Antepartal Period CH 4-7 Durham EXAM 1

A nurse is assessing a 16-year-old patient in her second trimester of pregnancy with her first child. The nurse recognizes that this patient is most likely to face which of the following challenges of adaptation to pregnancy? 1. Abandonment by her partner 2. Difficulty achieving maternal identity 3. Increased adverse pregnancy outcomes 4. Difficulty adjusting to body image changes 5. Difficulty balancing a career with the physical and psychological demands of pregnancy

1,2,3,4 Feedback 1: Adolescents who have an unintended pregnancy face a number of challenges, including abandonment by their partners, increased adverse pregnancy outcomes, and inability to complete school education. Feedback 2: Achieving maternal identity is very difficult for an adolescent who is in the throes of evolving her own identity as an adult capable of psychosocial independence from her family. Feedback 3: Adolescents who have an unintended pregnancy face a number of challenges, including abandonment by their partners, increased adverse pregnancy outcomes, and inability to complete school education. Feedback 4: The younger she is, the more difficulty the adolescent woman has with body image changes, acknowledging the pregnancy, seeking health care, and planning for the changes that pregnancy and parenting will bring. Feedback 5: Older mothers, not adolescent mothers, are more likely to have difficulty balancing a career with the physical and psychological demands of pregnancy.

A patient is now in her third trimester of pregnancy. The nurse is explaining to her all of the changes that have occurred in her cardiovascular system since becoming pregnant. Which of the following should the nurse mention? 1. Increase in blood volume by 40% to 45% 2. Increase in cardiac output by 40% 3. Increase in blood pressure 4. Increase in heart size 5. Increase of heart rate by 3 to 5 beats per minute

1,2,4 Feedback 1: Pregnancy results in an increase in blood volume by 40% to 45%. Feedback 2: Pregnancy results in an increase in cardiac output by 40%. Feedback 3: Pregnancy results in a decrease, not an increase, in blood pressure. Feedback 4: Pregnancy results in an increase in heart size. Feedback 5: Pregnancy results in an increase of heart rate by 15 to 20, not 3 to 5, beats per minute.

A nurse is assessing a patient's risk factors for preterm labor and birth. Which of the following characteristics of this patient would increase her risk for preterm labor and birth? 1. Prior preterm birth 2. Periodontal disease 3. Body mass index (BMI) of 24 4. Age 37 years 5. Intimate partner violence

1,2,4,5 Feedback 1: Prior preterm birth is the single most important risk factor for preterm labor and birth, with reoccurrence rates of up to 40%. Feedback 2: Infection, especially genitourinary infections and periodontal disease, is a risk factor for preterm labor and birth. Feedback 3: High BMI is a risk factor, but 24 is a normal BMI. Feedback 4: Age younger than 17 or older than 35 years is a risk factor for preterm labor and birth. Feedback 5: Preterm birth is more likely in the presence of intimate partner violence.

A nurse is caring for a patient who has just been found on ultrasound to have triplets. Which of the following risks should the nurse expect to be increased in this patient? 1. Preterm labor and delivery 2. Vaginal delivery 3. Preeclampsia 4. Low birth weight neonate 5. Perinatal fetal mortality

1,3,4,5 Feedback 1: A woman with multiple gestation is much more likely (90% or higher) to experience preterm labor and delivery than is a woman with a singleton pregnancy. Feedback 2: A woman with multiple gestation is at increased risk for cesarean birth, not vaginal delivery. Feedback 3: A woman with multiple gestation is at increased risk for hypertensive disorders and preeclampsia, which tend to develop earlier and be more severe. Feedback 4: A woman with multiple gestation is at increased risk (20%) of delivering a low birth weight neonate. Feedback 5: A woman with multiple gestation is at increased risk of perinatal fetal mortality.

A patient has undergone an extensive evaluation to confirm that she is pregnant. Which of the following would constitute a positive sign of pregnancy in this patient? 1. Auscultation of a fetal heart beat using a Doppler device 2. Amenorrhea 3. Observation and palpation of fetal movement by the nurse 4. Chadwick's sign 5. Sonographic visualization of the fetus

1,3,5 Feedback 1: Auscultation of a fetal heart beat using a Doppler device constitutes a positive sign of pregnancy because it is objective, meaning that the examiner can verify it, and that it can only be attributed to the fetus. Feedback 2: Amenorrhea is a presumptive, not positive, sign of pregnancy, because it is subjective, meaning it is perceived only by the woman herself. Feedback 3: Observation and palpation of fetal movement by the nurse constitute a positive sign of pregnancy because they are objective, meaning that the examiner can verify them, and that they can only be attributed to the fetus. Feedback 4: Chadwick's sign, which is a bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6 to 8 weeks, is a probable, not positive, sign of pregnancy, because it can be caused by factors other than pregnancy. Feedback 5: Sonographic visualization of the fetus constitutes a positive sign of pregnancy because it is objective, meaning that the examiner can verify it, and that it can only be attributed to the fetus.

