MATERNITY PRACTICE QUESTIONS EXAM 1

A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman's gastrointestinal tract, what would the nurse expect to find? Select all that apply. A. hyperemic gums B. increased peristalsis C. reports of bloating D. heartburn E. nausea

Answer: A, C, D, E Rationale: Gastrointestinal system changes include hyperemic gums due to estrogen and increased proliferation of blood vessels and circulation to the mouth; slowed peristalsis; acid indigestion and heartburn; bloating and nausea and vomiting.

Assessment of a pregnant woman reveals that she compulsively craves ice. The nurse documents this finding as: A. quickening. B. pica. C. ballottement. D. linea nigra.

Answer: B Rationale: Pica refers to the compulsive ingestion of nonfood substances such as ice. Quickening refers to the mother's sensation of fetal movement. Ballottement refers to the feeling of rebound from a floating fetus when an examiner pushes against the woman's cervix during a pelvic examination. Linea nigra refers to the pigmented line that develops in the middle of the woman's abdomen.

A pregnant woman needs an update in her immunizations. Which vaccination would the nurse ensure that the woman receives? A. measles B. mumps C. rubella D. hepatitis B

Answer: D Rationale: Hepatitis B vaccine should be considered during pregnancy. Immunizations for measles, mumps, and rubella are contraindicated during pregnancy.

After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful? A. "I will be sure to avoid getting pregnant for at least 1 year." B. "My intake of iron will have to be closely monitored for 6 months." C. "My blood pressure will continue to be increased for about 6 more months." D. "I won't use my birth control pills for at least a year or two."

Answer: A Rationale: After evacuation of trophoblastic tissue (hydatiform mole), long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for 1 year, and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow up after evacuation of a hydatiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided.

A couple asks the nurse at a preconception class for information on becoming pregnant. Which response made by the nurse is correct? A. "The 200 million sperm in ejaculated semen are necessary for conception to take place." B. "The 1 million sperm in ejaculated semen are necessary for conception to take." C. "Fertilization will typically occur 2 weeks before your last normal menstrual period." D. "Fertilization will typically occur 1 week after the last normal menstrual period."

Answer: A Rationale: Although more than 200 million sperm/mL are contained in the ejaculated semen, only one is able to enter the ovum to fertilize it. Fertilization would occur around 2 weeks after the last normal menstrual period.

A pregnant woman is scheduled to undergo an amniocentesis. When explaining this test to the client, the nurse would also include information about which test being done at the same time? A. ultrasound B. chorionic villus sampling C. biophysical profile D. Doppler flow study

Answer: A Rationale: An ultrasound is used to confirm placental location during amniocentesis. Chorionic villus sample, biophysical profile, and Doppler flow study are not done at the same time as an amniocentesis.

A client asks about a child inheriting an autosomal recessive disorder. What must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? A. Both parents must be carriers. B. One parent must have the disease. C. One parent, usually the mother, must be a carrier. D. One parent, usually the father, must not be a carrier or have the disease.

Answer: A Rationale: Autosomal recessive inheritance occurs when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, two abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be carriers of the gene, either clinically normal or expresses the disorder.

A woman in her second trimester comes to the clinic for a routine follow-up visit. The woman's prepregnancy blood pressure was 112/70 mm Hg. On this visit, the woman's blood pressure is 104/64 mm Hg. The nurse would interpret this finding as suggestive of which event? A. A normal pregnancy finding secondary to progesterone effects B. Indication that the woman is experiencing orthostatic hypotension C. Signal that the woman is developing gestational hypertension D. Sign that the woman is anemic

Answer: A Rationale: Blood pressure, especially the diastolic pressure, declines slightly during pregnancy as a result of peripheral vasodilation caused by progesterone. It usually reaches a low point midpregnancy and thereafter increases to prepregnancy levels until term. During the first trimester, blood pressure typically remains at the prepregnancy level. During the second trimester, the blood pressure decreases 5 to 10 mm Hg and thereafter returns to first-trimester levels. This decrease in blood pressure begins at about 7 weeks' gestation and persists until 32 weeks' gestation, when it begins to rise to prepregnancy levels. The client's blood pressure suggests a normal finding related to peripheral vasodilation from progesterone. Any significant rise in blood pressure during pregnancy should be investigated to rule out gestational hypertension. Gestational hypertension is a clinical diagnosis defined by the new onset of hypertension (systolic of 140 mm Hg or higher and/or diastolic of 90 mm Hg or higher) after 20 weeks' gestation. A lower blood pressure does not suggest anemia. Orthostatic hypotension occurs when the blood pressure drops more than 20 mm Hg systolic or 10 mm Hg diastolic with a change in position, such as going from a lying to a standing position.

A couple attends genetic counseling. What are the chances that the couple will have a child with Down syndrome? A. Chromosomal abnormalities occur in about 1 in 150 live-born infants. B. Chromosomal abnormalities cannot be inherited and occur at random. C. If a woman is a carrier, there is a 25% chance that her daughter will be affected. D. If a man is a carrier, there is a 25% chance that he will have an unaffected son.

Answer: A Rationale: Chromosomal abnormalities occur in about 1 in 150 live-born infants according to the March of Dimes. It is among the most common trisomies of chromosomes. Although some chromosomal disorders can be inherited, most occur due to random events during early fetal development.

A pregnant woman undergoes a triple screen at 16 to 18 weeks' gestation. What would the nurse suspect if the woman's estriol and alpha fetoprotein levels are decreased with high hCG levels? A. Down syndrome B. sickle-cell anemia C. cardiac defects D. respiratory disorders

Answer: A Rationale: Decreased levels might indicate Down syndrome or trisomy 18. Sickle cell anemia may be identified by chorionic villus sampling. Levels would be increased with cardiac defects, such as tetralogy of Fallot. It does not detect respiratory disorders.

In order for conception to take place, it is most common for a woman to get pregnant: A. two weeks after her normal menstrual period. B. two weeks before her normal menstrual period. C. immediately after a normal menstrual period. D. during her menstrual period.

Answer: A Rationale: Fertilization is the union of ovum and sperm, which is the starting point of pregnancy. Fertilization typically happens around 2 weeks after the last normal menstrual period in a 28-day cycle.

At prenatal classes a client asks the nurse how long it takes to actually become pregnant after having sexual intercourse. What is the nurse's best response? A. "Conception happens immediately after fertilization of the ovum." B. "Conception happens about 12 hours after fertilization of the ovum." C. "Conception happens about 24 hours after fertilization of the ovum." D. "Conception happens about 72 hours after fertilization of the ovum."

Answer: A Rationale: For conception to occur, a healthy ovum from the woman is released from the ovary, passes into an open fallopian tube, and starts its journey downward. Sperm from the male is deposited into the vagina and swims approximately 7 inches to meet the ovum at the outermost portion of the fallopian tube, the area where fertilization takes place. This process occurs in about an hour. When one spermatozoon penetrates the ovum's thick outer membrane, pregnancy begins. All this activity takes place within a 5-hour time span.

A nurse is auscultating the chest of a client at 16 weeks' gestation. The nurse immediately notifies the health care provider about which finding? A. heart rate 25 bpm above baseline B. soft systolic murmur C. clear breath sounds D. symmetrical chest movement.

Answer: A Rationale: Heart rate typically increases by 10 to 15 bpm starting between 14 to 20 weeks of pregnancy. However, an increase of 25 bpm would be a cause for concern. A soft systolic murmur, clear breath sounds, and symmetrical chest movement are normal findings.

During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse documents this finding as: A. Hegar sign. B. Goodell sign. C. Chadwick sign. D. Ortolani sign.

Answer: A Rationale: 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.

