Maternity Questions

A 54-year-old client calls her healthcare practitioner complaining of frequency and burning when she urinates. Which of the following factors that occurred within the preceding 3 days likely contributed to this client's problem? 1. She had intercourse with her partner 2. She returned from a trip abroad 3. She stopped taking hormone replacement therapy 4. She started a weight-lifting exercise program

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A woman, whose menstrual cycle is 35 days long, states that she often has a slight pain on one side of her lower abdomen on day 21 of her cycle. She wonders whether she has ovarian cancer. Which of the following is the nurse's best response? 1. "Women often feel a slight twinge when ovulation occurs." 2. "You should seek medical attention as soon as possible since ovarian cancer is definitely a possibility." 3. "Ovarian cancer is unlikely because the pain is not a constant pain." 4. "It is more likely that such pain indicates an ovarian cyst because pain is more common with that problem."

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A pregnant client's primary healthcare provider has ordered a 75-gram oral glucose tolerance test (OGTT) to screen the client for gestational diabetes. The nurse is providing preprocedure counseling to the client. Which of the following must the client do? Select all that apply. 1. Fast for 8 to 16 hours prior to the test. 2. Bring a first void urine specimen to the laboratory for testing. 3. Consume a solid sugar cube immediately upon awakening. 4. Drink 16 ounces of water 1 hour prior to the test. 5. Smoke no cigarettes the day of the test.

1 &5 1. Women must fast for a minimum of 8 hours and a maximum of 16 hours prior to the test. 2. No urine test is performed. 3. The client will be given 75 grams of glucose in a liquid form upon arrival at the laboratory. 4. The OGTT is a fasting test. Women should neither eat nor drink prior to arriving at the laboratory. 5. Smoking on the morning of the test can alter the results.

A woman is planning to become pregnant. Which of the following actions should she be counseled to take before she stops using birth control? Select all that apply. 1. Take a daily multivitamin. 2. See a medical doctor. 3. Drink beer instead of vodka. 4. Stop all over-the-counter medications. 5. Stop smoking cigarettes.

1, 2, & 5 1. Before attempting to become pregnant, it's very important that women begin taking daily multivitamin tablets. 2. Women who wish to become pregnant should first see a medical doctor for a complete checkup. 3. Women who wish to become pregnant should refrain from drinking any alcohol. 4. Women who wish to become pregnant should ask an obstetrician/gynecologist which over-the-counter medications should be avoided. Some—for example, acetaminophen—are safe to take, while others are not. 5. Women who wish to become pregnant should be counseled to stop smoking.

Which finding would the nurse view as normal when evaluating the laboratory reports of a 34-week gestation client? 1. Mild anemia. 2. Thrombocytopenia. 3. Polycythemia. 4. Hyperbilirubinemia.

1. Anemia is an expected finding.TEST-TAKING TIP: By the end of the second trimester, the blood supply of the woman increases by approximately 50%.This increase is necessary in order for the client to be able to perfuse the placenta.There is a concurrent increase in red blood cell production, but the vast majority of women are unable to produce the red blood cells in sufficient numbers to keep pace with the increase in blood volume. As a result, clients develop what is commonly called "physiological anemia of pregnancy." A hematocrit of 32% is considered normal for a pregnant woman.

A 38-week gestation client, Bishop score 1, is advised by her nurse midwife to take evening primrose daily. The office nurse advises the client to report which of the following side effects that has been attributed to the oil? 1. Skin rash. 2. Pedal edema. 3. Blurred vision. 4. Tinnitus.

1. Evening primrose has been shown to cause skin rash in some women. TEST-TAKING TIP: Even though evening primrose is a "natural" substance, it can cause side effects in some clients. The most common side effect seen from the oil is a skin rash. Headaches and nausea have also been seen.

17. The nurse notes each of the following findings in a 10-week gestation client. Which of the findings would enable the nurse to tell the client that she is positively pregnant? 1. Fetal heart rate via Doppler. 2. Positive pregnancy test. 3. Positive Chadwick sign. 4. Montgomery gland enlargements.

1. Hearing a fetal heart rate is a positive sign of pregnancy.

When assessing the psychological adjustment of an 8-week gravida, which of the following would the nurse expect to see signs of? 1. Ambivalence. 2. Depression. 3. Anxiety. 4. Ecstasy.