A patient has just learned that she is pregnant and would like to know when her estimated date of delivery (EDD) is. The nurse should tell the patient that most likely she will be told her EDD at which visit? 1. Initial visit (today) 2. Follow-up visit in 4 weeks 3. First visit of the second trimester 4. Second visit of the second trimester

1. Initial visit (today) The patient's EDD will be determined at the initial visit.

A nurse is assisting in the vaginal birth of a patient who has AIDS. Which of the following actions should be a priority for the nurse in this situation? 1. Leaving fetal membranes intact 2. Using fetal scalp electrodes when possible 3. Performing an episiotomy if possible 4. Providing and reinforcing education about the disease 5. Providing emotional support to the mother

1,4,5 Feedback 1: The nurse should leave fetal membranes intact, to prevent bleeding and possible transmission of the disease to the fetus or to medical staff. Feedback 2: The nurse should avoid using fetal scalp electrodes when possible, to reduce the risk of bleeding and possible transmission of the disease to the fetus or to medical staff. Feedback 3: The nurse should avoid performing an episiotomy if possible, to prevent bleeding and possible transmission of the disease to the fetus or to medical staff. Feedback 4: The nurse should provide and reinforce education about the disease. Feedback 5: The nurse should provide emotional support to the mother.

A nurse is assisting a couple who are expecting their first child together, although they each have children from prior relationships who live with them. The nurse recognizes that this family configuration is known as which of the following? 1. Blended family 2. Nuclear family 3. Cohabiting family 4. Extended family

1. Blended family The blended, or reconstituted, family is a combination of two families with children from one or both families and sometimes children of the newly married couple.

A nurse is observing a woman in preterm labor who has been given a tocolytic as well as a corticosteroid. Which of the following should cause the greatest concern in the nurse and be reported to the primary care provider? 1. Blood pressure of 145/95 mm Hg 2. Heart rate of 110 beats per minute 3. Temperature of 99.9°F (37.7°C) 4. Elevated white blood cell count (WBC)

1. Blood pressure of 145/95 mm Hg The nurse should report to the provider a blood pressure greater than 140/90 mm Hg

A woman in her 10th week of pregnancy is concerned that her fetus may have cystic fibrosis, as it is a genetic disorder that runs in her family. She would like to undergo a biochemical assessment to confirm or rule out this condition. The nurse should anticipate that which of the following assessments would be best for this purpose? 1. Chorionic villus sampling 2. Amniocentesis 3. Delta OD 450 4. Fetal blood sampling

1. Chorionic villus sampling Chorionic villus sampling is aspiration of a small amount of placental tissue (chorion) for chromosomal, metabolic, or DNA testing. This test is used for chromosomal analysis between 10 and 12 weeks' gestation to detect fetal abnormalities caused by genetic disorders. It tests for metabolic disorders such as cystic fibrosis but does not test for neural tube defects.

A woman is in the 32nd week of a low-risk, healthy pregnancy but is nervous about how her baby is doing. Which of the following tests of fetal status and well-being would be the most appropriate for the nurse to teach this patient to perform herself to reassure her that the baby is well? 1. Daily fetal movement count 2. Non-stress test (NST) 3. Vibroacoustic stimulation 4. Contraction stress test (CST)

1. Daily fetal movement count Daily fetal movement count (kick counts) is a maternal assessment of fetal movement by counting fetal movements in a period of time to identify potentially hypoxic fetuses. Maternal perception of fetal movement was one of the earliest and easiest tests of fetal well-being and remains an essential assessment of fetal health. Kick counts have been proposed as a primary method of fetal surveillance for all pregnancies after 28 weeks' gestation.

A patient in her first trimester is found to have developed gestational diabetes mellitus (GDM). Which of the following should be the nurse's primary goal for this patient in helping manage this condition? 1. Glycemic control 2. Lowering blood pressure 3. Reducing cholesterol level 4. Weight loss

1. Glycemic control The cornerstone of management of GDM is glycemic control, or keeping the patient's blood glucose level within normal parameters.

A nurse is counseling a patient regarding discontinuing contraception in anticipation of trying to become pregnant. Which of the following instructions should the nurse give the patient? 1. Have two or three normal menstrual cycles before trying to conceive 2. Switch from hormonal contraception to an intrauterine device several months before trying to conceive 3. If using Depo-Provera, continue taking injections until 1 month before trying to conceive 4. Use only barrier methods of contraception for at least a year before trying to conceive

1. Have two or three normal menstrual cycles before trying to conceive Before conception, it is ideal for a woman to have at least two or three normal menstrual periods.

On ultrasound during a routine prenatal visit, it is discovered that a patient's placenta is completely covering her internal cervical os. The nurse recognizes that the biggest risk for the patient associated with this condition in the third trimester is which of the following? 1. Hemorrhagic and hypovolemic shock 2. Eclampsia 3. Heart attack 4. Aneurysm

1. Hemorrhagic and hypovolemic shock Placenta previa occurs when the placenta attaches to the lower uterine segment of the uterus, near or over the internal cervical os instead of in the body or fundus of the uterus. Hemorrhage is especially likely to occur during the third trimester with development of the lower uterine segment and when uterine contractions dilate the cervix. Thus, if the bleeding is extreme, the woman is at risk for hemorrhagic and hypovolemic shock related to excessive blood loss.