A nurse is monitoring a client's hCG levels because she has had a previous ectopic pregnancy and one spontaneous abortion. Which finding would the nurse interpret as indicating that the pregnancy is progressing appropriately? A. doubling of the level every 2 to 3 days B. plateauing of the level at 7 days C. gradually increasing levels every month D. abruptly declining levels after 60 days

Answer: A Rationale: Human chorionic gonadotropin (hCG) is a glycoprotein and the earliest biochemical marker for pregnancy. Many pregnancy tests are based on the recognition of hCG or a beta subunit of hCG. hCG levels in normal pregnancy usually double every 48 to 72 hours until they peak approximately 60 to 70 days after fertilization. At this point, they decrease to a plateau at 100 to 130 days of pregnancy.

When describing genetic disorders to a group of couples planning to have children, the nurse would identify which as an example of an autosomal dominant inheritance disorder? A. Huntington disease B. sickle cell disease C. phenylketonuria D. cystic fibrosis

Answer: A Rationale: Huntington disease is an example of an autosomal dominant inheritance disorder. Sickle cell disease, phenylketonuria, and cystic fibrosis are examples of autosomal recessive inheritance disorders.

A nurse teaching a couple says that when X-linked recessive inheritance is present in a family, the genogram will reveal that: A. mostly males in the family have the disorder. B. the parents of the affected man have the disorder. C. sons of an affected man are also affected. D. all daughters and no sons will inherit the condition.

Answer: A Rationale: In X-linked recessive pattern of inheritance, a genogram will reveal there are more affected males than females because all the genes on a man's X chromosome will be expressed since a male has only one X chromosome. There is no male-to-male transmission (since no X chromosome from the male is transmitted to male offspring), but any man who is affected with an X-linked recessive disorder will have carrier daughters. If a woman is a carrier, there is a 25% chance she will have an affected son, a 25% chance that her daughter will be a carrier, a 25% chance that she will have an unaffected son, and a 25% chance her daughter will be a noncarrier. With X-linked dominant inheritance, all of the daughters and none of the sons of an affected male will inherit the condition, while both male and female offspring of an affected woman have a 50% chance of inheriting the condition.

Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which finding? A. linea nigra B. striae gravidarum (stretch marks) C. melasma (chloasma) D. vascular spiders

Answer: A Rationale: Linea nigra refers to the darkened line of pigmentation down the middle of the abdomen in pregnant women. Striae gravidarum refers to stretch marks, irregular reddish streaks on the abdomen, breasts, and buttocks. Melasma (chloasma) refers to the increased pigmentation on the face, also known as the "mask of pregnancy." Vascular spiders are small, spiderlike blood vessels that appear usually above the waist and on the neck, thorax, face, and arms.

A woman in the 34th week of pregnancy says to the nurse, "I still feel like having intercourse with my husband." The woman's pregnancy has been uneventful. The nurse responds based on the understanding that: A. it is safe to have intercourse at this time. B. intercourse at this time is likely to cause rupture of membranes. C. there are other ways that the couple can satisfy their needs. D. intercourse at this time is likely to result in premature labor.

Answer: A Rationale: Sexual activity is permissible during pregnancy unless there is a history of vaginal bleeding, placenta previa, risk of preterm labor, multiple gestation, incompetent cervix, premature rupture of membranes, or presence of infection. Rupture of membranes or premature labor is unlikely since the woman's pregnancy has been uneventful so far. Alternative sexual positions may be necessary as the woman's abdomen increases in size.

A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? A. 9 B. 7 C. 5 D. 3

Answer: A Rationale: The biophysical profile is a scored test with five components, each worth 2 points if present. A total score of 10 is possible if the NST is used. Overall, a score of 8 to 10 is considered normal if the amniotic fluid volume is adequate. A score of 6 or below is suspicious, possibly indicating a compromised fetus; further investigation of fetal well-being is needed.

In a client's seventh month of pregnancy, she reports feeling "dizzy, like I'm going to pass out, when I lie down flat on my back." The nurse explains that this is due to: A. pressure of the gravid uterus on the vena cava. B. a 50% increase in blood volume. C. physiologic anemia due to hemoglobin decrease. D. pressure of the presenting fetal part on the diaphragm.

Answer: A Rationale: The client is describing symptoms of supine hypotension syndrome, which occurs when the heavy gravid uterus falls back against the superior vena cava in the supine position. The vena cava is compressed, reducing venous return, cardiac output, and blood pressure, with increased orthostasis. The increased blood volume and physiologic anemia are unrelated to the client's symptoms. Pressure on the diaphragm would lead to dyspnea.

The nurse is assessing a 12-hour-old newborn and hears a heart murmur. What initial action should the nurse take? A. Document the finding as normal for age B. Report the finding to the health care provider C. Assess the infant every 2 hours for worsening symptoms D. Allow the infant to room in with the parents if temperature is stable

Answer: A Rationale: The ductus arteriosus is a fetal shunt allowing blood to bypass the lungs. It closes functionally within 72 hours of life and permanently by 3 to 4 weeks of life. On assessment a murmur can be heard with delayed closure, but this murmur is not related to a cardiac issue. The nurse should initially document the finding as normal for age. The information can be relayed to the health care provider. The nurse should continue to assess the newborn during the hospital stay and note any changes to the murmur. If the infant is stable, the infant should be allowed to remain with the parents.

A nurse is assessing a pregnant woman and suspects that the woman may be experiencing pica. To help support this suspicion, the nurse evaluates the woman for signs and symptoms of which condition? A. Iron-deficiency anemia B. Urinary tract infection C. Diarrhea D. Heartburn

Answer: A Rationale: Three main substances consumed by women with pica are soil or clay (geophagia), ice (pagophagia), and laundry starch (amylophagia). Because each of these can lead to irondeficiency anemia, the nurse should evaluate the client for the condition. Urinary tract infection, diarrhea, and heartburn are not associated with pica.

Which event will result in zygote formation? A. The nucleus of the ovum and sperm make contact and combine chromosomes. B. The nucleus of the ovum carries forth the genetic information at implantation. C. The nucleus of the sperm and the fallopian tube make contact and combines chromosomes. D. The nucleus of the sperm carries forth the genetic information at implantation.

Answer: A Rationale: When the nucleus from the ovum and the nucleus of the sperm make contact, they lose their respective nuclear membranes and combine their maternal and paternal chromosomes. Because each nucleus contains a haploid number of chromosomes (23), this union restores the diploid number (46). The resulting zygote begins the process of a new life.

During a prenatal class, the nurse is describing what happens when the ovum is fertilized by the sperm. Which statement would the nurse most likely include? A. The zygote is transported into the uterine cavity. B. The embryo is transported into the uterine cavity. C. Genetic material is shared with the embryo upon implantation. D. The placenta begins to form in the fallopian tube.

Answer: A Rationale: When the ovum is fertilized by the sperm (now called a zygote), the zygote is transported into the uterine cavity. The resulting zygote is not yet an embryo to be transported, nor is genetic material shared with an embryo. The placenta does not form in the fallopian tube.

A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority? A. hemorrhage B. jaundice C. edema D. infection

Answer: A Rationale: With a ruptured ectopic pregnancy, the woman is at high risk for hemorrhage. Jaundice, edema, and infection are not associated with a ruptured ectopic pregnancy.

A pregnant woman is scheduled for chorionic villus sampling. The nurse is describing the procedure and the potential for complications. When providing care to the client after the testing, the nurse would be alert for which complication as the most common? Select all that apply. A. vaginal bleeding B. cramping C. spontaneous abortion D. rupture of membranes E. hematoma

Answer: A, B Rationale: Although spontaneous abortion, rupture of membranes, and hematoma can occur after chorionic villus sampling, vaginal bleeding and cramping are the most common.

A nurse is assessing a client who may be pregnant. The nurse reviews the client's history for presumptive signs. Which signs would the nurse most likely note? Select all that apply. A. amenorrhea B. nausea C. abdominal enlargement D. Braxton-Hicks contractions E. fetal heart sounds

Answer: A, B Rationale: Presumptive signs include amenorrhea, nausea, breast tenderness, urinary frequency and fatigue. Abdominal enlargement and Braxton-Hicks contractions are probable signs of pregnancy. Fetal heart sounds are a positive sign of pregnancy.