1. It is common for women to be ambivalent about their pregnancy during the first trimester.

A woman's temperature has just risen 0.4F and will remain elevated during the remainder of her cycle. She expects to menstruate in about 2 weeks. Which of the following hormones is responsible for the change? 1. Estrogen 2. Progesterone 3. Luteinizing hormone (LH) 4. Follicle-stimulating hormone (FSH)

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The nurse working in an outpatient obstetric office assesses four primigravid clients. Which of the client findings should the nurse highlight for the physician? Select all that apply. 1. 17 weeks' gestation; denies feeling fetal movement. 2. 24 weeks' gestation; fundal height at the umbilicus. 3. 27 weeks' gestation; salivates excessively. 4. 34 weeks' gestation; experiences uterine cramping. 5. 37 weeks' gestation; complains of hemorrhoidal pain.

2 & 4 1. It is common for primigravid women not to feel fetal movement until 19 to 20 weeks' gestation. 2. The fundal height at 24 weeks should be 4 cm above the umbilicus. The fundal height at the level of the umbilicus is expected at 20 weeks' gestation. 3. Excessive salivation, called ptyalism, is an expected finding in pregnancy. 4. The woman may be going into preterm labor. 5. Hemorrhoids are commonly seen in pregnant women.

A third-trimester client is being seen for routine prenatal care. Which of the following assessments will the nurse perform during the visit? Select all that apply. 1. Blood glucose. 2. Blood pressure. 3. Fetal heart rate. 4. Urine protein. 5. Pelvic ultrasound.

2, 3, & 4 1. Urine glucose is performed at each visit, not the blood glucose. 2. The blood pressure is assessed at each prenatal visit. 3. The fetal heart rate is assessed at each prenatal visit. Depending on the equipment available, it will be assessed mechanically via Doppler or manually via fetoscope. The fetal heart is audible via Doppler many weeks before it is audible via fetoscope. 4. Urine protein is performed at each prenatal visit. 5. Ultrasounds are performed only when needed.

The nurse midwife tells a client that the baby is growing and that ballottement was evident during the vaginal examination. How should the nurse explain what the nurse midwife means by ballottement? 1. The nurse midwife saw that the mucous plug was intact. 2. The nurse midwife felt the baby rebound after being pushed. 3. The nurse midwife palpated the fetal parts through the uterine wall. 4. The nurse midwife assessed that the baby is head down.

2. This is the definition of ballottement.

A nurse midwife has advised a 40-week gestation gravid to take evening primrose oil 2,500 mg daily as a complementary therapy. This suggestion was made because evening primrose has been shown to perform which of the following actions? 1. Relieve back strain. 2. Improve development of colostrum. 3. Ripen the cervix. 4. Reduce the incidence of hemorrhoids.

3. Evening primrose converts to aprostaglandin substance in the body. Prostaglandins are responsible for readying the cervix for dilation. TEST-TAKING TIP: Nurse midwives often recommend complementary therapies during pregnancy as well as during labor and delivery. Nurse midwives usually believe in promoting natural means for maintaining a healthy pregnancy and for stimulating labor. Evening primrose is one of those interventions.

A client makes the following statement after finding out that her pregnancy test is positive, "This is not a good time. I am in college and the baby will be due during final exams!" Which of the following responses by the nurse would be most appropriate at this time? 1. "I'm absolutely positive that everything will turn out all right." 2. "I suggest that you e-mail your professors to set up an alternate plan." 3. "It sounds like you're feeling a little overwhelmed right now." 4. "You and the baby's father will find a way to get through the pregnancy."

3. This is the best comment. It acknowledges the concerns that the client is having.

The nurse takes the history of a client, G2 P1, at her first prenatal visit. Which of the following statements would indicate that the client should be referred to a genetic counselor? 1. "My first child has cerebral palsy." 2. "My first child has hypertension." 3. "My first child has asthma." 4. "My first child has cystic fibrosis."

4. Cystic fibrosis is an autosomal recessive genetic disease so the client with a history of cystic fibrosis should be referred to a genetic counselor.

A multigravid client is 22 weeks pregnant. Which of the following symptoms would the nurse expect the client to exhibit? 1. Nausea. 2. Dyspnea. 3. Urinary frequency. 4. Leg cramping.

