Module #1- Davis Practice Q's
A pregnant client is lactose intolerant. Which of the following foods could this woman consume to meet her calcium needs? 1. Turnip greens. 2. Green beans. 3. Cantaloupe. 4. Nectarines.
1.
A gravid woman who recently emigrated from mainland China is being seen at her first prenatal visit. She was never vaccinated in her home country. An injection to prevent which of the following communicable diseases should be administered to the woman during her pregnancy? 1. Influenza. 2. Mumps. 3. Rubella. 4. Varicella.
1.
A woman is planning to become pregnant. Which of the following actions should she be counseled to take before stopping 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
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.
2. at the end of the third trimester and through to early post-partum period, a normal leukocytosis is seen =protects woman's body from invasion of pathogens during the birth process =should rely on temp elevation to determine whether or not woman has an infection
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's.
4.
A client informs the nurse that she is "very constipated." Which of the following foods would be best for the nurse to recommend to the client? 1. Pasta. 2. Rice. 3. Yogurt. 4. Celery.
4. high fiber foods -progesterone, a muscle relaxant, is responsible for slowing of the digestive system
A 20-week gestation client is being seen in the prenatal clinic. Place an "X" on the place on the abdomen where the nurse would expect the fundal height to be felt.
at the umbilicus -at 28 weeks, felt between umbilicus and xiphoid -at 36, at xiphoid process
A mother is experiencing nausea and vomiting every afternoon. The ingestion of which of the following spices has been shown to be a safe complementary therapy for this complaint? 1. Ginger. 2. Sage. 3. Cloves. 4. Nutmeg.
1.
Which finding would the nurse view as normal when evaluating the laboratory reports of a 34-week gestation client? 1. Anemia. 2. Thrombocytopenia. 3. Polycythemia. 4. Hyperbilirubinemia.
1. by the end of the second trimester, the blood supply increases by approximately 50% > necessary for client to perfuse placenta -concurrent increase in RBC production, but vast majority are unable to produce RBC in sufficient numbers to keep pace with increase in blood volume > physiological anemia of pregnancy
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.
1. clients with ptyalism should be viligant in care of their teeth and gums =often accompanied by gingivitis and n/v -ptyalism is related to increase in vascular congestion of mucous membranes from increased estrogen production -because of caustic effects of gastric juices on enamel of teeth, inflammation seen in gums, and increased salivation, it is essential that pregnant woman take special care of their teeth during pregnancy
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
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 -fibrinogen levels will be slightly elevated in a 40 week pregnant woman because coagulation factors like fibrinogen increase to help prevent excessive blood loss during delivery -40 week pregnant woman's WBC will be elevated as a means of protecting her body from infection
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.
2.
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 be admitted. 4. Teach the woman exercises to evert her nipples.
2.
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.
Which of the following choices can the nurse teach a prenatal client is equivalent to one 2 oz protein serving? 1. 4 tbsp peanut butter. 2. 2 eggs. 3. 1 cup cooked lima beans. 4. 2 ounces mixed nuts.
2.
A mother has just experienced quickening. Which of the following developmental changes would the nurse expect to occur at the same time in the woman's pregnancy? 1. Fetal heart begins to beat. 2. Lanugo covers the fetal body. 3. Kidneys secrete urine. 4. Fingernails begin to form.
2. lanugo covers the body around 20 weeks gestation -quickening is detected 16-20 weeks -fetal heart beat begins during first trimester -kidneys secrete urine about week 12 -fingernails begin to form about week 10
A 36-week gestation gravid client is complaining of dyspnea when lying flat. Which of the following is the likely clinical reason for this complaint? 1. Maternal hypertension. 2. Fundal height. 3. Hydramnios. 4. Congestive heart failure.
2. at 36 weeks, the fundus is at the xiphoid process > diaphragm elevated, lungs displaced -should elevate the head of bed/ use multiple pillows
Which of the following skin changes should the nurse highlight for a pregnant woman's health care practitioner? 1. Linea nigra. 2. Melasma. 3. Petechiae. 4. Spider nevi.
