Chapter 15: Pregnancy: PREPU
A pregnant client of normal weight is concerned about excessive weight gain during her pregnancy. She states, "I don't want to get fat!" The nurse should inform her that she can expect to gain how much weight during her pregnancy? 1 35 to 40 pounds 2 25 to 30 pounds 3 20 to 25 pounds 4 15 to 20 pounds
2
Which genetic condition is caused by a small gene mutation that affects protein structure, producing hemoglobin S? 1 Marfan syndrome 2 hemophilia 3 Tay-Sachs disease 4 sickle cell anemia
4
Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy? 1 Split S1S2 2 Premature ventricular contractions 3 S4 (atrial gallop) 4 Soft systolic murmur
4
A woman is concerned that orgasm will be harmful during pregnancy. Which statement is factual? 1 Some women experience orgasm intensely during pregnancy. 2 Most women do not experience orgasm during pregnancy. 3 Orgasm during pregnancy is potentially harmful. 4 Venous congestion in the pelvis makes orgasm painful.
1
A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. What does the nurse anticipate in this woman's pregnancy? 1 potential for greater than usual back pain 2 cesarean birth 3 increased risk of miscarriage 4 increased risk of fetal trauma
1
Amniotic fluid does not grow stagnant because 1 amniotic fluid is constantly formed by the amnion. 2 amniotic fluid is constantly absorbed by the chorion. 3 the fetal urine increases the bulk of amniotic fluid. 4 amniotic fluid circulates through the chorionic villi.
1
Assessment for surfactant level via LS ratio in the amniotic fluid is a primary estimation of fetal maturity. The purpose of surfactant is to: 1 Prevent alveoli from collapsing on expiration. 2 Increase lung resistance on inspiration. 3 Encourage immunologic competence of lung tissue. 4 Promote maturation of lung alveoli.
1
At the first prenatal visit of all clients who come to the clinic appropriate blood screenings are obtained. The nurse realizes that a hemoglobin A1c above which level is concerning for diabetes and warrants further testing? 1 6.5% 2 6.0% 3 5.5% 4 5.0%
1
A client asks the nurse questions about female hygiene and wants to know if she should douche to clean her vagina. Which response by the nurse would be most appropriate? 1 "Only douche if the vagina has an odor." 2 "You do not need to douche; the vagina is self-cleaning." 3 "Only douche if you have itching and burning." 4 "If you want, douching is ok."
2
A patient who is 2 months pregnant is concerned about frequent urination. What should the nurse instruct the patient about this occurrence? 1 This means urine is more concentrated. 2 It is caused by pressure on the bladder from the uterus. 3 The fetus is adding urine to the patient's bladder. 4 There is a decrease in the glomerular cells of the kidney.
2
During a routine antepartal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse do next? 1 Notify the healthcare provider of a possible infection. 2 Tell the woman that this is entirely normal. 3 Advise the woman about the need to culture the discharge. 4 Check the discharge for evidence of ruptured membranes.
2
A patient who is 16 weeks pregnant has a lower blood pressure than that of prepregnancy levels. What should the nurse realize as being the cause for this lower blood pressure? 1 Prepregnancy blood pressure measurements were inaccurate. 2 Blood pressure progressively decreases throughout the entire pregnancy. 3 A decrease in the second trimester may occur because of placental growth. 4 Dehydration because blood pressure increases steadily throughout pregnancy.
3
How can the nurse best counsel a patient with pyrosis? 1. "It is important to continue to eat three meals a day." 2. "Chest pain is common and is not a concern in pregnancy." 3 "Avoid lying down 2 hours after eating." 4 "Avoid sleeping in an upright position."
3. Pyrosis means heartburn
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? 1 Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy. 2 Reassure the mother that this is normal as the baby is implanting into the uterus. 3 Obtain a detailed 24-hour intake to determine if the pain is related to what she has eaten. 4 Encourage her to ambulate since gas pains are common in early pregnancy.