4. Leg cramping is often a complaint of clients in the second trimester. TEST-TAKING TIP: Although clients in the second trimester do experience some physical discomfort, such as leg cramps and backaches, most women feel well.They no longer are fatigued, nauseous, and so on as in the first trimester, but the baby is not so large as to cause significant complaints like dyspnea or the recurrence of urinary frequency.

The midwife has just palpated the fundal height at the location noted on the picture below. It is likely that the client is how many weeks pregnant? 1. 12. 2. 20. 3. 28. 4. 36.

ANS 1 1 The client is likely 12 weeks pregnant. At 12 weeks, the fundal height is at the top of the symphysis. 2. The fundus is at the level of the umbilicus at 20 weeks' gestation. 3. The fundus is between the umbilicus and the xiphoid process at 28 weeks' gestation. 4. The fundus is at the level of the xiphoid process at 36 weeks' gestation.

Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following? 1. Avoid eating greasy foods. 2. Drink orange juice before rising. 3. Consume 1 teaspoon of nutmeg each morning. 4. Eat 3 large meals plus a bedtime snack.

ANS 1 1. Greasy foods should be avoided. 2. Saltine crackers should be eaten before rising. Drinking orange juice has not been recommended. 3. Although consuming ginger may help to alleviate the nausea and vomiting of pregnancy, neither cinnamon nor nutmeg has been shown to alleviate the symptoms 4. It is recommended that mothers eat small frequent meals throughout the day.

The following four changes occur during pregnancy. Which of them usually increases the father's interest and involvement in the pregnancy? 1. Learning the results of the pregnancy test. 2. Attending childbirth education classes. 3. Hearing the fetal heartbeat. 4. Meeting the obstetrician or midwife.

ANS 3 1. A positive pregnancy test will not necessarily promote fathers' interests in their partners' pregnancies. 2. Most fathers are very involved with their partners' pregnancies well before childbirth education classes begin. 3. Hearing the fetal heartbeat often increases fathers' interests in their partners' pregnancies. 4. Meeting the healthcare practitioner is unlikely to promote fathers' interests in their partners' pregnancies. TEST-TAKING TIP: Women who are in the first few weeks of pregnancy often experience a number of physical complaints—nausea and vomiting, fatigue, breast tenderness, and urinary frequency. Prospective fathers whose partners experience these complaints are often not very interested in the pregnancies. When the baby becomes "real," with a positive heartbeat or fetal movement, the fathers often become very excited.

A 20-year-old client states that the at-home pregnancy test that she took this morning was positive. Which of the following comments by the nurse is appropriate at this time? 1. "Congratulations, you and your family must be so happy." 2. "Have you told the baby's father yet?" 3. "How do you feel about the results?" 4. "Please tell me when your last menstrual period was."

ANS 3 1. It is inappropriate to assume that the client and her family are happy about the pregnancy. 2. It is inappropriate to assume that the baby's father is still in the young woman's life. 3. It is important for the nurse to ask the young woman how she feels about being pregnant. She may decide not to continue with the pregnancy. 4. This information is important, but it is not the best statement to make initially.

A woman in her third trimester advises the nurse that she wishes to breastfeed her baby, "but I don't think my nipples are right." Upon examination, the nurse notes that the client has inverted nipples. Which of the following actions should the nurse take at this time? 1. Advise the client that it is unlikely that she will be able to breastfeed. 2. Refer the client to a lactation consultant for advice. 3. Call the labor room and notify them that a client with inverted nipples will beadmitted. 4. Teach the woman exercises to evert her nipples.

2. The client should be referred to a lactationconsultant. TEST-TAKING TIP: Research on eversion exercises has shown that they are not effective plus breast manipulation can bring on contractions since oxytocin production is stimulated. Lactation consultants are breastfeeding specialists. A lactation consultant would probably recommend that the client wear breast shields in her bra. The shields are made of hard plastic and have a small hole through which the nipple everts.

33. Which of the following exercises should be taught to a pregnant woman who complains of backaches? 1. Kegeling. 2. Pelvic tilting. 3. Leg lifting. 4. Crunching.

2. The pelvic tilt is an exercise that canreduce backache pain. TEST-TAKING TIP: Pelvic tilt exercises help to reduce backache pain. The client is taught to get into an optimal position—on the hands and knees is often best. She is then taught to force her back out while tucking her head and buttocks under and holding that position for a few seconds, followed by holding the alternate position for a few seconds—arching her backwhile lifting her head and her buttocks toward the ceiling. These positions should be alternated repeatedly for about5 minutes. The exercises are very relaxing while also improving the muscle tone of the lower back.