A nurse is teaching a pregnant client in her first trimester about discomforts that she may experience. The nurse determines that the teaching was successful when the woman identifies which discomforts as common during the first trimester? Select all that apply. A. urinary frequency B. breast tenderness C. cravings D. backache E. leg cramps

Answer: A, B, C Rationale: Discomforts common in the first trimester include urinary frequency, breast tenderness, and cravings. Backache and leg cramps are common during the second trimester. Legs cramps are also common during the third trimester.

A client who is six weeks' pregnant asks the prenatal nurse, "What development has taken place with my baby by now?" Which information should the nurse include in the response? Select all that apply. A. "By week 3 there would be the beginning development of the brain, spinal cord, and heart." B. "By week 4 the arms and legs begin to grow and develop." C. "By week 5 the heart now beats and the eyes and ears can be seen." D. "By week 6 the lungs begin forming and the baby circulation is established." E. "By week 6 the baby makes active movements with sucking motions made with the mouth."

Answer: A, B, C, D Rationale: By week 3 there is the beginning development of brain and spinal cord, and the heart becomes more developed. Limb buds grow and develop at week 4. By week 5 the heart now beats at a regular rhythm. Beginning structures of eyes and ears are seen. Week 6 shows the lungs beginning to form and fetal circulation is established. At weeks 13 to 16 the fetus will make active movement, not at week 6. Sucking motions are made with the mouth in week 12, not in week 6.

A nurse is providing nutritional counseling to a pregnant woman and gives her suggestions about consuming foods that are high in folic acid. As part of the plan of care, the client is to keep a food diary that the client and nurse will review at the next visit. When reviewing the client's diary, which meals would indicate to the nurse that the client is increasing her intake of folic acid? Select all that apply. A. chicken breast with baked potato and broccoli B. cheeseburger with spinach and baked beans C. pork chop with mashed potatoes and green beans D. strawberry walnut salad with romaine lettuce E. fried chicken sandwich with mayonnaise and avocado

Answer: A, B, D Rationale: Good food sources of folic acid include dark green vegetables, such as broccoli, romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver. So the meals containing chicken breast with baked potato and broccoli, cheeseburger with spinach and baked beans, and the strawberry walnut salad with romaine lettuce demonstrate an intake of foods high in folic acid.

A nurse is teaching a pregnant woman about ways to prevent the development of the foodborne illness listeriosis. The nurse determines that the teaching was successful when the woman identifies the need to avoid which food(s)? Select all that apply. A. Soft cheeses B. Refrigerated meat spreads C. Canned tuna fish D. Store-made chicken salad E. Pasteurized milk

Answer: A, B, D Rationale: To prevent listeriosis, the woman should avoid soft cheeses such as feta, Brie, Camembert, and blue-veined cheeses, refrigerated pâté or meat spreads, refrigerated smoked seafood unless it is an ingredient in a cooked dish such as a casserole, salads made in the store such as ham salad, chicken salad, egg salad, tuna salad, or seafood salad, and unpasteurized milk. It is safe to eat canned or shelf-stable pâté and meat spreads and canned fish such as salmon and tuna or shelf-stable smoked seafood.

Which processes that occur after fertilization would lead to a normal pregnancy? Select all that apply. A. The morula divides into specialized cells that will form fetal structures. B. Within the morula is a blastocyst that will form the embryo. C. The morula develops into the embryonic membranes, the chorion, and placenta. D. The morula enters the uterine cavity about 72 hours after fertilization. E. The blastocyst reaches the uterine cavity immediately after fertilization.

Answer: A, B, D Rationale: With additional cell division, the morula divides into specialized cells that will later form fetal structures. Within the morula, an off-center, fluid-filled space appears, transforming it into a hollow ball of cells called a blastocyst. The outer layer of cells surrounding the blastocyst cavity is called a trophoblast, which develops into one of the embryonic membranes, the chorion, and helps to form the placenta. The morula reaches the uterine cavity about 72 hours after fertilization.

A prenatal nurse is conducting a class on healthy pregnancy and explains the role of placental hormones. Which statements would the nurse make? Select all that apply. A. Human chorionic gonadotropin is the basis for pregnancy tests. B. Human placental lactogen participates in the development of maternal breasts for lactation. C. Thyroxin modulates fetal and maternal metabolism. D. Progesterone stimulates maternal metabolism and breast development. E. Relaxin causes enlargement of a woman's breasts, uterus, and external genitalia. F. Estrogen causes enlargement of a woman's breasts.

Answer: A, B, D, F Rationale: Human chorionic gonadotropin is the basis for pregnancy tests. Human placental lactogen modulates fetal and maternal metabolism and participates in the development of maternal breasts for lactation. Estrogen (estriol) causes enlargement of a woman's breasts, uterus, and external genitalia and stimulates myometrial contractility. Progesterone (progestin) maintains the endometrium, decreases the contractility of the uterus, and stimulates maternal metabolism and breast development. Relaxin acts with progesterone to maintain pregnancy and causes relaxation of the pelvic ligaments. Progesterone maintains the endometrium, decreases the contractility of the uterus, and stimulates maternal metabolism and breast development. Thyroxin is not a placental hormone.

Which processes, if they occur during the formation of the placenta, would lead to a successful pregnancy? Select all that apply. A. Implantation of the trophoblast occurs in the upper uterus. B. Three days after conception, the trophoblast makes human chorionic gonadotropin (hCG). C. The trophoblast attaches to the fallopian tube for nourishment. D. The placenta is fully developed by the end of fourth week. E. The trophoblast develops into the placenta.

Answer: A, B, E Rationale: Implantation occurs in the upper uterus (fundus), where a rich blood supply is available. As early as 3 days after conception, the trophoblasts make human chorionic gonadotropin (hCG). By the end of the second week, the placenta is developing. The precursor cells of the placenta, the trophoblasts, first appear 4 days after fertilization. The trophoblast attaches to the wall of the uterus, not the fallopian tube.

Which characteristics about amniotic fluid would alert the prenatal nurse to further investigate? Select all that apply. A. Oligohydramnios is noted on assessment. B. The amount of amniotic fluid fluctuates at each checkup. C. Polyhydramnios is noted on assessment. D. The client has approximately 2 L of amniotic fluid at term. E. The client has approximately 1 L of amniotic fluid at term.

Answer: A, C, D Rationale: Amniotic fluid surrounds the embryo and increases in volume as the pregnancy progresses, reaching approximately 1 L at term. Its volume changes constantly as the fetus swallows and voids. Oligohydramnios is too little amniotic fluid (500 mL at term) and is associated with uteroplacental insufficiency, fetal renal abnormalities, and a higher risk of surgical births and low birth weight infants. Too much amniotic fluid (2,000 mL at term), termed polyhydramnios, is associated with maternal diabetes, neural tube defects, chromosomal deviations, and malformations of the central nervous system and/or gastrointestinal tract that prevent normal swallowing of amniotic fluid by the fetus.

A pregnant woman in her second trimester tells the nurse, "I've been passing a lot of gas and feel bloated." Which suggestion would be helpful for the woman? Select all that apply. A. "Watch how much beans and onions you eat." B. "Limit the amount of fluid you drink with meals." C. "Try exercising a little more." D. "Some say that eating mints can help." E. "Cut down on your intake of cheeses."

Answer: A, C, D, E Rationale: For gas and bloating, the nurse would instruct the woman to avoid gas-forming foods, such as beans, cabbage, and onions, as well as foods that have a high content of white sugar. Adding more fiber to the diet, increasing fluid intake, and increasing physical exercise are also helpful in reducing flatus. In addition, reducing the amount of swallowed air when chewing gum or smoking will reduce gas build-up. Reducing the intake of carbonated beverages and cheese and eating mints can also help reduce flatulence during pregnancy.

