Ch 9 - Ch 27 L&D 9th Edition

d) January 27 Pg. 187-188 According to Naegele rule, the nurse would determine the date of the first day of the client's LNMP (April 20), subtract 3 months (January 20) and then add 7 days (January 27) to obtain the estimated date of delivery/birth. The other options do not follow Naegele rule.

14. The nurse is determining a pregnant client's estimated date of delivery/birth (EDD) using Naegele rule. The date of the first day of the client's last normal menstrual period (LNMP) was April 20. What would be this client's EDD? a) January 20 b) December 27 c) December 25 d) January 27

d) Meats Pg. 291 Meats are the best source of heme-rich iron and should be included in her diet if she is not following a vegetarian diet. Grains and legumes are non-heme iron sources. Dairy products will add various vitamins and calcium to the diet.

30. The nurse is explaining the latest laboratory results to a pregnant client who is in her third trimester. After letting the client know she is anemic, which heme iron-rich foods should the nurse encourage her to add to her diet? a) Grains b) Legumes c) Dairy d) Meats

d) The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual Pg. 215 Slight bleeding after a pelvic exam in a pregnant woman is common due to the vascularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening and not substantiated by the data. Bleeding is not a normal finding during pregnancy and losing the mucus plug occurs at the end of pregnancy, just prior to labor.

1. A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding? a) It is possible she is losing her mucus plug, which can cause bloody show b) Some bleeding during pregnancy is not uncommon and this finding is expected c) She may have a bleeding disorder so she needs to come back to the clinic for blood work d) The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual

a) 10 Pg. 176-177 By day 10 after fertilization, the blastocyst has completely buried itself in the endometrial lining. Prior to day 10, the attachment is much looser.

1. The nurse is preparing a presentation for a health fair which will illustrate the development of a baby. The nurse should point out the fertilized egg is implanted in the endometrium by which day? a) 10 b) 8 c) 4 d) 6

b) "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them" Pg. 250 The nurse should reassure the client that these lab tests are ordered for all clients, not only those who are at high risk for sexually transmitted infections. Making general statements about the incidence of sexually transmitted infections or the need for thorough care does not address the client's expressed concern.

1. The nurse is providing care for a pregnant client who has been given the necessary requisitions for laboratory work by the primary care provider. The client notices that the lab tests include testing for HIV and other sexually transmitted infections, and expresses alarm, stating, "I don't understand why the doctor would suspect that I've got these diseases." What is the nurse's most therapeutic statement? a) "Unfortunately, these infections have the potential to harm the fetus. It's important that the doctor identifies them early in your pregnancy" b) "Every pregnant client is tested for these diseases; it doesn't necessarily suggest that the doctor suspects that you have them" c) "Pregnancy is a major change, so every member of the care team makes sure that your health is assessed carefully" d) "Sexually transmitted infections are much more common than most people believe"

c) Doppler Pg. 187 Fetal heart sounds are best heard with the Doppler from the 10th week onward. They can be heard with the fetoscope by about the 18th to 20th week only. A tocodynamometer is used to record uterine contractions and not to auscultate fetal heart tones. Fetal heart tones may not be audible with an ordinary stethoscope at the 12th week.

10. A nurse is asked to auscultate the fetal heart sounds in a pregnant client. Which equipment is most appropriate when auscultating fetal heart sounds at the 12th week? a) Stethoscope b) Tocodynometer c) Doppler d) Fetoscope

c) At the level of the umbilicus Pg. 239 By 20 weeks' gestation, the uterus is at about the level of the umbilicus; by 36 weeks, it nears the bottom of the sternum.

10. The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? a) At the level of the symphysis pubis b) At the level near the bottom of the sternum c) At the level of the umbilicus d) Three finger-breadths above the umbilicus

d) Detect fetal heart sounds with a Doppler Pg. 212 Fetal heart sounds are audible with a Doppler at 10 to 12 weeks' gestation but cannot be heard through a stethoscope until 18 to 20 weeks' gestation. Fetal movements can be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around 20 weeks' gestation. The fetal outline is also palpable around 20 weeks' gestation.

10. Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to: a) Hear the fetal heartbeat with a stethoscope b) Palpate the fetal outline c) Feel fetal movements d) Detect fetal heart sounds with a Doppler

c) Urinary frequency Pg. 220 The client is in the first trimester and would most likely experience urinary frequency as the growing uterus presses on the bladder. Ankle edema, backache, and hemorrhoids would be more common during the later stages of pregnancy.

11. A primiparous client is being seen in the clinic for the first prenatal visit. It is determined that the client is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what they will most likely experience during this period. Which possible effect would the nurse include? a) Backache b) Ankle edema c) Urinary frequency d) Hemorrhoids

c) Cell-free DNA testing Pg. 194 The nurse would anticipate performing the least invasive testing first and progressing as needed, based on test results. The client has the right to request or refuse genetic testing during her pregnancy. Cell-free DNA testing consists of testing a maternal blood specimen for DNA released by the placenta into the maternal bloodstream. This testing is done beginning at 10 weeks' gestation to test for various genetic and sex-linked disorders. An amniocentesis, which takes a sample of the amniotic fluid, can be used to determine whether the fetal lungs are mature enough to support respiration outside of the womb, as well as for genetic testing, because the fluid contains fetal cells with fetal DNA. This is typically completed between 15 to 20 weeks' gestation and is more invasive. Chorionic villus sampling (CVS) involves taking a sample of tissue from the placenta between 10 to 12 weeks' gestation to test for chromosomal and genetic abnormalities. This is also an invasive procedure with more risks than obtaining a maternal blood specimen. Rh factor testing is done to assess for potential maternal-fetal blood incompatibility by means of a maternal blood sample and can be done anytime during the pregnancy.

11. The nurse is caring for a client at 10 weeks' gestation who requests genetic testing for the fetus. The nurse will anticipate the health care provider prescribing which test first for this client? a) Chorionic villus sampling (CVS) b) Amniocentesis c) Cell-free DNA testing d) Rh factor testing

d) Relaxin Pg. 220 Relaxin, secreted by the corpus luteum of the ovary as well as the placenta, is responsible for helping to inhibit uterine activity and to soften the cervix and the collagen in joints. Softening of the cervix allows for dilatation at birth; softening of collagen allows for laxness in the lower spine and so helps enlarge the birth canal. The effect of estrogen is to cause breast and uterine enlargement. Progesterone has a major role in maintaining the endometrium, inhibiting uterine contractility, and aiding in the development of the breasts for lactation. Human placental lactogen (hPL), also known as human chorionic somatomammotropin, serves as an antagonist to insulin, making insulin less effective, thereby allowing more glucose to become available for fetal growth.

12. A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the client's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. This hormone is which of the following? a) Human placental lactogen b) Estrogen c) Progesterone d) Relaxin

a) Gestational age, length, weight, and systems developed Pg. 186 Client education is a major component of maternal-child nursing. During pregnancy, nurses provide anticipatory guidance to prepare the woman and her significant other for the changes each month brings. Clients most often want to know gestational age in weeks, length, weight, and systems developed; the client is then able to visualize what the fetus looks like.

12. The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to emphasize? a) Gestational age, length, weight, and systems developed b) Length, weight, sex c) Age in weeks and systems developed d) Sex and systems developed

b) Blood is trapped in the vena cava in a supine position Pg. 219 Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.

13. A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize? a) Sympathetic nerve responses cause dyspnea when a woman lies supine b) Blood is trapped in the vena cava in a supine position c) The uterus requires more blood in a supine position d) Cerebral arteries are growing congested with blood

b) 50% Pg. 176 The ovum contains only X chromosomes and the sperm contains either X or Y-chromosomes, so the fetus can be either XX or XY, dependent upon the genetic material contained in the sperm. Thus, the odds of having a male child are 50- 50.

