olds Maternity Ch. 11 13,14,

7) In early-pregnancy class, the nurse emphasizes the importance of 8-10 glasses of fluid per day. How many of these should be water? A) 1 to 2 B) 2 to 4 C) 4 to 6 D) 3 to 5

A) Answer: C Explanation: A) One to two glasses of water is not an adequate intake. B) Two to four glasses of water is not an adequate intake. C) A pregnant woman should consume at least 8 to 12 (8 oz) glasses of fluid each day, of which 4 to 6 glasses should be water. D) Three to five glasses of water is not an adequate intake.

19) The kosher diet followed by many Jewish people forbids the eating of what foods? A) Pig products and shellfish B) Dairy products C) All animal products D) Dairy products and eggs

A. A) The kosher diet followed by many Jewish people forbids the eating of pig products and shellfish. Certain cuts of meat from sheep and cattle are allowed, as are fish with fins and scales. In addition, many Jews believe that meat and dairy products should not be mixed or eaten at the same meal. B) Lacto-vegetarian diets include dairy products but no eggs. C) Vegans are strict vegetarians who will not eat any food from animal sources. Lacto-ovo-vegetarians include milk, dairy products, and eggs in their diet, but no meat

1) The nurse is assessing a pregnant client in the second trimester of pregnancy during a scheduled prenatal visit. Which questions are appropriate during the assessment process? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Do you feel bloated?" 2. "Do you have hemorrhoids?" 3. "Are you experiencing heartburn?" 4. "Are you experiencing constipation?" 5. "Are you experiencing nausea and vomiting?"

Answer: 1, 2, 3, 4 Explanation: Gastrointestinal symptoms that often occur during the second trimester of pregnancy include feeling bloated, the development of hemorrhoids, heartburn, and constipation. Nausea and vomiting are more common during the first trimester of pregnancy.

1) The nurse is preparing material to present to a group of patients in the second trimester of their pregnancies. Which topics should the nurse include in this presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Clothing 2. Infant feeding 3. Fetal movement 4. Exercise and rest 5. Skin and breast care

Answer: 1, 2, 3, 5 Explanation: Topics appropriate to teach patients in the second trimester of pregnancy include clothing, infant feeding, fetal movement, and skin and breast care. Exercise and rest are topics to be reviewed during the first and third trimesters

31) A patient asks if seafood is permitted during pregnancy. Which foods should the nurse encourage the patient to consume during this time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Shrimp 2. Catfish 3. Salmon 4. Swordfish 5. Canned light tuna

Answer: 1, 2, 3, 5 Explanation: Women who are pregnant or who may become pregnant, breastfeeding mothers, and young children should not eat swordfish, shark, tilefish, or king mackerel because these fish contain high levels of methyl mercury. Commonly eaten fish that are low in mercury include canned light tuna, shrimp, salmon, catfish, and pollack. Albacore (white) tuna has more mercury than canned light tuna; therefore, only 6 oz. / week of albacore tuna is recommended.

1) A patient in the first trimester of pregnancy is experiencing ptyalism. What should the nurse suggest to help this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use chewing gum 2. Suck on hard candy 3. Snack on soda crackers 4. Use an astringent mouthwash 5. Brush the teeth with baking soda

Answer: 1, 2, 4 Explanation: Ptyalism is a rare discomfort of pregnancy in which excessive, often bitter, saliva is produced. Its cause has not been established. Effective treatments are limited, however using astringent mouthwashes, chewing gum, or sucking on hard candy may minimize the problem. Many women also choose to carry tissues or a small towel to spit into when necessary. Soda crackers and brushing the teeth with baking soda are not identified as helpful with ptyalism.

1) A pregnant patient in the early stages of labor asks for assistance to sit in the whirlpool tub. What are the advantages of using this intervention for the laboring patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increases relaxation 2. Increases pain threshold 3. Reduces postural hypotension 4. Promotes maternal-infant bonding 5. Reduces the need for pain medication

Answer: 1, 2, 5 Explanation: The benefits of using a whirlpool tub during labor include increased relaxation, increased pain threshold, and reduced need for pain medication. The whirlpool tub will not reduce postural hypotension. Breastfeeding promotes maternal-infant bonding.

1) The nurse learns that a patient who is 8 weeks pregnant continues to smoke 10 cigarettes a day. In which order should the nurse provide a 5 to 15 minute intervention about smoking with this patient? 1. Ask about tobacco use 2. Advise to quit smoking 3. Assist in attempt to quit 4. Arrange for follow-up care 5. Assess willingness to quit

Answer: 1, 2, 5, 3, 4 Explanation: A C O G suggests that a 5- to 15-minute intervention with women who smoke fewer than 20 cigarettes a day is most effective. This program and other programs encourage healthcare providers to use the five As: ask about tobacco use; advise to quit smoking; assess willingness to quit; assist in attempt to quit; and arrange for follow-up care.