3. seen in hemorrhagic conditions -usually related to pathological condition, such as thrombocytopenia =normal skin changes- linea nigra, melasma, hyperpigmentation of areolae
The partner of a gravida accompanies her to her prenatal appointment. The nurse notes that the father of the baby has gained weight since she last saw him. Which of the following comments is most appropriate for the nurse to make to the father? 1. "I see that you are gaining weight right along with your partner." 2. "You and your partner will be able to go on a diet together after the baby is born." 3. "I can see that you are a bad influence on your partner's eating habits." 4. "I am so glad to see that you are taking so much interest in your partner's pregnancy."
4. -exhibiting a sign of couvade syndrome
A 12-week gestation client tells the nurse that she and her husband eat sushi at least once per week. She states, "I know that fish is good for me, so I make sure we eat it regularly." Which of the following responses by the nurse is appropriate? 1. "You are correct. Fish is very healthy for you." 2. "You can eat fish, but sushi is too salty to eat during pregnancy." 3. "Sushi is raw. Raw fish is especially high in mercury." 4. "It is recommended that fish be cooked to destroy harmful bacteria."
4. -fish should only be eaten well cooked to avoid ingestion of pathogens -consume 8-12 oz of seafood per week- to prevent potential consumption of toxic levels of methylmercury
A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2012. Using Nagele's rule, the nurse calculates the client's estimated date of delivery as: 1. May 30, 2013. 2. June 20, 2013. 3. June 27, 2013. 4. July 3, 2013.
3.
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.
3.
A client asks the nurse what was meant when the physician told her she had a positive Chadwick's 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."
3. -bluish color is due to increase in vascularization of the area in response to high levels of circulating estrogen in the pregnant woman's system
An ultrasound of a fetus's heart shows that normal fetal circulation is occurring. Which of the following statements should the nurse interpret as correct in relation to the fetal circulation? 1. The foramen ovale is a hole between the ventricles. 2. The umbilical vein contains oxygen-poor blood. 3. The right atrium contains both oxygen-rich and oxygen-poor blood. 4. The ductus venosus lies between the aorta and pulmonary artery.
3. blood bypasses the lungs since the baby is receiving oxygen-rich blood directly from the placenta via the umbilical vein -ductus venosus, foramen ovale, ductus arteriosus- enable the blood to bypass the lungs
A client asks the nurse, "Could you explain how the baby's blood and my blood separate at delivery?" Which of the following responses is appropriate for the nurse to make? 1. "When the placenta is born, the circulatory systems separate." 2. "When the doctor clamps the cord, the blood stops mixing." 3. "The separation happens after the baby takes the first breath. The baby's oxygen no longer has to come from you." 4. "The blood actually never mixes. Your blood supply and the baby's blood supply are completely separate."
4. -maternal portion of the placenta and fetal portion of placenta -by the time the placenta fully functions, at about 12 weeks' gestation, fetal blood vessels have burrowed into the decidual lining and maternal vessels have burrowed into the chorinoic liayer =vessels lie next to each other -gases and nutrients move across the membranes of the vessels to provide the baby with needed substances and for the mother to dispose of waste products
A pregnant woman must have a glucose challenge test (GCT). Which of the following should be included in the preprocedure teaching? 1. Fast for 12 hours before the test. 2. Bring a urine specimen to the laboratory on the day of the test. 3. Be prepared to have 4 blood specimens taken on the day of the test. 4. The test should take one hour to complete.
4. -the GCT is done at 24 weeks gestation to assess the client's ability to metabolize glucose -1 hour, nonfasting screening test =after a client consumes 50 g of a concentrated glucose solution, a serum glucose level is done =130+ mg/ dL- referred for a 3 hr GTT to determine gestational diabetes
The nurse is teaching a couple about fetal development. Which statement by the nurse is correct about the morula stage of development? 1. "The fertilized egg has yet to implant into the uterus." 2. "The lung fields are finally completely formed." 3. "The sex of the fetus can be clearly identified." 4. "The eyelids are unfused and begin to open and close."
1. -in the morula stage, about 2-4 days after fertilization, the fertilized egg has not yet implanted in the uterus -morula is the undifferentiated ball of cells that migrate down the fallopian tube toward the uterine body =lasts from 2nd to 4th day after fertilization
The nurse is caring for a pregnant client who is a vegan. Which of the following foods should the nurse suggest the client consume as substitutes for restricted foods? 1. Tofu, legumes, broccoli. 2. Corn, yams, green beans. 3. Potatoes, parsnips, turnips. 4. Cheese, yogurt, fish.