A woman visits the prenatal clinic and is noted to have oligohydramnios. The client asks, "Why is this fluid important anyway?" Which statements would be included in the nurse's response? Select all that apply. A. "Amniotic fluid helps maintain your baby's body temperature." B. "The fetus ingests amniotic fluid for its nourishment." C. "Too little amniotic fluid is linked with placental problems." D. "Amniotic fluid keeps your baby free from any teratogens." E. "It acts like a cushion protecting your baby from trauma that may occur."

Answer: A, C, E Rationale: Sufficient amounts of amniotic fluid help maintain a constant body temperature for the fetus and cushion the fetus from trauma. Oligohydramnios is associated with placental problems. The fetus does ingest amniotic fluid but not for nourishment. Amniotic fluid does not protect the fetus from teratogens.

A 24-year-old client who is planning to become pregnant comes to the clinic for an evaluation. When assessing the client, which finding would alert the nurse to implement measures to reduce the client's risk for problems during pregnancy? Select all that apply. A. drinks wine 3 to 4 times/week B. quit smoking 4 years ago C. follows a vegetarian diet D. has a BMI of 22 E. uses ibuprofen daily

Answer: A, E Rationale: The use of alcohol and prescription and over-the-counter drugs can be harmful to a growing fetus. Thus the nurse would need to address these areas with the client. If the client was still smoking, then that too would need to be addressed. Healthy nutrition is important, but being a vegetarian does not necessarily indicate that the client is a nutritional risk. A BMI of 22 is considered normal and would not pose a problem.

Assessment of a pregnant woman reveals oligohydramnios. The nurse would be alert for the development of which condition? A. maternal diabetes B. placental insufficiency C. neural tube defects D. fetal gastrointestinal malformations

Answer: B Rationale: 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.

The nurse is assessing the latest laboratory results of a pregnant client who is at 17 weeks gestation. The nurse should prepare to teach the client about which possible defects after noting the maternal serum alpha-fetoprotein level is elevated above normal? A. fetal hypoxia B. open spinal defects C. Down syndrome D. maternal hypertension

Answer: B Rationale: Elevated MSAFP levels are associated with open neural tube defects, underestimation of gestational age, the presence of multiple fetuses, gastrointestinal defects, low birth weight, oligohydramnios, material age, diabetes, and decreased maternal weight. Lower-than-expected MSAFP levels are seen when fetal gestational age is overestimated or in cases of fetal death, hydatidiform mole, increased maternal weight, maternal type 1 diabetes, and fetal trisomy 21 (Down syndrome) or 18. Fetal hypoxia would be noted with fetal heart rate tracings and via nonstress and contraction stress testing. Maternal hypertension would be noted via serial blood pressure monitoring.

A nurse is reviewing the medical record of a pregnant woman and notes that she is gravida II. The nurse interprets this to indicate the number of: A. births. B. pregnancies. C. spontaneous abortions. D. preterm births.

Answer: B Rationale: Gravida refers to a pregnant woman—gravida I (primigravida) during the first pregnancy, gravida II (secundigravida) during the second pregnancy, and so on. Para refers to the number of births at 20 weeks or greater that a woman has, regardless of whether the newborn is born alive or dead. "A" would be used to denote the number of abortions and "P" would be used to denote the number of preterm births when using the GTPAL system.

The nurse is discussing the insulin needs of a primiparous client with diabetes who has been using insulin for the past few years. The nurse informs the client that her insulin needs will increase during pregnancy based on the nurse's understanding that the placenta produces: A. hCG, which increases maternal glucose levels. B. hPL, which deceases the effectiveness of insulin. C. estriol, which interferes with insulin crossing the placenta. D. relaxin, which decreases the amount of insulin produced.

Answer: B Rationale: Human placental lactogen (hPL) acts as an antagonist to insulin, so the mother must produce more insulin to overcome this resistance. If the mother has diabetes, then her insulin need would most likely increase to meet this demand. Human chorionic gonadotropin (hCG) does not affect insulin and glucose level. Estrogen, not estriol, is believed to oppose insulin. In addition, insulin does not cross the placenta. Relaxin is not associated with insulin resistance.

The nurse is teaching a couple about X-linked disorders because they are concerned that they might pass on hemophilia to their children. Which response indicates the need for further teaching? A. "The father can't be a carrier if he doesn't have hemophilia." B. "If the father doesn't have it, then his kids won't either." C. "If the mother is a carrier, her daughter could be one too." D. "If the mother is a carrier, her sons will have hemophilia."

Answer: B Rationale: Males are more affected than females. A male has only one X chromosome, and all the genes on his X chromosome will be expressed whereas a female will usually need both X chromosomes to carry the disease. There is no male-to-male transmission (since no X chromosome from the male is transmitted to male offspring), but any man who is affected will have carrier daughters. If a woman is a carrier, there is a 50% chance that her sons will be affected and a 50% chance that her daughters will be carriers.

A nurse strongly encourages a pregnant client to avoid eating swordfish and tilefish because these fish contain which component? A. excess folic acid, which could increase the risk for neural tube defects B. mercury, which could harm the developing fetus if eaten in large amounts C. lactose, which leads to abdominal discomfort, gas, and diarrhea D. low-quality protein that does not meet the woman's requirements

Answer: B Rationale: Nearly all fish and shellfish contain traces of mercury, and some contain higher levels of mercury that may harm the developing fetus if ingested by pregnant women in large amounts. Among these fish are shark, swordfish, king mackerel, and tilefish. Folic acid is found in dark green vegetables, baked beans, black-eyed peas, citrus fruits, peanuts, and liver. Folic acid supplements are needed to prevent neural tube defects. Women who are lactose-intolerant experience abdominal discomfort, gas, and diarrhea if they ingest foods containing lactose. Fish and shellfish are an important part of a healthy diet because they contain high-quality proteins, are low in saturated fat, and contain omega-3 fatty acids.

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. during meiosis cell division B. at fertilization C. when the morula forms D. during oogenesis

Answer: B Rationale: 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.

After teaching a group of prospective new parents about the different perinatal education methods, the nurse determines that the teaching was successful when the parents identify which method as the Bradley method? A. psychoprophylactic method B. partner-coached method C. natural birth method D. mind prevention method

Answer: B Rationale: The Bradley method is also a partner-coached method that uses various exercises and slow, controlled abdominal breathing to accomplish relaxation and active participation of the partner as labor coach. The Lamaze method is a psychoprophylactic or mind prevention method. The Dick-Read method is referred to as natural birth. Dick-Read believed that prenatal instruction was essential for pain relief and that emotional factors during labor interfered with the normal labor progression. The woman achieves relaxation and reduces pain by arming herself with the knowledge of normal childbirth and using abdominal breathing during contractions.

At a routine visit, a pregnant woman nearing the end of her second trimester tells the nurse, "It is so strange. I lie down to go to sleep and then I have to get up to go to the bathroom. This always happens when I am trying to sleep." Which response by the nurse would be appropriate? A. "You might be developing a urinary tract infection. Let's get a urine sample." B. "Your kidneys increase their activity when you lie down causing you to urinate." C. "Lying on your side instead of lying on your back will help stop this problem." D. "Maybe you are drinking too much fluid before you go to bed."

Answer: B Rationale: The activity of the kidneys normally increases when a person lies down and decreases upon standing. This difference is amplified during pregnancy, which is one reason a pregnant woman feels the need to urinate frequently while trying to sleep. Late in the pregnancy (third trimester), the increase in kidney activity is even greater when the woman lies on her side rather than her back. Lying on either side relieves the pressure that the enlarged uterus puts on the vena cava carrying blood from the legs. Subsequently, venous return to the heart increases, leading to increased cardiac output. Increased cardiac output results in increased renal perfusion and glomerular filtration. The woman has not voiced any reports suggesting a urinary tract infection. Fluid intake may be contributing to the woman's urination concern, but it is important for the woman to drink adequate amounts of fluid.

A primiparous client is being seen in the clinic for her first prenatal visit. It is determined that she is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what she will most likely experience during this period. Which possible effect would the nurse include? A. ankle edema B. urinary frequency C. backache D. hemorrhoids

Answer: B Rationale: The client is in her 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.

