Chapter 04: Prenatal Care and Adaptations to Pregnancy

Which sign indicates the flexing of the body of the uterus against the cervix? 1 Hegar's sign 2 Goodell's sign 3 Chadwick's sign 4 McDonald's sign

ANS: 4 McDonald's sign, Hegar's sign, Goodell's sign, and Chadwick's sign all indicate pregnancy. McDonald's sign is the flexing of the body of the uterus against the cervix. It is caused by a softening of the lower uterine segment. The softening of the lower uterine segment is Hegar's sign. Goodell's sign indicates a softening of the cervix and the vagina as a result of increased vascular congestion. Chadwick's sign is characterized by the purplish or bluish discoloration of the cervix, vagina, and vulva as a result of increased vascular congestion.

Which amount of weight gain is the minimum in an obese patient carrying twins? 1 25 lb 2 11 lb 3 61 lb 4 52 lb

ANS: 1 The Institute of Medicine (IOM) has recommended certain limits for weight gain in patients during pregnancy on the basis of their body mass index in a non-pregnant state. Obese patients carrying twins should have a minimum weight gain of 25 lb. An obese patient who does not have multifetal gestation should gain a minimum of 11 lb during her pregnancy. The maximum amount of weight that obese patients carrying twins can gain is 42 lb. Thus patients may have complications during pregnancy and labor if they gain 61 lb or 52 lb.

Which condition is associated with a finding of rebound on ballottement in the postpartum patient's uterus? 1 Uterine polyps 2 Retained placental fragments 3 Cervical and perineal lacerations 4 Sensitive uterine wall

ANS: 1 The presence of polyps in the uterus or cervix is one reason the primary care provider may obtain a sense of ballottement. Hence, a sense of ballottement immediately postpartum may occur as a result of the presence of uterine polyps. Retained placental fragments cannot cause ballottement since they are attached to the uterine wall. Only floating structures can cause a sense of ballottement. Lacerations in the cervix and perineum cannot cause a ballottement sensation, as they cannot rebound. The uterine wall would not cause a sense of ballottement as it does not move and rebound.

While examining a pregnant patient, the registered nurse determines the patient's pulse rate and fetal heart rate simultaneously with a fetoscope. Which rationale supports this intervention? 1 To ensure that the fetal heartbeat is actually heard 2 To determine if the patient has uterine souffle 3 To differentiate the funic souffle from the fetal heart rate 4 To determine the patient's heart rate

ANS: 1 While assessing the fetal heart rate by a fetoscope, it is important to assess the patient's pulse rate simultaneously. This is to done to distinguish the audibility of fetal heartbeat from the patient's heartbeat. Uterine souffle is an additional soft blowing sound that is heard upon auscultating the uterus. Assessing the fetal heart rate and the patient's pulse rate simultaneously does not help to assess uterine souffle in the patient. Funic souffle is also an additional sound heard as a result of the flow of blood into the umbilical cord. It can be heard only by auscultating the uterus. Assessing the fetal heart rate and the patient's pulse rate simultaneously does not help to determine the patient's heart rate.

The nurse is collecting the data of a pregnant patient whose last menstrual period was on February 9, 2014. What is the estimated date of delivery (EDD) of the patient? Record your answer as MM/DD/YYYY.Answer: ____________.

ANS: 11/16/19 Nägele's rule is used to determine the estimated date of delivery (EDD). Based on Nägele's rule, the first day of the last normal menstrual period is February 9. Count backward 3 months: November 9. Add 7 days: November 16, 2014. Therefore the EDD is November 16, 2014.

The nurse is caring for a patient in the third trimester of pregnancy. Laboratory results show an 8% increase in white blood cell count and a hematocrit of 35%. On assessment the pulse rate has increased by 10-15 beats/minute and the blood pressure is 150/100 mm Hg. Which finding would the nurse report to the health care provider? 1 Hematocrit value of 35% 2 Blood pressure of 150/100 mm Hg 3 Increase in the white blood cell count by 8% 4 Increase in the pulse rate by 10-15 beats/minute

ANS: 2 During pregnancy the patient's blood pressure should be below 140/90 mm Hg. If the patient's blood pressure is found to be 150/100 mm Hg then it indicates that the patient may have hypertension. This can cause complications during pregnancy. During pregnancy, blood plasma increases more than the erythrocytes. Due to this, the hematocrit value is found to be 33%-46% rather than 36%-48%. Therefore a hematocrit value of 35% is a normal finding. The white blood cell count including neutrophils may increase by 8% during pregnancy and considered to be a normal finding. The pulse rate increases by 10-15 beats/minute as more blood is pumped from the heart during pregnancy.