28) A patient who is 12 weeks pregnant is counseled to increase her protein intake by an additional 40 grams per day. If each gram of protein is 4 calories, how many additional calories per day should this patient ingest to reach the recommended 300 calories more per day during the pregnancy?

Answer: 140 calories Explanation: The additional protein provides 160 calories (40 grams × 4 = 160). If the total increase in daily calories is to be 300 calories, then subtract 160 calories for the extra protein from 300 or 300 — 160 = 140 calories.

28) Before becoming pregnant, a patient had a B M I of 28.5 and weighed 150 l b s. What should be the minimum weight of this patient upon delivery?

Answer: 165 l b s. Explanation: For a patient who is overweight, the total weight gain during pregnancy should be between 15 and 25 l b s. The minimum weight of this patient upon delivery should be 165 l b s.

30) The nurse is instructing a pregnant patient on the importance of increasing her dietary intake of vitamin E. Which foods should the nurse recommend to meet this dietary need? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Milk 2. Eggs 3. Liver 4. Green salads 5. Whole grain bread

Answer: 2, 4, 5 Explanation: Vitamin E is widely distributed in foodstuffs, especially vegetable fats and oils, whole grains, greens, and eggs. Milk and liver are good sources of vitamin A.

32) A breastfeeding mother is instructed to increase her daily caloric intake an additional 500 calories each day. If her daily intake of protein is 65 grams at 4 calories per gram, how many calories will this patient need to ingest to reach the recommended daily intake?

Answer: 240 calories Explanation: The amount of calories ingested with the protein is 65 grams × 4 calories or 260 calories. To reach the recommended daily caloric increase of 500 calories, subtract 260 from 500 or 500 — 260 = 240 calories.

1) A patient weighing 80 k g with a body mass index of 29.8 is 6 weeks pregnant. What should be this patient's maximum weight at the time of delivery?

Answer: 89 k g Explanation: Women who are obese are advised to limit weight gain to 5 to 9 k g (11 to 20 lb). Since the patient weighs 80 k g at 6 weeks pregnant, the maximum amount she should weigh would be 80 k g + 9 k g = 89 k g.

16) The nurse is planning an educational session for pregnant vegans. What information should the nurse include? A) Eating beans and rice provides complete protein needs. B) Soy is not a good source of protein for vegans. C) Rice contains a high level of vitamin B12. D) Vegan diets are excessively high in iron.

Answer: A Explanation: A) Adequate dietary protein can be obtained by consuming a varied diet with adequate caloric intake and plant-based proteins. Consuming an assortment of plant proteins throughout the day such as beans and rice, peanut butter on whole-grain bread, and whole-grain cereal with soy milk ensures that the expectant mother obtains all essential amino acids. B) Good sources of plant proteins include beans, soy products, lentils, nuts, and nut butters. C) Vitamin B12 is the cobalt-containing vitamin found only in animal sources. D) Supplementation may be recommended for vegans who have difficulty meeting the recommended amounts of iron through food sources.

13) A pregnant client who was of normal pre-pregnancy weight is now 30 weeks pregnant. She asks the nurse what appropriate weight gain for her should be. What is the nurse's best response? A) "25-35 pounds" B) "30-40 pounds" C) "17-18 pounds" D) "Less than 15 pounds"

Answer: A Explanation: A) An appropriate weight gain for a woman of normal weight before pregnancy would be 25-35 pounds. B) This is not the correct range for woman of normal weight before pregnancy. C) This is not the correct range for woman of normal weight before pregnancy. D) A woman of normal weight before pregnancy should gain more than 15 pounds by 30 weeks.

1) The nurse has completed a community presentation about the changes of pregnancy, and knows that the lesson was successful when a community member states that which of the following is one probable or objective change of pregnancy? A) "Enlargement of the uterus" B) "Hearing the baby's heart rate" C) "Increased urinary frequency" D) "Nausea and vomiting"

Answer: A Explanation: A) An examiner can perceive the objective (probable) changes that occur in pregnancy. Enlargement of the uterus is a probable change. B) Hearing the fetal heart rate is a diagnostic, or positive, change of pregnancy. C) Increased urinary frequency is a subjective, or presumptive, change of pregnancy. D) Nausea and vomiting are subjective, or presumptive, changes of pregnancy.