A woman, 6 weeks pregnant, is having a vaginal examination. Which of the following would the practitioner expect to find? 1. Thin cervical muscle. 2. An enlarged ovary. 3. Thick cervical mucus. 4. Pale pink vaginal wall.

2. The practitioner would expect topalpate an enlarged ovary. TEST-TAKING TIP: The cervix is long andthick in order to retain the pregnancy inthe uterine cavity. The cervical mucus isthin and the vaginal wall is bluish incolor as a result of elevated estrogenlevels. The ovary is enlarged because thecorpus luteum is still functioning.

A client in her third trimester is concerned that she will not know the difference between labor contractions and normal aches and pains of pregnancy. How should the nurse respond? 1. "Don't worry. You'll know the difference when the contractions start." 2. "The contractions may feel just like a backache, but they will come and go." 3. "Contractions are a lot worse than your pregnancy aches and pains." 4. "I understand. You don't want to come to the hospital before you are in labor."

2. This is a true statement TEST-TAKING TIP: Labor contractions often begin in a woman's back, feeling much like a backache. The difference is that labor contractions are intermittent and rhythmic. The client should be advised to attend to any pains that come and go and time them. She may be beginning the labor process.

A 37-week gravid client states that she noticed a "white liquid" leaking from her breasts during a recent shower. Which of the following nursing responses is appropriate at this time? 1. Advise the woman that she may have a galactocele. 2. Encourage the woman to pump her breasts to stimulate an adequate milk supply. 3. Assess the liquid because a breast discharge is diagnostic of a mammary infection. 4. Reassure the mother that this is normal in the third trimester.

4. It is normal for colostrum to be expressed late in pregnancy. TEST-TAKING TIP: Even though colostrum is present in the breasts in the latter part of the third trimester, it is important for women not to pump their breasts.Oxytocin, the hormone that promotes the ejection of milk during lactation, is the hormone of labor. Pumping of the breasts, therefore, could stimulate the uterus to contract.

The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that are within normal limits during the latter half of the pregnancy. Which of the following comments by the client indicates that teaching was successful? Select all that apply. 1. "During the third trimester I may experience frequent urination." 2. "During the third trimester I may experience heartburn." 3. "During the third trimester I may experience nagging backaches." 4. "During the third trimester I may experience persistent headache." 5. "During the third trimester I may experience blurred vision."

4. Persistent headache should not be seen in pregnant women. TEST-TAKING TIP: This question is asking the test taker to determine which complaint is not expected during the third trimester. The nurse, therefore, must know which symptoms are normal during the third trimester in order to know which symptoms are not normal during that period. Persistent headache can indicate that the woman has developed a complication of pregnancy

The nurse asks a 31-week gestation client to lie on the examining table during a prenatal examination. In which of the following positions should the client be placed? 1. Orthopneic. 2. Lateral-recumbent. 3. Sims. 4. Semi-Fowler.

4. The client should be placed in a semi-Fowler's position. TEST-TAKING TIP: Because of the growth of the uterus, it is very difficult for women in the third trimester to breathe in the supine position. During the prenatal visit, the baby's heartbeat will be monitored and the fundal height will be assessed. Both of these procedures can safely be performed in the semi-Fowler's position.44.

A gravid woman and her husband inform the nurse that they have just moved into a three-story home that was built in the 1930s. Which of the following is critical for the nurse to advise the woman to protect the unborn child? 1. Stay out of any rooms that are being renovated. 2. Drink water only from the hot water tap. 3. Refrain from entering the basement. 4. Climb the stairs only once per day.

ANS 1 1. The woman should stay out of rooms that are being renovated. 2. The water should be tested for the presence of lead. If there is lead in the water, it is recommended that the water from the hot water tap not be consumed. 3. Unless mold has been found, there is no reason the client should refrain from entering the basement. 4. As long as she is feeling well, there is no reason the client should refrain from walking up the stairs.

Which of the following skin changes should the nurse highlight for a pregnant woman's healthcare practitioner? 1. Linea nigra. 2. Melasma. 3. Petechiae. 4. Spider nevi.