A woman comes to the prenatal clinic for an evaluation because she thinks that she may be pregnant. The nurse is assisting the health care provider with the vaginal examination. The exam reveals a vaginal mucosa and cervix that are bluish-purple in color. Based on this information, the nurse suspects that the client is most likely how many weeks pregnant? A. 5 weeks B. 6 weeks C. 14 weeks D. 16 weeks

Answer: B Rationale: The finding indicates Chadwick's sign, a bluish-purple discoloration of the vaginal mucosa and cervix. This typically occurs between 6 to 8 weeks. Goodell's sign (softening of the cervix) occurs at about 5 weeks. Abdominal enlargement typically begins at about 14 weeks and ballottement (when the examiner pushes against the woman's cervix during a pelvic examination and feels a rebound from the floating fetus) usually occurs at about 16 weeks.

A nurse is teaching a pregnant couple about birth education. The nurse determines that the teaching was successful when the couple makes which statement? A. "We'll have the knowledge to ensure a pain-free birth." B. "We'll know what to do to actively take part in our child's birth." C. "We won't be anxious, so the birth will be uncomplicated." D. "We will be in total control of the birth process."

Answer: B Rationale: The primary focus of birth education is to provide information and support to clients and their families to foster a more active role in the upcoming birth. Some methods of birth education focus on pain-free childbirth. Information provided in birth education classes helps to minimize anxiety and provide the couple with control over the situation, but elimination of anxiety or total control is unrealistic.

When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes which goal as the primary one? A. Equip a couple with the knowledge to experience a pain-free birth. B. Provide knowledge and skills to actively participate in birth and parenting. C. Eliminate anxiety so that they can have an uncomplicated birth. D. Empower the couple to totally control the birth process.

Answer: B Rationale: The primary focus of perinatal education is to provide information and support to clients and their families to foster a more active role in the upcoming birth. It also includes preparation for breastfeeding, infant care, transition to new parenting roles, relationships skills, family health promotion, and sexuality. Some methods of birth education focus on pain-free birth. Information provided in birth education classes helps to minimize anxiety and provide the couple with control over the situation, but elimination of anxiety or total control is unrealistic.

A client's last menstrual period was April 11. Using the Naegele rule, her estimated date of delivery (EDD) would be: A. January 4. B. January 18. C. January 25. D. February 24.

Answer: B Rationale: To use the Naegele rule, subtract 3 months and then add 7 days to the first day of the client's LMP (April 11): April minus 3 months is January, plus 7 days is 18. Thus, her EDB would be January 18 of the next year.

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? A. tissue perfusion B. gas exchange C. activity D. anxiety

Answer: B Rationale: Typically, heart rate increases by approximately 10 to 15 beats per minute during pregnancy and the lungs should be clear. Dyspnea may occur during the third trimester as the enlarging uterus presses on the diaphragm. However, the findings described indicate that the woman is experiencing impaired gas exchange. There is no evidence to support problems with tissue perfusion, activity, or anxiety.

During a routine prenatal visit, a client, 36 weeks pregnant, 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. Which nursing diagnosis would be the priority for this client? A. Ineffective tissue perfusion related to supine hypotensive syndrome B. Impaired gas exchange related to pulmonary congestion C. Activity intolerance related to increased metabolic requirements D. Anxiety related to fear of pregnancy outcome

Answer: B Rationale: Typically, heart rate increases by approximately 10 to 15 beats per minute during pregnancy and the lungs should be clear. Dyspnea may occur during the third trimester as the enlarging uterus presses on the diaphragm. However, the findings described indicate that the woman is experiencing impaired gas exchange. There is no evidence to support supine hypotensive syndrome, increased metabolism, or anxiety.

During a routine prenatal visit, a client, 36 weeks pregnant, 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. Which nursing diagnosis would be the priority for this client? A. Ineffective tissue perfusion related to supine hypotensive syndrome B. Impaired gas exchange related to pulmonary congestion C. Activity intolerance related to increased metabolic requirements D. Anxiety related to fear of pregnancy outcome

Answer: B Rationale: Typically, heart rate increases by approximately 10 to 15 beats per minute during pregnancy, and the lungs should be clear. Dyspnea may occur during the third trimester as the enlarging uterus presses on the diaphragm. However, the findings described indicate that the woman is experiencing impaired gas exchange. There is no evidence to support supine hypotensive syndrome, increased metabolism, or anxiety.

A pregnant woman comes to the clinic and tells the nurse that she has been having a whitish vaginal discharge. The nurse suspects vulvovaginal candidiasis based on which assessment finding? A. fever B. vaginal itching C. urinary frequency D. incontinence

Answer: B Rationale: Vaginal secretions become more acidic, white, and thick during pregnancy. Most women experience an increase in a whitish vaginal discharge, called leukorrhea. This is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Fever would suggest a more serious infection. Urinary frequency occurs commonly in the first trimester, disappears during the second trimester, and reappears during the third trimester. Incontinence would not be associated with a vulvovaginal candidiasis. Incontinence would require additional evaluation.

The nurse is preparing a client for a chorionic villi sampling procedure. Which factor should the nurse point out in the teaching session to the client? A. "The results should be available in about 2 weeks." B. "You'll have an ultrasound first and then the test." C. "Afterward, you can resume your exercise program." D. "This test is very helpful for identifying spinal defects."

Answer: B Rationale: With CVS, an ultrasound is done to confirm gestational age and viability. Then, under continuous ultrasound guidance, CVS is performed using either a transcervical or transabdominal approach. With the transcervical approach, the woman is placed in the lithotomy position and a sterile catheter is introduced through the cervix and inserted in the placenta, where a sample of chorionic villi is aspirated. This approach requires the client to have a full bladder to push the uterus and placenta into a position that is more accessible to the catheter. A full bladder also helps in better visualization of the helps in better visualization of the structures. With the transabdominal approach, an 18-gauge spinal needle is inserted through the abdominal wall into the placental tissue and a sample of chorionic villi is aspirated. Regardless of the approach used, the sample is sent to the cytogenetics laboratory for analysis. The results are usually available in less than one week. After the procedure, the woman is assisted into a position of comfort and any excess lubricant or secretions are cleaned from the area. The woman is instructed about signs to watch for and report, such as fever, cramping, and vaginal bleeding. The woman is also urged not to engage in any strenuous activity for the next 48 hours. RhoGAM is given to an unsensitized Rh-negative woman after the procedure. CVS can be used to detect numerous genetic disorders but not neural tube defects as no amniotic fluid is collected with this procedure. The woman would need to have MSAFP levels drawn at 16 to 18 weeks' gestation to test for neural tube defects.

A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem? A. oligohydramnios B. preeclampsia C. post-term labor D. chorioamnionitis

Answer: B Rationale: Women with multiple gestations are at high risk for preeclampsia, preterm labor, polyhydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.

At a prenatal class, the participants ask the nurse who would benefit from genetic counseling. Which responses by the nurse are correct? Select all that apply. A. "A woman who is a grand multigravida." B. "A woman whose husband is age 50 years or older." C. "A woman who has been exposed to teratogens." D. "A young teenager experiencing her first pregnancy." E. "A woman who receives an abnormal alpha-fetoprotein result."

Answer: B, C, E Rationale: Those shown to benefit from genetic counseling are women over the maternal age 35 years or older when the baby is born; couples where the paternal age is 50 years or older; when a pregnancy screening abnormality is noted, including the alpha-fetoprotein. Genetic screening is encouraged where there has been teratogen exposure or risk. Teenage pregnancies or having multiple pregnancies do not qualify for genetic counseling unless the above risks have been identified.

A client's recent prenatal ultrasound assessment reveals a normal placenta. Which outcomes would the nurse expect? Select all that apply. A. The placenta will filter out toxins that the mother ingests. B. The hormones made by the placenta support fetal growth. C. The placenta removes the fetal waste products such as stool. D. The placenta protects the fetus from an immune attack created by the mother. E. The placenta produces hormones that ready the fetus for extrauterine life.