1
A client in her second trimester of pregnancy complains to the nurse of heartburn. Which of the following should the nurse suggest to the client as a preventative measure? 1 Have small frequent meals 2 Use extra pillows when sleeping 3 Eat dry crackers and toast before rising 4 Drink plenty of fluids before bedtime
1
A nurse is performing a physical assessment of a woman in labor. As part of her assessment, she examines the outer and inner surfaces of her lips. What is the best rationale for this assessment? 1 Detection of herpes virus infection 2 Detection of a respiratory infection 3 Detection of anemia 4 Detection of rales
1
A nurse overhears a colleague tell a client that based on the genetic testing results she should terminate the pregnancy. Which action is most appropriate for the nurse to take? 1 Immediately stop the nurse. 2 Call the client later and apologize. 3 Contact the health care provider. 4 Tell the unlicensed assistive personal.
1
A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which instruction should the nurse give to the client? 1 Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding. 2 Avoid tub baths at all times during pregnancy, as they may be dangerous for the fetus. 3 Long soaks in very hot water are encouraged during pregnancy to promote relaxation. 4 Tub baths are fine, but avoid using soap, as this may prove a teratogen to the fetus.
1
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. What is this hormone? 1 relaxin 2 progesterone 3 estrogen 4 human placental lactogen
1
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? 1 maintains the endometrial lining of the uterus during pregnancy 2 ensures the corpus luteum of the ovary continues to produce estrogen 3 contributes to mammary gland development 4 regulates maternal glucose, protein, and fat levels
1
A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond? 1 Fats are essential during pregnancy, and vegetable oils are a good source. 2 Fats are essential during pregnancy, and fish such as marlin and orange roughy are good sources. 3 Fats are not essential during pregnancy and thus are optional. 4 Fats should be avoided during pregnancy.
1
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: 1 85 beats per minute. 2 90 beats per minute. 3 95 beats per minute. 4 100 beats per minute.
1
During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy? 1 prepregnancy BMI 2 current weight 3 height and bone structure 4 hemoglobin level
1
The nurse is assisting a primigravid on calculating the due date of her baby using Naegele's rule. The most important information provided by the mother is: 1 the first day of the last menstrual period. 2 the ovulation date between her periods. 3 the date that intercourse occurred. 4 the last day of her menstrual period.
1
The results of a woman's quadruple marker screen show that her alpha-fetoprotein (AFP) blood level is more than twice the value of the mean for that gestational age. The nurse recognizes that this finding is most strongly associated with: 1 a neural tube disorder. 2 a trisomy disorder. 3 a chromosomal disorder. 4 Down syndrome.
1
When the primary caregiver is hospitalized, this creates the need for _________ within the family. 1 Role reversal 2 Role stress 3 Role abandonment 4 Role play
1
Before beginning the initial prenatal examination, a nurse should instruct a client to complete what procedure before undressing? 1 clean catch urine 2 initial blood tests 3 measurement of fundal height 4 ultrasound for fetal measurements
1 The first procedure a nurse should ask the client to do is obtain a clean catch, midstream urine before undressing. Lab tests can be done after the examination is complete. At the first visit, the fetus is too small to be measured or ultrasound done.
A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply. 1 increase in heart rate 2 increase in blood pressure 3 increase in respiratory rate 4 slight decrease in body temperature 5 increase in gastric emptying and pH
1 2 3
As part of her physical examination of a pregnant client, the nurse examines the woman's breasts. Which are healthy breast changes that indicate pregnancy? Select all that apply. 1 areolae darken 2 overall breast size increases 3 blue streaking of veins becomes prominent 4 montgomery tubercles become prominent 5 breasts become softer in consistency 6 hard, painless lumps form
1 2 3 4
A newly wed young adult patient tells the nurse that she hopes to become pregnant soon. What should the nurse recommend to this patient to support the 2020 National Health Goals for pregnancy? Select all that apply. 1 Stop smoking. 2 Increase exercise. 3 Eat a healthy diet. 4 Reduce work hours. 5 Limit alcohol intake.