13. An ovum has received chromosomes for both of the parents. What are the odds of the infant being a male? a) 100% b) 50% c) 0% d) 25%

c) Visualization of the fetus by ultrasound Pg. 212 There are only three documented or positive signs of pregnancy: 1) demonstration of a fetal heart separate from the mother's, 2) fetal movements felt by an examiner, and 3) visualization of the fetus by ultrasound. The absence of a period is an example of a presumptive symptom, which is a symptom that, when taken as a single entity, could easily indicate other conditions. Laboratory tests of either urine or blood serum for human chorionic gonadotropin (hCG) are examples of probable signs of pregnancy, which are objective and so can be verified by an examiner.

14. A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? a) Laboratory test of a urine specimen for hCG b) Absence of a period c) Visualization of the fetus by ultrasound d) Laboratory test of a blood serum specimen for hCG

c) "A one time discharge of bloody mucus in the toilet might have been your mucus plug" Pg. 215 Bloody mucus can either be a mucus plug or bloody show. The one-time occurrence would be more likely to be the mucus plug. A bloody show would continue if her cervix was changing, but this usually does not occur until after contractions start. It is a sign that something is happening and should be reported to the health care provider. The bloody mucus is not a sign of labor, but it can be an early sign that labor is coming soon.

15. A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse? a) "It might be nothing. If it happens again call your provider who is on-call" b) "Bloody mucus is a sign you are in labor. Please come to the hospital" c) "A one time discharge of bloody mucus in the toilet might have been your mucus plug" d) "If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it"

c) Human chorionic gonadotropin (hCG) Pg. 178 The placenta produces hCG, which is the basis for pregnancy tests. This hormone preserves the corpus luteum and its progesterone production so that the endometrial lining is maintained. Human placental lactogen modulates fetal and maternal metabolism and participates in the development of the breasts for lactation. Estrogen causes enlargement of the woman's breasts, uterus, and external genitalia and stimulates myometrial contractility. Progesterone maintains the endometrium.

15. After teaching a pregnant woman about the hormones produced by the placenta, the nurse determines that the teaching was successful when the woman identifies which hormone produced as being the basis for pregnancy tests? a) Human placental lactogen (hPL) b) Estrogen (estriol) c) Human chorionic gonadotropin (hCG) d) Progesterone (progestin)

c) Chorion and amnion Pg. 179 The chorion and amnion are the two fetal membranes. The ectoderm, mesoderm, and endoderm are layers in the developing blastocyst.

16. A group of nursing students are preparing a presentation for a health fair illustrating the structures found during a pregnancy. Which structures should the students point out form a protective barrier around the developing fetus? a) Chorion and endoderm b) Ectoderm and amnion c) Chorion and amnion d) Amnion and mesoderm

c) Bruising Pg. 217 Bruising would not be a normal finding. Evidence of bruising might suggest domestic violence. Linea nigra, striae, and darkening of the umbilicus are normal findings.

16. During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding? a) Striae b) Darkening of the umbilicus c) Bruising d) Linea nigra

a) Zygote Pg. 176 A fertilized ovum is known as a zygote and is the beginning of potential individual human development. The developing human organism is known as an embryo from the time it implants on the uterine wall until the eighth week after inception and as a fetus from the beginning of the ninth week after fertilization through birth. The chorion is the outermost cell layer that surrounds the embryo and fluid cavity.

17. A fertilized ovum is known as which structure? a) Zygote b) Chorion c) Embryo d) Fetus

b) Hemorrhoids Pg. 220 The displacement of the intestines and possible slowed motility of the intestines can lead to constipation in the pregnant woman. This, along with elevated venous pressure, can lead to development of hemorrhoids.

17. A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem? a) Varicose veins b) Hemorrhoids c) Umbilical hernia d) Gastrointestinal reflux

c) Some of the home pregnancy tests can detect the presence of hCG within 1 day of the woman's missed period Pg. 210-211 Home pregnancy tests are 95% reliable if used according to the instructions on the kit. In fact, some can detect hCG within 1 day after a missed period. These tests often give a false negative, not false positive, reading. Results can be tested with the first voided specimen of the day.

18. A client who suspects she is pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that: a) Their reliability is only about 90% b) Home pregnancy tests often give a false positive result c) Some of the home pregnancy tests can detect the presence of hCG within 1 day of the woman's missed period d) The test works best on a midday urine sample

a) Down syndrome b) Neural tube defects Pg. 196 Maternal blood is drawn between 15 and 20 weeks and is used in screening for Down syndrome and other trisomies, neural tube defects, gastroschisis, and other fetal abnormalities.

18. The client is having her blood drawn for a triple or Quad screen. For what does this test screen? Select all that apply. a) Down syndrome b) Neural tube defects c) Rubella d) Gestational diabetes e) Pre-eclampsia

d) Positive home pregnancy test Pg. 210 A urine pregnancy test is considered a probable sign of pregnancy as the hCG may be from another source other than pregnancy. Fatigue, amenorrhea, and vomiting are presumptive or possible signs of pregnancy and can also have other causes.

19. The nurse is assessing a client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy? a) Nausea and vomiting b) Fatigue c) Amenorrhea d) Positive home pregnancy test

d) At fertilization Pg. 185 Sex determination occurs at the time of fertilization. Meiosis refers to cell division resulting in the formation of an ovum or sperm with half the number of chromosomes. The morula develops after a series of four cleavages following the formation of the zygote. Oogenesis refers to the development of a mature ovum, which has half the number of chromosomes.

19. The nurse is conducting a presentation for a young adult community group about fetal development and pregnancy. The nurse determines that the teaching was successful when the group identifies that the sex of offspring is determined at which time? a) When the morula forms b) During oogenesis c) During meiosis cell division d) At fertilization

b) History of diabetes for 4 years Pg. 233 A diagnosis of diabetes in a pregnant client increases risk for both the client and the infant during pregnancy and requires close monitoring and follow-up. This client's age, exercise history, and history of occasional OTC pain reliever use do not increase pregnancy risk.

3. A nurse is taking a history during a client's first prenatal visit. Which assessment finding would alert the nurse to the need for further assessment? a) History of exercising twice a week b) History of diabetes for 4 years c) History of occasional use of OTC pain relievers d) Maternal age of 28 years

b) Melasma (chloasma) Pg. 217 Melasma (chloasma), or "mask of pregnancy," is a blotchy brown discoloration on the face. In some women, a darkened line up the abdomen appears, which is called linea nigra. Striae gravidarum are "stretch marks. Melanotropin is the hormone responsible for melasma (chloasma).

3. Increased pigmentation on the face of some pregnant women is called: a) Melanotropin b) Melasma (chloasma) c) Striae gravidarum (stretch marks) d) Nigra

c) Ultrasound Pg. 174-175, 194 The nurse would state that an ultrasound is a noninvasive test that is completely safe for both mother and child. Amniocentesis, chorionic villus sampling, and percutaneous umbilical cord sampling are invasive tests that are associated with maternal and fetal risk.

2. A 33-year-old pregnant client asks the nurse about testing for birth defects that are safe for both her and her fetus. Which test would the nurse state as being safe and noninvasive? a) Percutaneous umbilical cord sampling b) Chorionic villus sampling c) Ultrasound d) Amniocentesis

a) "That is a very normal feeling, especially at this point in pregnancy" Pg. 207-209 During the third trimester, the client is preparing for parenthood and is often tired and ready for a break. The woman may feel large and unable to do any normal activities, and may feel ready to have the baby in her arms rather than in her uterus. This is not an abnormal statement, and the provider should not overreact. Deciding to induce labor is something that should be done in consultation with the health care provider and only when it is necessary for the health/safety of the mother or baby.