1. -sources of protein and iron
Which of the following developmental features would the nurse expect to be absent in a 41-week gestation fetus? 1. Fingernails. 2. Eyelashes. 3. Lanugo. 4. Milia.
3. because this baby is post-term, lanugo would not be present -lanugo is fine hair that covers the body of the fetus -disappears at 38 weeks, completely vanishes at 41 weeks
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
An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? Select all that apply. 1. Amenorrhea. 2. Breast tenderness. 3. Quickening. 4. Frequent urination. 5. Uterine growth.
1, 2, 3, 4 -presumptive- subjective -probable- objective
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."
1, 2, 3
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
A woman has just completed her first trimester. Which of the following fetal structures can the nurse tell the woman are well formed at this time? Select all that apply. 1. Genitals. 2. Heart. 3. Fingers. 4. Alveoli. 5. Kidneys.
1, 2, 3, 5 -genitals formed at the of first trimester -heart formed by end of first trimester -fingers formed by end of first trimester -kidneys formed by end of first trimester
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/ mm2. 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, 2, 4 1. underweight 2. non-immune to rubella. If exposed, she is at risk of developing the disease 4. Because a woman is at high risk for developing anemia during pregnancy, it is important to identify any woman who enters her pregnancy with a below normal hematocrit
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
A gravida, G1 P0000, 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 challenge test. 4. Biophysical profile. 5. Complete blood count.
1, 5 -At the first prenatal visit, pregnant clients will undergo complete OB and medical PA to provide the HCP with baseline data
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.
A nurse, who is providing nutrition counseling to a new gravid client, advises the woman that a serving of meat is approximately equal in size to which of the following items? 1. Deck of cards. 2. Paperback book. 3. Clenched fist. 4. Large tomato.
1.
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.
1.
During a preconception counseling session, the nurse encourages a couple to prepare a birth plan. Which of the following is the most important goal for this action? 1. Promote communication between the couple and health care professionals. 2. Enable the couple to learn about the types of pain medicine used in labor. 3. Provide the couple with a list of items that they should take to the hospital for the labor and delivery. 4. Give the high-risk couple a sense of control over the likelihood of having a surgical delivery.
1.
A nurse is discussing the serving sizes in the grain food group with a new prenatal client. Which of the following foods equals 1 ounce serving size from the grain group? Select all that apply. 1. 1 bagel. 2. 1 slice of bread. 3. 1 cup cooked pasta. 4. 1 tortilla. 5. 1 cup dry cereal.
2, 4, 5
The nurse is reading an article that states that the maternal mortality rate in the United States in the year 2000 was 17. Which of the following statements would be an accurate interpretation of the statement? 1. There were 17 maternal deaths in the United States in 2,000 per 100,000 live births. 2. There were 17 maternal deaths in the United States in 2,000 per 100,000 women of childbearing age. 3. There were 17 maternal deaths in the United States in 2,000 per 100,000 pregnancies. 4. There were 17 maternal deaths in the United States in 2,000 per 100,000 women in the country.
1.
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's sign. 4. Montgomery gland enlargements.
1.
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.
Why is it essential that women of childbearing age be counseled to plan their pregnancies? 1. Much of the organogenesis occurs before the missed menstrual period. 2. Insurance companies must preapprove many prenatal care expenditures. 3. It is recommended that women be pregnant no more than 3 times during their lifetime. 4. The cardiovascular system is stressed when pregnancies are less than 2 years apart.
1.
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.
1. -top of fundus is at level of symphisus at end of first trimester
A client enters the prenatal clinic. She states that she believes she is pregnant. Which of the following hormone elevations will indicate a high probability that the client is pregnant? 1. Chorionic gonadotropin. 2. Oxytocin. 3. Prolactin. 4. Luteinizing hormone.
1. HCG is produced by the fertilized egg -presence in the bloodstream signals the body to keep the corpus luteum alive -until the placenta takes over the function of producing progesterone and estrogen, the corpus luteum produces the hormones that are essential to maintain pregnancy
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.
1. -antique houses contain lead-based paint and water piping that has been soldered with lead-based sodler -lead, when ingested through respiratory or GI tract can cause permanent damage to the CNS of the unbonrn child
A woman states that she frequently awakens with "painful leg cramps" during the night. Which of the following assessments should the nurse make? 1. Dietary evaluation. 2. Goodell's sign. 3. Hegar's sign. 4. Posture evaluation.