1 3 5
A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? 1 Trace of glucose 2 2+ Protein in urine 3 Specific gravity of 1.010 4 Straw-like color
2
During a routine prenatal visit, a client at 36 weeks' gestation states she has difficulty breathing and feels like her pulse rate is really fast. The nurse finds her pulse to be 100 beats per minute (increased from baseline readings of 70 to 74 beats per minute) and irregular, with bilateral crackles in the lower lung bases. The nurse would develop a plan of care identifying interventions to promote which area as the priority? 1 tissue perfusion 2 gas exchange 3 activity 4 anxiety
2
During her first prenatal visit, a woman 18 weeks pregnant reports she did not realize she was pregnant and continued to take her birth control pills. She is concerned about their effects on her baby. Which of the following would be the best response to her concerns? 1 "There are no risks to the fetus related to the ingestion of birth control pills during pregnancy." 2 "Because of concerns about the estrogen exposure to the baby, we will monitor the fetal development." 3 "As long as you did not take them too far into the second trimester, there is no risk." 4 "Birth defects are a realistic possibility and must be monitored."
2
Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting? 1 limiting carbohydrate intake 2 limiting intake of heavy, greasy foods 3 increasing fluid intake 4 drinking liquids with meals
2
On what day during pregnancy does the embryo implant on the uterine surface? 1 the 14th day of a "typical" menstrual cycle 2 eight days after ovulation 3 ten days after the start of the menstrual flow 4 four days after ovulation
2
The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client? 1 Reduce walking to half a block daily. 2 Continue this as long as she enjoys it. 3 Stop and rest every block. 4 Engage in aerobics for greater benefits.
2
The nurse is assigned to clients who are having the following procedures: <br />Amniocentesis<br />Fetal nonstress test<br />Chorionic villus sampling<br />Percutaneous umbilical blood sampling<br />Doppler assessment of fetal heart rate<br />For which clients will the nurse ensure that the informed consent is on the chart? 1 Amniocentesis, chorionic villus sampling, fetal nonstress test 2 Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling 3 Fetal nonstress test, Doppler assessment of fetal heart rate 4 Amniocentesis, percutaneous umbilical blood sampling, Doppler assessment of fetal heart rate
2
The nurse is completing a physical assessment with a patient who has just learned of being pregnant. The patient's last menstrual period was August 15. When should the nurse instruct the patient that the baby will be due? 1 July 15 2 May 22 3 June 22 4 April 15
2
The nurse is teaching a pregnant client some nonpharmacologic ways to handle common situations encountered during pregnancy. The nurse determines the session is successful when the client correctly chooses which condition that can be minimized if she avoids drinking fluids with her meals? 1 Nosebleeds 2 Heartburn 3 Blood clots 4 Constipation
2
To screen for chromosomal disorders, a 39-year-old woman is scheduled for a circulating cell-free DNA test. What type of test is this? 1 skin biopsy 2 blood specimen collection 3 ultrasound 4 urine specimen collection
2
A pregnant woman's husband does not voice concerns at prenatal visits. You would believe he is emotionally involved in the pregnancy by observing which of the following actions? 1 He states he definitely wants a girl. 2 He walks around furniture as if his abdomen is enlarged. 3 He states he is concerned about the loss of his free time. 4 He has refused to paint the baby's room blue.
2 Men who identify with their wife's pregnancy may act as if their abdomen is enlarging, the same as they may take on nausea of pregnancy.
A woman in her third trimester complains to the nurse of significant back pain. The nurse questions the client carefully and records a detailed account of her back symptoms. What is the best rationale for the nurse evaluating the client's back symptoms with such care? 1 Back pain could be a result of a soft mattress 2 Back pain could be a sign of bladder or kidney infection 3 Back pain could be a result of improper lifting 4 Back pain could be a sign of degenerated discs
2 Obtaining a detailed account of a woman's back symptoms is crucial because back pain can be an initial sign of a bladder or kidney infection. The other causes of back pain listed do not warrant as much immediate concern as the possibility of a bladder or kidney infection.
A client at 16 weeks' gestation is scheduled for prenatal testing. Which of the following would the nurse anticipate as the most likely screening test for congenital anomalies based on the current age of this pregnancy? 1. Cardocentesis. 2. Amniocentesis. 3. Nuchal translucency testing. 4. Chorionic villi sampling.