2. A client at 40 weeks' gestation informs the nurse that she is tired of being pregnant. What is the best response from the nurse? a) "That is a very normal feeling, especially at this point in pregnancy" b) "Most woman would have asked to be induced by this point. Is that what you want?" c) "Are you getting enough rest? If you don't take time for rest, that is why you might be tired" d) "Do you need to speak with someone about your feelings?"

c) Alert the RN or health care provider Pg. 228 A client on an SSRI or SRI (serotonin reuptake inhibitor) might be in current treatment for a psychiatric disorder. The medication may also be one that is not safe during pregnancy. The RN and the health care provider need to be alerted to seek more information from the client. Reassurance is good practice, but not enough in this case. You do not have enough information to refer her for drug and alcohol counseling. She is under the care of another provider for her mental disorder, so do not confuse her with more material to read.

2. Charlene McCoy, who has several children already, reports for a first prenatal visit. She seems preoccupied and withdrawn, and she makes consistently negative remarks about the pregnancy. Reviewing her records, you note that she is receiving a serotonin reuptake inhibitor. What should you do? a) Reassure her that ambivalence is normal b) Give her printed material to read at home c) Alert the RN or health care provider d) Refer her for drug and alcohol counseling

c) Have you been sexually active in the past 2 months? Pg. 211 The client is presenting with presumptive or subjective symptoms of pregnancy. Given her symptoms and age, asking about sexual activity is the most appropriate question. Whether she is taking an oral contraceptive will not assist in identifying the cause of her symptoms. If she has vaginal itching, the underlying cause of her symptoms needs to be identified before treatment can be prescribed. Asking about family history is part of a comprehensive health history, but is not the priority based on the client's presentation.

20. A 22-year-old client comes to the walk-in clinic complaining of fatigue, breast heaviness and extreme tenderness, and a clear vaginal discharge. What question would the nurse ask this client? a) Do you have vaginal itching? b) Are you taking oral contraceptives? c) Have you been sexually active in the past 2 months? d) Do you have a family history of breast cancer?

d) May Pg. 188 Naegele rule says to subtract 3 months from the first day of the last menstrual period and then add 7 days. A woman who had her last menstrual period on August 1 would subtract 3 months to reach May 1, then add 7 days to reach an estimated date of birth of May 8. To follow the client's intentions, the client would submit for her leave to begin in May. April would be beginning the leave too early. June and July are after the due date.

20. The nurse is caring for a woman at her first prenatal appointment. The woman reports her last menstrual period was August 1. The woman would like to begin her maternity leave at the beginning of the month of her due date. Which month would the nurse advise the woman to submit for her leave to begin? a) April b) July c) June d) May

a) Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy Pg. 534 The nurse should recognize that abdominal pain is not normal during pregnancy and warrants investigation since ectopic pregnancy is a distinct possibility. An abdominal ultrasound would be best practice for this complaint. Dismissing her reports as normal is not a wise choice.

21. A client comes to the clinic with concerns about her pregnancy. She is in her first trimester and is now experiencing moderate abdominal pain on the right side. What would be the nurse's first action? a) Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy b) Obtain a detailed 24-hour intake to determine if the pain is related to what she has eaten c) Reassure the mother that this is normal as the baby is implanting into the uterus d) Encourage her to ambulate since gas pains are common in early pregnancy

b) Montgomery glands (Montgomery tubercles) become more prominent Pg. 216 Montgomery glands (Montgomery tubercles), sebaceous glands on the areolas, produce secretions that lubricate the nipple. Montgomery glands become more prominent during pregnancy. The other listed phenomena do not happen.

21. A nurse is providing care to a pregnant woman in her first trimester who has come to the clinic for a follow-up visit. During the visit, the nurse teaches the woman about some of the changes that she will be experiencing during her pregnancy. Which information would the nurse include when describing changes in the breast? a) Estrogen causes the breasts to feel nodular b) Montgomery glands (Montgomery tubercles) become more prominent c) Prolactin, an anterior pituitary hormone, stimulates the breasts to grow d) The areolas becomes lighter in color

b) Halfway between the symphysis pubis and the umbilicus Pg. 214 As the pregnancy progresses, the uterus enlarges and enters the abdominal cavity. At 16 weeks, the nurse should be able to palpate the uterus halfway between the symphysis pubis and the umbilicus.

22. A client at 16 weeks' gestation comes to the office for a routine exam. At what location within the abdomen would the nurse anticipate the uterus to be found? a) Below the symphysis pubis b) Halfway between the symphysis pubis and the umbilicus c) At the xiphoid process d) At the level of the umbilicus

c) Prepare the client for an induction of labor Pg. 177 Placental insufficiency is a serious complication where the placenta no longer works properly to provide nutrition and oxygen to the fetus, nor remove waste products from the fetus. Because this client's fetus is at full term, the nurse would anticipate an induction of labor or a cesarean birth. The client is not stable enough to be sent home for monitoring. Hypertension can be a cause of placental insufficiency; however, at this point in the pregnancy, birth is the best option. Betamethasone is a steroid given to clients to hasten preterm fetal lung development. This client is at term and does not need betamethasone.

22. A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate? a) Discharge the client home with daily nonstress testing b) Assess the client's blood pressure every 2 hours c) Prepare the client for an induction of labor d) Administer one dose of betamethasone

a) "Exposure to certain substances during the embryonic phase may be harmful to the developing fetus" Pg. 177 Exposure to a teratogen during the embryonic stage produces the greatest damaging effects because cells are rapidly dividing and differentiating into specific body structures.

23. A pregnant client in the first trimester asks the nurse about taking medications while she is pregnant. She tells the nurse that she heard that it can be harmful to the fetus if medications are taken at certain times during pregnancy. What is the best response by the nurse? a) "Exposure to certain substances during the embryonic phase may be harmful to the developing fetus" b) "You cannot drink alcohol, but you can take some medications, such as cold preparations and over-the-counter medications" c) "As long as you are past 4 weeks of pregnancy, you should be able to take most medications" d) "There is no need for you to worry; you are not far enough along in your pregnancy for this to be a problem"

d) "A stuffy nose is common in pregnancy because of high estrogen levels" Pg. A local change that often occurs in the respiratory system is marked congestion, or "stuffiness," of the nasopharynx, a response to increased estrogen levels. A pregnant client may worry this stuffiness indicates an allergy or a cold. Rather, it is a symptom of pregnancy. The use of any medication during pregnancy needs to be evaluated to make sure that it is safe for the client to use.

23. During a visit to the clinic, a client in the first trimester tells the nurse, "My nose is so stuffy, lately. Could I have a cold?" Which response by the nurse is appropriate? a) "I will check to see if you we can give you an antihistamine to help." b) "Probably. Let's see if you have any other symptoms" c) "It is more likely that you are having some allergies to something" d) "A stuffy nose is common in pregnancy because of high estrogen levels"

d) Obtain a signed consent form Pg. 188 Nursing responsibilities for assessment procedures include seeing a signed consent form has been obtained as needed (necessary if the procedure poses any risk to the mother or fetus that would not otherwise be present, as is the case with amniocentesis). All of the answers are nursing interventions that should be made before or during amniocentesis, but having the client sign a consent form should be completed before the others.