The nurse is caring for a patient in the second trimester of pregnancy who reports a burning sensation in the chest, burping, and a sour taste in the mouth. Which instruction would the nurse provide to alleviate these symptoms? 1 "Eat dry crackers in the morning." 2 "Sit up for 30 minutes after meals." 3 "Decrease your intake of fluid before bedtime." 4 "Drink coffee three or four times a day."

ANS: 2 During pregnancy, increased progesterone levels relax the esophageal sphincter and may cause regurgitation of gastric contents. That regurgitation may cause heartburn, which is characterized by burping and a sour taste in the mouth. Sitting up for 30 minutes after meals would prevent regurgitation and alleviate the symptoms of heartburn. Eating dry crackers and toast in the morning helps prevent nausea and vomiting. Patients are advised to decrease fluid intake before bedtime to reduce nocturia. Coffee contains caffeine, which has a diuretic effect and may cause frequent urination. Therefore coffee should be avoided during pregnancy.

Which statement made by a pregnant patient to the nurse indicates a risk for aortocaval compression? 1 "I am drinking fluids between meals." 2 "I sleep flat on my back every night." 3 "I am using Alka-Seltzer for heartburn." 4 "I sit up for 30 minutes after meals."

ANS: 2 Pregnant patients should avoid sleeping on their backs because this may cause compression or pressure on the inferior vena cava and can result in aortocaval compression or vena cava syndrome. Patients are advised to drink fluids between meals to avoid nausea and vomiting. Alka-Seltzer should be avoided during pregnancy, but it does not increase the risk of aortocaval compression. Pregnant patients are advised to sit up for 30 minutes after meals to alleviate the symptoms of pyrosis.

Which routine assessments are made at each prenatal visit? Select all that apply. 1 Glucose tolerance test 2 Fundal height 3 Urinalysis for protein, glucose, and ketones 4 Fetal heart rate 5 Leopold's maneuvers

ANS: 2, 3, 4 A glucose tolerance test is done one time, routinely around 28 weeks. Leopold's maneuvers are done closer to the delivery date to identify the position of the baby. Fundal height, urinalysis, and fetal heart rate are all done routinely at each visit.

A patient who is in the first trimester of pregnancy has been prescribed a hemoglobin electrophoresis test. Which fetal complication is being assessed for? 1 Rh incompatibility 2 Fetal loss 3 Sickle cell anemia 4 Chromosomal anomalies

ANS: 3 A pregnant woman in the first trimester is usually prescribed hemoglobin electrophoresis to detect the presence of sickle cell anemia. Blood typing, Rh factor, and antibody screen checks are used to detect the risk of Rh incompatibility. An endovaginal ultrasound is used to determine the risk of fetal loss. Chromosomal anomalies are detected by the serum alpha-fetoprotein test during the second trimester.

A first-trimester ultrasound differs from Nagele's calculation for the estimated day of delivery by 10 days. Based on the discrepancy, which ultrasound measurement would the nurse refer to for the estimated date of delivery? 1 Femur length 2 Biparietal diameter 3 Crown-rump length 4 Head circumference

ANS: 3 If the last menstrual period is unknown, or the abdominal ultrasound in the first trimester differs from Nagele's calculation by more than 5 days, a crown-rump length obtained by ultrasound can be used to determine the estimated date of delivery. The femur length, biparietal diameter, and head circumference can be used to confirm the estimated date of delivery after 14 weeks of gestation

The nurse is evaluating the assessment skills of a student nurse who is caring for a patient in the 16th week of gestation. Which action by the student nurse needs correction? 1 Palpating the abdomen to assess the fundal height 2 Referencing the ultrasound report to check the fetal heart rate 3 Performing Leopold's maneuver to assess the presentation of the fetus 4 Taking the weight of the patient and then asking for the pre-pregnancy weight

ANS: 3 Leopold's maneuver is performed to assess the lie and presentation of the fetus only after 36 weeks of pregnancy. Therefore the nurse should not perform this maneuver while assessing a pregnant woman who is in the 16th week of gestation. Alterations in fundal height can be detected any time after the eighth week of pregnancy. The fundal height is assessed to ensure the proper growth of the fetus. During early pregnancy the fetal heart rate is assessed using an ultrasound. The assessment of pregnancy weight gain is done to prevent inadequate or too-rapid weight gain.