ANS 3 1. Linea nigra—the darkened area on the skin from the symphysis to the umbilicus—is a normal skin change seen in pregnancy. 2. Melasma—the "mask" of pregnancy—is a normal skin change seen in pregnancy. 3. Petechiae are pinpoint red or purple spots on the skin. They are seen in hemorrhagic conditions. 4. Spider nevi—benign radiating blood vessels— are normal skin changes seen in pregnancy. TEST-TAKING TIP: There are many skin changes that occur normally during pregnancy. Most of the changes—such as linea nigra, melasma, and hyperpigmentation of the areolae—are related to an increase in the melanin- producing bodies of the skin as a result of stimulation by the female hormones estrogen and progesterone. The presence of petechiae is usually related to a pathological condition, such as thrombocytopeni

A client is 15 weeks pregnant. She calls the obstetric office to request a medication for a headache. The nurse answers the telephone. Which of the following is the nurse's best response? 1. "Because the organ systems in the baby are developing right now, you may takeno medication." 2. "You can take any of the over-the-counter medications because they are all safein pregnancy." 3. "The physician will prescribe a medication for you that has been shown not tocause any fetal injuries." 4. "The physician will prescribe a rectal suppository because the medicine will not enter your blood stream."

ANS 3 1. The majority of the organ systems are developed before the end of the first trimester. This client is in her second trimester. 2. There are a number of over-the-counter medications that should be taken with care during pregnancy. 3. The physician will prescribe a medication that is safe to take during pregnancy. 4. There are oral medications that can be taken during pregnancy. Also, many medications administered rectally do enter the blood stream.

A woman is 36 weeks' gestation. Which of the following tests will be done during her prenatal visit? 1. Oral glucose tolerance test. 2. Amniotic fluid volume assessment. 3. Vaginal and rectal cultures. 4. Karyotype analysis.

ANS 3 1. The oral glucose tolerance test (OGTT) is performed at approximately 24 weeks' gestation. 2. Amniotic fluid volume assessment is part of the biophysical profile (BPP). The BPP is performed when the healthcare practitioner is concerned about the health and well-being of the fetus. 3. Vaginal and rectal cultures are done at approximately 36 weeks' gestation. 4. Karyotype analysis or chromosomal analysis, if performed, is done early in pregnancy. TEST-TAKING TIP: Vaginal and rectal cultures are done to assess for the presence of group B streptococcal (GBS) bacteria in the woman's vagina and rectum. If the woman has GBS as part of her normal flora, she will be given IV antibiotics during labor to prevent vertical transmission to her baby at birth. GBS is often called "the baby killer."

A nurse is working in the prenatal clinic. Which of the following findings seen in third-trimester pregnant women would the nurse consider to be within normal limits? Select all that apply. 1. Leg cramps. 2. Varicose veins. 3. Hemorrhoids. 4. Fainting spells. 5. Lordosis.

1, 2, 3, & 5 1. Although annoying, leg cramps are not pathological. 2. Varicose veins are normal, although client teaching may be needed. 3. Hemorrhoids are normal, although client teaching may be needed. 4. Fainting spells are not normal, although the client may feel faint when rising quickly from a lying position. 5. Lordosis, or change in the curvature of the spine, is normal, although patient teaching may be needed. TEST-TAKING TIP: There are a number of physical complaints that are "normal" during pregnancy. There are interventions, however, that can be taught to help to alleviate some of the discomforts. The test taker should be familiar with patient education information that should be conveyed regarding the physical complaints of pregnancy. For example, clients who complain of hemorrhoids should be encouraged to eat high-fiber foods and drink fluids to produce softer stools. The softer stools should decrease the irritation of the hemorrhoids.

Which of the following findings in an 8-week gestation client, G2 P1001, should the nurse highlight for the nurse midwife? Select all that apply. 1. Body mass index of 17 kg/m2. 2. Rubella titer of 1:8. 3. Blood pressure of 100/60 mm Hg. 4. Hematocrit of 30%. 5. Hemoglobin of 13.2 g/dL.

1. The BMI of 17 is of concern. This client is entering her pregnancy underweight. TEST-TAKING TIP: Women who enter theirpregnancies underweight are encouragedto gain slightly more—35 to 45 lb—during their pregnancies than are womenof normal weight who are encouraged togain 25 to 35 lb.