A woman in her 35th week of gestation experiences premature rupture of membranes (PROM). Which of the following courses of action should the nurse most expect the primary care provider to take in this situation? 1. Induction of labor and treatment for group B streptococcal prophylaxis 2. A 48-hour course of intravenous ampicillin and erythromycin followed by 5 days of amoxicillin and erythromycin 3. A single course of antenatal corticosteroids 4. Patient counseling about risks to fetus

1. Induction of labor and treatment for group B streptococcal prophylaxis Patients with PROM between 34 and 36 weeks should be managed as if they were at term, with induction of labor and treatment for group B streptococcal prophylaxis recommended.

A nurse calculates a patient's body mass index (BMI) and finds it to be 37. The nurse understands that this patient is at increased risk for which of the following pregnancy-related outcomes? 1. Infertility 2. Low blood pressure 3. Vaginal delivery 4. Small for gestational age neonate

1. Infertility Obesity, which is defined as having a BMI of greater than or equal to 30.0, increases a woman's risk for infertility.

During her pregnancy, a single woman receives much support from her mother, who cooks meals for her and helps her with cleaning her house. The nurse recognizes this assistance as which type of social support? 1. Instrumental 2. Emotional 3. Informational 4. Comparison

1. Instrumental Material, or instrumental, support consists of practical help such as assistance with chores, meals, and managing finances.

A nurse is providing preconception counseling to a woman who is hoping to become pregnant for the first time. Which of the following terms most accurately describes this patient's status and thus should be recorded in the patient's health record? 1. Nulligravida 2. Primigravida 3. Multigravida 4. Gravida

1. Nulligravida A nulligravida is a woman who has never been pregnant or given birth, which applies to the patient in this case.

A patient in her first trimester is found on ultrasound to have a hydatiform mole pregnancy. Which of the following would be an appropriate nursing action associated with this condition? 1. Offer emotional support related to pregnancy loss 2. Administer magnesium sulfate per orders 3. Instruct the patient on how to maintain glycemic control 4. Prepare the patient for cesarean birth

1. Offer emotional support related to pregnancy loss A hydatiform mole is a benign proliferating growth of the trophoblast in which the chorionic villi develop into edematous, cystic, vascular transparent vesicles that hang in grape-like clusters without a viable fetus. This is a nonviable pregnancy; thus, an appropriate nursing action in this case would be to offer emotional support related to pregnancy loss.

A nurse in the birth center is working with a patient in her third trimester who has ischemic heart disease. Which of the following should be the primary goal of nursing actions in this situation? 1. Prevention of complications 2. Reduction of serum cholesterol levels 3. Reduction of blood pressure 4. Adoption of a heart-healthy diet by the patient

1. Prevention of complications Antepartum nursing measures should be directed toward prevention of complications related to heart disease, not primary treatment of this condition.

A nurse is counseling an obese client who is in her third trimester on a sleeping position that can decrease the negative effects that obesity has on respiratory function. Which of the following should the nurse suggest? 1. Sitting position 2. Prone position 3. Supine position 4. Side-lying position

1. Sitting position The nurse should encourage the woman to sleep in a sitting position, as the effects of obesity on the respiratory system are decreased in this position.

A nurse is consoling a Native American patient whose friend just died. The nurse asks whether the patient will be attending the friend's funeral. The patient, who is in her third trimester of pregnancy, responds that sadly she will not, because she believes it would bring bad luck to the baby. She explains that this is a traditional belief of her tribe. The nurse recognizes this belief as an example of which of the following? 1. Taboo 2. Stereotype 3. Ethnocentrism 4. Prescriptive belief

1. Taboo Taboos are cultural restrictions believed to have serious supernatural consequences.

As a patient is lying down for an antepartum examination, the nurse instructs her to lie on her side. Which of the following is the primary rationale for this instruction? 1. To prevent supine hypotensive syndrome 2. To maximize the patient's comfort 3. To prevent diastasis recti 4. To prevent lordosis

1. To prevent supine hypotensive syndrome Supine hypotensive syndrome is a hypotensive condition resulting from a woman lying on her back in mid- to late pregnancy. In a supine position, the enlarged uterus compresses the inferior vena cava, leading to a significant drop in cardiac output and blood pressure, and resulting in the woman feeling dizzy and faint.

A patient has a prepregnancy body mass index (BMI) of 28. How many pounds should the nurse recommend that this patient gain over the course of her pregnancy? 1. 28 to 40 2. 25 to 35 3. 15 to 25 4. 11 to 20

2. 25 to 35 A woman who is normal weight (BMI 18.5 to 24.9) should gain 25 to 35 pounds during pregnancy.

A nurse is caring for a patient who has an acute asthma exacerbation during labor. Which of the following interventions should the nurse make? 1. Measure blood pressure 2. Administer oxygen 3. Assist patient in performing breathing exercises 4. Take a detailed history of respiratory status

2. Administer oxygen During an acute asthma exacerbation in the patient, the nurse should administer oxygen to maintain PaO₂ greater than 95%.

A nurse is examining a patient in her third trimester who has brought her four-year-old daughter along to the visit. Based on the age and level of development of the daughter, which of the following responses to the pregnancy should the nurse expect in this child? 1. An unawareness of the pregnancy 2. An interest in the pregnancy and fascination with hearing the fetal heartbeat 3. A keen interest in the details of pregnancy and birth 4. An embarrassment in the changes in her mother's appearance

2. An interest in the pregnancy and fascination with hearing the fetal heartbeat Children four to five years old often enjoy listening to the fetal heartbeat and may show interest in the development of the fetus.