Answer: B, D, E Rationale: The placenta will not filter out all toxins. The placenta begins to make hormones that control the basic physiology of the mother so the fetus is supplied with the nutrients and oxygen needed for growth. The placenta also protects the fetus from immune attack by the mother and removes waste products from the fetus. The placenta produces hormones that ready fetal organs for life outside the uterus.

A nurse is developing a teaching plan about nutrition for a group of pregnant women. Which recommendations would the nurse include in the discussion? Select all that apply. A. Keep weight gain to 15 lb (6.8 kg). B. Eat three meals with snacking. C. Limit the use of salt in cooking. D. Avoid using diuretics. E. Participate in physical activity.

Answer: B, D, E Rationale: To promote optimal nutrition, the nurse would recommend gradual and steady weight gain based on the client's prepregnant weight, eating three meals with one or two snacks daily, not restricting the use of salt unless instructed to do so by the health care provider, avoiding the use of diuretics, and participating in reasonable physical activity daily.

A pregnant woman has a rubella titer drawn on her first prenatal visit. The nurse explains that this test measures: A. platelet level. B. Rh status. C. immunity to German measles. D. red blood cell count.

Answer: C Rationale: A rubella titer detects antibodies for the virus that causes German measles. If the titer is 1:8 or less, the woman is not immune and requires immunization after birth. Platelet level and red blood cell count would be determined by a complete blood count. Rh status would be determined by blood typing.

During a prenatal visit, a pregnant woman says, "I know the amniotic fluid is important, but can you tell me more about it?" When describing amniotic fluid to a pregnant woman, which description would the nurse most likely include? A. "This fluid acts as transport mechanism for oxygen and nutrients." B. "The fluid is mostly protein to provide nourishment to your baby." C. "This fluid acts as a cushion to help to protect your baby from injury." D. "The amount of fluid remains fairly constant throughout the pregnancy."

Answer: C Rationale: Amniotic fluid protects the floating embryo and cushions the fetus from trauma. The placenta acts as a transport mechanism for oxygen and nutrients. Amniotic fluid is primarily water with some organic matter. Throughout pregnancy, amniotic fluid volume fluctuates.

A gravida 2 para 1 client in the 10th week of her pregnancy says to the nurse, "I've never urinated as often as I have for the past three weeks." Which response would be most appropriate for the nurse to make? A. "Having to urinate so often is annoying. I suggest that you watch how much fluid you are drinking and limit it." B. "You shouldn't be urinating this frequently now; it usually stops by the time you're eight weeks pregnant. Is there anything else bothering you?" C. "By the time you are 12 weeks pregnant, this frequent urination should really decrease, but it is likely to return toward the end of your pregnancy." D. "Women having their second child generally don't have frequent urination. Are you experiencing any burning sensations?"

Answer: C Rationale: As the uterus grows, it presses on the urinary bladder, causing the increased frequency of urination during the first trimester. This complaint lessens during the second trimester only to reappear in the third trimester as the fetus begins to descend into the pelvis, causing pressure on the bladder.

When preparing a woman for an amniocentesis, the nurse would instruct her to perform which action? A. Shower with an antiseptic scrub. B. Swallow the preprocedure sedative. C. Empty the bladder. D. Lie on the left side.

Answer: C Rationale: Before an amniocentesis, the woman should empty her bladder to reduce the risk of bladder puncture during the procedure. Showering with an antiseptic scrub and preprocedural sedation are not necessary. The woman usually is positioned in a way that provides an adequate pocket of amniotic fluid on ultrasound.

On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse documents this finding as: A. Hagar sign. B. Goodall sign. C. Chadwick sign. D. Homans sign.

Answer: C Rationale: Chadwick sign refers to the bluish coloration of the cervix and vaginal mucosa. Hegar sign refers to softening of the isthmus. Goodell sign refers to softening of the cervix. Homans sign indicates pain on dorsiflexion of the foot.

A nurse is working with a pregnant client to schedule follow-up visits for the pregnancy. Which statement by the client indicates that she understands the scheduling? A. "I need to make visits every 2 months until I am 36 weeks' pregnant." B. "Once I get to 28 weeks' pregnant, I have to come twice a month." C. "From now until I am 28 weeks' pregnant, I will be coming once a month." D. "I will make sure to get a day off every 2 weeks to make my visits."

Answer: C Rationale: Continuous prenatal care is important for a successful pregnancy outcome. The recommended follow-up visit schedule for a healthy pregnant woman is as follows: every 4 weeks up to 28 weeks' (7 months') gestation; every 2 weeks from 29 to 36 weeks' gestation; every week from 37 weeks' gestation to birth.

A nurse is conducting a class for a group of pregnant women in their first trimester about the emotional responses that occur during pregnancy. Which response would the nurse identify as being seen commonly during the second trimester? A. Introversion B. Ambivalence C. Acceptance D. Emotional balance

Answer: C Rationale: During the second trimester, the physical changes of pregnancy, including an enlarging abdomen and fetal movement, bring a sense of reality and validity to the pregnancy leading to acceptance. Ambivalence, or having conflicting feelings at the same time, is a universal feeling and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester. Usually ambivalence evolves into acceptance by the second trimester, when fetal movement is felt. Introversion seems to heighten during the first and third trimesters, when the woman's focus is on behaviors that will ensure a safe and health pregnancy outcome. Emotional lability, not emotional balance, is characteristic throughout most pregnancies. One moment a woman can feel great joy, and within a short time, she can feel shock and disbelief. It is not more common during one trimester or another.

A woman in her second trimester comes for a follow-up visit and says to the nurse, "I feel like I'm on an emotional roller-coaster." Which response by the nurse would be most appropriate? A. "How often has this been happening to you?" B. "Maybe you need some medication to level things out." C. "Mood swings are completely normal during pregnancy." D. "Have you been experiencing any thoughts of harming yourself?"

Answer: C Rationale: Emotional lability is characteristic throughout most pregnancies. One moment a woman can feel great joy, and within a short time she can feel shock and disbelief. Frequently, pregnant women will start to cry without any apparent cause. Some women feel as though they are riding an "emotional roller-coaster." These extremes in emotion can make it difficult for partners and family members to communicate with the pregnant woman without placing blame on themselves for their mood changes. Clear explanations about how common mood swings are during pregnancy are essential.

A nurse is reviewing a client's history and physical examination findings. Which information would the nurse identify as contributing to the client's risk for an ectopic pregnancy? A. use of oral contraceptives for 5 years B. ovarian cyst 2 years ago C. recurrent pelvic infections D. heavy, irregular menses

Answer: C Rationale: In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy.

A woman suspecting she is pregnant asks the nurse about which signs would confirm her pregnancy. The nurse would explain that which sign would confirm the pregnancy? A. absence of menstrual period B. abdominal enlargement C. palpable fetal movement D. morning sickness

Answer: C Rationale: Only positive signs of pregnancy would confirm a pregnancy. The positive signs of pregnancy confirm that a fetus is growing in the uterus. Visualizing the fetus by ultrasound, palpating for fetal movements, and hearing a fetal heartbeat are all signs that make the pregnancy a certainty. Absence of menstrual period and morning sickness are presumptive signs, which can be due to conditions other than pregnancy. Abdominal enlargement is a probable sign.

A client at a prenatal class requests information on how the gender of a baby is determined. Which statement made by the nurse would be most accurate? A. "Gender is determined by week 20 of gestation and depends on whether the ovum is fertilized by a Y-bearing or an X-bearing sperm." B. "Gender is determined as the embryo is fertilized by a Y-bearing or an X-bearing sperm." C. "Gender is determined at conception and depends on whether the ovum is fertilized by a Ybearing or an X-bearing sperm." D. "Gender is determined at conception and depends on whether the sperm is fertilized by a Ybearing or X-bearing ovum.