22) Which statement is best to include when teaching a pregnant adolescent about her nutritional needs in pregnancy? A) "It is important to eat iron-rich foods like meat every day." B) "Calcium and milk aren't needed until the third trimester." C) "Folic acid intake is the key to having a healthy baby." D) "You just need to pay attention to what you eat now."

Answer: A Explanation: A) An inadequate iron intake is a major concern with the adolescent diet. Iron needs are high for the pregnant teen because of the requirement for iron by the enlarging maternal muscle mass and blood volume. Giving specific examples is helpful when giving nutritional information. B) Calcium is needed throughout pregnancy, and should be consumed daily. C) Although folic acid is important during pregnancy to prevent neural tube defects, and for lactation, there is no single nutritional element responsible for having a healthy baby. D) This response is too vague to be helpful. Adolescents will need specific information to improve nutrition during pregnancy.

5) The nurse is presenting a preconception counseling class. The nurse instructs the participants that niacin intake should increase during pregnancy to promote metabolic coenzyme activity. The nurse will know that teaching has been effective if a client suggests which food as a source of niacin? A) Fish B) Apples C) Broccoli D) Milk

Answer: A Explanation: A) Dietary sources of niacin include meats, fish, and whole grains. B) Apples are a source of other vitamins; however, they do not contain significant niacin. C) Broccoli is a source of other vitamins; however, it does not contain significant niacin. D) Milk is a source of other vitamins; however, it does not contain significant niacin.

1) A 38-year-old client in her second trimester states a desire to begin an exercise program to decrease her fatigue. What is the most appropriate nursing response? A) "Fatigue should resolve in the second trimester, but walking daily might help." B) "Avoid a strenuous exercise regimen at your age. Drink coffee to combat fatigue." C) "Avoid an exercise regimen due to your pregnancy. Try to nap daily." D) "Fatigue will increase as pregnancy progresses, but running daily might help."

Answer: A Explanation: A) Even mild to moderate exercise is beneficial during pregnancy. Regular exercise-at least 30 minutes of moderate exercise daily or at least most days of the week-is preferred. B) The age of 38 is not too old to begin an exercise routine. Nurses should advise women of common sources of caffeine, including coffee, tea, colas, and chocolate and suggest they limit their caffeine intake to about 300 m g/day. C) Mild to moderate exercise is beneficial during pregnancy. Scheduling activities to allow for napping is helpful. D) Jogging or running is acceptable for women already conditioned to these activities, as long as they avoid exercising at maximum effort and overheating.

15) The prenatal clinic nurse is caring for a 15-year-old client who is at 8 weeks' gestation. The client asks the nurse why she is supposed to gain so much weight. What is the best response by the nurse? A) "Gaining 25-35 pounds is recommended for healthy fetal growth." B) "It's what your certified nurse-midwife recommended for you." C) "Inadequate weight gain delays lactation after delivery." D) "Weight gain is important to ensure that you get enough vitamins."

Answer: A Explanation: A) For an appropriate-weight woman, 25-35 pounds of weight gain is recommended for optimal fetal growth and development. B) Although this statement might be true, the client has asked a "why" question that should be directly answered. C) Inadequate weight gain can lead to decreased fetal growth and development. D) Vitamin intake is related to the types of food consumed, not to caloric intake. Because this client is 15, her diet may not be optimal from a nutritional standpoint.

25) The nurse is preparing a prenatal class about infant feeding methods. The maternal nutritional requirements for breastfeeding and formula-feeding will be discussed. What statement should the nurse include? A) "Breastfeeding requires a continued high intake of protein and calcium." B) "Formula-feeding mothers should protect their health with a lot of calcium." C) "Producing breast milk requires calories, but any source of food is fine." D) "Formula-feeding mothers need a high protein intake to avoid fatigue."

Answer: A Explanation: A) Lactation requires calories, along with increased protein and calcium intake. B) Formula-feeding mothers do not need additional nutrients. C) Although any food source would provide the additional calories, an adequate protein intake is essential while breastfeeding because protein is an important component of breast milk and calcium is an important nutrient in milk production, and increases over non-pregnancy needs are expected. D) Formula-feeding moms do not need additional nutrients.

1) The primiparous client has told the nurse that she is afraid she will develop hemorrhoids during pregnancy because her mother did. Which statement would be best for the nurse to make? A) "It is not unusual for women to develop hemorrhoids during pregnancy." B) "Most women don't have any problem until after they've delivered." C) "If your mother had hemorrhoids, you will get them, too." D) "If you get hemorrhoids, you probably will need surgery to get rid of them."