1. -leg cramps can occur as a result of low Ca and/or high phosphorus
Which of the following vital sign changes should the nurse highlight for a pregnant woman's obstetrician? 1. Prepregnancy blood pressure (BP) 100/60 and third trimester BP 140/90. 2. Prepregnancy respiratory rate (RR) 16 rpm and third trimester RR 22 rpm. 3. Prepregnancy heart rate (HR) 76 bpm and third trimester HR 88 bpm. 4. Prepregnancy temperature (T) 98.6oF and third trimester T 99.2oF.
1. BP should not elevate during pregnancy -BMR increases during pregnancy =RR 20-24 rpm -high levels of progesterone > decreased contractility of smooth muscles throughout body > increased pulse -progesterone is thermogenic > slight rise in body's temp
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's syndrome. 4. The woman diagnosed with myasthenia gravis.
1. PKU is a genetic disease characterized by absence of 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 nurse is discussing diet with a pregnant woman. Which of the following foods should the nurse advise the client to avoid consuming during her pregnancy? 1. Bologna. 2. Cantaloupe. 3. Asparagus. 4. Popcorn.
1. because pregnant women are slightly immunocompromised, they are susceptible to certain disease -deli metas, unless heated to steaming hot, can cause listeriosis > pregnant women should avoid these foods
A gravida's fundal height is noted to be at the xiphoid process. The nurse is aware that which of the following fetal changes is likely to be occurring at the same time in the pregnancy? 1. Surfactant is formed in the fetal lungs. 2. Eyes begin to open and close. 3. Respiratory movements begin. 4. Spinal column is completely formed.
1. surfactant formed in fetal lungs by 36th week -xiphoid process- fundal height at 36 weeks -spinal column- end of first trimester -fetal resp movements- 24 weeks -eyes open/ close- 28 weeks -babies born preterm are high risk for a number of reasons- lack of surfactant, lack of iron stores, lack of brown adipose tissue for thermoregulation
The nurse is assisting a couple to develop decisions for their birth plan. Which of the following decisions should be considered nonnegotiable by the parents? 1. Whether or not the father will be present during labor. 2. Whether or not the woman will have an episiotomy. 3. Whether or not the woman will be able to have an epidural. 4. Whether or not the father will be able to take pictures of the delivery.
1. the presence of a father at delivery should be nonnegotiable
The nurse asks a woman about how the woman's husband is dealing with the pregnancy. The nurse concludes that counseling is needed when the woman makes which of the following statements? 1. "My husband is ready for the pregnancy to end so that we can have sex again." 2. "My husband has gained quite a bit of weight during this pregnancy." 3. "My husband seems more worried about our finances now than before the pregnancy." 4. "My husband plays his favorite music for my belly so the baby will learn to like it."
1. there is no need to refrain from sexual interourse during a normal pregnancy
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
A woman asks the nurse about the function of amniotic fluid. Which of the following statements by the woman indicates that the teaching was successful? Select all that apply. 1. The fluid provides fetal nutrition. 2. The fluid cushions the fetus from injury. 3. The fluid enables the fetus to grow. 4. The fluid provides the fetus with a stable thermal environment. 5. The fluid enables the fetus to practice swallowing.
2, 3, 4, 5 -umbilical cord delivers nutrition to the developing fetus -baby practices breathing the amniotic fluid in and out of lungs in prep for breathing air and drinks the amniotic fluid in prep for extrauterine feeding
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 -During the first trimester, the embryo is developing, hormones are increasing, and maternal blood supply is increasing. To accomplish each of these tasks, the body uses energy -The mother is fatigued because not only is the body undergoing great change, but the thyroid gland has not caught up with increasing energy demands -Organs are confined within the bony pelvis, the enlarging uterus prevents the bladder from expanding with large quantities of urine > urinary frequency
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 the primigravid women to not feel movement until 19-20 weeks gestation; primigravidas often feel fetal movement later than multigravidas *2. the fundal height at 24 weeks should be 4 cm above the umbilicus; the fundal height at the umbilicus is expected at 20 weeks gestation 3. excessive salivation (ptyalism) is an expected finding in pregnancy *4. women may be going into preterm labor 5. hermorrhoids are commonly seen in pregnant woman
A woman, 26-weeks' gestation, calls the triage nurse stating, "I'm really scared. I tried not to but I had an orgasm when we were making love. I just know that I will go into preterm labor now." Which of the following responses by the nurse is appropriate? 1. "Lie down and drink a quart of water. If you feel any back pressure at all call me back right away." 2. "Although oxytocin was responsible for your orgasm, it is very unlikely that it will stimulate preterm labor." 3. "I will inform the doctor for you. What I want you to do is to come to the hospital right now to be checked." 4. "The best thing for you to do right now is to take a warm shower, and then do a fetal kick count assessment."
