregnancy outcomes. Therefore, pregnant women should avoid going to communities that have active mosquito transmission of the virus. Option 3: There is no vaccine to prevent the Zika virus. Option 4: Using a condom with an infected spouse is a standard precaution against infection.

A client states to the nurse, "This is my fourth pregnancy. Do I really need to have all these appointments?" Which is the most appropriate response by the nurse? 1. "I'm sure you are very busy with your other children." 2. "Early and regular prenatal care can catch problems early and reduce complications." 3. "Do you need assistance with transportation or have financial concerns?" 4. "Of course. Skipping appointments will jeopardize the health of you and your baby."

Answer: 2 Option 1: The nurse acknowledges the client's situation, but this response does not answer her question. Option 2: This is a factual response that answers the client's question regarding why she does need to receive prenatal care. Option 3: Transportation and finances can be a barrier to receiving prenatal care and should be addressed. However, this response does not answer the client's question. Option 4: This response by the nurse is non-therapeutic. It assumes the client would willingly place herself or child in danger.

A client states, "I think I might be pregnant. My period is late and I've been feeling really nauseous." Which would be the best response by the nurse? 1. "That's great! I am so happy for you." 2. "These are presumptive signs of pregnancy. You could be pregnant." 3. "These are positive signs of pregnancy. You are absolutely pregnant." 4. "You should schedule an appointment to make sure you do not have an ectopic pregnancy."

Answer: 2 Option 1: The symptoms reported by the client do not confirm pregnancy. It is also unknown how the client feels about this situation. Option 2: Amenorrhea and nausea are presumptive signs of pregnancy (subjective signs experienced by the patient). Option 3: Positive signs of pregnancy include auscultating fetal heart tones or observing the fetus on an ultrasound. Option 4: The symptoms reported do not confirm pregnancy, nor do they support diagnosis of possible ectopic pregnancy, which could include abdominal pain and vaginal bleeding.

The nurse educator is teaching a class of pregnant teenagers about the importance of receiving regular prenatal care. which are the maingoals of prenatal care that the nurse would include in the teaching? Select all that apply. 1. To complete a one-time assessment of health risk status of the pregnancy 2. To provide referrals to resources 3. To maintain maternal fetal health 4. To build rapport with the physician and nursing staff 5. To determine the gestational age of the fetus

Answer: 2,3,5 Option 1: Prenatal care is an ongoing assessment of risk factors and risk-appropriate interventions. It is not a one-time visit. Option 2: Referrals to appropriate resources may be implemented during prenatal care visits. Option 3: Ongoing assessment throughout the pregnancy helps identify abnormalities early. Early intervention improves health outcomes for mother and infant. Option 4: A goal of prenatal care is to build rapport with the patient and her family. Option 5: Prenatal care helps determine accurate gestational age. This is important in monitoring the growth and development of the fetus as well as guiding teaching during the pregnancy.

A student nurse in developing a plan of care documented, "Altered pattern of elimination" for a pregnant client who complained of not having regular bowel movements. Which nursing action by the student nurse is appropriate for the client to resume regular bowel patterns? Select all that apply. 1. Advise the client to avoid high-fat and spicy food. 2. Assist the client to establish regular time for bowel movement. 3. Suggest the client eat small, frequent meals instead of large meals. 4. Encourage the client to eat high-fiber foods and fresh vegetables. 5. Discuss with the client prior strategies used successfully to relieve constipation.

Answer: 2,4,5, Option 1: Advising the client to avoid high-fat and spicy food will decrease nausea and vomiting. Option 2: Establishing a regular time for bowel movement will help the client to resume regular bowel patterns. Option 3: Suggesting to the client they eat small, frequent meals, instead of large meals, will decrease nausea and vomiting. Option 4: Encourage the client to eat high-fiber foods and fresh vegetables to resume regular bowel patterns. Option 5: Discussing prior strategies used successfully to relieve constipation with the client will help to resume regular bowel patterns.

After completing a physical examination of a pregnant women, the nurse states, "You are definitely pregnant." Which positive finding would have prompted the nurse to make that statement? 1. An enlarged abdomen 2. Hyperpigmentation of the skin 3. The palpation of fetal movement 4. An increase in the vascularity of the breasts

Answer: 3 Option 1: An enlarged abdomen is a probable sign of pregnancy. Option 2: Hyperpigmentation of the skin is a probable sign of pregnancy. Option 3: The palpation of fetal movement is a positive sign of pregnancy. Option 4: An increase in the vascularity of the breasts is a presumptive sign of pregnancy.

A client asks the nurse about the importance of preconception counseling. In responding, the nurse states that preconception counseling helps women lessen risky behaviors and eliminate exposure to harmful substances. Which statement made by the nurse about contraception cessation would be included in the preconception counseling? 1. "Women taking contraception up to a month before pregnancy will be better able to conceive and date the pregnancy." 2. "Women using hormonal contraception need to discontinue its use at least one menstrual period before conception." 3. "It may take several months or up to a year to conceive after discontinuing Depo-Provera." 4. "Women using an intrauterine device (IUD) will have it removed during labor."

Answer: 3 Option 1: Continuing with contraception a month before pregnancy is not safe and will not aid in facilitating conception and dating the pregnancy. Option 2: Women using hormonal contraception need to discontinue its use few months instead of a month before conception. Option 3: It may take a woman several months or up to a year to conceive after discontinuing Depo-Provera. Option 4: An intrauterine device (IUD) should be removed before the woman becomes pregnant.

A pregnant woman calls the clinic in a panic, stating that she is packing to leave her partner who has just assaulted her. Which is the most appropriate response by the nurse? 1. "Have you taken out a restraining order as you were advised to do?" 2. "What have you done for your partner to do this to you?" 3. "Call the police and consider alerting your neighbor." 4. "I will have to document this new development."

Answer: 3 Option 1: Educating her on taking out a restraining order is best practice for patient care, but is not the most appropriate response by the nurse in this present situation. Option 2: The nurse should articulate her belief in the woman so the woman knows the abuse is not her fault. Option 3: Safety is a priority, especially when the woman decided to leave the abusive relationship. Option 4: Documenting in order to accurately capture and record the nature of the injuries is important, but can be done after the woman's safety has been assured.

The nurse is teaching a pregnant client about positioning to avoid supine hypotensive syndrome. Which positioning would be effective? 1. Elevate her feet while she is sitting. 2. Dangle her feet over the edge of the bed for 30 seconds before getting up. 3. Sleep in a side-lying position. 4. Place a pillow under her knees while she is in bed.

Answer: 3 Option 1: Elevation of the feet will help with dependent edema, but not supine hypotension. Option 2: Sitting on the edge of the bed before rising would help with orthostatic hypotension, but not supine hypotension. Option 3: Sleeping in a side-lying position displaces the uterus so that it does not compress the vena cava. Option 4: This may help increase the client's general comfort, but does not affect the positioning of the uterus. A pillow placed under one side of her hip would be beneficial.

A nurse is providing prenatal education to a group of primigravida clients with gestational diabetes. Which is the nurse's best explanation for increased maternal insulin needed during the second trimester? 1. "Placental hormone human chorionic gonadotropin (hCG) causes maternal insulin resistant." 2. "Placental hormone progesterone causes maternal insulin resistant." 3. "Placental hormone human chorionic somatomammotropin (hCS) causes maternal insulin resistant." 4. "Placental hormone oxytocin causes maternal insulin resistant."

Answer: 3 Option 1: Placental hormone hCG does not cause maternal insulin resistant. It is detected by a pregnancy test, maintains corpus luteum until placenta becomes fully functional. Option 2: Placental hormone progesterone does not cause maternal insulin resistant. It maintains pregnancy by relaxation of smooth muscles leading to decreased uterine activity. Option 3: Placental hormone hCS produced in the second trimester facilitates fetal growth by acting as an insulin antagonist thereby altering maternal glucose metabolism. Option 4: Oxytocin is a posterior pituitary hormone. It stimulates uterine contraction.