A father experiencing couvade syndrome is likely to exhibit which of the following symptoms/behaviors? Select all that apply.1. Heartburn.2. Promiscuity.3. Hypertension.4. Bloating.5. Abdominal pain.

1, 4, & 5 1. Heartburn is a common symptom. 2. It is inappropriate for a prospective father to engage in promiscuity. 3. Hypertension in a prospective father should be investigated. 4. Some fathers complain of abdominal bloating. 5. Some fathers complain of abdominal pain.TEST- TAKING TIP: Heartburn, bloating, and abdominal pain are subjective complaints that fathers often experience during their partners' pregnancies. Fathers who are experiencing couvade symptoms are exhibiting a strong affiliation between themselves and their partners. It is inappropriate for prospective fathers to engage in illicit relationships and/or indifference toward their partners' pregnancies. They should be fully engaged in the process. Hypertension, an objective sign, should be investigated further. The father may have developed a pathological condition.

The nurse has taken a health history on four primigravid clients at their first prenatal visits. It is high priority that which of the clients receives nutrition counseling? 1. The woman diagnosed with phenylketonuria. 2. The woman who has Graves disease. 3. The woman with Cushing syndrome. 4. The woman diagnosed with myasthenia gravis.

1. The client with phenylketonuria(PKU) must receive counseling from aregistered dietitian. TEST-TAKING TIP: PKU is a genetic disease that is characterized by the absence of the enzyme needed to metabolize phenylalanine, an essential amino acid. When patients with PKU consume phenylalanine, a metabolite that affects cognitive centers in the brain is created in the body. If a pregnant woman who has PKU were to eat foods high in phenylalanine, her baby would develop severe mental retardation in utero.

A client is in the 10th week of her pregnancy. Which of the following symptoms would the nurse expect the client to exhibit? Select all that apply. 1. Backache. 2. Urinary frequency. 3. Dyspnea on exertion. 4. Fatigue. 5. Diarrhea.

2 & 4 are correct. 1. Backaches usually do not develop until thesecond trimester of pregnancy. 2. The woman will likely complain of urinary frequency. 3. Dyspnea is associated with the third trimester of pregnancy. 4. Most women complain of fatigue during the first trimester. 5. Diarrhea is not a complaint normally heard from prenatal clients.

A third-trimester client is being seen for routine prenatal care. Which of the following assessments will the nurse perform during the visit? Select all that apply. 1. Blood glucose. 2. Blood pressure. 3. Fetal heart rate. 4. Urine protein. 5. Pelvic ultrasound.

2, 3,&4 1. Urine glucose is performed at each visit, not the blood glucose. 2. The blood pressure is assessed at each prenatal visit. 3. The fetal heart rate is assessed at each prenatal visit. Depending on the equipment available, it will be assessed mechanically via Doppler or manually via fetoscope. The fetal heart is audible via Doppler many weeks before it is audible via fetoscope. 4. Urine protein is performed at each prenatal visit. 5. Ultrasounds are performed only when needed.

The nurse plans to provide anticipatory guidance to a 10-week gravid client who is being seen in the prenatal clinic. Which of the following information should be a priority for the nurse to provide? 1. Pain management during labor. 2. Methods to relieve backaches. 3. Breastfeeding positions. 4. Characteristics of the newborn

ANS 2 1. it is too early in the pregnancy to provide anticipatory guidance about pain management during labor 2. It is appropriate for the nurse to provide anticipatory guidance regarding methods to relieve back pain. 3. It is too early in the pregnancy to provide anticipatory guidance about breastfeeding positions. 4. It is too early in the pregnancy to provide anticipatory guidance about characteristics of the newborn.

During a prenatal visit, a gravid client is complaining of ptyalism. Which of the following nursing interventions is appropriate? 1. Encourage the woman to brush her teeth carefully. 2. Advise the woman to have her blood pressure checked regularly. 3. Encourage the woman to wear supportive hosiery. 4. Advise the woman to avoid eating rare meat.