2.
It is discovered that a pregnant woman practices pica. Which of the following complications is most often associated with this behavior? 1. Hypothyroidism. 2. Iron-deficiency anemia. 3. Hypercalcemia. 4. Overexposure to zinc.
2.
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.
2.
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.
A woman who is seen in the prenatal clinic is found to be 8 weeks pregnant. She confides to the nurse that she is afraid her baby may be "permanently damaged because I had at least 5 beers the night I had sex." Which of the following responses by the nurse would be appropriate? 1. "I would let the doctor know that if I were you." 2. "It is unlikely that the baby was affected." 3. "Abortions during the first trimester are very safe." 4. "An ultrasound will tell you if the baby was affected."
2. -2 week period between ovulation and implantation is called the all or nothing period =fertilized egg/ embryo is floating freely in the woman's fallopian tubes toward the uterine body =mother is not supplying embryo with nutrients at this time -embryo is self-sufficeint =if insult occurs, embryo is destroyed or completely spared =since woman is found to be pregnant, nurse can assure embryo was spared
A woman tells the nurse that she would like suggestions for alternate vitamin C sources because she isn't very fond of citrus fruits. Which of the following suggestions is appropriate? 1. Barley and brown rice. 2. Strawberries and potatoes. 3. Buckwheat and lentils. 4. Wheat flour and figs.
2. -also zucchini, blueberries, kiwi, green beans, green peas, and the like
A client enters the prenatal clinic. She states that she missed her period yesterday and used a home pregnancy test this morning. She states that the results were negative, but "I still think I am pregnant." Which of the following statements would be appropriate for the nurse to make at this time? 1. "Your period is probably just irregular." 2. "We could do a blood test to check." 3. "Home pregnancy test results are very accurate." 4. "My recommendation would be to repeat the test in one week."
2. -because quantitative pregnancy tests measure the exact quantity of human chorionic gonadotropin in the bloodstream, they are more accurate than urine tests that simply measure whether or not the hormone is present in the urine
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.
2. -because the weight of the gravid uterus compresses the great vessels, the nurse would expect the client to complain of dizziness when lying supine =blood supply to the head and other parts of the body is diminished when great vessels are compressed
An 18-week gestation client telephones the obstetrician's office stating, "I'm really scared. I think I have breast cancer. My breasts are filled with tumors." The nurse should base the response on which of the following? 1. Breast cancer is often triggered by pregnancy. 2. Nodular breast tissue is normal during pregnancy. 3. The woman is exhibiting signs of a psychotic break. 4. Anxiety attacks are especially common in the second trimester.
2. -high levels of estrogen seen in pregnancy result in a number of changes > hypertrophy, hyperplasia of breast tissue in prep for neonatal lactation
A woman is carrying dizygotic twins. She asks the nurse about the babies. Which of the following explanations is accurate? 1. During a period of rapid growth, the fertilized egg divided completely. 2. When the woman ovulated, she expelled two mature ova. 3. The babies share one placenta and a common chorion. 4. The babies will definitely be the same sex and have the same blood type.
2. -monozygotic- originate from one fertilized ovum =babies have same DNA and same sex =share placenta and chorion -dizygotic- arise from 2 separately fertilized eggs =genetic relationship is the same as if they were siblings born from different pregnancies
A 16-year-old, G1 P0000, 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?"
2. -quickening occurs between 16-20 weeks -it would be impossible to feel movement at 10 weeks- should elicit more information from the teen to determine what she felt
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 cervix is long the thick to retain pregnancy in the uterine cavity -the cervical mucus is thin and the vaginal wall is bluish in color as a result -the ovary is enlarged because the corpus luteum is still functioning
A client states that she is a strong believer in vitamin supplements to maintain her health. The nurse advises the woman that it is recommended to refrain from consuming excess quantities of which of the following vitamins during pregnancy? 1. Vitamin C. 2. Vitamin D. 3. Vitamin B2 (niacin). 4. Vitamin B12 (cobalamin).