Which pregnancy test is the most reliable to confirm pregnancy 1 week after ovulation? 1 Blood test 2 Ultrasonography 3 Radioimmunoassay (RIA) 4 Home pregnancy test

ANS: 3 Radioimmunoassay (RIA) is the most reliable test for confirming pregnancy as early as 1 week after ovulation. RIA can precisely detect very low levels of human chorionic gonadotropin (hCG). Blood tests may not detect low levels of hCG and may give a false negative result. Ultrasonography would likely not capture the fetus as early as the first week of pregnancy. Home pregnancy tests may not be accurate and reliable as they may not be able to detect hCG levels.

29. The nurse reminds the prenatal patient that she should add ________ kcal to her daily intake to nourish the fetus.

ANS: 300 The recommended dietary intake increase is 300 kcal a day.

Which condition in the fetus is associated with excessive maternal intake of vitamin A? 1 Numbness 2 Nerve damage 3 Insulin resistance 4 Cardiac defects

ANS: 4 Adequate intake of vitamins is essential during pregnancy, but excess intake of vitamins may cause problems. Vitamin A intake should not exceed 3000 mcg/day. Excess vitamin A may cause fetal anomalies and cardiac defects. Excess intake of pyridoxine may cause numbness and nerve damage. Insulin resistance is developed as a result of excess intake of folic acid supplements.

The nurse is caring for a patient at 30 weeks of gestation who is irritated as a result of leakage from the nipples and breast lumps. Which instructions does the nurse reinforce while providing intervention to relieve the patient? 1 Instruct the patient to massage the breasts. 2 Teach the patient to perform breast exercises. 3 Ask the patient to apply alcohol-based ointment on the nipples. 4 Instruct the patient to clean the nipples with water.

ANS: 4 The nipples should be kept clean to prevent the milk ducts from being blocked by colostrum. Therefore it is necessary to clean the breasts using water since the use of soap may cause dry skin. Massaging the breasts may increase the risk of preterm labor. Therefore it is not advisable to massage the breasts to relieve lumps. Breast exercises will induce oxytocin production. Oxytocin has the property of uterine contraction and may cause preterm labor. Therefore breast exercises should be avoided. Applying an alcohol-based ointment on the nipples may result in dry skin. Therefore ointment should be avoided.

A pregnant patient reports tingling of the fingers to the nurse. Which instruction would the nurse give to the patient? 1 "You should perform Kegel exercises." 2 "You should avoid gas-forming foods." 3 "You should increase your fluid intake." 4 "You should wear a supportive maternity bra."

ANS: 4 The nurse should advise the patient to wear a supportive maternity bra if she reports a tingling sensation in the fingers. This tingling sensation in the fingers is a result of breast enlargement. Breast enlargement leads to drooping of the shoulders. This causes traction on the brachial plexus; therefore the patient may experience tingling, pain, limited motion, and numbness in the arm. Kegel exercises are performed to strengthen the pelvic muscles but not decrease tingling sensation in the fingers of the patient. The patient should avoid gas-forming foods and increase fluid intake to prevent constipation.

The nurse is caring for a patient after a recent preterm delivery and finds that the patient had a miscarriage during her first pregnancy and gave birth to twins at full term during the second pregnancy. Which documentation of this information by the nurse using the TPALM system is accurate? 1 Gravida 2 TPALM 01110 2 Gravida 2 TPALM 01031 3 Gravida 3 TPALM 11131 4 Gravida 3 TPALM 21131

ANS: 4 The patient was pregnant three times, so gravid would be 3. The patient had one full-term delivery, one preterm delivery, and one abortion. During the second delivery the patient gave birth to twins, and during the third delivery the patient gave birth to one child, so the total number of living children is three. Therefore the nurse should represent this information as gravida 3 TPALM 21131. Here, T indicates term, P indicates preterm, A denotes abortions, L specifies living children, and M stands for multiple gestation. If the patient had two pregnancies with one preterm, one child, and one abortion, then it would be indicated as gravida 2 TPALM 01110. If the patient had two pregnancies with one preterm and one child, then it would be indicated as gravida 2 TPALM 01031. If the patient had three pregnancies with two term deliveries, one abortion, one preterm delivery, and three children, it would be indicated as gravida 3 TPALM 21131.