Answer: A Explanation: A) Many pregnant women will develop hemorrhoids. Hemorrhoids are varicosities of the veins in the lower end of the rectum and anus. During pregnancy, the gravid uterus presses on the veins and interferes with venous circulation. As the pregnancy progresses, the straining that accompanies constipation can contribute to the development of hemorrhoids. B) It is not true that most women have no hemorrhoids until after the birth. Many women develop hemorrhoids during pregnancy. C) A family history does not automatically mean that a client will develop the condition. D) Hemorrhoids that occur in pregnancy or at birth usually become asymptomatic after the early postpartum period.

1) A Navajo client who is 36 weeks pregnant meets with a traditional healer as well as her physician. What does the nurse understand this to mean? A) The client is seeking spiritual direction. B) The client does not trust her physician. C) The client will not adapt well to mothering. D) The client is experiencing complications of pregnancy.

Answer: A Explanation: A) Navajo clients are aware of the mind-soul connection, and might try to follow certain practices to have a healthy pregnancy and birth. Practices could include focus on peace and positive thoughts as well as certain types of prayers and ceremonies. A traditional healer may assist them. B) Seeing a traditional healer does not indicate mistrust of the provider. C) Seeking a spiritual healer does not indicate the client's lack of parenting ability. D) Seeking a spiritual healer does not indicate any type of pathology or complications.

1) The introduction of a new baby into the family is often the beginning of which of the following? A) Sibling rivalry B) Inconsistent childrearing C) Toilet training D) Weaning

Answer: A Explanation: A) Sibling rivalry results from children's fear of change in the security of their relationships with their parents, which comes with the birth of a sibling. B) Consistency is important in dealing with young children. They need reassurance that certain people, special things, and familiar places will continue to exist after the new baby arrives. C) Parents should know that the older, toilet-trained child may regress to wetting or soiling because he or she sees the new baby getting attention for such behavior. D) The older, weaned child may want to drink from the breast or bottle again after the new baby comes.

1) After teaching a pregnant client about the effects of smoking on pregnancy, the nurse knows that the client needs further education when she makes which statement? A) "I am at increased risk for preeclampsia." B) "I am at increased risk for preterm birth." C) "I am at increased risk for placenta previa." D) "I am at increased risk for abruptio placentae."

Answer: A Explanation: A) Smoking is not associated with increased risk for preeclampsia. B) Smoking is associated with increased risk for preterm birth. C) Smoking is associated with increased risk for placenta previa. D) Smoking is associated with increased risk for abruptio placentae.

1) The nurse notes purplish stretch marks on the pregnant client's breasts during the physical assessment. Which term will the nurse use when documenting this finding in the medical record? A) Striae B) Colostrum C) Linea nigra D) Chadwick's sign

Answer: A Explanation: A) Striae is the term used to document the purplish stretch marks that may be noted on the breasts during pregnancy. B) Colostrum is not the term used to document the purplish stretch marks that may be noted on the breasts during pregnancy. C) Linea nigra is not the term used to document the purplish stretch marks that may be noted on the breasts during pregnancy. D) Chadwick's sign is not the term used to document the purplish stretch marks that may be noted on the breasts during pregnancy.

11) The nurse is preparing for a postpartum home visit. The client has been home for a week, is breastfeeding, and experienced a third-degree perineal tear after vaginal delivery. The nurse should assess the client for which of the following? A) Dietary intake of fiber and fluids B) Dietary intake of folic acid and prenatal vitamins C) Return of hemoglobin and hematocrit levels to baseline D) Return of protein and albumin to predelivery levels

Answer: A Explanation: A) This mother needs to avoid the risk of constipation. She might be hesitant to have a bowel movement due to anticipated pain from the perineal tear, and constipation will decrease the healing of the laceration. B) Dietary intake of prenatal vitamins is important while breastfeeding, but folic acid is more important prior to conception and in the first weeks of pregnancy to prevent neural tube defects. C) It will take several months for the laboratory levels to return to normal. It will take several months for the laboratory levels to return to normal

5) The nurse evaluates the diet of a pregnant client and finds that it is low in zinc. The nurse knows that zinc intake should increase during pregnancy to promote protein metabolism. Which food should the nurse suggest in order to increase intake of zinc? A) Shellfish B) Bananas C) Yogurt D) Cabbage

Answer: A Explanation: A) Zinc is found in greatest concentration in meats, shellfish, and poultry. Other good sources include whole grains and legumes. B) Bananas are high in other nutrients, but do not have significant levels of zinc. C) Yogurt is high in other nutrients, but does not have significant levels of zinc. D) Cabbage is high in other nutrients, but does not have significant levels of zinc.