2. -water soluble vitamins, if consumed in large quantities, have not been shown to be harmful during pregnancy bc body can eliminate them -fat soluble vitamins (A, D, E, K) can build up in the body- vitamin A and D have been shown to be teratogenic in megadoses
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.
2. At this stage of pregnancy, expected to gain 0.8-1 lb a week
A woman confides in the nurse that she practices pica. Which of the following alternatives could the nurse suggest to the woman? 1. Replace laundry starch with salt. 2. Replace ice with frozen fruit juice. 3. Replace soap with cream cheese. 4. Replace soil with uncooked pie crust.
2. fruit juice, although high in sugar, contains vitamins
The nurse is caring for a prenatal client who states she is prone to developing anemia. Which of the following foods should the nurse advise the gravida is the best source of iron? 1. Raisins. 2. Hamburger. 3. Broccoli. 4. Molasses.
2. iron is present in animal sources- seafood, meats, eggs
A woman delivers a fetal demise that has lanugo covering the entire body, nails that are present on the fingers and toes, but eyes that are still fused. Prior to the death, the mother stated that she had felt quickening. Based on this information, the nurse knows that the baby is about how many weeks' gestation? 1. 15 weeks. 2. 22 weeks. 3. 29 weeks. 4. 36 weeks.
2. nails start to develop in first trimester, lanugo starts to develop 20 weeks, eyes remain fused until 29 weeks -quickening occurs by week 20
Below are four important landmarks of fetal development. Please place them in chronological order: 1. Four-chambered heart is formed. 2. Vernix caseosa is present. 3. Blastocyst development is complete. 4. Testes have descended into the scrotal sac.
3, 1, 2, 4 -blastocyst is developed 6 days after fertilization and before implantation in the uterus has occurred -4 chambered heart is formed during early part of first trimester -vernix caseosa is present during latter half of pregnancy -testes descend in scrotal sac about mid third trimester
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."
3.
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.
A nurse is providing diet counseling to a new prenatal client. Which of the following dairy products should the client be advised to avoid eating during the pregnancy? 1. Vanilla yogurt. 2. Parmesan cheese. 3. Gorgonzola cheese. 4. Chocolate milk.
3. -Gorgonzola is a soft cheese > harbor Listeria -pregnant woman are at high risk of developing this infection because they are slightly immunocompromised
When assessing the fruit intake of a pregnant client, the nurse notes that the client usually eats 1 piece of fruit per day and drinks a 12 oz glass of fruit juice per day. Which of the following is the most important communication for the nurse to make? 1. "You are effectively meeting your daily fruit requirements." 2. "Fruit juices are excellent sources of folic acid." 3. "It would be even better if you were to consume more whole fruits and less fruit juice." 4. "Your fruit intake far exceeds the recommended daily fruit intake."
3. -benefit of fiber from whole fruits as opposed to added sugar in fruit juice
The glucose challenge screening test is performed at or after 24 weeks' gestation to assess for the maternal physiological response to which of the following pregnancy hormones? 1. Estrogen. 2. Progesterone. 3. Human placental lactogen. 4. Human chorionic gonadotropin.
3. -hPL is an insulin antagonist =produced by the placenta- as the placenta grows, the hormone levels rise -at 24 weeks gestation, the levels are high enough to affect glucose metabolism -if performed earlier, the GCT test may result in a false negative test
A woman provides the nurse with the following obstetrical history: Delivered a son, now 7 years old, at 28 weeks' gestation; delivered a daughter, now 5 years old, at 39 weeks' gestation; had a miscarriage 3 years ago, and had a first-trimester abortion 2 years ago. She is currently pregnant. Which of the following portrays an accurate picture of this woman's gravidity and parity? 1. G4 P2121. 2. G4 P1212. 3. G5 P1122. 4. G5 P2211.
3. -miscarriage counts as an abortion
A nurse midwife has advised a 39-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 a prostaglandin substance in the body > prostaglandins are responsible for readying the cervix for dilation
A woman is 36 weeks' gestation. Which of the following tests will be done during her prenatal visit? 1. Glucose challenge test. 2. Amniotic fluid volume assessment. 3. Vaginal and rectal cultures. 4. Karyotype analysis.