Answer: C Rationale: Sex determination is also determined at fertilization and depends on whether the ovum is fertilized by a Y-bearing sperm or an X-bearing sperm. Approximately half of sperm carry the XX chromosome and the other half carries XY. An XX zygote will become a female, and an XY zygote will become a male. That is why it is scientifically correct to say that the sex of the infant is determined by the father and not by the mother. Gender is determined before the embryo stage and at conception by sperm carrying Y- or X-bearing chromosomes.

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which response by the nurse would be most appropriate? A. "Why are you crying?" B. "Will a pill help your pain?" C. "I'm sorry you lost your baby." D. "A baby still wasn't formed in your uterus."

Answer: C Rationale: Telling the client that the nurse is sorry for the loss acknowledges the loss to the woman, validates her feelings, and brings the loss into reality. Asking why the client is crying is ineffective at this time. Offering a pill for the pain ignores the client's feelings. Telling the client that the baby was not formed is inappropriate and discounts any feelings or beliefs that the client has.

A pregnant woman in the 36th week of gestation reports that her feet are quite swollen at the end of the day. After careful assessment, the nurse determines that this is an expected finding at this stage of pregnancy. Which intervention is appropriate for the nurse to suggest? A. "Limit your intake of fluids." B. "Eliminate salt from your diet." C. "Try elevating your legs when you sit." D. "Wear spandex-type full-length pants."

Answer: C Rationale: The client is experiencing dependent edema due to the effect of gravity and increased capillary permeability caused by elevated hormone levels and increased blood volume and accompanied by sodium and water retention. The best suggestion would be to encourage the woman to elevate her legs when sitting to promote venous return and minimize the effects of gravity. Neither fluids nor salt should be limited or eliminated. Six to eight glasses of water each day are necessary to replace fluids lost through perspiration. Foods high in sodium should be avoided. Spandex-type full-length pants would be constricting and interfere with venous return.

A woman is at 20 weeks' gestation. The nurse would expect to find the fundus at which area? A. just above the symphysis pubis B. midway between the pubis and umbilicus C. at the level of the umbilicus D. midway between the umbilicus and xiphoid process

Answer: C Rationale: The uterus, which starts as a pear-shaped organ, becomes ovoid as length increases over width. By 20 weeks' gestation, the fundus, or top of the uterus, is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly used to date the pregnancy.

A nurse measures a pregnant woman's fundal height and finds it to be 28 cm. The nurse interprets this to indicate that the client is at how many weeks' gestation? A. 14 weeks' gestation B. 20 weeks' gestation C. 28 weeks' gestation D. 36 weeks' gestation

Answer: C Rationale: Typically, the height of the fundus is measured when the uterus arises out of the pelvis to evaluate fetal growth. At 12 weeks' gestation the fundus can be palpated at the symphysis pubis. At 16 weeks' gestation the fundus is midway between the symphysis and the umbilicus. At 20 weeks the fundus can be palpated at the umbilicus and measures approximately 20 cm from the symphysis pubis. By 36 weeks the fundus is just below the xiphoid process and measures approximately 36 cm.

A client who is 4 months pregnant is at the prenatal clinic for her initial visit. Her history reveals she has 7-year-old twins who were born at 34 weeks' gestation, a 2-year-old son born at 39 weeks' gestation, and a spontaneous abortion (miscarriage) 1 year ago at 6 weeks' gestation. Using the GTPAL method, the nurse would document her obstetric history as: A. 3 2 1 0 3. B. 3 1 2 2 3. C. 4 1 1 1 3. D. 4 2 1 3 1.

Answer: C Rationale: Using the GTPAL method, the woman's history would be documented as 4 (her fourth pregnancy), 1 (number of term pregnancies), 1 (number of pregnancies ending in preterm birth), 1 (number of pregnancies ending before 20 weeks or viability), and 3 (number of living children).

A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy, which statement indicates that the teaching was successful? A. "I'll sit in a window seat so I can focus on the sky to help relax me." B. "I won't drink too much fluid so I don't have to urinate so often." C. "I'll get up and walk around the airplane about every 2 hours." D. "I'll do some upper arm stretches while sitting in my seat."

Answer: C Rationale: When traveling by airplane, the woman should get up and walk about the plane every 2 hours to promote circulation. An aisle seat is recommended so that she can have easy access to the aisle. Drinking water throughout the flight is encouraged to maintain hydration. Calf-tensing exercises are important to improve circulation to the lower extremities.

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding? A. urinary output of 20 mL per hour B. respiratory rate of 10 breaths/minute C. deep tendons reflexes 2+ D. difficulty in arousing

Answer: C Rationale: With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity.

Which change in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy? A. ligament tightening B. decreased swayback C. increased lordosis D. joint contraction

Answer: C Rationale: With pregnancy, the woman's center of gravity shifts forward, requiring a realignment of the spinal curvatures. There is an increase in the normal lumbosacral curve (lordosis). Ligaments of the sacroiliac joints and pubis symphysis soften and stretch. Increased swayback and an upper spine extension to compensate for the enlarging abdomen occur. Joint relaxation and increased mobility occur due to the influence of the hormones relaxin and progesterone.

A pregnant woman asks the nurse, "I've heard that I should avoid eating certain types of fish. So what fish can I eat?" Which type of fish would the nurse recommend? Select all that apply. A. shark B. tilefish C. shrimp D. salmon E. catfish

Answer: C, D, E Rationale: The nurse should recommend eating up to 12 ounces (two average meals) weekly of low-mercury-level fish such as shrimp, canned light tuna, salmon, pollock, and catfish and avoid eating shark, swordfish, king mackerel, orange roughy, ahi tuna, and tilefish because they are high in mercury levels.

During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. This occurs about 4 or 5 times during the testing period. The nurse interprets this as: A. variable decelerations. B. fetal tachycardia. C. a nonreactive pattern. D. reactive pattern.

Answer: D Rationale: A reactive NST includes at least two fetal heart rate accelerations from the baseline of at least 15 bpm for at least 15 seconds within the 20-minute recording period. If the test does not meet these criteria after 40 minutes, it is considered nonreactive. A nonreactive NST is characterized by the absence of two fetal heart rate accelerations using the 15-by-15 criterion in a 20-minute time frame. An increase in the fetal heart rate does not indicate variable decelerations. Fetal tachycardia would be noted as a heart rate greater than 160 bpm.

A client comes to the prenatal clinic for her first visit. When determining the client's estimated due date, the nurse understands what which method is the most accurate? A. Nagele's rule B. gestational wheel C. birth calculator D. ultrasound

Answer: D Rationale: Although there are several methods for determining the EDD, the ultrasound is considered the most accurate method for dating the pregnancy.

The nurse is assessing a pregnant woman who is at 12 weeks' gestation. The woman's BMI was 18 prior to becoming pregnant. Her prepregnancy weight was 98 lb (44.5 kg). Which measurement would the nurse determine as appropriate weight gain for the woman during the first trimester? A. 99 lb (45 kg) B. 100 lb (45.5 kg) C. 102 lb (46 kg) D. 104 lb (47 kg)

Answer: D Rationale: During the first trimester, for underweight women, weight gain should be at least 5 lb (2.25 kg). For this woman with a prepregnancy weight of 98 lb (44.5), a weight of 104 lb (47 kg) would meet this criteria.

A nurse is assessing a pregnant woman in her last trimester. Which question would be most appropriate to use to gather information about weight gain and fluid retention? A. "What's your usual dietary intake for a typical week?" B. "What size maternity clothes are you wearing now?" C. "How puffy does your face look by the end of a day?" D. "How swollen do your ankles appear before you go to bed?

Answer: D Rationale: Edema, especially in the dependent areas such as the legs and feet, occurs throughout the day due to gravity. It improves after a night's sleep. Therefore, questioning the client about ankle swelling would provide the most valuable information. Asking about her usual dietary intake would be valuable in assessing complaints of heartburn and indigestion. The size of maternity clothing may provide information about weight gain but would have little significance for fluid retention. Swelling in the face may suggest preeclampsia, especially if it is accompanied by dizziness, blurred vision, headaches, upper quadrant pain, or nausea.