1) What self-care measures would a nurse recommend for a client in her first trimester to reduce the discomfort of nausea and vomiting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Avoid odors or causative factors. B) Have small but frequent meals. C) Drink carbonated beverages. D) Drink milk before arising in the morning. E) Eat highly seasoned food.

Answer: A, B, C Explanation: A) The nurse would recommend for a client in her first trimester to avoid odors and causative factors to reduce the discomfort of nausea and vomiting. B) The nurse would recommend for a client in her first trimester to have small but frequent meals to reduce the discomfort of nausea and vomiting. C) The nurse would recommend for a client in her first trimester to drink carbonated beverages to reduce the discomfort of nausea and vomiting. D) The nurse would recommend for a client in her first trimester to eat dry crackers or toast before arising in the morning to reduce the discomfort of nausea and vomiting. E) The nurse would recommend for a client in her first trimester to avoid greasy or highly seasoned foods to reduce the discomfort of nausea and vomiting.

1) The prenatal period should be used to expose the prospective parents to up-to-date, evidence-based information about which of the following topics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Breastfeeding B) Pain relief C) Obstetric complications and procedures D) Toddler care E) Antepartum adjustment

Answer: A, B, C Explanation: A) The prenatal period should expose prospective parents to up-to-date, evidence-based information about breastfeeding. B) The prenatal period should expose prospective parents to up-to-date, evidence-based information about pain relief. C) The prenatal period should expose prospective parents to up-to-date, evidence-based information about obstetric complications and procedures. D) The prenatal period should expose prospective parents to up-to-date, evidence-based information about normal newborn care. E) The prenatal period should expose prospective parents to up-to-date, evidence-based information about postpartum adjustment.

4) The nurse is planning an early-pregnancy class session on nutrition. Which information should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Protein is important for fetal development. B) Iron helps both mother and baby maintain the oxygen-carrying capacity of the blood. C) Calcium prevents constipation at the end of pregnancy. D) Zinc facilitates synthesis of R N A and D N A. E) Vitamin A promotes development of the baby's eyes.

Answer: A, B, D, E Explanation: A) During pregnancy, the woman needs increased amounts of protein to provide amino acids for fetal development. B) Iron deficiency anemia is associated with an increased incidence of preterm birth, low-birth-weight infants, and maternal and infant mortality. C) Calcium is not related to constipation. Calcium is involved in the mineralization of fetal bones and teeth, energy and cell production, and acid-base buffering. D) Zinc is involved in R N A and D N A synthesis, and milk production during lactation. E) Vitamin A promotes healthy formation and development of the fetal eyes.

1) Remedies for back pain in pregnancy that are supported by research evidence and may safely be taught to any pregnant woman by the nurse include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Pelvic tilt B) Water aerobics C) Sit-ups D) Proper body mechanics E) Good posture is important because it allows more room for the stomach to function.

Answer: A, B, D, E Explanation: A) The pelvic tilt can help restore proper body alignment and relieve back pain. B) Exercise is an effective treatment for lower back pain. Exercise in water seems to provide benefits while being physically comfortable for expectant mothers. C) Sit-ups require back-lying. Because of the pressure of the enlarging uterus on the vena cava, the woman should not lie flat on her back after about the fourth month. D) The use of proper posture and good body mechanics throughout pregnancy is important. E) Good posture is important because it allows more room for the stomach to function.

3) The pregnant client states she does not want "to take all these supplements." What recommendations could the nurse make for the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Folic acid has been found to be essential for minimizing the risk of neural tube defects." B) "You do not have to take these supplements if you think you are healthy enough." C) "Most women do not have adequate intake of iron pre-pregnancy, and iron needs increase with pregnancy." D) "These medications do the same thing. I will call your physician to cancel one of your medications." E) "You should take the folic acid, but the vitamins are not that important."

Answer: A, C Explanation: A) An inadequate intake of folic acid has been associated with neural tube defects (N T Ds) (e.g., spina bifida, anencephaly). B) This answer is incorrect because prenatal vitamins with iron and folic acid are necessary. C) Iron is essential because many pregnant women do not have adequate intake of iron before pregnancy. D) It is not the nurse's role to tell the physician to cancel any prescribed medication. E) Both folic acid and other vitamins and minerals are necessary for a successful pregnancy and a healthy baby.