3. done at 36 weeks gestation -to assess for group B streptococcal (GBS) bacteria =if present, will be given IV antibiotics during labor to prevent vertical transmission to her baby at birth
A 34-week gestation woman calls the obstetric office stating, "Since last night I have had three nosebleeds." Which of the following responses by the nurse is appropriate? 1. "You should see the doctor to make sure you are not becoming severely anemic." 2. "Do you have a temperature?" 3. "One of the hormones of pregnancy makes the nasal passages prone to bleeds." 4. "Do you use any inhaled drugs?"
3. hormonal changes in pregnancy makes the nasal passages prone to bleeds -estrogen promotes vasocongestion of the mucous membranes of the body =increased vascular perfusion of the mucous membranes of the gyn system is essential for the developing fetus to survive =vasocongestion occurs in al mucous membranes of the body, leading to complaints of nosebleed and gingival bleeding
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?"
3. to determine a prenatal client's health teaching needs
The nurse discusses sexual intimacy with a pregnant couple. Which of the following should be included in the teaching plan? 1. Vaginal intercourse should cease by the beginning of the third trimester. 2. Breast fondling should be discouraged because of the potential for preterm labor. 3. The couple may find it necessary to experiment with alternate positions. 4. Vaginal lubricant should be used sparingly throughout the pregnancy.
3. with increasing size of the uterine body, the couple may need counseling regarding alternate options for sexual intimacy
A woman asks the nurse about consuming herbal supplements during pregnancy. Which of the following responses is appropriate? 1. Herbals are natural substances, so they are safely ingested during pregnancy. 2. It is safe to take licorice and cat's claw, but no other herbs are safe. 3. A federal commission has established the safety of herbals during pregnancy. 4. The woman should discuss everything she eats with a health care practitioner.
4.
The nurse takes the history of a client, G2 P1001, 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. -CP is not a genetic disease -CF is inherited via an autosomal recessive inheritance pattern
A client is 35 weeks' gestation. Which of the following findings would the nurse expect to see? 1. Nausea and vomiting. 2. Maternal ambivalence. 3. Fundal height 10 cm above the umbilicus. 4. Use of three pillows for sleep comfort.
4. -at 35 weeks, the fundus should be 15 cm above the umbilicus
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, it is risky to take medicine." 2. "You can take any of the over-the-counter medications because they are all safe in pregnancy." 3. "The physician will prescribe a category 'X' medication for you." 4. "You can take acetaminophen because it is a category 'B' medicine."
4. -category A and B medications are safe to take throughout pregnancy -category X- teratogenic
A client is having an ultrasound assessment done at her prenatal appointment at 8 weeks' gestation. She asks the nurse, "Can you tell what sex my baby is yet?" Which of the following responses would be appropriate for the nurse to make at this time? 1. "The technician did tell me the sex, but I will have to let the doctor tell you what it is." 2. "The organs are completely formed and present, but the baby is too small for them to be seen." 3. "The technician says that the baby has a penis. It looks like you are having a boy." 4. "I am sorry. It will not be possible to see which sex the baby is for another month or so."
4. -genitourinary system is the last organ system to fully develop -before 12 weeks, both female and male genitalia are present =sex is determined genetically, but not determined visually
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. 1. nausea- first trimester 2. dyspnea- third trimester 3. urinary frequency- first trimester, late third trimester ^baby is not large enough to cause these
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."
4. For first trimester, expected weight gain is 3-5 lbs for the entire first trimester and approximately 0.8-1 lb per week from weeks 13-40
A nurse has identified the following nursing diagnosis for a prenatal client: Altered nutrition: less than body requirements related to poor folic acid intake. Which of the following foods should the nurse suggest the client consume? 1. Potatoes and grapes. 2. Cranberries and squash. 3. Apples and corn. 4. Oranges and spinach.
4. high in folic acid
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. normal for colostrum to be expressed late in pregnancy -important for women not to pump their breasts -oxytocin, the hormone that promotes ejection of milk during lactation, is the hormone of labor =could stimulate uterus to contract
A vegan is being counseled regarding vitamin intake. It is essential that this woman supplement which of the following B vitamins? 1. B1 (thiamine). 2. B2 (niacin). 3. B6 (pyridoxine). 4. B12 (cobalamin).
4. vitamin B 12 if found in animal products > lack of B12 leads to anemia and nervous system disorders, also important for pregnancy (DNA synthesis)