A client from a shelter for battered woman stated, "It is my fault, as I should have not stayed in the situation for so long." Which statement by the nurse is the best response? 1. "Did you alert your neighbors to call the police?" 2. "Tell your partner that you will be taking out a restraining order." 3. "The abuse was not your fault. No one deserves to be mistreated." 4. "Whether or not you give me consent, I will be reporting this to the police."

Answer: 3 Option 1: The shelter can be a lifesaving community resource; therefore, she is not in any immediate danger. Option 2: A restraining order is a lifesaving resource, and telling her partner will jeopardize her safety. Option 3: The nurse is to articulate her belief in the woman by reassuring her that the abuse was not her fault and she does not deserve to be mistreated. Option 4: Reporting the abuse to the police without the woman's consent is a breach of confidentiality.

The urine culture of a client who is at 36 weeks gestation revealed a urinary tract infection. The client's medical records also show that this is the third occurrence since the onset of pregnancy. which advice should the nurse give her on preventing a reoccurrence? Select all that apply. 1. "It is time that you explore different sexual positions." 2. "Practice doing Kegel exercises while urinating." 3. "Urinate immediately before and after sexual intercourse." 4. "Wipe from back to front after passing urine." 5. "Drink at least 8 glasses of liquid each day."

Answer: 3,4 Option 1: Exploring different sexual positions will accommodate the changes of pregnancy. Option 2: Practicing Kegel exercises while urinating will help to strengthen the pelvic floor muscle. Option 3: Urinating immediately before and after sexual intercourse will decrease the risk for a UTI. Option 4: Wiping from back to front after passing urine will increase the risk of having a UTI. Option 5: Drinking at least 8 glasses of liquid each day will decrease the risk for a UTI.

During preconception counseling, the nurse is teaching a client about diagnosing pregnancy. Which signs are considered probable signs of pregnancy? Select all that apply. 1. Fetal heart tones 2. Quickening 3. Uterine growth 4. Frequent urination 5. Positive home pregnancy test

Answer: 3,5 Option 1: This is an objective sign of pregnancy that is only caused by the presence of a fetus, which makes it a positive sign of pregnancy. Option 2: Quickening is fetal movement felt by the mother. This is subjective and could be caused by something other than pregnancy, such as intestinal gas. Option 3: This is an objective measure that could be caused by something other than pregnancy, such as uterine fibroids or tumors, which makes it a probable sign of pregnancy. Option 4: Frequent urination can be caused by multiple factors other than pregnancy, such as bladder infection, increased water intake, diabetes, etc. It is a presumptive sign of pregnancy. Option 5: This is an objective measure that could produce false-positive or false-negative results, therefore making it a probable sign of pregnancy.

The nurse is conducting a presentation on the prevention of food-borne illnesses with the clients of the prenatal clinic. Which advice would the nurse emphasize? 1. Warm cooked food should be taken out of the refrigerator for more than two hours before consuming. 2. Drink plenty herbal teas such as peppermint and chamomile. 3. Refrigerate smoked seafood before consuming. 4. Wash hands before and after handling food.

Answer: 4 Option 1: Cooked food taken out of the refrigerator for more than two hours should be discarded. Option 2: Teas, such as peppermint and chamomile, can cause food-borne illnesses and should be avoided during pregnancy. Option 3: Refrigerated smoked seafood should be avoided in pregnancy. Option 4: Washing hands before and after handling food prevents the transmission of food-borne illness.

During the nursing assessment, a pregnant client reports that her spouse has been verbally abusive and slapped her recently. which is the priority nursing intervention at this time? 1. Document the statement in the woman's chart. 2. Call the police to report the incident. 3. Bring in another staff member as a witness to the statement. 4. Reassure her that she is not alone and help is available.

Answer: 4 Option 1: Documentation of the client's statement is important but is not the priority. Option 2: States may have mandatory reporting laws. However, the phone call can be made later and is not the priority. Option 3: Confidentiality is important when screening for intimate partner violence. The woman may feel a violation of privacy if other people are in the room. Option 4: Reassuring the client that she is not alone and that they are is believed is the nurse's first action.

A woman visits the clinic and stated that she has missed four menstrual periods and remains unsure whether or not she is pregnant. The nurse informs her that a ballottement test will be done to diagnose whether or not she is pregnant. How can a ballottement test assist the nurse in confirming a pregnancy? 1. By using a transvaginal ultrasound the nurse will be able to visualize the gestational sac. 2. By detecting the presence of the human chorionic gonadotropin in the urine sample in a laboratory. 3. By detecting the presence of the human chorionic gonadotropin in the blood sample in a laboratory. 4. By tapping on the cervix the fetus will rise in the amniotic fluid and then rebound to its original position.

Answer: 4 Option 1: Transvaginal ultrasound involves using a vaginal probe to visualize the gestational sac as early as 5- weeks gestation. Option 2: Doing a laboratory test can detect human chorionic gonadotropin in the maternal urine. Option 3: Doing a laboratory test can detect human chorionic gonadotropin in the maternal blood. Option 4: Tapping on the cervix causes the fetus to rise in the amniotic fluid, and then rebound to its original position.

The nurse is providing education regarding exercise and pregnancy. Which response by the client indicates an understanding of the teaching? 1. "I should start a new exercise routine to keep in shape." 2. "I will perform non-weight-bearing exercises." 3. "Exercise will help me lose weight during the pregnancy." 4. "Walking and stretching exercises will help with overall body conditioning."

Answer: 4 Option 1: Women should confer with their health care provider before starting any new exercise routine. It is best to start such a program several months in advance, so exercise is already comfortable and routine. Option 2: Weight-bearing exercises are recommended to enhance muscle tone and bone health. Option 3: Weight loss should not be a goal during pregnancy. Preconception weight loss is advisable if BMI is over normal. Option 4: Aerobic exercise and stretching helps condition the entire body, helps with weight management, and can enhance psychological well-being.

A client's first day of last menstrual period (LMP) was April 6, 2018. Using the Naegele's rule, what estimated date of delivery (EDD) will the nurse communicate to the client?

Answer: January 13, 2019 Test Taking Tip: To complete this problem, you need to know Naegele's formula and how to adjust the year as necessary.

Using Naegele's Rule, calculate the estimated due date (EDD) if the woman's last menstrual period (LMP) was June 11.

March 11 Correct Feedback Using Naegele's Rule, subtract 3 months and add 7 days to the LMP.

70. The perinatal nurse describes common complaints of pregnancy to the prenatal class attendees. Nasal __________, medically termed "__________ of pregnancy," is caused by increased levels of estrogen and progesterone.

ANS: stuffiness; rhinitis Nasal stuffiness and congestion (rhinitis of pregnancy) are common complaints during pregnancy. The nurse should educate the patient about these normal changes and offer reassurance. Increasing oral fluid intake helps to keep the mucus thin and easier to mobilize.

51. Interventions for low back pain during pregnancy should include (select all that apply): a. Utilizing proper body mechanics b. Applying ice or heat to affected area c. Avoiding pelvic rock and pelvic tilt d. Using additional pillows for support during sleep

ANS: a, b, d Interventions for back pain during pregnancy include utilizing proper body mechanics, applying heat or ice to the area, using additional pillows during sleep, and not avoiding pelvic rock/tilt, but encouraging pelvic rock/tilt.

68. The clinic nurse explains to the new nurse that during pregnancy, the maternal metabolism is altered to support the pregnancy by the hormones __________ and __________, which are produced by the anterior __________ gland.