24. A woman at 15 weeks' gestation is about to undergo amniocentesis. Which nursing intervention should be made first? a) Observe the fetal heart rate monitor b) Place the client in supine position c) Have the client void d) Obtain a signed consent form

a) Hegar sign Pg. 211 Hegar sign refers to the softening of the lower uterine segment or isthmus. Bluish coloration of the cervix is termed Chadwick sign. Goodell sign refers to the softening of the cervix. Ortolani sign is a maneuver done to identify developmental dysplasia of the hip in infants.

24. During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse documents this finding as: a) Hegar sign b) Chadwick sign c) Ortolani sign d) Goodell sign

c) Fetal femur measurement of 30 mm d) Fetal implantation in the uterine fundus e) Fetal heart beat present Pg. 194 Many providers perform a fetal survey by ultrasound at 20 weeks' gestation. The fetus is now large enough at this point for all major organs to be visible on ultrasound. Measurements of bones can be compared to the expected size (29 to 31 mm at 20 weeks). Basic characteristics of the organs can identify anomalies. The fetal heart should be beating and valve functioning is identified. Down syndrome characteristics are not fully visible and an amniocentesis best confirms the chromosomal structure. The procedure also can indicate placental placement in the fundus. At this point of gestation, typically the fetal head is not showing engagement in the pelvis. This occurs closer to the end of the pregnancy.

25. A client is at 20 weeks' gestation and is scheduled for a fetal survey with ultrasound. To confirm normal development thus far in pregnancy, which result(s) are expected? Select all that apply. a) Down syndrome (trisomy 21) in the fetus b) Fetal head engagement in the pelvis c) Fetal femur measurement of 30 mm d) Fetal implantation in the uterine fundus e) Fetal heart beat present

a) Discard foods that have been left out at room temperature for more than 2 hours c) Do not drink raw or unpasteurized milk e) Wash raw fruits and vegetables with hot water and a mild soap Pg. 291 While pregnant, women must adhere to certain rules regarding food preparation and storage. The woman should discard foods that have been left out at room temperature for more than 2 hours, wash raw fruits and vegetables with hot water and a mild soap, and avoid drinking raw or unpasteurized milk. Soft cheeses should be avoided. There is no need to limit beef during pregnancy.

25. Which interventions would a pregnant client be taught regarding dietary restrictions during pregnancy? Select all that apply. a) Discard foods that have been left out at room temperature for more than 2 hours b) Eat only soft cheeses such as feta or brie c) Do not drink raw or unpasteurized milk d) Limit beef intake to 10 to 12 ounces per week e) Wash raw fruits and vegetables with hot water and a mild soap

b) Pre-embryonic c) Fetal d) Embryonic Pg. 175 The three stages of fetal development are the pre-embryonic, embryonic, and fetal stage. Placental and umbilical are not stages of fetal development.

26. After teaching a class on the stages of fetal development, the nurse determines that the teaching was successful when the group identifies which stages? Select all that apply. a) Placental b) Pre-embryonic c) Fetal d) Embryonic e) Umbilical

a) During pregnancy blood volume can increase by at least 40% Pg. 219 The pregnant woman can experience a blood volume increase by approximately 40% to 50% above prepregnancy levels by the end of the third trimester. Pregnancy results in an increased respiratory rate to provide oxygen to both the mother and fetus. Hemoglobin levels are usually low during pregnancy because of hemodilution of red blood cells, which is termed physiologic anemia of pregnancy. Blood pressure usually reaches a low point mid-pregnancy and, thereafter, increases to prepregnancy levels by the third trimester.

26. The nurse cares for a pregnant client at the first prenatal visit and reviews expected changes that will occur during pregnancy. Which information will the nurse include in the education? a) During pregnancy blood volume can increase by at least 40% b) Blood pressure decreases in the third trimester c) Hemoglobin levels rise significantly during pregnancy d) Pregnancy typically causes a decrease in respiratory rate

c) Fetal movement felt by examiner Pg. 212 The positive signs of pregnancy are fetal image on a sonogram, hearing a fetal heart rate, and examiner feeling fetal movement. A pregnancy test has 95% accuracy; however, it may come back as a false positive. Hegar sign is a softening of the uterine isthmus. Chadwick sign may have other causes besides pregnancy.

27. A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy? a) Positive office pregnancy test b) Chadwick sign c) Fetal movement felt by examiner d) Hegar sign

b) Down syndrome Pg. 196 The nurse is correct to interpret the lab results and develop a teaching plan. The nurse would teach the client that since the serum level is elevated above 2 MoM, there is a significant risk of Down syndrome. Instruction would then indicate further testing and considerations if the diagnosis is confirmed. Pregnancies found to have a fetus with Edwards syndrome have AFP, uE3, and hCG with lower MoM. The MSAFP test does not provide information about the risk for Tay-Sachs disease or hemophilia A.

3. The nurse is reporting a maternal serum alpha-fetoprotein (MSAFP) level of 2.5 MoM on shift hand-off. The oncoming nurse would be correct to initiate a teaching plan related to the fetus being at higher risk for which condition? a) Hemophilia A b) Down syndrome c) Tay-Sachs disease d) Edwards syndrome

d) Trisomy numeric abnormality Pg. 167 Down syndrome is an example of a chromosomal abnormality involving the number of chromosomes (trisomy numeric abnormality), in particular chromosome 21, in which the individual has three copies of that chromosome. Multifactorial inheritance gives rise to disorders such as cleft lip, congenital heart disease, neural tube defects, and pyloric stenosis. X-linked recessive inheritance is associated with disorders such as hemophilia. Chromosomal deletion is involved with disorders such as cri-du-chat syndrome.

27. While talking with a pregnant client who has undergone genetic testing, the client informs the nurse that the baby will be born with Down syndrome. The nurse understands that Down syndrome is an example of a: a) X-linked recessive inheritance b) Chromosomal deletion c) Multifactorial inheritance d) Trisomy numeric abnormality

a) It supplies oxygen and nutrients to the fetus b) It produces hormones that help maintain the pregnancy c) It carries waste away for excretion by the mother Pg. 177-179 The placenta supplies the developing organism with food and oxygen, carries waste away for excretion by the mother, slows the maternal immune response so that the mother's body does not reject the fetal tissues, and produces hormones that help maintain the pregnancy. Wharton's jelly protects the umbilical cord and the foramen ovale permits most of the blood to bypass the right ventricle. The amniotic fluid cushions the fetus against injury.

28. A nurse is describing the development of the fetus to a group of pregnant women. When describing the function of the placenta, which information would the nurse most likely include? Select all that apply. a) It supplies oxygen and nutrients to the fetus b) It produces hormones that help maintain the pregnancy c) It carries waste away for excretion by the mother d) It cushions the fetus against injury e) It permits blood to bypass the right ventricle f) It protects the umbilical cord

c) Amenorrhea e) Breast changes f) Morning sickness Pg. 211 Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother (e.g., breast changes, amenorrhea, morning sickness). Probable signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions (e.g., hydatidiform mole). Positive signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study, (e.g., ultrasound.)

28. The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. a) Ultrasound pictures b) Fetal heartbeat c) Amenorrhea d) Hydatidiform mole e) Breast changes f) Morning sickness

d) From fertilization to the end of the second week after fertilization Pg. 175 The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. The fetal stage begins at 9 weeks after fertilization and ends at birth. There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period.

29. A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage? a) Approximately 6 weeks after fertilization to the end of 8 weeks b) Approximately 2 weeks after fertilization to the end of the eighth week c) Approximately 9 weeks after fertilization to birth d) From fertilization to the end of the second week after fertilization

a) Nuts b) Beans e) Lentils Pg. 302-303 Ways to ensure adequate protein intake include using soy foods, beans, lentils, nuts, grains, and seeds. Orange juice and green leafy vegetables can help promote calcium and vitamin C intake.