ANS 1 1. Clients who experience ptyalism have an excess of saliva. They should be advised to be vigilant in the care of their teeth and gums. Ptyalism is often accompanied by gingivitis and nausea and vomiting. 2. Ptyalism is not related to a change in blood pressure. 3. Ptyalism is not related to changes in the lower extremities. 4. Ptyalism is not related to the meat intake.TEST- TAKING TIP: Ptyalism is related to the increase in vascular congestion of the mucous membranes from increased estrogen production. Women with increased salivation often also experience gingivitis, which is also related to estrogen production. In addition, ptyalism is seen in women with nausea and vomiting. Because of the caustic effects of gastric juices on the enamel of the teeth, the inflammation seen in the gums, and the increased salivation, it is essential that the pregnant woman take special care of her teeth during pregnancy, including regular visits to the dentist and/or the dental hygienist.

A woman whose prenatal weight was 105 lb weighs 109 lb at her 12-week visit. Which of the following comments by the nurse is appropriate at this time? 1. "We expect you to gain about 1 lb per week, so your weight is a little low at this time." 2. "Most women gain no weight during the first trimester, so I would suggest you eat fewer desserts for the next few weeks." 3. "You entered the pregnancy well underweight, so we should check your diet to make sure you are getting the nutrients you need." 4. "Your weight gain is exactly what we would expect it to be at this time."

ANS 1 & 4 1. Weight gain of 0.8 to 1 lb per week is expected during the second and third trimesters only. 2. A weight gain of 3 to 5 lb is expected during the entire first trimester. 3. Since the client's height is not stated, there is no way to know whether or not the client is underweight. 4. The weight gain is normal for the first trimester.

A gravida, G1 P0, is having her first prenatal physical examination. Which of the following assessments should the nurse inform the client that she will have that day? Select all that apply. 1. Pap smear. 2. Mammogram. 3. Glucose tolerance test. 4. Biophysical profile. 5. Complete blood count.

ANS 1 & 5 1 The client will have a Pap smear done. A mammogram will not be performed. 2 A glucose assessment will likely be performed at the end of the second trimester. 3 A biophysical profile may be done but not until the third trimester. 4 A complete blood count will be performed.

A couple is preparing to interview obstetric primary care providers to determine who they will go to for care during their pregnancy and delivery. To make the best choice, which of the following actions should the couple perform first? 1. Take a tour of hospital delivery areas. 2. Develop a preliminary birth plan. 3. Make appointments with three or four obstetric care providers. 4. Search the Internet for the malpractice histories of the providers.

ANS 2 1. Although the tour of the facility is important, this should not be the couple's first step. 2. It is best that a couple first develop a birth plan. 3. Although appointments should be made, this should not be the couple's first step. 4. Although the couple may wish to research the healthcare practitioner's malpractice history, this should not be the couple's first step.

The blood of a pregnant client was initially assessed at 10 weeks' gestation and reassessed at 38 weeks' gestation. Which of the following results would the nurse expect to see? 1. Rise in hematocrit from 34% to 38%. 2. Rise in white blood cells from 5,000 cells/mm3 to 15,000 cells/mm3. 3. Rise in potassium from 3.9 mEq/L to 5.2 mEq/L. 4. Rise in sodium from 137 mEq/L to 150 mEq/L.

ANS 2 1. The nurse would expect the hematocrit to drop. 2. The nurse would expect to see an elevated white blood cell count. 3. The nurse would not expect to see an abnormal potassium level. 4. The nurse would not expect to see an abnormal sodium level. TEST-TAKING TIP: At the end of the third trimester and through to the early postpartum period, a normal leukocytosis, or rise in white blood cell count, is seen. This is a natural physiological change that protects the woman's body from the invasion of pathogens during the birth process.

A client who was seen in the prenatal clinic at 20 weeks' gestation weighed 128 lb at that time. Approximately how many pounds would the nurse expect the client to weigh at her next visit at 24 weeks' gestation? 1. 129 to 130 lb. 2. 131 to 132 lb. 3. 133 to 134 lb. 4. 135 to 136 lb.

ANS 2 1. The woman would be expected to weigh 131 to 132 lb. At this stage of pregnancy, the woman is expected to gain about 0.8 to 1 lb a week. 2. The woman would be expected to weigh 131 to 132 lb. At this stage of pregnancy, the woman is expected to gain about 0.8 to 1 lb a week. 3. The woman would be expected to weigh 131 to 132 lb. At this stage of pregnancy, the woman is expected to gain about 0.8 to 1 lb a week. 4. The woman would be expected to weigh 131 to 132 lb. At this stage of pregnancy, the woman is expected to gain about 0.8 to 1 lb a week. TEST-TAKING TIP: The incremental weight gain of a client is an important means of assessing the growth and development of the fetus. The nurse would expect that during the second and third trimesters, the woman should gain approximately 0.8 to 1 lb per week.