ANS: thyrotropin; adrenotropin; pituitary Maternal metabolism is altered to support the pregnancy by thyrotropin and adrenotropin. These hormones, produced by the anterior pituitary gland, exert their effects on the thyroid and adrenal glands. Thyrotropin causes an increased basal metabolism, and adrenotropin alters adrenal gland function to increase fluid retention by the kidneys.

The nurse is discussing the physiological changes of pregnancy with a group of adolescent mothers. One clients ask the nurse if her skin will be affected also. Which statement by the nurse is correct about the changes that will take place in the integumentary system? 1. "You will have some skin changes such as gingivitis, bleeding gums, and periodontal disease." 2. "You will have some skin changes such as the Goodell's, Hegar's, and Chadwick signs." 3. "You will have some skin changes, such as edema of the limbs, varicosities, and hemorrhoids." 4. "You will have some skin changes, such as linea nigra, melasma, and striae gravidarum."

Answer: 4 Option 1: Gingivitis, bleeding gums, and periodontal disease are changes that take place in the gastrointestinal system. Option 2: Goodell's, Hegar's, and Chadwick signs are changes that take place in the reproductive system. Option 3: Edema of the limbs, varicosities, and hemorrhoids are changes that take place in the cardiovascular system. Option 4: Linea nigra, melasma, and striae gravidarum are changes that take place in the integumentary system.

5. The prenatal nurse cautions a pregnant woman about Caesar salad consumption during pregnancy or any source of __________ or __________ milk.

aNS: raw eggs; unpasteurized A word of caution should be provided by health-care providers to pregnant women with regard to microbial food-borne illness. Raw, or unpasteurized, milk as well as partially cooked eggs and foods containing raw or partially cooked eggs should be avoided.

14. Lina is an 18-year-old woman at 20 weeks' gestation. This is her first pregnancy. Lina is complaining of fatigue and listlessness. Her vital signs are within a normal range: BP = 118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina's fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The perinatal nurse's best approach to care at this visit is to: a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week. b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry. c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks' gestation). d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including the risk of gestational diabetes.

...ANS: a Feedback a. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. To facilitate this process, it is the nurse's responsibility to gather more information on the woman's dietary practices through a food diary. b. Nutrition and weight management play an essential role in the development of a healthy pregnancy. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. c. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices, not just inform the patient of expected normal weight gain. d. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices.

32. The clinic nurse includes screening for domestic violence in the first prenatal visit for all patients. An appropriate question would be: a. This is something that we ask everyone. Do you feel safe in your current living environment and relationships? b. This is something we ask everyone. Do you have any abuse in your life right now? c. Is your partner threatening or harming you in any way right now? d. I need to ask you, do you feel safe from abuse right now?

ANS: a Feedback a. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home and whether they have been hurt physically, emotionally, or sexually by a past or present partner. b. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home rather than asking if they have any abuse, as women may define abuse differently than care providers. c. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home and whether they have been hurt physically, emotionally, or sexually by a past or present partner. d. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home rather than asking if they have any abuse, as women may define abuse differently than care providers.

21. A patient at 37 weeks' gestation is being seen in the prenatal clinic. Where would the nurse expect the fundal height to be palpated? a. At the xiphoid process b. At a point between the umbilicus and the xiphoid c. At the umbilicus d. At a level directly above the symphysis pubis

ANS: a Feedback a. At 36 weeks' gestation, the fundus should be felt at the xiphoid process. b. At 36 weeks' gestation, the fundus should be felt at the xiphoid process. c. At 20 weeks' gestation, the fundus should be felt at the umbilicus. d. At 12 weeks' gestation, the fundus should be felt directly above the symphysis pubis.

42. The clinic nurse describes possible interventions for the pregnant woman who is experiencing pain and numbness in her wrists. The nurse suggests (select all that apply): a. Elevating the arms and wrists at night b. Reassessment during the postpartum period c. The use of "cock splints" to prevent wrist flexion d. Massaging the hands and wrists with alcohol

ANS: a, b, c Edema from vascular permeability can lead to a collection of fluid in the wrist that puts pressure on the median nerve lying beneath the carpal ligament, leading to carpal tunnel syndrome. Elevation of the hands at night may help to reduce the edema. Occasionally, a woman may need to wear a "cock splint" to prevent the wrist from flexing. Reassessment in the postpartum period is indicated because although carpal tunnel syndrome usually subsides after the pregnancy has ended, some women may require surgical treatment if symptoms persist. Massaging the hands and wrists with alcohol does not improve pain and numbness.

12. The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and position. The nurse's hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the: a. First maneuver b. Second maneuver c. Third maneuver d. Fourth maneuver

ANS: a Feedback a. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver determines which fetal body part (e.g., head or buttocks) occupies the uterine fundus. The examiner faces the patient's head and places the hands on the abdomen, using the palmar surface of the hands to gently palpate the fundal region of the uterus. The buttocks feel soft, broad, and poorly defined and move with the trunk. The fetal head feels firm and round and moves independently of the trunk. b. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. c. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. d. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario.

18. A nurse is reviewing diet with a pregnant woman in her second trimester. Which of the following foods should the nurse advise the patient to avoid consuming during her pregnancy? a. Brie cheese b. Bartlett pears c. Sweet potatoes d. Grilled lamb

ANS: a Feedback a. Soft cheese may harbor Listeria. The patient should avoid consuming uncooked soft cheese. b. A pear is an excellent food for a pregnant woman to consume. c. Sweet potatoes are an excellent food for a pregnant woman to consume. d. Grilled lamb is an excellent food for a pregnant woman to consume, although it should be well cooked.

9. A 26-year-old woman at 29 weeks' gestation experienced epigastric pain following the consumption of a large meal of fried fish and onion rings. The pain resolved a few hours later. The most likely diagnosis for this symptom is: a. Cholelithiasis b. Influenza c. Urinary tract infection d. Indigestion

ANS: a a. The progesterone-induced prolonged emptying time of bile from the gallbladder, combined with elevated blood cholesterol levels, may predispose the pregnant woman to gallstone formation (cholelithiasis). Pain in the epigastric region following ingestion of a high-fat meal constitutes the major symptom of these conditions. The pain is self-limiting and usually resolves within 2 hours. b. The symptoms described are not associated with influenza. c. The symptoms described are not associated with urinary tract infection. d. Prolonged emptying time of bile from the gallbladder, combined with elevated blood cholesterol levels, make cholelithiasis a more probable diagnosis than indigestion.

4. Asking the pregnant woman about her use of recreational drugs is an essential component of the prenatal history. Harmful fetal effects that may occur from recreational drugs include (select all that apply): a. Miscarriage/spontaneous abortion b. Low birth weight c. Macrosomia d. Post-term labor/birth

ANS: a, b Illegal or recreational drug use can have a number of detrimental effects on maternal and fetal health, including spontaneous abortion, low birth weight, placental abruption, and preterm labor. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

40. The clinic nurse describes the respiratory system changes common to pregnancy to the new nurse. These changes include (select all that apply): a. An increased tidal volume b. A decreased airway resistance c. An increased chest circumference d. An increased airway resistance

ANS: a, b, c During pregnancy, a number of changes occur to meet the woman's increased oxygen requirements. The tidal volume (amount of air breathed in each minute) increases 30% to 40%. The enlarging uterus creates an upward pressure that elevates the diaphragm and increases the subcostal angle. The chest circumference may increase by as much as 6 centimeters, and airway resistance decreases. Although the "up and down" capacity of diaphragmatic movement is reduced, lateral movement of the chest and intercostal muscles accommodates for this loss of movement and keeps pulmonary functions stable. There is no increase in airway resistance during pregnancy.