A nurse notices a pregnant woman in the waiting room who is stroking her belly and laughing as she feels the baby kick. The nurse recognizes that the patient is most likely engaging in which of Rubin's maternal tasks? 1. Ensuring safe passage 2. Binding-in 3. Ensuring social acceptance of the child 4. Giving herself to the demands of being a mother

2. Binding-in Attaching or "binding-in" to the child refers to the development of maternal-fetal attachment, such as is occurring in this scenario.

A nurse is instructing a patient on how to avoid nausea and vomiting during her first trimester. Which of the following should the nurse mention? 1. Take vitamins first thing in the morning 2. Drink ginger ale 3. Brush teeth before eating 4. Eat at a rapid pace

2. Drink ginger ale The patient should drink cold, clear carbonated beverages such as ginger ale.

A patient in her third trimester explains to her nurse that she has decided to have a home birth. The nurse recognizes that which of the following is the advantage of a home birth as opposed to a hospital or birth center birth? 1. It is the safest setting in which a woman with a high-risk pregnancy may give birth. 2. It allows the expectant family to be in control of the experience. 3. It features emergency equipment that is available but stored out of view. 4. It allows quick access to a whole team of medical experts, should complications arise.

2. It allows the expectant family to be in control of the experience. Home births allow the expectant family to be in control of the experience, and the mother may be more relaxed at home than in the hospital environment. It may be less expensive, and there may be decreased risk of serious infection.

A nurse is observing a patient with severe preeclampsia when the patient begins to have a seizure. The nurse calls for help. Which of the following is the most critical intervention for the nurse to perform next? 1. Raise side rails and pad them 2. Lower the head of the bed and turn the woman's head to one side 3. Record the time, length, and type of seizure activity 4. Administer magnesium sulfate per orders

2. Lower the head of the bed and turn the woman's head to one side Because aspiration is the leading cause of maternal mortality, the most critical intervention for the nurse to perform at this time is to lower the head of the bed and turn the woman's head to one side to help ensure a patent airway.

A patient in her 20th week of gestation is concerned because she has developed a brownish pigmentation of the skin over her cheeks, nose, and forehead. The nurse should explain that this phenomenon is normal and that it is known as which of the following? 1. Linea nigra 2. Melasma 3. Striae 4. Palmar erythema

2. Melasma Melasma (chloasma), also referred to as mask of pregnancy, is a brownish pigmentation of the skin over the cheeks, nose, and forehead.

During a prenatal appointment, a patient in her third trimester chatters to the nurse about how she and her partner spent the whole last weekend painting the expected baby's nursery, picking out a crib, and organizing all of the clothes and toys that they received at their last baby shower. The nurse recognizes this behavior of the patient as which of the following? 1. Binding-in 2. Nesting 3. Ambivalence 4. Fear of loss of self-esteem

2. Nesting The pregnant woman may engage in a flurry of activity known as "nesting behavior," hurrying to finish preparing for the newborn's arrival, as is apparent in this case.

A nurse is calculating a patient's estimated date of delivery (EDD) using Naegele's rule. Given that the patient's first day of her last normal menstrual period (LMP) was January 11, which of the following should the nurse determine is the woman's EDD? 1. October 11 2. October 18 3. October 4 4. October 25

2. October 18 Naegele's rule, which is the standard formula for determining EDD based on the LMP, is calculated as follows: first day of LMP - 3 months + 7 days = EDD. Thus, in this case, the equation would be as follows: January 11 - 3 months + 7 days = October 18.

A patient in her first trimester confesses that she has been craving and consuming starch and clay in recent weeks. The nurse recognizes this condition as which of the following? 1. Ptyalism 2. Pica 3. Lordosis 4. Melasma

2. Pica Pica is a craving for and consumption of nonfood substances such as starch and clay. It can result in toxicity due to ingested substances or malnutrition from replacing nutritious foods with nonfood substances.

On ultrasound, it is discovered that a patient's trophoblast of the placenta has invaded the uterine wall beyond the normal boundary but not into the uterine myometrium. The nurse should recognize that the patient has which of the following conditions? 1. Placenta previa 2. Placenta accreta 3. Placenta increta 4. Placenta percreta

2. Placenta accreta In placenta accreta, invasion of the trophoblast is beyond the normal boundary (80% of cases).

On examination, a nurse finds that a patient in her third trimester is experiencing hyperventilation and increased tidal volume. An increase in which hormone during pregnancy can account for this phenomenon? 1. Estrogen 2. Progesterone 3. Testosterone 4. Adrenaline

2. Progesterone Increased progesterone during pregnancy results in maternal hyperventilation and increased tidal volume.

A woman who is at 22 weeks of gestation reports pelvic pressure and increased mucoid vaginal discharge. On examination, her cervix is found to be dilated, and on ultrasound, it appears to be funneling. She is not experiencing any contractions. The primary care provider diagnoses her with incompetent cervix. Which of the following courses of action does the nurse anticipate next in this situation? 1. Prophylactic cerclage 2. Rescue cerclage 3. Administration of oxytocin 4. Administration of a tocolytic

2. Rescue cerclage Treatment of incompetent cervix is cerclage, which is a type of purse string suture placed cervically to reinforce a weak cervix. Rescue cerclage is placed after the cervix has dilated with no perceived contractions, up to about 24 weeks of gestation, which is the case here.