29. A pregnant woman who is a vegetarian asks the nurse, "What would you suggest to make sure that I get enough protein in my diet while I am pregnant?" Which food(s) would be appropriate for the nurse to suggest? Select all that apply. a) Nuts b) Beans c) Orange juice d) Green leafy vegetables e) Lentils

c) Prevent alveoli from collapsing on expiration Pg. 183 Surfactant is a phospholipid that reduces surface tension; it prevents alveoli from collapsing on expiration. Resistance to airflow is an effect of tissue elasticity and airway size. Immunologic competence is provided by antibodies in the mucus layer. Fully matured alveoli contain squamous cells as well as type II surfactant cells.

30. Assessment for surfactant level via lecithin/sphingomyelin (L/S) ratio in the amniotic fluid is a primary estimation of fetal maturity. The purpose of surfactant is to: a) Encourage immunologic competence of lung tissue b) Promote maturation of lung alveoli c) Prevent alveoli from collapsing on expiration d) Increase lung resistance on inspiration

d) November 15 Pg. To calculate the date of delivery by Naegele rule, the nurse will count backward 3 calendar months from the first day of a client's last menstrual period and add 7 days. For this client, the first day of the last menstrual period was February 8. Counting back 3 months would be November; then adding 7 days, the estimated date of delivery will be November 15.

31. A nurse is calculating the estimated date of birth for a client who has just found out about being pregnant. The client's last menstrual period started on February 8 and lasted for 6 days. Using Naegele rule, which date does the nurse determine as the estimated date of delivery? a) December 1 b) October 8 c) May 1 d) November 15

b) 2+ Protein in urine Pg. 222 During pregnancy, there may be a slight amount of glucose found in the urine due to the fact that the kidney tubules are not able to absorb as much glucose as there were before pregnancy. However, there should be minimal protein in the urine. A specific gravity of 1.010 and a straw- like color are both normal findings.

31. A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? a) Straw-like color b) 2+ Protein in urine c) Specific gravity of 1.010 d) Trace of glucose

a) "Based on your results, your baby is doing well" Pg. Biophysical profiles may be done as often as daily during a high-risk pregnancy. A score of 8 to 10 means the fetus is considered to be doing well. A score of 6 is considered suspicious and a score of 4 denotes a fetus potentially in jeopardy. A score of 9 does not indicate the need for additional testing, a greater risk for preterm labor, or a fetus in jeopardy.

32. A client has had a biophysical profile done and receives a score of 9. The client asks the nurse, "What does this mean?" Which response by the nurse would be appropriate? a) "Based on your results, your baby is doing well" b) "We'll have to watch you closely because your baby may be in jeopardy" c) "Your score is a little low so we need to do more testing" d) "Your score means that you are likely to go into preterm labor"

c) Fetal heartbeat Pg. 212 The only positive sign of pregnancy is a sign or symptom that could only be attributable to the fetus; thus, fetal heartbeat can have no other origin. Chadwick sign is a color change in the cervix, vagina, and perineum; these could all be the result of other causes. A positive urine hCG is a probable sign as it can be related to causes other than pregnancy. A change in the size and shape of the uterus can occur due to other causes.

32. The nurse is conducting an annual examination on a young female who reports her last menses was 2 months ago. The client insists she is not pregnant due to a negative home pregnancy test. Which assessment should the nurse use to assess confirm the pregnancy? a) Uterine size and shape changes b) Positive urine human chorionic gonadotropin (hCG) c) Fetal heartbeat d) Chadwick sign

d) "I forgot to tell you at my first prenatal appointment that I take phenytoin for seizures" Pg. 273 Phenytoin is a teratogen and the provider would consider an alternate seizure medication if indicated. Ideally, the client would have alerted the health care provider as early as possible. Acetaminophen is not considered a teratogen when taken as directed and heparin does not cross the placental barrier and is considered safe during pregnancy. Smoking during pregnancy can cause intrauterine growth restriction, but this client stopped smoking before the pregnancy.

33. The nurse is caring for several pregnant clients in the office setting. Which client's statement would be of most concern to the nurse? a) "I smoked cigarettes daily until a few years ago, and I was able to quit" b) "A few weeks before I knew I was pregnant, I took acetaminophen for a headache" c) "I take heparin every day since I have a history of blood clots" d) "I forgot to tell you at my first prenatal appointment that I take phenytoin for seizures"

d) Abdominal pain coming and going during the third trimester Pg. 223 Any abdominal pain needs to be reported to the health care provider ASAP. This could be a sign of preterm labor and needs to be addressed. Vomiting during the first trimester is normal. Heartburn is caused by the shifting of abdominal organs. Frequent urination is the result of increased pressure on the bladder.

33. Which of the following changes, with highest priority, should the nurse teach a pregnant client to report to the health care provider as soon as possible? a) Frequent urination, every 1 to 2 hours, during the first trimester b) Vomiting 2 to 3 times a day during first trimester c) Heartburn awakening her at night during the first trimester d) Abdominal pain coming and going during the third trimester

b) 300 Pg. 227 A BMI of 23 is considered a healthy weight. For clients at a healthy weight, 300 additional calories are needed to support fetal growth in the second and third trimester of the pregnancy. If the client had been underweight, more calories would have been recommended; if the client had been obese, less calories would have been recommended.

34. The nurse is counseling a client with a BMI of 23 about weight gain during pregnancy. The nurse teaches the client that during the second and third trimester of pregnancy, dietary intake should be increase by how many calories per day above what she was eating prior to the pregnancy? a) 100 b) 300 c) 500 d) 1000

d) Continues progesterone production by corpus luteum Pg. 177, 179 The corpus luteum is responsible for producing progesterone until this function is assumed by the placenta. hCG is a fail-safe mechanism to prolong the life of the corpus luteum and ensure progesterone production. Estrogen is responsible for providing a rich blood supply to the decidua. Progesterone helps maintain a nutrient-rich decidua.

34. The nursing instructor is preparing a class presentation covering the various hormones and their functions during pregnancy. The instructor determines the class is successful when the class correctly matches which function with hCG? a) Sustains life of placenta b) Maintains nutrient-rich decidua c) Provides rich blood supply to decidua d) Continues progesterone production by corpus luteum

b) The end of the second trimester Pg. 187 During the second trimester, fetal growth is significant. The fetus begins this trimester 3 inches long and weighing less than 1 oz (0.8 gm). By the end of the second trimester, the fetus is about 15 inches long and weighs more than 2 lbs (1000 gm). Major organs develop to the point that the fetus may survive (with help) outside the womb. The fetus would not be able to survive at the end of the first trimester. The end of the third trimester is the expected time of deliver. The fourth trimester involves the time after delivery.

35. A multigravida client is concerned that she may deliver early. When asking the nurse what is the earliest her baby can be delivered and survive, which time frame would the nurse point out? a) The end of the first trimester b) The end of the second trimester c) The end of the fourth trimester d) The end of the third trimester

a) Dyspnea Pg. 218 In the third trimester, a women experiences dyspnea from the uterus pushing up into the diaphragm. A pregnant woman will experience lordosis, not kyphosis. Ptyalism is excessive saliva production and is often seen in the first trimester of pregnancy. The hematocrit of a pregnant woman will decrease in the third trimester, not increase.