52. Jorgina is a 24-year-old pregnant woman at 26 weeks' gestation. This is Jorgina's third pregnancy, and her obstetrical history includes one full-term birth, one preterm birth, and two living children. Today Jorgina arrives at the clinic with complaints of fatigue, insomnia, and backache. She reports that she is a nurse on an oncology unit and is worried about continuing with working her 12-hour shifts. The perinatal nurse identifies concerns in Jorgina's history and work environment including (select all that apply): a. Risk of preterm birth b. Presence of chemotherapeutic agents c. Requirement for heavy lifting d. History of diabetes

ANS: a, b, c Women who are currently experiencing pregnancy complications and those who have a history of pregnancy complications (such as history of preterm birth) or other preexisting health disorders may be required to reduce their hours or stop working. The potential for maternal exposure to toxic substances such as chemotherapeutic agents, lead, and ionizing radiation (found in laboratories and health-care facilities); heavy lifting; and use of heavy machinery and other hazardous equipment should prompt reassignment to a different work area. If reassignment is not possible, Jorgina may need to stop working until the pregnancy has been completed. In this scenario there is no history of diabetes.

45. The clinic nurse schedules Tracy for her first prenatal appointment with the certified nurse-midwife (CNM) in the clinic. Tracy has appropriate questions for her potential health-care provider that include (select all that apply): a. Complementary and alternative methods used during labor and birth b. An opportunity to meet other providers in the practice c. Beliefs and practices concerning an episiotomy and an epidural anesthetic d. Whether the nurse-midwife will be continually available for support during labor

ANS: a, b, c A woman's journey through the pregnancy experience can have long-term effects on her self-perception and self-concept. Therefore, it is especially important that the patient choose a care provider and group with whom she can openly relate and who shares the same philosophical views on the management of pregnancy. At the first prenatal visit, it is not common to explore whether the nurse-midwife will be continually available for support during labor.

38. The clinic nurse encourages all pregnant women to increase their water intake to at least 8 to 10 glasses per day in order to (select all that apply): a. Decrease the risk of constipation b. Decrease the risk of bile stasis c. Decrease their feelings of fatigue d. Decrease the risk of urinary tract infections

ANS: a, b, c, d Patients should be encouraged to drink at least 8 to 10 glasses of water each day and empty their bladders at least every 2 to 3 hours and immediately after intercourse. These measures will help prevent stasis of urine and the bacterial contamination that leads to infection, as well as constipation. Some women experience symptoms of fatigue that can be alleviated by remaining adequately hydrated.

55. During the initial antenatal visit, the clinic nurse asks questions about the woman's nutritional intake. Specific questions should include information pertaining to (select all that apply): a. Preferred foods b. The presence of cravings c. Use of herbal supplements d. Aversions to certain foods and odors

ANS: a, b, c, d The nurse should obtain a nutritional history on all pregnant patients and patients of childbearing age to gain specific information related to the pregnancy, including foods that are preferred while pregnant (which may provide information about cultural and environmental dietary factors), special diets (which will assist the nurse in planning for education or interventions for risk factors associated with dietary practices), cravings or aversions to specific foods, and use of herbal supplements.

34. The perinatal nurse teaches the student nurse about the physiological changes in pregnancy that most often contribute to the increased incidence of urinary tract infections. These changes include (select all that apply): a. Relaxation of the smooth muscle of the urinary sphincter b. Relaxation of the smooth muscle of the bladder c. Inadequate emptying of the bladder d. Increased incidence of bacteriuria

ANS: a, b, c, d Ascension of bacteria into the bladder can cause asymptomatic bacteriuria (ASB), or urinary tract infections (UTIs). These infections occur more frequently in pregnancy due to relaxation of the smooth muscle of the bladder and urinary sphincter and inadequate emptying of the bladder, changes that allow bacterial ascent into the bladder.

48. Presumptive signs of pregnancy include (select all that apply): a. Nausea b. Fatigue c. Ballottement d. Amenorrhea

ANS: a, b, d Nausea and vomiting, fatigue, and amenorrhea are all common during pregnancy and are the presumptive signs of pregnancy. Ballottement is a probably sign, noted during a vaginal exam.

33. An 18-year-old woman at 23 weeks' gestation tells the nurse that she has fainted two times. The nurse teaches about the warning signs that often precede syncope so that she can sit or lie down to prevent personal injury. Warning signs include (select all that apply): a. Sweating b. Nausea c. Chills d. Yawning

ANS: a, b, d Sweating is a warning sign that often precedes syncope. Syncope (a trandient loss of consciousness and postural tone with spontaneous recovery) during pregnancy is frequently attributed to orthostatic hypotension or inferior vena cava compression by the gravid uterus. Nausea and yawning are warning signs that often precede syncope. Lightheadedness, sweating, nausea, yawning, and feelings of warmth are warning signs that often precede syncope. Chills are not a warning sign that often precede syncope.

39. The perinatal nurse examines the thyroid gland as part of the physical examination of Savannah, a pregnant woman who is now at 16 weeks' gestation. The perinatal nurse informs Savannah that during pregnancy (select all that apply): a. Increased size of the thyroid gland is normal b. Increased function of the thyroid gland is normal c. Decreased function of the thyroid gland is normal d. The thyroid gland will return to its normal size and function during the postpartal period

ANS: a, b, d The thyroid gland changes in size and activity during pregnancy. Enlargement is caused by increased circulation from the progesterone-induced effects on the vessel walls, and by estrogen-induced hyperplasia of the glandular tissue. The thyroid gland increases not decreases in size and activity during pregnancy. The thyroid gland returns to normal size and activity postpartum.

54. Teera is a 22-year-old woman who is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. Teera is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. The perinatal nurse discusses Teera's diet with her as she may be deficient in (select all that apply): a. Iron b. Magnesium c. Zinc d. Vitamin B12

ANS: a, c Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork and have adequate intake of magnesium. Pregnant women who adhere to this diet may consume inadequate amounts of iron and zinc. Because strict vegetarians (vegans) consume only plant products, their diets are deficient in vitamin B12, found only in foods of animal origin.

53. The clinic nurse is assessing the complete blood count results for Kim-Ly, a 23-year-old pregnant woman. Kim-Ly's hemoglobin is 9.8 g/dL. This laboratory finding places Kim-Ly's pregnancy at risk for (select all that apply): a. Preterm birth b. Placental abruption c. Intrauterine growth restriction d. Thrombocytopenia

ANS: a, c True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The blood's decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction (IUGR) and preterm birth. There is not a risk factor for abruption or thrombocytopenia.

41. The clinic nurse teaches the new nurse about pregnancy-induced blood clotting changes. The nurse explains that a pregnant woman is at risk for venous thrombosis due to (select all that apply): a. Increased fibrinogen volume b. Increased blood factor V c. Increased blood factor X d. Venous stasis

ANS: a, c, d Although the platelet cell count does not change significantly during pregnancy, fibrinogen volume has been shown to increase by as much as 50%. This alteration leads to an increase in the sedimentation rate. Blood factors VII, VIII, IX, and X are also increased, and this change causes hypercoagulability. The hypercoagulability state, coupled with venous stasis (poor blood return from the lower extremities) places the pregnant woman at an increased risk for venous thrombosis, embolism, and, when complications are present, disseminated intravascular coagulation (DIC). Blood factor V does not increase.

50. Urinary tract infection (UTI) prevention measures during pregnancy include counseling the pregnant woman to (select all that apply): a. Delay urination until bladder is full b. Limit hydration c. Wipe from front to back d. Urinate after intercourse

ANS: a, c, d Anticipatory guidance for urinary tract infection prevention includes delaying urination, wipe front to back, and maintaining adequate hydration.