Which condition increases the risk of yeast infection in a postpartum patient? 1 The presence of lower levels of normal lactobacilli 2 The presence of lower levels of anaerobic bacteria 3 The presence of higher levels of glucose in the patient's urine 4 The presence of higher levels of glycogen in the patient's vaginal secretions

ANS: 4 Vaginal secretions increase after childbirth and may contain high amounts of glycogen. This promotes the growth of Candida albicans, a fungal organism that is responsible for causing yeast infections. Lower levels of normal lactobacilli may make the patient prone to bacterial infections, but it does not cause yeast infections. Higher levels of anaerobic bacteria are found in the vagina of a pregnant woman resulting from a decrease in the number of normal lactobacilli, and it is a normal finding. Higher levels of glucose in the urine indicate gestational diabetes, but it is not related to yeast infections.

3. During the physical examination for the first prenatal visit, it is noted that Chadwick's sign is present. This refers to the: a. bluish or purplish discoloration of the vulva, vagina, and cervix. b. presence of early fetal movements. c. darkening of the areola and breast tenderness. d. palpation of the fetal outline.

ANS: A Chadwick's sign is the purplish or bluish discoloration of the cervix and vagina.

21. The nurse explains that the number of years between menarche and the date of conception is known as _____ age. a. gynecological b. fertile c. conception d. gravid

ANS: A Gynecological age is a term that refers to the number of years between the starting of the menses and the date of conception.

17. A woman pregnant for the first time asks the nurse, "When will I begin to feel the baby move?" The nurse would answer: a. "You may notice the baby moving around the 4th to 5th month." b. "Quickening varies with every woman." c. "You'll feel something by the end of the first trimester." d. "The baby will be big enough for you to feel in your 8th month."

ANS: A Quickening, fetal movement felt by the mother, is first perceived at 16 to 20 weeks of gestation.

20. An ultrasound confirms that a 16-year-old girl is pregnant. The nurse recognizes the need for prenatal care and counseling for adolescents because: a. a pregnant adolescent is experiencing two major life transitions at the same time. b. adolescents who get pregnant are more likely to have other chronic health problems. c. adolescents are at greater risk for multifetal pregnancies. d. at this age, a pregnant adolescent will accept the nurse's advice.

ANS: A The pregnant adolescent must cope with two of life's most stress-laden transitions simultaneously: adolescence and parenthood.

18. The patient who is 40 weeks pregnant complains of a sense of weakness and dizziness when she lies on her back. The nurse assesses this as an indication of: a. supine hypotension. b. orthostatic hypotension. c. gestational hypertension. d. pseudoanemia.

ANS: A When in the supine position, the weight of the uterus compresses the vena cava and aorta, causing hypotension. Placing a pillow under the right hip will reduce the symptoms.

25. The nurse cautions the patient that, because of hormonal changes in late pregnancy, the pelvic joints relax. What does this result in? Select all that apply. a. Waddling gait b. Joint instability c. Urinary frequency d. Back pain e. Aching in cervical spine

ANS: A, B A waddling gait and joint instability are the only signs that relate to joint changes. The other discomforts are related to the enlarging uterus with its attendant weight.

27. What should the nurse do for the prenatal patient in terms of prenatal care? Select all that apply. a. Offer nutritional counseling. b. Reinforce responsibility of parenthood. c. Reduce risk factors. d. Improve health practices. e. Make financial arrangements for delivery.

ANS: A, B, C, D Nutritional counseling, reinforcing and discussing the responsibility of parenthood, reducing risk factors for the pregnant woman and the fetus, and improving health practices are all goals of prenatal care.