35. Which would be a normal finding by the nurse during a physical exam of a woman in her third trimester? a) Dyspnea b) Kyphosis c) Increased hematocrit d) Ptyalism

b) Ovum d) Zygote c) Embryo a) Fetus Pg. Fetal growth begins with the ovum (from ovulation to fertilization) and then continues as follows: zygote (fertilization to implantation), embryo (implantation from 5 to 8 weeks) and fetus (from 5 to 8 weeks to term).

36. A nurse is describing fetal growth to a group of newly pregnant clients. Place the structures below in the order from ovulation to term. Use all options. a) Fetus b) Ovum c) Embryo d) Zygote

c) Melasma (chloasma) Pg. 217 The so-called mask of pregnancy, melasma (also known as chloasma) can appear as brown blotchy areas on the forehead, cheeks, and nose of the pregnant woman. This condition may be permanent, or it may regress between pregnancies.

36. Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called? a) Ballottement b) Chadwick sign c) Melasma (chloasma) d) Linea rubria

a) Appearance of striae b) Darkening of the areola c) Nodular tissue upon palpation e) Secretions from sebaceous glands on the areola Pg. 216 Changes in breast tissue during pregnancy begin early and continue until delivery. Striae or stretch marks appear, the areola darkens, and the breast tissue may feel nodular from the stimulated glandular production and the Montgomery glands (Montgomery tubercles) produce secretions to lubricate the nipples. A red rash is not a normal finding.

37. A pregnant woman questions the nurse about changes she is noticing in her breasts and is concerned if they are normal. Which reported changes would the nurse recognize as normal breast changes during pregnancy? Select all that apply. a) Appearance of striae b) Darkening of the areola c) Nodular tissue upon palpation d) Red rash over the anterior breast tissue e) Secretions from sebaceous glands on the areola

b) Estriol c) Relaxin d) Progestin e) Human chorionic somatomammotropin Pg. 177-179 Estriol, relaxin, progestin, and human chorionic somatomammotropin are secreted by the placenta. Prolactin is secreted after delivery for breastfeeding.

37. During a prenatal class for a group of new mothers, the nurse is describing the hormones produced by the placenta. What hormones would the nurse include? Select all that apply. a) Prolactin b) Estriol c) Relaxin d) Progestin e) Human chorionic somatomammotropin

c) Mistaking implantation bleeding for last menstrual period (LMP) Pg. 177 The most common cause is implantation bleeding, which can occur as the blastocyst implants itself into the endometrium. This bleeding can be mistaken for a scanty menstrual period and can lead to miscalculation of fetal age by 2 weeks. The other choices might also contribute, especially the math miscalculation, but are not the primary reason.

38. A woman is confused after finding out the ultrasound results predict a different due date for the birth of her baby. Which factor should the nurse point out is most likely the reason for the miscalculation of the fetal age? a) Amount of weight gain of mother in early weeks of pregnancy b) Not seeking prenatal care in the beginning c) Mistaking implantation bleeding for last menstrual period (LMP) d) An error in math when calculating

c) Both findings are normal at this point of the pregnancy Pg. 219 A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.

38. During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? a) The blood pressure should be higher since the cardiac volume is increased b) Combined, both of these findings are very concerning and warrant further investigation c) Both findings are normal at this point of the pregnancy d) The heart rate increase may indicate that the client is experiencing cardiac overload

b) Protects the fetus from changes in temperature e) Shields the fetus against pressure or a blow to the mother's abdomen Pg. 180 The most important purpose of amniotic fluid is to shield the fetus against pressure or a blow to the mother's abdomen. Because liquid changes temperature more slowly than air, it also protects the fetus from changes in temperature. And yet another function, it aids in muscular development, as amniotic fluid allows the fetus freedom to move. Finally, it protects the umbilical cord from pressure, protecting the fetal oxygen supply. It is progesterone that maintains the endometrial lining of the uterus. It is estrogen that contributes to mammary gland development in preparation for lactation and stimulates uterine growth to accommodate the developing fetus.

39. A young mother in a prenatal class asks the nurse why there is amniotic fluid in the uterus with her baby. Which functions of the amniotic fluid should the nurse point out to the client? Select all that apply. a) Contributes to mammary gland development in preparation for lactation b) Protects the fetus from changes in temperature c) Maintains the endometrial lining of the uterus d) Stimulates uterine growth to accommodate the developing fetus e) Shields the fetus against pressure or a blow to the mother's abdomen

c) Increased tidal volume Pg. 218 A pregnant client breathes more deeply, which increases the tidal volume of gas moved in and out of the respiratory tract with each breath. The expiratory volume, residual volume, and respiratory rate decrease as the pregnancy progresses. The increased oxygen consumption in the pregnant client is 15% to 20% greater than in the nonpregnant state.

39. The nursing instructor is presenting the basic physiologic changes in the woman that can occur during a pregnancy. The instructor determines the session is successful when the students correctly choose which change in the respiratory function during pregnancy as normal? a) Decreased oxygen consumption b) Increased expiratory volume c) Increased tidal volume d) Decreased respiratory rate

a) Chew gum e) Suck on hard candies Pg. 295 Ptyalism or excess salivation may be relieved by chewing gum or sucking on hard candies. Many of the interventions used to relieve nausea and vomiting may also work for ptyalism.

4. A client at 10 weeks' gestation is complaining of ptyalism over the past 2 weeks. What intervention would the nurse recommend to this client? Select all that apply. a) Chew gum b) Wear a panty liner c) Eat a large, protein rich meal in the evening d) Use saline nasal spray e) Suck on hard candies

b) It is going to be close but you may still be pregnant at the wedding Pg. 187-188 To answer the client's question, the nurse would determine the client's estimated date of delivery/birth. The formula for Naegele rule says to subtract 3 months from the first day of the last normal menstrual period (August 1) and add 7 days to the result. This client has an EDD of May 8. Because the wedding is on May 1, the dates are too close to be certain if the infant will be born before or after the wedding date. It is most accurate for the nurse to state that there is the possibility that the client will be pregnant at the wedding. The client would not have "weeks of pregnancy" remaining nor be postpartum for weeks when the wedding occurs. The wedding is not just past the due date.

4. A pregnant client asks the nurse about the estimated date of delivery/birth, because the client is in a wedding and wants to know if the infant will be born before the wedding date. The client reports that the last normal menstrual period was on August 1. The wedding is May 1. Using Naegele rule to determine the estimated date of delivery/birth, which response is accurate? a) You will just pass your due date so chances are that the infant will be born b) It is going to be close but you may still be pregnant at the wedding c) There is no problem, you still have several weeks until you reach your estimated date of delivery d) The infant will be 4 weeks old when the wedding occurs

c) Darkened breast areolae Pg. 216 As part of the pigment changes that occur with pregnancy, breast areolae become darker. The breast tissue should not be softer or slacker than before. There should not yet be any lymph enlargement, and the nipples should not have fissures.

4. The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting? a) Slack, soft breast tissue b) Enlarged lymph nodes c) Darkened breast areolae d) Deeply fissured nipples

d) With a pillow under her right hip Pg. 219-220 Pregnancy places strain on the cardiovascular system with increased fluid in the lungs and heart. The use of one pillow under the right hip will help displace the uterus and fetus off the major blood vessels, allowing the circulation to flow appropriately and provide relief to the client. When the woman lies flat on her back the uterus and contents can compress the vena cava and aorta and reduce blood flow, resulting in the light-headedness and dizzy spells. Removal of the pillow would not alter the effects on the vena cava. A pillow under the shoulders would hurt the neck, and a pillow under both hips would exacerbate the light-headedness.