During a patient's second trimester office visit, the nurse performs Leopold's maneuvers. What is the appropriate rationale for this intervention? 1. To assess fetal movement 2. To identify the position of the fetus in utero 3. To change the presentation of the fetus from breech to cephalic 4. To determine fetal heart rate

2. To identify the position of the fetus in utero Leopold's maneuvers, or palpation of the abdomen, are performed to identify the position of the fetus in utero.

A woman in her second trimester is found to have a TORCH infection. Which of the following is included in this category? 1. Gonorrhea 2. Toxoplasmosis 3. Human immunodeficiency virus 4. Group B streptococcal virus

2. Toxoplasmosis TORCH is an acronym that stands for Toxoplasmosis, Other (hepatitis B), Rubella, Cytomegalovirus, and Herpes simplex virus.

A nurse is observing a patient with severe preeclampsia when she receives the patient's latest laboratory values. Which of the following changes indicated by the laboratory results are indicative of a life-threatening condition that occurs as a complication of severe preeclampsia? 1. Increased blood glucose 2. Elevated triglycerides 3. Hemolysis 4. Elevated liver enzymes 5. Low platelets

3,4,5 Feedback 1: Increased blood glucose is associated with diabetes, not with HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, which is the life-threatening complication of severe preeclampsia. Feedback 2: Elevated triglycerides are not associated with HELLP syndrome, which is the life-threatening complication of severe preeclampsia. Feedback 3: HELLP syndrome is the acronym used to designate the variant changes in laboratory values that can occur as a complication of severe preeclampsia. Feedback 4: HELLP syndrome is the acronym used to designate the variant changes in laboratory values that can occur as a complication of severe preeclampsia. Feedback 5: HELLP syndrome is the acronym used to designate the variant changes in laboratory values that can occur as a complication of severe preeclampsia.

The nurse is discussing concerns that a couple has about sexual activity during their pregnancy. Which of the following should the nurse mention? 1. No sexual intercourse during the third trimester 2. No sexual intercourse in the side-by-side position 3. No sexual intercourse after membranes have ruptured 4. No sexual intercourse if vaginal bleeding is present 5. No sexual intercourse if the woman is at risk of premature labor

3,4,5 Feedback 1: Sexual intercourse during the third trimester is fine as long as certain contraindications are not present. Feedback 2: The side-by-side, woman-above, and rear-entry positions are generally more comfortable than the man-above position during pregnancy. Feedback 3: Advise them that there are no contraindications to intercourse or masturbation to orgasm provided the woman's membranes are intact, there is no vaginal bleeding, and she has no current problems or history of premature labor. Feedback 4: Advise them that there are no contraindications to intercourse or masturbation to orgasm provided the woman's membranes are intact, there is no vaginal bleeding, and she has no current problems or history of premature labor. Feedback 5: Advise them that there are no contraindications to intercourse or masturbation to orgasm provided the woman's membranes are intact, there is no vaginal bleeding, and she has no current problems or history of premature labor.

A nurse is teaching a patient measures to help prevent urinary tract infections. Which of the following should the nurse mention? 1. Wipe from back to front after urinating 2. Urinate before intercourse 3. Empty the bladder frequently 4. Wash hands before and after urination 5. Drink at least eight glasses of fluid a day

3,4,5 Feedback 1: The patient should wipe from front to back after urinating, not back to front, to prevent introducing bacteria into the urethra from the anus. Feedback 2: The patient should urinate after intercourse, not before, to help cleanse the urinary tract of bacteria introduced during intercourse. Feedback 3: The patient should empty the bladder frequently, as urinary stasis promotes bacterial growth and increases the woman's risk for urinary tract infections. Feedback 4: The patient should wash her hands before and after urination: before to help remove bacteria from the hands that might be introduced to the urinary tract during the process of wiping after urination, and after to remove bacteria from the hands that might have been picked up during wiping. Feedback 5: The patient should maintain adequate hydration by drinking eight glasses of fluid a day, which helps prevent urinary tract infections.

A nurse is explaining to a patient who has just learned that she is pregnant the overall plan for her prenatal visits beginning now, at her first visit, and continuing until labor and delivery. The pregnancy is expected to be low risk. About how many prenatal visits should the nurse tell the patient to expect? 1. 6 to 8 2. 10 to 12 3. 14 to 16 4. 18 to 20

3. 14 to 16 The standard accepted frequency of prenatal care visits in a low-risk population in the United States results in approximately 14 to 16 prenatal visits per pregnancy.

A woman with a high-risk pregnancy is undergoing a battery of antepartal assessments during her 16th week of gestation. Which of the following assessments that the patient will undergo should the nurse explain as a routine screening for neural tube defects? 1. Umbilical artery Doppler flow 2. Delta OD 450 3. Alfa-fetoprotein (AFP) assay 4. Chorionic villus sampling

3. Alfa-fetoprotein (AFP) assay AFP is a glycoprotein produced in the fetal liver, gastrointestinal tract, and yolk sac in early gestation. Assessing for the levels of AFP in the maternal blood is a screening tool for certain developmental defects in the fetus such as fetal neural tube defects (NTDs) and ventral abdominal wall defects. Because 95% of NTDs occur in the absence of risk factors, routine screening is recommended.