56. The perinatal nurse talks to the prenatal class attendees about guidelines for exercise in pregnancy. Recommended guidelines include (select all that apply): a. Stopping if the woman is tired b. Bouncing and slowly arching the back c. Increasing fluid intake throughout the physical activity d. Maintaining the ability to walk and talk during exercise

ANS: a, c, d Women should adhere to some basic safety guidelines when formulating their exercise program, including monitoring the breathing rate and ensuring that the ability to walk and talk comfortably is maintained during physical activity, stopping exercise when the woman becomes tired, and maintaining adequate fluid intake. Pregnant women should avoid exercises that can cause any degree of trauma to the abdomen or those that include rigorous bouncing, arching of the back, or bending beyond a 45-degree angle.

43. The clinic nurse advocates for smoking cessation during pregnancy. Potential harmful effects of prenatal tobacco use include (select all that apply): a. Preterm birth b. Gestational hypertension c. Gestational diabetes d. Low birth weight

ANS: a, d Nurses can help to improve the fetal environment by educating women about the dangers of direct and passive smoking during pregnancy. Effects of tobacco use during pregnancy are well documented and predispose to premature rupture of the membranes, preterm labor, placental abruption, placenta previa, and infants who are low birth weight or small for gestational age (SGA). Gestational hypertension and diabetes are not associated with smoking during pregnancy. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

5. Intimate partner violence (IPV) against women consists of actual or threatened physical or sexual violence and psychological and emotional abuse. Screening for IPV during pregnancy is recommended for: a. Pregnant women with a history of domestic violence b. All pregnant women c. All low-income pregnant women d. Pregnant adolescents

ANS: b Feedback a. Intimate partner violence is underreported by women, necessitating universal screening. b. Correct. AWHONN advocates for universal screening for domestic violence for all pregnant women. Homicide is the most likely cause of death for pregnant or recently pregnant women, and a significant portion of those homicides are committed by their intimate partners. One in six pregnant women reported physical or sexual abuse during pregnancy, seriously impacting maternal and fetal health and infant birth weight. c. IPV crosses all ethnic, racial, religious, and socioeconomic levels. d. IPV crosses all ethnic, racial, religious, and socioeconomic levels. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Moderate

13. The clinic nurse talks with Kathy about her possible pregnancy. Kathy has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. These symptoms are best described as: a. Positive signs of pregnancy b. Presumptive signs of pregnancy c. Probable signs of pregnancy d. Possible signs of pregnancy

ANS: b Feedback a. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements palpated by the examiner. b. Presumptive signs of pregnancy include amenorrhea, nausea and vomiting, frequent urination, breast tenderness, perception of fetal movement, skin changes, and fatigue. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements palpated by the examiner. c. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement. d. Possible signs of pregnancy may vary widely.

30. The nurse who is assessing a G2 P1 palpates the fundal height at the location noted on the picture below. The nurse concludes that the fetus is equal to which of the following gestational ages? a. 12 weeks b. 20 weeks c. 28 weeks d. 36 weeks

ANS: b Feedback a. At 12 weeks' gestation, the fundus should be felt at the level of the symphysis pubis. b. The fundus at the level of the umbilicus indicates 20 weeks' gestation. In this question, the fact that this patient is a multigravida is not relevant. Uterine growth should be consistent for both primigravidas and multigravidas. c. At 28 weeks' gestation, the fundus should be felt 8 cm above the level of the umbilicus. d. At 36 weeks' gestation, the fundus should be felt at the xiphoid process. KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

24. Which of the following findings, seen in pregnant women in the third trimester, would the nurse consider to be within normal limits? a. Diplopia b. Epistaxis c. Bradycardia d. Oliguria

ANS: b Feedback a. Diplopia is sometimes seen in patients with pregnancy-induced hypertension (PIH). b. Epistaxis is commonly seen in pregnant patients. The bleeding is related to the increased vascularity of the mucous membranes. Unless the blood loss is significant, it is a normal finding. c. Bradycardia is often seen immediately after delivery but not during the third trimester. d. Oliguria is seen in patients with PIH. KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

23. A pregnant woman informs the nurse that her last normal menstrual period was on July 6, 2007. Using Naegele's rule, which of the following would the nurse determine to be the patient's estimated date of delivery (EDC)? a. January 9, 2008 b. April 13, 2008 c. April 20, 2008 d. September 6, 2008

ANS: b Feedback a. The EDC is calculated as April 13, 2008. b. The EDC is calculated as April 13, 2008. Naegele's rule: subtract 3 months and add 7 days to the first day of the last normal menstrual period. c. The EDC is calculated as April 13, 2008. d. The EDC is calculated as April 13, 2008. KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

To avoid supine hypotensive syndrome while measuring fundal height, where would a nurse position a pillow under a client? 1. Head 2. Hip 3. Feet 4. Knees

Answer: 2 Option 1: The client must remain supine while having a fundal height measurement. The pillow cannot go under her head to elevate her. Option 2: The client must remain supine while having a fundal height measurement. To displace the uterus, a pillow should be placed under her hip. Option 3: The client must remain supine while having a fundal height measurement. The pillow cannot go under her feet to elevate her Option 4: The client must remain supine while having a fundal height measurement. The pillow cannot go under her knees to elevate her.

7. At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse and tells you shyly that she wants to maintain a sexual relationship with her partner. The best response is to: a. Reassure woman/couple of normalcy of response b. Suggest alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse c. Recommend cessation of intercourse until after delivery due to advanced gestation d. Suggest woman discuss this with her care provider at her next appointment

ANS: b a. Although this is a normal response, providing reassurance is not enough. Further intervention is indicated. b. Although shy to discuss this, she wants to maintain a sexual relationship with her partner. Suggesting alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse provides the woman with information to maintain sexual relations. c. She wants to maintain a sexual relationship with her partner, and there are no contraindications to intercourse during a healthy pregnancy. d. The patient is seeking out information and to defer her to her care provider at her next appointment is inappropriate. Additionally, she may not be comfortable discussing this with anyone else.

1. Folic acid supplementation during pregnancy is to: a. Improve the bone density of pregnant women b. Decrease the incidence of neural tube defects in the fetus c. Decrease the incidence of Down syndrome in the fetus d. Improve calcium uptake in pregnant women

ANS: b Feedback a. Folic acid is not related to bone density. b. Correct. The use of folic acid has decreased the incidence of neural tube defects by 50%. c. The use of folic acid is not associated with a reduction in Down syndrome. d. Folic acid is not related to calcium uptake in women. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Pharmacological/Parenteral Therapies | Difficulty Level: Moderate

10. The clinic nurse reviews the complete blood count results for a 30-year-old woman who is now 33 weeks' gestation. Tamara's hemoglobin value is 11.2 g/dL, and her hematocrit is 38%. The clinic nurse interprets these findings as: a. Normal adult values b. Normal pregnancy values for the third trimester c. Increased adult values d. Increased values for 33 weeks' gestation

ANS: b Feedback a. The values are low normal for adults but represent normal findings for pregnant women. b. During pregnancy the woman's hematocrit values may appear low due to the increase in total plasma volume (on average, 50%). Because the plasma volume is greater than the increase in erythrocytes (30%), the hematocrit decreases by about 7%. This alteration is termed "physiologic anemia of pregnancy," or "pseudo-anemia." The hemodilution effect is most apparent at 32 to 34 weeks. The mean acceptable hemoglobin level in pregnancy is 11 to 12 g/dL of blood. c. The values are not increased; they are low normal for adults but represent normal findings for pregnant women. d. The values are not increased; they are low normal for adults but represent normal findings for pregnant women.