40. A client in her third trimester reports sleeping poorly: sleeping on her back results in lightheadedness and dizziness and lying on her side results in no sleep. Which suggestion for sleeping should the nurse prioritize for this client? a) Without a pillow b) With a pillow under her shoulders c) With a pillow under both hips d) With a pillow under her right hip

b) Ectopic pregnancy Pg. 534 An ectopic pregnancy or tubal pregnancy can result when there is blockage or scarring of the fallopian tubes due to infection (PID) or trauma (tubal ligation reversal). Ectopic pregnancy may present with vague signs and symptoms but is the leading cause of maternal death in the first trimester and should be given priority when determining the cause of abdominal complaints. The other choices would be ruled out after the ectopic pregnancy is ruled out.

40. The nurse is assessing a young female who just found out she is pregnant. She is now reporting vague abdominal discomfort. After noting the client has a history of PID, the nurse predicts the health care provider will give priority to ruling out which situation? a) Repeat PID b) Ectopic pregnancy c) Endometriosis d) UTI

b) Goodell sign Pg. 211 The description of a Goodell sign is softening of the cervix. Ballottement is when tapping the lower uterine segment on a bimanual exam elicits the fetus to rise against the abdominal wall. Chadwick sign is when the vagina changes color from pink to violet. Hegar sign is softening of the lower uterine segment.

41. The nurse is performing an assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The women is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes? a) Chadwick sign b) Goodell sign c) Hegar sign d) Ballottement

b) Level of fetal surfactants Pg. 197 Amniocentesis is done to check the lung surfactant ratio of the fetus, which will determine if the lungs are matured enough for delivery. Amniocentesis can be used to determine fetal renal and alimentary output, but these factors are not critical to birth. Maternal blood work will reveal information about the mother and not the lung maturity of the fetus.

41. The nurse is preparing a pregnant client with severe hypertension for an emergent amniocentesis for possible early delivery of the fetus. The nurse will explain to the client that the health care provider is evaluating which parameter? a) Fetal alimentary output b) Level of fetal surfactants c) Maternal blood makeup d) Fetal renal output

d) The amount gradually fluctuates during pregnancy Pg. 179 Amniotic fluid is alkaline. Amniotic fluid is composed of 98% water and 2% organic matter. Amniotic fluid volume gradually fluctuates throughout pregnancy. Sufficient amounts promote fetal movement to enhance musculoskeletal development.

42. When describing the characteristics of the amniotic fluid to a pregnant woman, the nurse would include which information? a) It is usually an acidic fluid b) It is composed primarily of organic substances c) It limits fetal movement in utero d) The amount gradually fluctuates during pregnancy

a) When the umbilical cord is clamped, the newborn no longer requires the placenta for oxygenation Pg. When the umbilical cord is clamped, the newborn begins breathing oxygen on one's own rather than getting oxygenated blood from the placenta. Crowning is when the fetal head is visible in the birth canal, and the placenta is still providing oxygenation at this time. The cord may be clamped at different times after the birth, so it is not the birth itself that causes the newborn to not require oxygenated blood from the placenta. Surfactant is produced during the 22- to 28-week stage of development, but that time frame is not when the fetus supplies one's own oxygen.

43. The nurse is conducting prenatal education with a group of women. One participant asks the nurse when the fetus's blood will no longer require the placenta for oxygenation. How will the nurse respond? a) When the umbilical cord is clamped, the newborn no longer requires the placenta for oxygenation b) When the birth occurs, the placenta is no longer required to provide the newborn with oxygen c) When the fetal head is crowning or "presenting" the fetal blood moves away from the placenta d) When the fetal lungs produce surfactant, around 22 to 28 weeks' gestation, the placenta no longer supplies oxygen

c) Taking "natural" medications d) Taking over-the-counter herbs e) Receiving immunizations Pg. 273 The pregnant woman is taught to consider that substances she takes into her body may pass to the fetus. These include immunizations, over-the-counter herbs, and all medications, even the ones labeled as "natural." The woman should verify with her health care provider before any of those things are taken. Eating spicy food and drinking specific brands of bottled water would not need to be cleared with the provider unless the woman experienced gastrointestinal symptoms following ingestion.

44. The nurse is providing prenatal education in the community. The nurse advises the pregnant women to check with their health care provider before what activity(ies)? Select all that apply. a) Eating spicy foods b) Drinking bottled water c) Taking "natural" medications d) Taking over-the-counter herbs e) Receiving immunizations

b) Maintains the endometrial lining of the uterus during pregnancy Pg. 179 Progesterone is necessary to maintain the endometrial lining of the uterus during pregnancy. It is human chorionic gonadotropin (hCG) that acts to ensure the corpus luteum of the ovary continues to produce estrogen and progesterone. Estrogen contributes to mammary gland development, and human placental lactogen regulates maternal glucose, protein, and fat levels.

45. A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough of it naturally. She asks the nurse what function this hormone has in her pregnancy. What should the nurse explain is the primary function of progesterone? a) Regulates maternal glucose, protein, and fat levels b) Maintains the endometrial lining of the uterus during pregnancy c) Contributes to mammary gland development d) Ensures the corpus luteum of the ovary continues to produce estrogen

d) Placental insufficiency Pg. 185 A deficiency of amniotic fluid, oligohydramnios, is associated with uteroplacental insufficiency and fetal renal abnormalities. Excess amniotic fluid is associated with maternal diabetes, neural tube defects, and malformations of the gastrointestinal tract and central nervous system.

46. Assessment of a pregnant woman reveals oligohydramnios. The nurse would be alert for the development of which condition? a) Fetal gastrointestinal malformations b) Maternal diabetes c) Neural tube defects d) Placental insufficiency

a) From fertilization to the end of the second week after fertilization Pg. 175 The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. The fetal stage begins at 9 weeks after fertilization and ends at birth. There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period.

47. A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage? a) From fertilization to the end of the second week after fertilization b) Approximately 6 weeks after fertilization to the end of 8 weeks c) Approximately 9 weeks after fertilization to birth d) Approximately 2 weeks after fertilization to the end of the eighth week

b) "We will have to wait until the baby is 16 weeks' gestation to determine what the sex is" Pg. 187 The sex of the baby can be determined by ultrasound at 16 weeks' gestation. An ultrasound at 6 and 8 weeks would be too early to determine the sex. An ultrasound at 20 weeks should confirm what was found at 16 weeks.

48. The pregnant client at 6 weeks' gestation asks the nurse if an ultrasound will reveal the sex of the fetus yet. What is the best response by the nurse? a) "We will have to wait until the baby is 20 weeks' gestation to determine the sex of the baby" b) "We will have to wait until the baby is 16 weeks' gestation to determine what the sex is" c) "We will be able to determine the sex of the baby today with transvaginal ultrasound" d) "We will have to wait until the baby is 8 weeks' gestation to be able to determine what the sex is"

a) Varicella b) Rubella e) Zika virus Pg. The Zika virus, varicella, and rubella are known as infectious teratogens. A urinary tract infection and a sinus infection would likely not alone cause fetal abnormalities.

49. The nurse is reviewing prenatal charts in the clinic and notes some clients report infections during their pregnancies. Which maternal infection(s) places the fetus at high risk for developmental abnormalities? Select all that apply. a) Varicella b) Rubella c) Urinary tract infections d) Sinus infections e) Zika virus

c) Accepting the pregnancy Pg. 205 Acceptance of pregnancy is multi-factorial, and how the woman responds to the pregnancy is certainly influenced by her age and if the pregnancy was planned. As a teenager, she may not have been trying to get pregnant and may not want to accept the role and experience. Baby and parenthood decisions should all occur later.