2.
A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight? 1 Wear a padded bra. 2 Wear low-heeled shoes. 3 Wear support hose. 4 Wear cotton clothes.
3
A pregnant woman has a child at home who has been diagnosed with neurofibromatosis. She asks the nurse what she should look for in the new baby that would indicate that it also has neurofibromatosis. What sign should the nurse instruct the woman to look for in the new baby? 1 Increased urination 2 Projectile vomiting 3 Café-au-lait spots 4 Xanthoma
3
The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care? 1) once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth 2) once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth 3) once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth 4) once every 4 weeks for the first 36 weeks, then weekly until the birth
3
The nurse is aware that labor pain and contractions can lead to all of the following EXCEPT 1 Hyperventilation 2 Decreased blood flow to the uterus 3 Respiratory acidosis 4 Fatigue and sleep deprivation
3
When visiting with a pregnant female for the first time, the nurse should address the topic of rest. Which position should the nurse encourage the woman to assume when resting? 1 supine with a pillow under the knees to ease back strain 2 semi-Fowler's position with head elevated on two pillows 3 left-sided Sims position with the top leg forward 4 right-sided reverse Trendelenburg with pillows under the arms
3
You care for a patient who has a retroverted uterus. You would explain that this means her: 1 uterus is bent sharply backward at the cervix. 2 cervix is located behind the Douglas cul-de-sac. 3 entire uterus is tipped backward. 4 uterus is anterior to the bladder.
3
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? 1 The heart rate increase may indicate that the client is experiencing cardiac overload. 2 The blood pressure should be higher since the cardiac volume is increased. 3 Both findings are normal at this point of the pregnancy. 4 Combined, both of these findings are very concerning and warrant further investigation.
3 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.
An 18-year-old pregnant woman asks why she has to have a routine alpha-fetoprotein serum level drawn. You explain that this 1 is a screening test for placental function. 2 tests the ability of her heart to accommodate the pregnancy. 3 may reveal chromosomal abnormalities. 4 measures the fetal liver function.
3 An alpha-fetoprotein analysis is a cost-effective screening test to detect chromosomal and open-body-cavity disorders.
A pregnant woman tends not to eat for long periods of time because of her busy work schedule. What process safeguards her fetus from becoming hypoglycemic during this time? 1 The brain is too undeveloped to use glucose. 2 Women naturally ingest complex carbohydrates to last for long periods during pregnancy. 3 Somatomammotropin helps to regulate glucose levels. 4 Fetal oxygen interferes with the metabolism of glucose and prolongs its action.
3 Somatomammotropin makes insulin "less effective" than normal, thus decreasing its ability to produce hypoglycemia.
A client in her third trimester reports to the nurse shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem? 1 Avoid overeating. 2 Lie on a firmer mattress. 3 Use extra pillows. 4 Avoid spicy food.
3 The nurse should instruct the client to use extra pillows at night to keep her more upright.
A woman at 15 weeks' gestation asks the nurse what the fetus looks like. Which response by the nurse would be most accurate? 1 The fetus is covered with a white, greasy film called vernix. 2 The fetus is about 15 inches in length. 3 Fingernails and toenails are present. 4 Rhythmic breathing movements are occurring.
3 Vernix caseosa, a white, greasy film, covers the fetus at weeks 17 through 20. The fetus reaches a length of approximately 15 inches by weeks 25 to 28. Fingernails and toenails are present by approximately week 13 through 15. Rhythmic breathing movements occur between weeks 29 through 32.
A pregnant patient is concerned that the baby is going to drown in the uterus because of the fluid. What should the nurse respond about fetal respiration? 1 "You are breathing for the baby." 2 "The baby's lungs can accommodate all of the fluid." 3 "Oxygen is provided to the baby through the placenta." 4 "The baby's breathing is very minor until delivery."
3. Fetal circulation differs from extrauterine circulation because the fetus derives oxygen and excretes carbon dioxide not from gas exchange in the lung but from exchange in the placenta
A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? 1 Keep the client's legs slightly elevated. 2 Place the client in an orthopneic position. 3 Keep the head of the client's bed slightly elevated. 4 Place the client in the left lateral position.