A 32-year-old woman now at 32 weeks' gestation is complaining of right-sided sharp abdominal pain. The patient is examined by the clinic nurse and given information about abdominal discomfort in pregnancy. She is also instructed to seek immediate attention if she (select all that apply): a. Has heartburn b. Has chills or a fever c. Feels decreased fetal movements d. Has increased abdominal pain

ANS: b, c, d Heartburn is a common discomfort throughout pregnancy. Because the appendix is pushed upward and posterior by the gravid uterus, the typical location of pain is not a reliable indicator for a ruptured appendix during pregnancy. The pain should gradually subside, but if it persists or is accompanied by fever, a change in bowel habits, or decreased fetal movement, the patient should promptly contact her medical provider.

73. The clinic nurse is aware of the importance of chlamydia screening during pregnancy. Chlamydia transmission to the infant at __________ may result in __________.

ANS: birth; ophthalmia neonatorum Chlamydia trachomatis is a bacteria that causes infection that is prevalent in sexually active populations, especially those in the under-25 age group. Complications of chlamydia infections include salpingitis, pelvic inflammatory disease, infertility, ectopic pregnancy, premature rupture of the membranes, and preterm birth. Transmission to the neonate may occur during birth and results in ophthalmia neonatorum and chlamydial neonatal pneumonia. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

19. The nurse is working in a prenatal clinic caring for a patient at 14 weeks' gestation, G2 P1001. Which of the following findings should the nurse highlight for the nurse midwife? a. Body mass index of 23 b. Blood pressure of 100/60 c. Hematocrit of 29% d. Pulse rate of 76 bpm

ANS: c Feedback a. A body mass index of 23 is normal. b. A blood pressure of 100/60 is normal. c. A hematocrit of 29% indicates that the patient is anemic. The nurse should highlight the finding for the nurse-midwife. d. A pulse rate of 76 bpm is a normal rate.

25. A primigravida patient is 39 weeks pregnant. Which of the following symptoms would the nurse expect the patient to exhibit? a. Nausea b. Dysuria c. Urinary frequency d. Intermittent diarrhea

ANS: c Feedback a. Nausea is usually not seen in the third trimester. b. Dysuria is not a normal finding at any time during a pregnancy. The possibility of a urinary traction infection (UTI) should be considered. c. Urinary frequency recurs at the end of the third trimester. As the uterus enlarges, it again compresses the bladder causing urinary frequency. d. Diarrhea is not a normal finding at any time during a pregnancy. KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

26. The nurse has taken a health history on four multigravida patients at their first prenatal visits. It is high priority that the patient whose first child was diagnosed with which of the following diseases receives nutrition counseling? a. Development dysplasia of the hip b. Achondroplastic dwarfism c. Spina bifida d. Muscular dystrophy

ANS: c Feedback a. The etiology of developmental dysplasia of the hip is unrelated to the mother's nutritional status. b. Achondroplasia is an inherited defect. Its etiology is unrelated to the mother's nutritional status. c. The incidence of spina bifida is much higher in women with poor folic acid intakes. It is a priority that this patient receives nutrition counseling. d. Most forms of muscular dystrophy are inherited. Their etiologies are unrelated to the mother's nutritional status. KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care; Collaboration with Interdisciplinary Team; Management of Care: Referrals | Client Need: Health Promotion and Maintenance; Safe and Effective Care Environment: Management of Care | Difficulty Level: Moderate

22. A nurse is performing an assessment on a pregnant woman during a prenatal visit. Which of the following findings would lead the nurse to report to the obstetrician that the patient may be experiencing intrauterine growth restriction (IUGR)? a. Leopold's maneuvers: Hard round object in the fundus, flat object on left of uterus, small parts on right of uterus, soft round object above the symphysis b. Weight gain: 6-pound increase over 4-week period c. Fundal height measurement: 22 cm at 26 weeks' gestation d. Alpha-fetoprotein assessment: level is one-half normal, accompanied by complaints of severe nausea and vomiting

ANS: c Feedback a. This baby is in the breech position. This is not a sign of IUGR. b. This weight gain is slightly above normal. This is not a sign of IUGR. c. The fundal height at 26 weeks should be approximately 26 cm. The fundal height, therefore, is below expected. This patient may be experiencing intrauterine growth restriction. d. A low AFP level is seen in patients whose babies have spina bifida and other central nervous system defects. KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

11. The clinic nurse is aware that the pregnant woman's blood volume increases by: a. 20% to 25% b. 30% to 35% c. 40% to 45% d. 50% to 55%

ANS: c Feedback a. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not 20% to 25%. b. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45, not 30% to 35%. c. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45% and is primarily due to an increase in plasma and erythrocyte volume. Additional erythrocytes, needed because of the extra oxygen requirements of the maternal and placental tissue, ensure an adequate supply of oxygen to the fetus. The elevation in erythrocyte volume remains constant during pregnancy. d. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not as high as 50% to 55%. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

3. During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to: a. Order an EKG. b. Report this abnormal finding immediately to her care provider. c. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension. d. Order a nonstress test to assess fetal well-being.

ANS: c Feedback a. This is a normal occurrence in pregnancy and does not indicate pathology. The probable cause of the problem is supine hypotension. b. This is a normal finding that does not warrant immediate notification to her care provider. c. Correct. Teaching the woman to avoid lying on her back because of occlusion of the vena cava with the gravid uterus causes supine hypotension syndrome. d. Antenatal testing is not indicated with supine hypotension.

17. While performing Leopold's maneuvers on a woman in early labor, the nurse palpates a flat area in the fundal region, a hard round mass on the left side, a soft round mass on the right side, and small parts just above the symphysis. The nurse concludes which of the following? a. The fetal position is right occiput posterior. b. The fetal attitude is flexed. c. The fetal presentation is scapular. d. The fetal lie is vertical.

ANS: c Feedback a. This is a shoulder presentation. b. It is not possible to determine whether the attitude is flexed or not when doing Leopold's maneuvers. c. This is a shoulder presentation. d The lie is transverse or horizontal.

37. The clinic nurse talks with Suzy, a pregnant woman at 9 weeks' gestation who has just learned of her pregnancy. Suzy's nausea and vomiting are most likely caused by (select all that apply): a. Increased levels of estrogen b. Increased levels of progesterone c. An altered carbohydrate metabolism d. Increased levels of human chorionic gonadotropin

ANS: c, d Nausea and vomiting during the first trimester most likely are related to rising levels of human chorionic gonadotropin (hCG) and altered carbohydrate metabolism. Changes in taste and smell, due to alterations in the oral and nasal mucosa, can further aggravate the gastrointestinal discomfort.

6. The clinic nurse explains to Margaret, a newly diagnosed pregnant woman at 10 weeks' gestation, that her rubella titer indicates that she is not immune. Margaret should be advised to (select all that apply): a. Avoid contact with all children b. Be retested in 3 months c. Receive the rubella vaccine postpartum d. Report signs or symptoms of fever, runny nose, and generalized red rash to the health-care provider

ANS: c, d Testing for rubella (German measles) is not necessary as titers are reliable indicators of immunity. Rubella (German measles) is one of the most commonly recognized viral infections known to cause congenital problems. If a woman contracts rubella during the first 12 weeks of pregnancy, the fetus has a 90% chance of being adversely affected. A maternity patient who is not immune to rubella should be offered the rubella immunization following childbirth, ideally prior to hospital discharge. The patient should report signs or symptoms of rubella during pregnancy to her health-care provider. It is not realistic for a woman to avoid contact with all children.