5. A 17-year-old client arrives for an annual examination and reports no changes since the last exam; however, the nurse assesses a positive Chadwick sign, slightly enlarged uterus, and subsequent positive urine pregnancy test. Which task should the nurse prioritize to assist this client who is denying any possibility that she is pregnant? a) Preparing for parenthood b) Accepting the baby c) Accepting the pregnancy d) Telling her partner and family

b) At the level of the umbilicus Pg. 238 In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

5. A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client? a) At the top of the symphysis pubis b) At the level of the umbilicus c) At the xiphoid process d0 Halfway between the symphysis pubis and the umbilicus

a) Physical protection Pg. 180 Amniotic fluid serves four main functions for the fetus: physical protection, temperature regulation, provision of unrestricted movement, and symmetrical growth.

5. Amniotic fluid is produced throughout the pregnancy by the fetal membranes. Amniotic fluid has four major functions. What is one of these functions? a) Physical protection b) Restriction of movement c) Medium in which to test organ maturity d) Provide fluid to keep the fetus hydrated

d) More definitive evaluations to conclude anything Pg. 196 Increased maternal serum alpha-fetoprotein levels may indicate a neural tube defect, Turner syndrome, tetralogy of Fallot, multiple gestation, omphalocele, gastroschisis, or hydrocephaly. Therefore, additional information and more specific determinations need to be done before any conclusion can be made. Down syndrome is associated with decreased maternal serum alpha-fetoprotein levels. This type of testing provides no information about the acid-base status of the fetus. Immediate termination is not warranted; more information is needed.

6. Prenatal testing is used to assess for genetic risks and to identify genetic disorders. In explaining to a couple about an elevated maternal serum alpha-fetoprotein screening test result, the nurse would discuss the need for: a) A more specific determination of the acid-base status b) Special care needed for a Down syndrome infant c) Immediate termination of the pregnancy based on results d) More definitive evaluations to conclude anything

d) Prolactin Pg. 217 Prolactin is the hormone responsible for the initiation of lactation, the production of breast milk. Oxytocin is responsible for the letdown of milk and uterine contractions enabling the infant to be born, and estrogen and progesterone are responsible for uterine and pregnancy maintenance.

6. The nursing instructor is teaching a class on the various hormones necessary for a successful pregnancy and birthing process. The instructor determines the session is successful when the students correctly choose which hormone as being necessary after birth to ensure growth of the newborn? a) Estrogen b) Progesterone c) Oxytocin d) Prolactin

d) Facial edema Pg. 241 Generalized hair loss, hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.

6. Which of the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy? a) A hyperpigmented rash over the maxillary region bilaterally b) Nosebleeds c) Generalized hair loss d) Facial edema

d) "Amniotic fluid cushions your baby to prevent injury" Pg. 180 The amniotic fluid, kept inside the amnion, cushions the fetus against injury, regulates temperature, and allows the fetus to move freely inside it, which allows normal musculoskeletal development of the fetus. The woman's blood supplies food to—and carries wastes away from—the fetus. The placenta supplies the developing organism with food and oxygen; then the umbilical cord connects the fetal blood vessels contained in the villi of the placenta with those found within the fetal body.

7. A pregnant woman undergoing amniocentesis asks her nurse why the baby needs this fluid. What would be an accurate response from the nurse? a) "Amniotic fluid supplies the food your baby needs to grow" b) "Amniotic fluid provides fetal blood circulation" c) "Amniotic fluid keeps the fetus from moving freely inside it to prevent injury" d) "Amniotic fluid cushions your baby to prevent injury"

b) 85 beats per minute Pg. 219 During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.

7. Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately: a) 90 beats per minute b) 85 beats per minute c) 100 beats per minute d) 95 beats per minute

a) 20 cm Pg. 191 Between weeks 18 and 32 the fundal height in centimeters should match the gestational age of the pregnancy. At 20 weeks' the fundal height should be at the umbilicus. A fundal height smaller than expected can indicate that the original dates were miscalculated, oligohydramnios, or that the fetus is smaller than expected. If the fundal height is larger than expected this can indicate multiple gestation, the original dates were miscalculated, polyhydramnios, or a molar pregnancy.

7. The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy? a) 20 cm b) 24 cm c) 16 cm d) 12 cm

a) "A one time discharge of bloody mucus in the toilet might have been your mucus plug" Pg. 215 Bloody mucus can either be a mucus plug or bloody show. The one-time occurrence would be more likely to be the mucus plug. A bloody show would continue if her cervix was changing, but this usually does not occur until after contractions start. It is a sign that something is happening and should be reported to the health care provider. The bloody mucus is not a sign of labor, but it can be an early sign that labor is coming soon.

8. A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucus discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse? a) "A one time discharge of bloody mucus in the toilet might have been your mucus plug" b) "It might be nothing. If it happens again call your provider who is on-call" c) "If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it" d) "Bloody mucus is a sign you are in labor. Please come to the hospital"

b) Intrauterine infection of the fetus e) Maternal smoking Pg. 190 There are a number of contributory causes for IUGR in a fetus, including maternal smoking or drug/alcohol use, infections such as cytomegalovirus and rubella, maternal hypertension, and chronic maternal diseases such as sickle cell disease or renal disease. Maternal heartburn is a normal maternal complaint and does not affect the fetal well-being. Small parents could cause a fetus to be small, but would not cause IUGR. Maternal exercise does not cause IUGR.

8. An infant was born at term but has intrauterine growth restriction (IUGR). What findings in the infant's history would contribute to this problem? Select all that apply. a) Parents small in stature b) Intrauterine infection of the fetus c) Maternal heartburn d) Daily maternal exercise e) Maternal smoking

a) Stretching and breathing exercises such as yoga Pg. 260-261 It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high-impact sports are not appropriate for the pregnant mother. Hot areas such as a jacuzzi, hot tub, and sauna are also inappropriate.

8. The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? a) Stretching and breathing exercises such as yoga b) All activities that the client does in a prepregnant state c) Relaxing activities such as hot baths and jacuzzis d) High-impact movements enabling less time in the activity

d) "Taking gentle enemas no more frequently than once a week is acceptable" Pg. 289 Constipation is a common source of concern for many women in pregnancy. It results from the slowing of intestinal peristalsis and also as a side effect of iron administration. Steps such as increasing fluid intake, increasing dietary fiber, and exercising are beneficial in reducing constipation. Weekly enemas during the pregnancy are not advisable. Enemas can be habit forming and do not correct the causes of the constipation being experienced.

9. A gravid woman who is in her first trimester reports experiencing constipation. Which statement by the client indicates the need for further instruction? a) "Exercise such as walking daily helps increase my bowel movements" b) "Adding more vegetables to my diet will be helpful" c) "Increasing my water intake will aid in reducing my constipation" d) "Taking gentle enemas no more frequently than once a week is acceptable"

c) Umbilical arteries Pg. 177 The placenta is a flat, round structure which forms on the decidua and attaches to the fetus by the umbilical cord. The placenta is the organ responsible for supplying nutrients and oxygenated blood to the fetus. The amniotic fluid surrounds the fetus and provides protection, temperature regulation, allows movement, and symmetric growth. It collects urine and other waste products from the fetus. The decidua is the name given to the endometrium after the pregnancy starts. The umbilical arteries carry waste products away from the fetus to the placenta, where they are filtered out into the maternal body for proper disposal.

9. A nurse is discussing the importance of good nutrition to a young pregnant client. The nurse would point out that the growing fetus is getting nutrition from the mother via which structure? a) Amniotic fluid b) Placenta c) Umbilical arteries d) Decidua

d) Quickening Pg. 206 The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus.

9. The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence? a) Lightening b) Linea nigra c) Placenta previa d) Quickening