28. The nurse recognizes which behavior characteristic(s) of women in their first trimester of pregnancy? Select all that apply. a. Showing off her sonogram photos b. Ambivalence about pregnancy c. Emotional and labile mood d. Focusing on her infant e. Fatigue

ANS: A, B, C, E Showing off photos, feeling ambivalence about the pregnancy, fragile emotions, and fatigue and sleepiness are all characteristic of behaviors seen in the first trimester. Women are not focused on their infant; they are focused on themselves and the physical changes they are experiencing.

10. When the nurse tells a pregnant woman that she needs 1,200 mg of calcium daily during pregnancy, the woman responds, "I don't like milk." What dietary adjustments could the nurse recommend? a. Increase intake of organ meats. b. Eat more green leafy vegetables. c. Choose more fresh fruits, particularly citrus fruits. d. Include molasses and whole-grain breads in the diet.

ANS: B For women who do not like milk, other sources of calcium include enriched cereals, legumes, nuts, dried fruits, green leafy vegetables, and canned salmon and sardines that contain bones.

2. A woman asks the nurse about the frequency of prenatal visits. In an uncomplicated pregnancy, the nurse would tell her that appointments are scheduled: a. every 3 weeks until the 6th month, then every 2 weeks until delivery. b. every 4 weeks until the 7th month, after which appointments will become more frequent. c. monthly until the 8th month. d. every 2 to 3 weeks for the entire pregnancy.

ANS: B Monthly visits are scheduled up to 28 weeks, and then visits increase to every 2 to 3 weeks through 36 weeks. From 36 weeks until delivery, visits are weekly.

5. The nurse has explained physiological changes that occur during pregnancy. Which statement indicates that the woman understands the information? a. "Blood pressure goes up toward the end of pregnancy." b. "My breathing will get deeper and a little faster." c. "I'll notice a decreased pigmentation in my skin." d. "There will be a curvature in the upper spine area."

ANS: B The pregnant woman breathes more deeply, and her respiratory rate may increase slightly.

26. The nurse assesses the progress from the announcement stage of fatherhood to the acceptance stage when the patient reports which action(s) by the father? Select all that apply. a. Goes fishing every afternoon b. Has revised his financial plan c. Spends leisure time with his friends d. Traded his sports car for a sedan e. Helped select a crib

ANS: B, D, E Active planning for an infant is an indication of the acceptance stage. Concentration on a hobby and spending time away from home are indicators of nonacceptance.

13. The patient remarks that she has heard some foods will enhance brain development of the fetus. The nurse replies that foods high in docosahexaenoic acid (DHA) are thought to enhance brain development. Such foods include: a. fried fish. b. olive oil. c. red meat. d. leafy green vegetables.

ANS: C Foods rich in DHA are red meat, flounder, halibut, and soybean and canola oil. Frying fish negatively alters the DHA.

19. A pregnant woman inquires about exercising during pregnancy. In planning the teaching for this woman, the nurse should include what information? a. Exercise elevates the mother's temperature and improves fetal circulation. b. Exercise increases catecholamines, which can prevent preterm labor. c. A regular schedule of moderate exercise during pregnancy is beneficial. d. Pregnant women should limit water intake during exercise.

ANS: C In general, moderate exercise several times a week, from the 8th week through delivery, is advised during pregnancy.

1. A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a 2-year-old son and had one previous spontaneous abortion. Using the TPAL system, the patient's obstetric history would be recorded as: a. gravida 2 para 20120. b. gravida 3 para 10011. c. gravida 3 para 10110. d. gravida 2 para 11110.

ANS: C Refer to Box 4-1 in the textbook for the TPAL system of identifying gravida and para.

7. During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an electronic Doppler device. When this instrument is used, fetal heart tones can be detected as early as _____ weeks. a. 4 b. 8 c. 10 d. 14

ANS: C The fetal heartbeat can be detected as early as 10 weeks of pregnancy using a Doppler device.

16. At her initial prenatal visit a woman asks, "When can I hear the baby's heartbeat?" The nurse would respond that the fetal heartbeat can be auscultated with a specially adapted stethoscope or fetoscope at _____ weeks. a. 4 b. 12 c. 18 d. 24

ANS: C The fetal heartbeat can be heard with a fetoscope between the 18th and 20th week of pregnancy.

12. The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. The nurse should initially: a. assess food intake. b. weigh the patient again. c. take the blood pressure. d. notify the physician.