4. Blood volume expansion during pregnancy leads to: a. Iron-deficiency anemia b. Maternal iron stores being insufficient to meet the demands for iron in fetal development c. Plasma fibrin increase of 40% and fibrinogen increase of 50% d. Physiological anemia of pregnancy

ANS: d Feedback a. Iron-deficiency anemia is treated with iron supplementation. Iron-deficiency anemia is defined as hemoglobin of less than 11 g/dL and hematocrit less than 33%. b. Maternal iron stores that are insufficient to meet the demands for iron in fetal development result in iron-deficiency anemia. c. Hypercoagulation that occurs during pregnancy is to decrease the risk of postpartum hemorrhage. These changes taking place are not related to blood volume expansion. d. Correct. Physiological anemia of pregnancy, also referred to as pseudo-anemia of pregnancy, is due to hemodilution. The increase in plasma volume is relatively larger than the increase in RBCs that results in decreased hemoglobin and hematocrit values.

8. The clinic nurse talks to a 30-year-old woman at 34 weeks' gestation who complains of having difficulty sleeping. Jayne has noticed that getting back to sleep after she has been up at night is difficult. The nurse's best response is: a. "This is abnormal; it is important that you describe this problem to the doctor." b. "This is normal, and many women have this same problem during pregnancy; try napping for several hours each morning and afternoon." c. "This is abnormal; tell the doctor about this problem because diagnostic testing may be necessary." d. "This is normal in pregnancy, particularly during the third trimester when you also feel fetal movement at night; try napping once a day."

ANS: d Feedback a. This sleep pattern is a normal finding. b. Sleeping for several hours in the morning and afternoon would contribute to further sleep disturbances at night. c. This sleep pattern is a normal finding. d. Pregnancy sleep patterns are characterized by reduced sleep efficiency, fewer hours of night sleep, frequent awakenings, and difficulty going to sleep. Nurses can advise patients that afternoon napping may help alleviate the fatigue associated with the sleep alterations

2. The positive signs of pregnancy are: a. All physiological and anatomical changes of pregnancy b. All subjective signs of pregnancy c. All those physiological changes perceived by the woman herself d. The objective signs of pregnancy that can only be attributed to the fetus

ANS: d feedback a. Physiological and anatomical changes of pregnancy are presumptive signs of pregnancy. b. All subjective signs of pregnancy are the probable signs of pregnancy. c. All those physiological changes perceived by the woman herself are presumptive signs of pregnancy. d. Correct. Positive signs of pregnancy are the objective signs of pregnancy that can only be attributed to the fetus, such as fetal heart tones. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy

79. The perinatal nurse knows that __________, which is the eating of nonnutritive substances, is a common __________.

ANS: pica; eating disorder Pica, the consumption of nonnutritive substances or food, is a common eating disorder that can affect pregnancy. Substances that are most often ingested include clay, dirt, cornstarch, and ice.

72. The clinic nurse monitors the blood pressure and assesses a woman's urine at each prenatal visit to assess for signs or symptoms of __________. A previous history or the presence of a __________ are also risk factors.

ANS: preeclampsia; new partner A previous history of preeclampsia increases the woman's likelihood of a recurrence during subsequent pregnancies. If a woman did not experience preeclampsia with previous pregnancies but has a new partner for her current pregnancy, her risk of developing preeclampsia is similar to that of a woman who is pregnant for the first time. Although preeclampsia is a systemic disorder that occurs only during pregnancy, it is generally recognized by two classic symptoms: elevated blood pressure and proteinuria.

78. The clinic nurse understands that the physiological changes of pregnancy include vascular relaxation from the effects of __________ and impaired venous circulation from pressure exerted by the enlarged uterus, predisposing the pregnant woman to __________.

ANS: progesterone; varicose veins Progesterone results in vascular relaxation which combined with impaired venous return increases the incidence of varicose veins in pregnant women.

69. During the prenatal class, the perinatal nurse describes factors that may initiate the process of labor. One of these factors is the production of __________, which are found in the uterine __________ and are released from the __________ at term as it softens and dilates.

ANS: prostaglandins; decidua or lining; cervix Prostaglandins are lipid substances found in high concentrations in the female reproductive tract and in the uterine decidua during pregnancy. Their exact function in pregnancy is unknown, although they may maintain a reduced placental vascular resistance. A decrease in prostaglandin levels may contribute to hypertension and preeclampsia. At term, an increased release of prostaglandins from the cervix as it softens and dilates may contribute to the onset of labor.

6. The clinic nurse describes to the student nurse that __________ is excessive saliva production in pregnancy. This condition is most likely caused by increased __________ levels.

ANS: ptyalism; hormone Ptyalism, or excessive salivation, can be quite distressing for the pregnant woman who must frequently wipe her mouth or spit into a cup. Although the cause of ptyalism is unknown, it is most likely related to increased hormone levels.

74. The prenatal nurse describes the need for __________ and __________ screening at the first antenatal visit. If the pregnant woman is not immune, she will be counseled to avoid contact with young children who have a rash and could be infectious.

ANS: rubella; varicella Some of the routine maternal laboratory tests screen for childhood diseases that are known to cause congenital anomalies or other pregnancy complications if contracted during early pregnancy. When contracted during the first trimester, rubella causes a number of fetal deformities. Varicella (chickenpox) is another common childhood disease that may cause problems in the developing embryo and fetus. Therefore, all pregnant women are screened for rubella and varicella.

The nurse is preparing to measure a client's fundal height. which would the nurse do to obtain the most accurate measurement? 1. Instruct the client to empty her bladder. 2. Place the measuring tape just below the umbilicus. 3. Use the millimeter markings on the measuring tape to record fundal height. 4. Instruct the client to take a deep breath and hold it during the measurement.

Answer: 1 Option 1: A full bladder may falsely increase the fundal height measurement. By having the client empty her bladder, the nurse can obtain the most accurate measurement. Option 2: To obtain fundal height, the nurse should put the zero point of the tape on the symphysis pubis. Option 3: Fundal height is measured using a centimeter measuring tape. Option 4: Maternal respiration does not alter the fundal height measurement. The mother should breathe normally during the examination.

During a physical examination, the nurse observed that a client in her late pregnancy has hemorrhoids and varicosities in her legs. Which statement by the nurse explains the cause for these two conditions in a pregnant client? 1. "Increased venous pressure and decreased blood flow to the extremities, due to compression of the iliac veins and inferior vena cava." 2. "Increased action of adrenocorticosteroids leads to cutaneous elastic tissues becoming fragile." 3. "The stretching of the abdominal muscle, due to the enlarging uterus." 4. "Increased plasma fibrin by 40% and the fibrinogen by 50%."

Answer: 1 Option 1: Hemorrhoids and varicosities occur as a result of increased venous pressure and decreased blood flow to the extremities, due to compression of the iliac veins and inferior vena cava. Option 2: Striae gravidarum occurs as a result of the increased action of adrenocorticosteroids, which leads to the cutaneous elastic tissues becoming fragile. Option 3: Diastasis recti occurs due to the stretching of the abdominal muscle as a result of the enlarging uterus. Option 4: Hypercoagulability occurs due to an increase of plasma fibrin by 40% and the fibrinogen by 50%.

The nurse is providing preconception counseling to a client. Which topic is most important to educate the client on at this time? 1. Adequate intake of folic acid 2. Common discomforts of pregnancy 3. Infant safety at home 4. Gaining an appropriate amount of weight during pregnancy

Answer: 1 Option 1: Preconception nutrition counseling is important at this time because nutritional deficits at the beginning of pregnancy can affect the development of the fetus. Inadequate folic acid has been linked to an increased risk of neural tube defects. Option 2: The client is seeking preconception counseling and is not yet pregnant. This would be an important topic in her early prenatal care. Option 3: The client is seeking preconception counseling and is not yet pregnant. This would be an important topic in the second or third trimester. Option 4: The client is seeking preconception counseling and is not yet pregnant. Ensuring she has a healthy BMI before pregnancy would be important, but weight gain during pregnancy can be discussed later.