9) Postpartum nutritional status is determined primarily by assessing which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Dietary history B) Menstrual history C) Mother's weight D) Hemoglobin levels E) Mother's height

Answer: A, C, D Explanation: A) Postpartum nutritional status is determined by assessing the new mother's dietary history. B) Postpartum nutritional status is not determined by assessing the new mother's menstrual history. C) Postpartum nutritional status is determined by assessing the new mother's weight. D) Postpartum nutritional status is determined by assessing the new mother's hemoglobin levels. E) Postpartum nutritional status is not determined by assessing the new mother's height.

1) The nurse is assessing a client in the third trimester of pregnancy. What physiologic changes in the client are expected? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The client's chest circumference has increased by 6 cm during the pregnancy. B) The client has a narrowed subcostal angle. C) The client is using thoracic breathing. D) The client may have epistaxis. E) The client has a productive cough.

Answer: A, C, D Explanation: A) The chest increase compensates for the elevated diaphragm. B) The diaphragm is elevated and the subcostal angle is increased as a result of pressure from the enlarging uterus. C) Breathing changes from abdominal to thoracic as pregnancy progresses. D) Epistaxis (nosebleeds) may occur and are primarily the result of estrogen-induced edema and vascular congestion of the nasal mucosa. E) A productive cough is never a normal finding.

27) Carbohydrates provide the body's primary source of energy as well as fiber necessary for proper bowel functioning. If the carbohydrate intake is not adequate, the body will use which of the following for energy? A) Iron B) Protein C) Vitamin C D) Vitamin D

Answer: B Explanation: A) The body would not use iron as a source of energy. B) If the carbohydrate intake is not adequate, the body uses protein for energy. Protein then becomes unavailable for growth needs. C) A major function of vitamin C is to aid the formation and development of connective tissue and the vascular system. D) Vitamin D is best known for its role in the absorption and utilization of calcium and phosphorus in skeletal development.

1) The nurse understands that a client's pregnancy is progressing normally when what physiologic changes are documented on the prenatal record of a woman at 36 weeks' gestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The joints of the pelvis have relaxed, causing a waddling gait. B) The cervix is firm and blue-purple in color. C) The uterus vasculature contains one sixth of the total maternal blood volume. D) Gastric emptying time is delayed, and the client complains of constipation and bloating. E) Supine hypotension occurs when the client lies on her back.

Answer: A, C, D, E Explanation: A) The sacroiliac, sacrococcygeal, and pubic joints of the pelvis relax in the later part of the pregnancy, presumably as a result of hormonal changes. This often causes a waddling gait. B) Cervical changes during pregnancy include softening and blue-purple discoloration. C) By the end of pregnancy, one sixth of the total maternal blood volume is contained within the vascular system of the uterus. D) Gastric emptying time and intestinal motility are delayed, leading to frequent complaints of bloating and constipation, which can be aggravated by the smooth muscle relaxation and increased electrolyte and water reabsorption in the large intestine. E) The enlarging uterus may exert pressure on the vena cava when the woman lies supine, causing a drop in blood pressure. This is called the vena caval syndrome, or supine hypotension.

26) Women with eating disorders who become pregnant are at risk for a variety of complications including which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Premature birth B) Too many nutrients available for the fetus C) Miscarriage D) High birth weight E) Perinatal mortality

Answer: A, C, E Explanation: A) Risks to the mother and baby include premature birth. B) Risks to the mother and baby include lack of nutrients available for the fetus. C) Risks to the mother and baby include miscarriage. D) Risks to the mother and baby include low birth weight. E) Risks to the mother and baby include perinatal mortality.

24) The pregnant teen who was prescribed prenatal vitamins at her initial prenatal visit states that she does not like to take them. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Folic acid has been found to be essential for minimizing the risk of neural tube defects." B) "You do not have to take these supplements if you think you are healthy enough." C) "These medications do the same thing. I will call your doctor to cancel one of your medications." D) "You can trust your doctor to know what you need." E) "You need the supplements because your dietary intake may not be adequate for fetal development."

Answer: A, E Explanation: A) The C D C estimates that most neural tube defects could be prevented if women followed folic acid supplementation recommendations before they became pregnant. B) One role of the nurse is educator, and this client needs additional information on why she needs the supplements. C) One role of the nurse is educator, and this client needs additional information on why she needs the supplements. D) Therapeutic communication requires addressing the client's concern. One role of the nurse is educator, and this client needs additional information on why she needs the supplements. E) One role of the nurse is educator, and this client needs additional information on why she needs the supplements. This response answers the client's concerns.