A 16-year-old, G1 P0, is being seen at her 10-week gestation visit. She tells the nurse that she felt the baby move that morning. Which of the following responses by the nurse is appropriate? 1. "That is very exciting. The baby must be very healthy." 2. "Would you please describe what you felt for me?" 3. "That is impossible. The baby is not big enough yet." 4. "Would you please let me see if I can feel the baby?"

ANS 2 1. This is an inappropriate statement to make. 2. The nurse should query the young woman about what she felt. 3. Even though this statement is correct, it is inappropriate to dismiss the young woman so abruptly. 4. This is an inappropriate statement to make.

When analyzing the need for health teaching of a prenatal multigravida, the nurse should ask which of the following questions? 1. "What are the ages of your children?" 2. "What is your marital status?" 3. "Do you ever drink alcohol?" 4. "Do you have any allergies?

ANS 3 1. This is an important question, but it is not associated with health teaching. 2. This is an important question, but it is not associated with health teaching. 3. This question is important to ask to determine a prenatal client's health teaching needs. 4. This is an important question, but it is not associated with health teaching.

A client asks the nurse what was meant when the physician told her she had a positive Chadwick sign. Which of the following information about the finding would be appropriate for the nurse to convey at this time? 1. "It is a purplish stretch mark on your abdomen." 2. "It means that you are having heart palpitations." 3. "It is a bluish coloration of your cervix and vagina." 4. "It means the doctor heard abnormal sounds when you breathed in."

ANS 3 1. purplish stretch marks are called abdominal striae 2. Chadwick sign is not related to the heartmuscle. 3. A positive Chadwick sign means that the client's cervix and vagina are a bluish color. It is a probable sign of pregnancy. 4. Chadwick sign is not related to the respiratory system.

A nurse is advising a pregnant woman about the danger signs of pregnancy. The nurse should teach the mother that she should notify the physician immediately if she experiences which of the following signs/symptoms? Select all that apply. 1. Convulsions. 2. Double vision. 3. Epigastric pain. 4. Persistent vomiting. 5. Polyuria.

1, 2, 3, & 4 1. Convulsions are a danger sign of pregnancy. 2. Double vision is a danger sign of pregnancy. 3. Epigastric pain is a danger sign of pregnancy. 4. Persistent vomiting is a danger sign of pregnancy. 5. Although polyuria may be a sign of diabetes or another illness, it is not highlighted as a danger sign of pregnancy. TEST-TAKING TIP: The danger signs of pregnancy are signs or symptoms that can occur in an otherwise healthy pregnancy that are likely due to serious pregnancy complications. For example, double vision, epigastric pain, and blurred vision are symptoms of the hypertensive illnesses of pregnancy, and persistent vomiting is a symptom of hyperemesis gravidarum.

The nurse is assessing the laboratory report of a 40-week gestation client. Which of the following values would the nurse expect to find elevated above prepregnancy levels? Select all that apply. 1. Glucose. 2. Fibrinogen. 3. Hematocrit. 4. Bilirubin. 5. White blood cells.

2 & 5 1. Glucose levels should be within normal limits. 2. Fibrinogen levels will be elevated slightly in a 40-week pregnant woman because coagulation factors like fibrinogen increase to help prevent excessive blood loss during delivery. 3. Hematocrit levels are usually slightly lower. 4. Bilirubin levels should be within normal limits. 5. A 40-week pregnant woman's white blood cell count will be elevated above normal as a means of protecting her body from infection.

A 36-week gestation gravid lies flat on her back. Which of the following maternal signs/symptoms would the nurse expect to observe? 1. Hypertension. 2. Dizziness. 3. Rales. 4. Chloasma.

ANS 2 1. The nurse would expect to note hypotension rather than hypertension. 2. Dizziness is an expected finding. 3. The nurse would expect to see dyspnea, not rales. 4. The nurse would not expect to see any skin changes. TEST-TAKING TIP: Because the weight of the gravid uterus compresses the great vessels, the nurse would expect the client to become hypotensive and to complain of dizziness when lying supine. In addition, the fetal heart rate may drop. The blood supply to the head and other parts of the body, including the placenta, is diminished when the great vessels are compressed.