The nurse is educating a 34-week gestation client about danger signs to report to her health care provider. Which symptom would be added to the nursing care? 1. Blurry vision or seeing "floaters" 2. Edema in her feet and ankles after being on her feet at work 3. Frequent urination 4. Occasional nausea and vomiting

Answer: 1 Option 1: Visual changes can be indicative of hypertensive disorders and should be reported to the health care provider. Option 2: Dependent edema is common in the third trimester due to the pressure of the fetus slowing venous return from the lower half of the body. Option 3: Urinary frequency (with the absence of pain or urgency) reappears in the third trimester due to increasing weight of the fetus and lightening. Option 4: Occasional nausea and vomiting is unlikely to cause significant dehydration or nutritional deficits. Prolonged nausea and vomiting should be reported.

A couple that recently emigrated from another country visited the prenatal clinic for the first time. The nurses decided to conduct a cultural assessment of the couple. Which assessment by the nurse could assist in planning a culture-specific prenatal care for this couple? Select all that apply. 1. The couple's expectation of the health care system 2. The couple's need for one-on-one prenatal care 3. The couple's beliefs relating to pregnancy 4. History of intimate partner violence 5. A review of systems

Answer: 1,3 Option 1: Assessing the couple's expectations of the health care system allows the nurse to plan culture-specific care. Option 2: Joining a small group will provide a sense of community instead of a one-on-one prenatal care for this couple. Option 3: Assessing the couple's beliefs relating to pregnancy allows the nurse to plan culture- specific care. Option 4: All women should be assessed for intimate partner violence regardless of their nationality. Option 5: The nurse should conduct a review of systems for all women visiting the clinic for the first time.

During a prenatal appointment, the nurse assesses the client's blood pressure and obtains a reading of 152/94 mmHg. The nurse should assess for which additional symptoms? Select all that apply. 1. Facial edema 2. Dyspnea 3. Vision changes 4. Severe headache 5. Pelvic pressure

Answer: 1,3,4 Option 1: Facial and generalized edema are likely present in clients with hypertensive disorders. Option 2: Difficulty breathing is not likely associated with hypertensive disorders. Option 3: Hypertensive disorders may cause swelling and pressure on the optic nerve resulting in visual changes Option 4: Headache not relieved by usual measure (such as acetaminophen) are associated with hypertensive disorders. Option 5: Pelvic pressure would be present in a patient who could be experiencing preterm labor. It is not associated with increased blood pressure.

The nurse is admitting a client whose blood type is A-negative and had a miscarriage at 5-weeks gestation. which is the appropriate nursing intervention? 1. Prepare the client for a dilation and curettage (D&C) 2. Administer Rho (D) Immune Globulin (RhoGAM) 3. Instruct the client to use contraception for the next 6 months 4. Perform an ultrasound to confirm all products of conception have been expelled

Answer: 2 Option 1: A D&C is performed when products of conception remain inside the uterus. This information was not included in the question stem. Option 2: Rho (D) Immune Globulin is administered to Rh-negative women with likely exposure to Rh-positive blood such as with pregnancy loss. Option 3: Health care providers typically encourage the client to wait for 2-3 normal menstrual cycles before trying to conceive following a pregnancy loss. Option 4: Performing an ultrasound is not within the nurse's scope of practice. This would be done by a physician/midwife or radiological technician.

An immigrant from Asia who has being living in the shelter for more than a month visits the prenatal clinic. Which laboratory screening would the nurse consider to be priority for this client? 1. Tay-Sachs 2. Tuberculosis skin test 3. Hepatitis B surface antigen 4. Cystic fibrosis carrier screening

Answer: 2 Option 1: Tay-Sachs would be a consideration for persons of eastern European Jewish ancestry. Option 2: Tuberculosis skin test is used for clients at risk, such as recent immigrants and those living in group homes. Option 3: Hepatitis B surface antigen is a consideration to identify women whose infants need immunoprophylaxis post-delivery. Option 4: Cystic fibrosis carrier screening is mainly a consideration for Caucasians.

A spouse calls the birthing center stating that his wife who is 36 weeks gestation is going into premature labor. Which data from the spouse would assist the nurse in determining that premature labor is imminent? Select all that apply. 1. "Her headache is not responding to the medication." 2. "She is having abdominal cramps every 6 minutes." 3. "She is having low back pain with pelvic pressure." 4. "Her bag of membranes has just ruptured." 5. "She has generalized edema."

Answer: 2,3,4 Option 1: Severe headache that does not respond to usual relief measures is a symptom of hypertensive disorder. Option 2: Rhythmic lower abdominal cramping means that labor is imminent. Option 3: Low back pain with pelvic pressure is a symptom of preterm labor. Option 4: Leaking of amniotic fluid is a sign that the client is going into preterm labor. Option 5: Generalized edema is a sign of hypertensive disorder.

The nurse is admitting a client who is 10-weeks pregnant. An ultrasound has been scheduled and the client asks the nurse why this test is necessary. which are the appropriate responses from the nurse? Select all that apply. 1. "To determine the sex of your baby." 2. "To verify your gestational age." 3. "To make sure the baby has a strong heartbeat." 4. "To make sure the baby is inside your uterus and not in the fallopian tube." 5. "To see if you are carrying more than one baby."

Answer: 2,3,4,5 Option 1: External genitalia are not developed enough at 10-week gestation to determine infant sex via ultrasound Option 2: First trimester ultrasound can be used to verify gestational age along with last menstrual period. Option 3: First trimester ultrasound can be used to determine viability Option 4: First trimester ultrasound can be used to identify ectopic pregnancies Option 5: Multifetal gestation can be identified in the first trimester via ultrasound.

During prenatal appointments, the nurse provides teaching to the client. When providing teaching, which action would the nurse include? 1. Provide teaching about all procedures the client will need in one sitting. 2. Avoid teaching to the family to assure client privacy. 3. Assess the client's understanding of teaching. 4. Inform the client that if she has questions, they can be answered at the next visit.

Answer: 3 Option 1: Teaching about procedures can be provided as needed. Teaching everything at once can be overwhelming for the client. Option 2: Providing teaching to significant support persons is an important aspect of family-centered care. Option 3: Following teaching, the nurse should assess the client's level of understanding and clarify items if needed. Option 4: Adequate time should be given during the appointment to allow for client questions.

The nurse is documenting the obstetrical history of a client using the GTPAL system. The client is currently pregnant with her third child. Her first pregnancy resulted in the birth of a daughter at 38 weeks and 1-day gestation. Her second pregnancy resulted in the birth of a son at 35 weeks and 5 days gestation. Both are still living. What does the nurse document as the GTPAL?

Answer: 3-1-1-0-2 Correct Feedback Each pregnancy counts as a gravidity (two previous children + current pregnancy). The daughter born at 38 + 1 was term (T) and the son born at 35 + 5 was preterm (P). She had no abortions/miscarriages (A), and both her children are still living (L). Test Taking Tip: With GTPAL questions, it is helpful to write tally marks as you work through the question. If the patient is currently pregnant, remember to add that pregnancy in the gravidity column.

A woman diagnosed with Gestational Diabetes Mellitus (GDM) was referred to have a Group B Streptococcus (GBS) screening done. At which stage of the pregnancy would the nurse recommend the client to have this screening done? 1. 10 to 12 weeks of gestation 2. 15 to 23 weeks of gestation 3. 24 to 28 weeks of gestation 4. 35 to 37 weeks of gestation

Answer: 4 Option 1: Doppler ultrasound is recommended between 10 to 12 weeks of gestation to assess the fetal heart tones. Option 2: Screening for neural tube defect and Trisomy 21 screening are recommended between 15 to 23 weeks of gestation. Option 3: Screening for Gestational Diabetes Mellitus is recommended between 24 to 28 weeks of gestation. Option 4: Screening for Group B Streptococcus is recommended between 35 to 37 weeks of gestation.