A woman in her third trimester complains of heartburn. Which of the following recommendations should the nurse make to the patient to help prevent this condition? 1. Eating one or two large meals daily 2. Increasing intake of fluids during meals 3. Avoiding fatty or fried foods 4. Lying down for 30 to 45 minutes after eating

3. Avoiding fatty or fried foods The patient should avoid fatty or fried foods.

A patient in her third trimester has just been diagnosed with moderate (grade 2) placental abruption. Which of the following signs and symptoms should the nurse expect to find in this patient? 1. No blood loss, normal vital signs and fetal heart rate pattern 2. Blood loss less than 500 mL, vague lower abdominal discomfort, normal vital signs and fetal heart rate 3. Blood loss 1,000 to 1,500 mL, abdominal pain, mild shock, fetal heart rate shows signs of compromise 4. Blood loss greater than 1,500 mL, abrupt and knifelike uterine pain, moderate-to-profound shock, fetal heart rate shows signs of compromise

3. Blood loss 1,000 to 1,500 mL, abdominal pain, mild shock, fetal heart rate shows signs of compromise Blood loss 1,000 to 1,500 mL, abdominal pain, mild shock, and fetal heart rate showing signs of compromise indicate moderate (grade 2) placental abruption.

A nurse is describing to a patient how in pregnancy there are increased levels of coagulation factors and decreased fibrinolysis, venous dilation, and obstruction of the venous system by the gravid uterus. Which common complication associated with these changes should the nurse mention? 1. Gestational diabetes mellitus 2. Infertility 3. Deep vein thrombosis 4. Pelvic inflammatory disease

3. Deep vein thrombosis Deep vein thrombosis is a complication associated with the changes described.

An obstetrician suspects that the fetus of a patient in her second trimester may have life-threatening anemia. A sample of the patient's amniotic fluid has already been obtained. The nurse should anticipate that which of the following assessments would be best for confirming or ruling out this suspicion? 1. Chorionic villus sampling 2. Amniocentesis 3. Delta OD 450 4. Fetal blood sampling

3. Delta OD 450 Delta OD 450 is a diagnostic evaluation of amniotic fluid obtained via amniocentesis to predict life-threatening anemia in the fetus during the second and third trimesters.

A patient expresses concern to the nurse that her abdominal muscles appear to be separating as a result of her enlarging uterus. The nurse should explain to the woman that this condition is known as which of the following? 1. Lordosis 2. Linea nigra 3. Diastasis recti 4. Striae

3. Diastasis recti Diastasis recti is the separation of the rectus abdominis muscle in the midline caused by the abdominal distention. It is a benign condition that can occur in the third trimester.

A woman in her first trimester reports to the office with abdominal pain and vaginal bleeding. On ultrasound, it is found that the blastocyst has implanted in the fallopian tube. The nurse recognizes this condition as which of the following? 1. Placenta accreta 2. Eclampsia 3. Ectopic pregnancy 4. Hyperemesis gravidarum

3. Ectopic pregnancy An ectopic pregnancy develops as a result of the blastocyst implanting somewhere other than the endometrial lining of the uterus. The embryo or fetus in an ectopic pregnancy is absent or stunted, and this is a nonviable pregnancy. The vast majority of ectopic pregnancies occur in the fallopian tube (95%).

A nurse is reviewing a patient's completed health history form with the patient and wants to know whether the patient's mother or father ever had a heart attack or stroke. Which component or section of the health history should the nurse consult to find this information? 1. Identifying information 2. Health status 3. Family medical 4. Self-care/lifestyle/safety behaviors

3. Family medical Family medical includes the current health status of family members, along with genetic and other medical conditions or diseases that family members may have.

A nurse is providing preconception counseling to a woman. Which prenatal vitamin should the nurse recommend to the patient specifically to reduce the risk of neural tube defects? 1. Calcium 2. Vitamin D 3. Folic acid 4. Iron

3. Folic acid Folic acid supplementation decreases the risk of neural tube defects.

A nurse is working with a woman who is pregnant with her second child. The nurse recognizes that which of the following is likely to be the biggest challenge for this multigravida in adapting to pregnancy? 1. Developing a strategy for managing pain during labor 2. Adjusting to the changes in her body 3. Grieving the loss of the special relationship with her firstborn 4. Coping with nausea during the first trimester

3. Grieving the loss of the special relationship with her firstborn For multigravidas—those who are pregnant for at least the second time—pregnancy tasks may be more complex. Giving adequate attention to all of her children and supporting sibling adaptation are unique challenges faced by the multigravida. She may spend a great deal of time working on a new relationship with the first child and grieve the loss of their special relationship.

A woman who is in her first trimester of pregnancy has been admitted to the hospital with severe vomiting. She is dehydrated and her electrolytes are out of balance. The nurse recognizes this condition as which of the following? 1. Preeclampsia 2. Eclampsia 3. Hyperemesis gravidarum 4. Placenta previa

3. Hyperemesis gravidarum Hyperemesis gravidarum is vomiting during pregnancy that is so severe it leads to dehydration, electrolyte and acid-base imbalance, starvation ketosis, and weight loss.