4
A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her? 1 Perform nipple exercises and stimulation on a regular basis. 2 Take a hot water bath or shower daily to maintain hygiene. 3 Apply lanolin ointment to the nipple and areola to prevent cracking. 4 Rest on the left side for at least 1 hour in the morning and afternoon.
4
A nurse is reviewing a journal article about fetal development and the formation of various body systems. When reading about the development of the digestive system, the nurse finds information related to the developmental abnormality of omphalocele. The nurse demonstrates understanding of this information by identifying which situation as the reason for an omphalocele? 1 Fetus suffered a bowel obstruction at an early point in life. 2 Fetal abdomen formed with a smaller internal cavity than normal. 3 Intestines formed without sufficient nerve innervation for contraction. 4 Intestines failed to return to the abdominal cavity during intrauterine life.
4
A nursing student is explaining to a newly pregnant woman what happens during each stage of fetal development. At which stage does the nurse inform the woman that the lungs are fully shaped? 1 end of 4 weeks 2 end of 8 weeks 3 end of 12 weeks 4 end of 16 weeks
4
A patient who is 4 months pregnant is experiencing pyrosis. Which suggestion should the nurse make to the patient to help with this health problem? 1 Increase vitamin intake by adding more citrus fruit. 2 Take 30 ml of milk of magnesia after every meal. 3 Try to include complex carbohydrates in meals. 4 Eat small meals and do not lie down after meals.
4
A woman has a positive pregnancy test and comes to the nurse with left lower quadrant pain. Bimanual examination reveals a tender mass. Which of the following is suspected? 1 Threatened abortion 2 Appendicitis 3 Ovarian cyst 4 Tubal pregnancy
4
The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? 1 All activities that the client does in a prepregnant state 2 Relaxing activities such as those including hot baths and jacuzzis 3 High impact movements enabling less time in the activity 4 Stretching and breathing exercises such as yoga
4
The nurse is emphasizing the importance of adequate rest and sleep with a pregnant patient. Which position should the nurse suggest the patient use? 1 On the back with a pillow under the head 2 On the stomach with a pillow under her breasts 3 On the back with a pillow under the knees and hips 4 On the side with the weight of the uterus on the bed
4
The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured based on which result? 1 5.0 2 5.5 3 6.0 4 6.5
4
When assessing newborns for chromosomal disorders, which assessment would be most suggestive of a problem? 1 bowed legs 2 slanting of the palpebral fissure 3 short neck 4 low-set ears
4
Women who are obese in pregnancy are at higher risk for developing all of the following EXCEPT 1 Macrosomia 2 Pregnancy-induced hypertension 3 Gestational diabetes 4 Neural tube defects 5 Cesarean birth
4 Folic acid deficiency increases the risk for neural tube defects.
The nurse teaches a pregnant patient the manifestations associated with complications while pregnant. Which statement indicates that additional patient teaching is needed? 1 "Pain with urination is expected during pregnancy." 2 "I should call the doctor if I have any vaginal bleeding." 3 "A sudden rush of fluid means that my membranes ruptured. 4 "I should not worry if I vomit once a day for the first 12 weeks."
1
A woman in a prenatal clinic tells the nurse that her pregnancy was unplanned and unwanted. At what point in pregnancy does the average woman change her mind about an unwanted pregnancy? 1 around the third month 2 when quickening occurs 3 after lightening happens 4 after the seventh month
2 Quickening, or feeling the baby move inside the body, is such a dramatic event that it can cause a woman's perceptions about the pregnancy to change.
Which reason explains why women should be encouraged to perform Kegel exercises after delivery? 1 They assist with lochia removal 2 They promote the return of normal bowel function 3 They promote blood flow, enabling healing and muscle strengthening 4 They assist the woman in burning calories for rapid postpartum weight loss
3
A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition? 1 Keep the client's legs slightly elevated. 2 Place the client in an orthopneic position. 3 Keep the head of the client's bed slightly elevated. 4 Place the client in the left lateral position.
4 The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.