When describing gender determination at a prenatal class, the nurse would include which statement? A. "Gender is determined when the primary oocyte completes its first mitotic division." B. "Gender is determined when the sperm and the oocyte undergo the process of mitosis." C. "Gender is determined when the ovum and the spermatozoon undergo the process of meiosis." D. "Gender is determined at fertilization when the ovum is fertilized."

Answer: D Rationale: Gender is determined at fertilization and depends on whether the ovum is fertilized by a Y-bearing sperm or an X-bearing sperm. Approximately half of sperm carry the XX chromosome, and the other half carries XY. An XX zygote will become a female, and an XY zygote will become a male. X- and Y-bearing sperm determine the gender.

The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. What would be most important for the nurse to do when working with this family? A. Gather information for three generations. B. Inform the family of the need for information. C. Maintain the confidentiality of the information. D. Present the information in a factual, nondirective manner.

Answer: D Rationale: It is essential to respect client autonomy and present information in a factual, nondirective manner. In these situations, the nurse needs to understand that the choice is the couple's to make. Gathering information for three generations obtains a broad overview of what has been seen in both sides of the family. Maintaining confidentiality of the information is as important as with any other client information gathered. Informing the family of the need for information is necessary because of its personal nature.

A nurse is describing the various birth methods to pregnant couples. Which information would the nurse include as part of the Lamaze method? A. focus on the pleasurable sensations of birth B. concentration on sensations while turning on to own bodies C. interruption of the fear-tension-pain cycle D. use of specific breathing and relaxation techniques

Answer: D Rationale: Lamaze is a psychoprophylactic ("mind prevention") method of preparing for labor and birth that promotes the use of specific breathing and relaxation techniques. The Bradley method emphasizes the pleasurable sensations of birth, teaching women to concentrate on these sensations while "turning on" to their own bodies. The Dick-Read method seeks to interrupt the circular pattern of fear, tension, and pain during the labor and birthing process.

While talking with a woman in her third trimester, the nurse understands that which behavior indicates that the woman is learning to give of oneself? A. showing concern for self and fetus as a unit B. unconditionally accepting the pregnancy without rejection C. longing to hold infant D. questioning ability to become a good mother

Answer: D Rationale: Learning to give of oneself would be demonstrated when the woman questions her ability to become a good mother to the infant. Showing concern for herself and fetus as a unit reflects the task of ensuring safe passage throughout pregnancy and birth. Unconditionally accepting the pregnancy reflects the task of seeking acceptance of the infant by others. Longing to hold the infant reflects the task of seeking acceptance of self in the maternal role to the infant.

The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. What will the mother likely experience at that time? A. dysuria B. dyspnea C. constipation D. urinary frequency

Answer: D Rationale: Lightening refers to the descent of the fetal head into the pelvis and engagement. With this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection. Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to lightening.

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed? A. hemoglobin and hematocrit B. urine for culture C. fetal ultrasound D. fundal height measurement

Answer: D Rationale: On every follow-up visit, fundal height measurements are performed to evaluate fetal growth and gestation. Hemoglobin and hematocrit, as part of a complete blood count, would be done on the initial visit and then repeated if the woman's status indicates a need for doing so. Urine is checked for protein, glucose, ketones, and nitrites. A culture would be done if there are signs and symptoms of an infection. Fetal ultrasound can be done at any time during the prenatal period, but it is not done at every visit.

After teaching a refresher class to a group of prenatal clinic nurses about pregnancy, insulin, and glucose, the nurse determines that additional teaching is needed when the group identifies which hormone as being involved with opposing insulin? A. prolactin B. estrogen C. progesterone D. aldosterone

Answer: D Rationale: Prolactin, estrogen, and progesterone are all thought to oppose insulin. As a result, glucose is less likely to enter the mother's cells and is more likely to cross over the placenta to the fetus. Aldosterone does not oppose insulin.

A nurse is reviewing the results of four clients who have undergone amniocentesis. Which client would the nurse recommend that the health care provider see first? A. client at 16 weeks' gestation with placenta previa and high alpha-fetoprotein level B. client at 34 weeks' gestation with gestational diabetes and L/S ratio of 2:1 C. client at 36 weeks' gestation with preeclampsia and amniotic fluid negative for bilirubin D. client at 38 weeks' gestation with fetal heart rate of 110 and green amniotic fluid sample

Answer: D Rationale: The client at 38 weeks' gestation should be evaluated first because the green amniotic fluid suggests possible meconium staining and the fetal heart rate is bradycardic. Immediate evaluation and intervention would be essential. A high alpha fetoprotein level may suggest a neural tube defect or possible chromosomal abnormality. Although important to address, this client would not be the priority. The client at 34 weeks' with gestational diabetes and an L/S ratio of 2:1 indicates that the lung of the fetus are mature, should delivery be necessary. Amniotic fluid that is negative for bilirubin is a normal finding.

The nurse is teaching a couple about the pros and cons of genetic testing. Which statement by the nurse best describes the limits of genetic testing? A. "Various genetic tests help the primary care provider choose appropriate treatments." B. "Genetic testing helps couples avoid having children with fatal diseases." C. "Genetic tests identify people at high risk for preventable conditions." D. "Some genetic tests can give a probability for developing a disorder."

Answer: D Rationale: The fact that some tests only provide a probability for developing a disorder raises a problem. A serious limitation of these susceptibility tests is that some people who carry a disease-associated mutation never develop the disease. Choosing appropriate treatments, avoiding having children with fatal diseases, and identifying those at high risk affirm the value of genetic tests.

Which mother is in the fetal stage of development? A. a pregnant mother who is one week pregnant B. a pregnant mother who is five weeks' pregnant C. a pregnant mother who is seven weeks' pregnant D. a pregnant mother who is thirty weeks' pregnant

Answer: D Rationale: The fetal stage of development during pregnancy occurs at the end of the eighth week and continues through to birth. The mother at one week gestation is in the preembryonic stage. The mothers at five weeks and seven weeks are in the embryonic stage.

When teaching a pregnant client about the physiologic changes of pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which underlying reason for the effect would the nurse include? A. Pancreatic function is affected by pregnancy. B. Glucose is utilized more rapidly during a pregnancy. C. The pregnant woman increases her dietary intake. D. Glucose moves through the placenta to assist the fetus.

Answer: D Rationale: The growing fetus has large needs for glucose, amino acids, and lipids, placing demands on maternal glucose stores. During the first half of pregnancy, much of the maternal glucose is diverted to the growing fetus. The pancreas continues to function during pregnancy. However, the placental hormones can affect maternal insulin levels. The demand for glucose by the fetus during pregnancy is high, but it is not necessarily used more rapidly. Placental hormones, not the woman's dietary intake, play a major role in glucose metabolism during pregnancy.

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. progesterone (progestin) D. human chorionic gonadotropin (hCG)

Answer: D Rationale: 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.

It is determined that a client's blood Rh is negative and her partner's is Rh positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time? A. at 32 weeks' gestation and immediately before discharge B. 24 hours before birth and 24 hours after birth C. in the first trimester and within 2 hours of birth D. at 28 weeks' gestation and again within 72 hours after birth

Answer: D Rationale: To prevent isoimmunization, the woman should receive Rho(D) immune globulin at 28 weeks and again within 72 hours after birth.

A couple comes to the clinic for preconception counseling and care. As part of the visit, the nurse teaches the couple about fertilization and initial development, stating that the zygote formed by the union of the ovum and sperm consists of how many chromosomes? A. 22 B. 23 C. 44 D. 46

Answer: D Rationale: With fertilization, the ovum, containing 23 chromosomes, and the sperm, containing 23 chromosomes, join, forming a zygote with a diploid number or 46 chromosomes.