A nurse is advising a patient who is in her second trimester on her diet. What recommendation should the nurse give her regarding her daily caloric intake? 1. Decrease it by 250 kcal/day compared with non-pregnancy intake 2. Maintain normal non-pregnancy intake level 3. Increase it by 340 kcal/day compared with non-pregnancy intake 4. Increase it by 750 kcal/day compared with non-pregnancy intake

3. Increase it by 340 kcal/day compared with non-pregnancy intake The nurse should recommend that the patient increase daily caloric intake by 340 kcal/day during the second trimester.

Shortly after a patient has gone into labor, she asks the nurse to be sure to save the placenta after the birth of the baby, as she plans to bury it, in observance of her Cambodian culture. The nurse recognizes that this cultural practice may be classified as which of the following? 1. Taboo 2. Functional 3. Neutral 4. Nonfunctional

3. Neutral A neutral cultural practice is one that does not harm or help the woman or child, which appears to be the case in this situation.

A nurse sees a patient who is in the second trimester of pregnancy smoking outside the doctor's office just before her antepartal appointment. Which of the following should the nurse do when meeting with the patient later in the office? 1. Adopt an adversarial approach if the woman does not agree to seek treatment 2. Assume that the patient will not quit and proceed with the examination 3. Provide nonjudgmental health education about the risks to the fetus of substance use during pregnancy 4. Let the physician know that the woman is a smoker so that the physician can discuss it during the exam

3. Provide nonjudgmental health education about the risks to the fetus of substance use during pregnancy Women are more receptive to treatment and lifestyle changes during pregnancy; therefore, pregnancy may be a window of opportunity for chemically dependent women to enter treatment. To facilitate this, nurses must be armed with knowledge and information necessary to screen and identify women who abuse substances during pregnancy. The nurse should maintain a nonjudgmental and nonpunitive attitude.

A woman has been diagnosed with preeclampsia in the 25th week of her pregnancy. Her primary care provider orders magnesium sulfate to be administered to her. The nurse recognizes that which of the following is the proper rationale for this intervention? 1. Lower the blood pressure 2. Clear up a group B Streptococcus infection 3. Reduce the risk of seizures 4. Decrease blood glucose level

3. Reduce the risk of seizures Magnesium sulfate, a central nervous system depressant, has been proven to help reduce seizure activity without documentation of long-term adverse effects to the woman and fetus.

A nurse is counseling a woman with iron-deficiency anemia regarding when she should take iron supplements to increase absorption and decrease gastrointestinal upset. Which of the following recommendations should she give? 1. Take iron supplements in the morning on a full stomach 2. Take iron supplements in the morning on an empty stomach 3. Take iron supplements at bedtime on an empty stomach 4. Take iron supplements at bedtime on a full stomach

3. Take iron supplements at bedtime on an empty stomach The nurse should advise the patient that taking iron supplementation at bedtime and on an empty stomach may increase absorption and decrease gastrointestinal upset.

A patient has gone into preterm labor at week 33 of gestation. The attending physician has ordered that the patient be given the calcium channel blocker nifedipine, a common tocolytic drug. The nurse should recognize that which of the following is the appropriate rationale for this intervention? 1. To stop preterm labor and ensure a full-term delivery 2. To facilitate fetal lung maturity 3. To delay delivery for up to 72 hours 4. To clear up group B Streptococcus infections

3. To delay delivery for up to 72 hours Tocolytic drugs, of which the calcium channel blocker nifedipine is one, are medications that are used to suppress uterine contractions in preterm labor and thus to delay delivery for up to 72 hours so that glucocorticoids (corticosteroids) can be administered and facilitate fetal lung maturity.

An obstetrician is concerned that a patient in her third trimester who has an intrauterine growth-restricted fetus may not have adequate blood flow in her placenta. The nurse should anticipate that which of the following biophysical assessments would be used to confirm or rule out the doctor's concern? 1. Standard ultrasonography 2. Three-dimensional (3-D) ultrasonography 3. Umbilical artery Doppler flow 4. Magnetic resonance imaging (MRI)

3. Umbilical artery Doppler flow Umbilical artery Doppler flow is a noninvasive screening technique that uses advanced ultrasound technology to assess resistance to blood flow in the placenta. It evaluates the rate and volume of blood flow through the placenta and umbilical cord vessels using ultrasound. This assessment is commonly used in combination with other diagnostic tests to assess fetal status in intrauterine growth restricted fetuses.

A woman with a high-risk pregnancy is seeking advice from the nurse regarding the setting for her upcoming birth. Moreover, she is concerned because her partner recently left her, and she has no one else to help support her during labor and delivery. Which of the following should the nurse recommend to this patient? 1. A home birth attended by a nurse-midwife 2. A birth center birth attended by a doula 3. A home birth attended by an obstetrician 4. A hospital birth attended by an obstetrician and a doula

4. A hospital birth attended by an obstetrician and a doula Because the woman has a high-risk pregnancy, she should plan to have her birth at the hospital with an obstetrician attending. A doula would be an ideal support person during labor and delivery.