ANS: C The marked weight gain may be an indication of gestational hypertension. The blood pressure should be assessed before notifying the physician.

11. A pregnant woman is experiencing nausea in the early morning. What recommendations would the nurse offer to alleviate this symptom? a. Eat three well-balanced meals per day and limit snacks. b. Drink a full glass of fluid at the beginning of each meal. c. Have crackers handy at the bedside, and eat a few before getting out of bed. d. Eat a bland diet and avoid concentrated sweets.

ANS: C The nurse can recommend eating dry toast or crackers before getting out of bed in the morning to alleviate nausea during pregnancy.

9. A woman's prepregnant weight is average for her height. The nurse would advise the woman that her recommended weight gain during pregnancy would be _____ pounds. a. 10 to 20 b. 15 to 25 c. 25 to 35 d. 28 to 40

ANS: C The recommended weight gain for a woman of normal weight before pregnancy is 25 to 35 pounds.

6. A woman reports that her last normal menstrual period began on August 5, 2010. Using Nägele's rule, her expected date of delivery would be _____, 2011. a. April 30 b. May 5 c. May 12 d. May 26

ANS: C To determine the expected date of delivery, count backward 3 months from the first day of the last menstrual period, then add 7 days.

24. A woman who is 36 weeks pregnant tells the nurse she plans to fly to Hawaii, which is a 12-hour flight. What would the nurse recommend that the patient do during the flight? Select all that apply. a. Wear tight fitting clothing to promote venous return. b. Eat a large meal before boarding the flight. c. Request a seat with greater leg room. d. Drink at least 4 ounces of water every hour. e. Get up and walk around the plane frequently

ANS: C, D, E Because of the increase in clotting potential, the pregnant patient is prone to a thromboembolism. Adequate hydration, frequent position changes and movement decrease the risk.

22. The woman who becomes pregnant for the first time after the age of ____ years is described as an "elderly primip." a. 25 b. 28 c. 30 d. 35

ANS: D A woman over the age of 35 who becomes pregnant for the first time is described as an "elderly primip."

4. After the examination is completed, the patient asks the nurse why Chadwick's sign occurs during pregnancy. The nurse would explain that it is caused by the: a. enlargement of the uterus. b. progesterone action on the breasts. c. increasing activity of the fetus. d. vascular congestion in the pelvic area.

ANS: D Chadwick's sign is caused by increased vascular congestion in the cervical and vaginal area.

14. The nurse encourages adequate intake of folic acid because it is thought to decrease the incidence of: a. structural heart defects. b. craniofacial deformities. c. limb deformities. d. neural tube defects.

ANS: D Folic acid can reduce the incidence of neural tube defects such as spina bifida and anencephaly.

23. The nurse explains that the softening of the cervix and vagina is a probable sign of pregnancy called _____ sign. a. Chadwick's b. Hegar's c. McDonald's d. Goodell's

ANS: D Goodell's sign is one of the probable signs of pregnancy that describes a softened cervix and vagina.

15. A woman tells the nurse that she is quite sure she is pregnant. The nurse recognizes which as a positive sign of pregnancy? a. Amenorrhea b. Uterine enlargement c. HCG detected in the urine d. Fetal heartbeat

ANS: D Positive indications are caused only by the developing fetus and include fetal heart activity, visualization by ultrasound, or fetal movements felt by the examiner.

8. In a routine prenatal visit, the nurse examining a patient who is 37 weeks pregnant notices that the fetal heart rate (FHR) has dropped to 120 beats/min from a rate of 160 beats/min earlier in the pregnancy. The nurse should: a. ask if the patient has taken a sedative. b. notify the physician. c. turn the patient to her right side. d. record rate as a normal finding.

ANS: D The FHR at term ranges from a low of 110 to 120 beats/min to a high of 150 to 160 beats/min. This should be recorded as normal. The FHR drops in the late stages of pregnancy.

31. The nurse is aware that ______________ maneuver can assess the position and presentation of the fetus.

ANS: Leopold's Leopold's maneuver assesses the position and the presentation of the fetus by palpation.

30. The patient confesses to eating crushed ice 10 or 12 times daily. The nurse assesses this behavior as __________.

ANS: pica Pica is the craving and ingestion of nonfood substances such as clay, crushed ice, and ashes.