1) The adolescent client reports to the clinic nurse that her period is late, but her home pregnancy test is negative. What should the nurse explain that these findings most likely indicate? A) "This means you are not pregnant." B) "You might be pregnant, but it might be too early for your home test to be accurate." C) "We don't trust home tests. Come to the clinic for a blood test." D) "Most people don't use the tests correctly. Did you read the instructions?"

Answer: B Explanation: A) Although it might be true that she is not pregnant, this is not the best statement because the pregnancy might be too early for a urine pregnancy test to detect. B) This is a true statement. Most home pregnancy tests have low false-positive rates, but the false-negative rate is slightly higher. Repeating the test in a week is recommended. C) This statement is not worded therapeutically. A clinic pregnancy test is usually a urine test. D) Although this statement gets at the need to read the instructions for the test, it is not worded therapeutically.

12) Which of the following is important for the development of the central nervous system of the fetus? A) Calcium and phosphorus B) Essential fatty acids C) Iron D) Vitamin D

Answer: B Explanation: A) Calcium and phosphorus are involved in the mineralization of fetal bones and teeth, energy and cell production, and acid-base buffering. B) Essential fatty acids are important for the development of the central nervous system of the fetus. Of particular interest are the omega-3 fatty acids and their derivatives. C) Iron requirements increase during pregnancy because of the growth of the fetus and placenta and the expansion of maternal blood volume. D) Vitamin D is known for its role in the absorption and utilization of calcium and phosphorus in skeletal development.

23) The school nurse is planning a class about nutrition for pregnant teens, several of whom have been diagnosed with iron-deficiency anemia. In order to increase iron absorption, the nurse would encourage the teens to consume more of what beverage? A) Gatorade B) Orange juice C) Milk D) Green tea

Answer: B Explanation: A) Gatorade does not contain vitamin C, which increases iron absorption. B) Vitamin C is found in citrus fruits and juices, and is known to enhance the absorption of iron from meat and non-meat sources. C) Milk does not contain vitamin C, which increases iron absorption. D) Green tea does not contain vitamin C, which increases iron absorption.

10) The breastfeeding mother is concerned that her milk production has decreased. The nurse knows that further client teaching is needed based on which statement? A) "I am drinking a minimum of 8 to 10 glasses of liquid a day." B) "I have started cutting back on my protein intake." C) "At least three times a day, I drink a glass of milk." D) "My calorie intake is higher than during the pregnancy."

Answer: B Explanation: A) The breastfeeding mother must consume a minimum of 8 to 10 glasses of liquid per day. B) An adequate protein intake is essential while breastfeeding because protein is an important component of breast milk. C) The breastfeeding mother must increase her protein and calcium intake. D) An inadequate caloric intake can reduce milk volume. Breastfeeding mothers should increase their caloric intake by 200 kcal over the pregnancy requirements.

1) The pregnant client at 14 weeks' gestation is in the clinic for a regular prenatal visit. Her mother also is present. The grandmother-to-be states that she is quite uncertain about how she can be a good grandmother to this baby because she works full time. Her own grandmother was retired, and was always available when needed by a grandchild. What is the nurse's best response to this concern? A) "Don't worry. You'll be a wonderful grandmother. It will all work out fine." B) "What are your thoughts on what your role as grandmother will include?" C) "As long as there is another grandmother available, you don't have to worry." "Grandmothers are supposed to be available. You should retire from your job

Answer: B Explanation: A) It is important to avoid clichés in order to promote effective therapeutic communication. B) Although relationships with parents can be very complex, the expectant grandparents often become increasingly supportive of the expectant couple, even if conflicts previously existed. But it can be difficult for even sensitive grandparents to know how deeply to become involved in the childrearing process. In some areas, classes for grandparents provide information about changes in birthing and parenting practices. C) It is important to avoid placing guilt on clients in order to promote effective therapeutic communication. D) It is important to avoid placing guilt on clients in order to promote effective therapeutic communication.

8) What would the nurse do to accurately assess a pregnant client's food intake? A) Assess her most recent laboratory values. B) Ask her to complete a nutritional questionnaire. C) Observe for signs of hunger. D) Ask about her cooking facilities.

Answer: B Explanation: A) Laboratory values may provide information on the nutritional status of the client, but do not indicate what foods she has eaten. B) Diet may be evaluated using a food frequency questionnaire, which lists common categories of foods and asks the woman how frequently in a day (or week) she consumes foods from the list. C) Hunger alone is not an adequate indicator of nutritional status. D) Cooking facilities are not related to food intake.