A woman in the 39th week of pregnancy has just undergone a non-stress test in which the fetus has proven nonreactive. The baseline fetal heart rate has revealed bradycardia. Which of the following tests should the nurse anticipate being performed next to confirm fetal well-being? 1. Daily fetal movement count 2. Amniocentesis 3. Vibroacoustic stimulation (VAS) 4. Contraction stress test (CST)

4. Contraction stress test (CST) The CST is a screening tool used to assess fetal well-being and uteroplacental function with electronic fetal monitoring in women with a nonreactive non-stress test at term gestation. The purpose of the CST is to identify a fetus that is at risk for compromise through observation of the fetal response to intermittent reduction in uteroplacental blood flow associated with stimulated uterine contractions.

A patient asks the nurse how she can avoid developing varicosities during her pregnancy. Which of the following should the nurse suggest to her? 1. Crossing her legs when sitting 2. Putting on support hose in the evening after being on her feet all day 3. Standing for long periods when possible 4. Dorsiflexing her feet periodically when standing or sitting

4. Dorsiflexing her feet periodically when standing or sitting The patient should dorsiflex her feet periodically when standing or sitting.

A nurse is providing fertility counseling to a couple who currently live together with no other family members. The nurse recognizes that this family configuration is known as which of the following? 1. Nuclear family 2. Extended family 3. Single-parent family 4. Dyad family

4. Dyad family The dyad family consists of a couple living alone without children.

A nurse is evaluating a patient's mood, anxiety level, and emotional state during a prenatal visit near the end of the patient's first trimester. Which three aspects of the patient's emotional response should the nurse assess for? 1. Facial expressions, hand gestures, and tone of voice 2. Attitude toward self, baby, and partner 3. Direction of gaze, posture, and rate of speech 4. Frequency, duration, and intensity of the woman's emotional response

4. Frequency, duration, and intensity of the woman's emotional response The nurse should assess the woman's mood, anxiety, and emotional state and consider three aspects: frequency, duration, and intensity of emotional response.

The fetus of a patient in her second trimester is suspected of having a brain abnormality. The nurse should anticipate that which of the following biophysical assessments would be used to confirm or rule out this concern? 1. Standard ultrasonography 2. Three-dimensional (3-D) ultrasonography 3. Umbilical artery Doppler flow 4. Magnetic resonance imaging (MRI)

4. Magnetic resonance imaging (MRI) MRI is a diagnostic radiological evaluation of tissue and organs from multiple planes. During pregnancy it is used to visualize maternal and/or fetal structures for detailed imaging when screening tests indicate possible abnormalities. It is most commonly performed for suspected brain abnormality.

A nurse is caring for a patient in her third trimester who has gonorrhea. The nurse recognizes that which major complication in the mother is associated with this sexually transmitted infection? 1. Hemorrhagic and hypovolemic shock 2. Seizures 3. Disseminated intravascular coagulation 4. Pelvic inflammatory disease

4. Pelvic inflammatory disease Sexually transmitted infections, including gonorrhea, can cause pelvic inflammatory disease.

A woman in her 15th week of gestation is concerned that her fetus may have trisomy 21 (Down syndrome), as it is a genetic disorder that runs in her family. The nurse should recognize that which of the following assessments would provide the greatest ability to detect trisomy 21? 1. Delta OD 450 2. Alfa-fetoprotein (AFP) assay 3. Triple marker screen 4. Quad marker screen

4. Quad marker screen Quad screen adds inhibin-A to the triple marker screen to increase detection of trisomy 21 to 80%.

A nurse is reviewing a patient's completed health history form with the patient and wants to know whether the patient uses tobacco. Which component or section of the health history should the nurse consult to find this information? 1. Identifying information 2. Health status 3. Family medical 4. Self-care/lifestyle/safety behaviors

4. Self-care/lifestyle/safety behaviors Self-care/lifestyle/safety behaviors include frequency of health maintenance visits, bowel patterns, sleep patterns, stress management, nutrition, body mass index, exercise history, use and abuse of substances (tobacco, alcohol, caffeine, etc.), use of complementary and alternative medicine modalities, and safety practices (use of seat belts, sunscreen, smoke alarms, carbon monoxide detectors, and guns).

Soon after learning that she was pregnant, a patient calls the office reporting heavy vaginal bleeding. On examination in the office, it is discovered that the patient has lost her pregnancy. The nurse should record this event as which of the following in the patient's record? 1. Induced abortion 2. Elective abortion 3. Therapeutic abortion 4. Spontaneous abortion

4. Spontaneous abortion Spontaneous abortion is termination of a pregnancy before 20 weeks' gestation without medical or mechanical means. It is also called miscarriage.

A nurse observes the male partner of a patient who is in her third trimester of pregnancy as he interacts with her. Given the stage of her pregnancy and the probable phase of his paternal adaptation (based on May's classic research), which of the following should the nurse most expect to be the primary preoccupation or feeling of the father? 1. Ambivalence toward the pregnancy 2. Fear of hurting the fetus during intercourse 3. Feelings of rivalry with the fetus 4. Thinking of himself as a father

4. Thinking of himself as a father During the focusing phase, which begins in the last trimester, men begin to think of themselves as fathers.