1) The nurse is conducting an initial prenatal appointment for a client who believes she is pregnant. Which is considered a positive sign of pregnancy? A) Linea nigra B) Fetal heartbeat C) Breast tenderness D) Urinary frequency

Answer: B Explanation: A) Linea nigra is a probable, not positive, sign of pregnancy. B) A fetal heartbeat is a positive sign of pregnancy. C) Breast tenderness is a probable, not positive, sign of pregnancy. D) Urinary frequency is a probable, not positive, sign of pregnancy.

1) A client who is in the second trimester of pregnancy tells the nurse that she has developed a darkening of the line in the midline of her abdomen from the symphysis pubis to the umbilicus. What other expected changes during pregnancy might she also notice? A) Lightening of the nipples and areolas B) Reddish streaks called striae on her abdomen C) A decrease in hair thickness D) Small purplish dots on her face and arms

Answer: B Explanation: A) Pigmentation of the skin increases in areas already hyperpigmented: areolae, nipples, vulva, perianal area, and linea alba. B) Striae, or stretch marks, are reddish, wavy, depressed streaks that may occur over the abdomen, breasts, and thighs as pregnancy progresses. C) A greater percentage of hair follicles go into the dormant phase, resulting in less hair shedding, which is perceived as thickening of the hair. D) Although bright-red elevations on the skin (vascular spider nevi) are a normal finding, petechiae are not

1) A prenatal educator is asking a partner about normal psychologic adjustment of an expectant mother during the second trimester of pregnancy. Which answer by the partner would indicate a typical expectant mother's response to pregnancy? A) "She is very body-conscious, and hates every little change." B) "She daydreams about what kind of parent she is going to be." C) "I haven't noticed anything. I just found out she was pregnant." D) "She has been having dreams at night about misplacing the baby."

Answer: B Explanation: A) Psychologic adjustment to pregnancy is as significant as the physiologic changes. B) The second trimester brings increased introspection and consideration of how she will parent. She might begin to get furniture and clothing as concrete preparation, and may feel movement and be aware of the fetus as she begins to incorporate it into her identity. C) In the first trimester, pregnant women usually tell their partners of the pregnancy. This answer is incorrect. D) Psychologic adjustment to pregnancy is as significant as the physiologic changes. In the third trimester, dreams of misplacing the baby or being unable to get to the baby are common.

1) The nurse is preparing a class for expectant fathers. Which information should the nurse include? A) Siblings adjust readily to the new baby. B) Sexual activity is safe for normal pregnancy. C) The expectant mother decides the feeding method. D) Fathers are expected to be involved in labor and birth.

Answer: B Explanation: A) Siblings often have difficulty adapting to the arrival of a new baby. Parents who are unprepared for the older child's feelings of anger, jealousy, and rejection may respond inappropriately in their confusion and surprise. B) In a healthy pregnancy, there is no medical reason to limit sexual activity. C) Often, the father wants input in deciding on the feeding method. D) In some cultures, the father is not present at birth. The nurse should recognize the importance of birth practices that are part of a family's tradition and honor these practices when possible.

14) A client presents to the antepartum clinic with a history of a 20-pound weight loss. Her pregnancy test is positive. She is concerned about gaining the weight back, and asks the nurse if she can remain on her diet. What is the nurse's best response? A) "As long as you supplement your diet with the prenatal vitamin, the amount of weight you gain in pregnancy is not significant." B) "I understand that gaining weight after such an accomplishment might not appeal to you but weight gain during pregnancy is important for proper fetal growth." C) "Dieting during pregnancy is considered child neglect." D) "Excessive weight gain in pregnancy is due to water retention, so weight loss following birth will not be an issue."

Answer: B Explanation: A) Supplementation with vitamins is important, but so is maintaining weight gain within the expected parameters. B) Maternal weight gain is an important factor in fetal growth and in infant birth weight. An adequate weight gain over time indicates an adequate caloric intake. Child neglect can apply only after the child is born D) Weight gain during pregnancy typically is not water-related. Excess weight gain can be difficult to lose.

1) The pregnant client has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question? A) "Birth defects are very rare. Don't worry; your doctor will watch for problems." B) "To be safe, don't take any medication without talking to your doctor." C) "Too much vitamin C is one of the most common issues." D) "Almost all medications will cause birth defects in the first trimester."

Answer: B Explanation: A) The nurse should avoid giving a "don't worry" answer to ensure therapeutic communication, but it is appropriate to instruct the client to check with her caregiver about medications. B) The nurse should remind the client of the need to check with her caregiver about medications. If a woman has taken a drug in category D or X, she should be informed of the risks associated with that drug and of alternatives. C) Vitamin C is cited as a category A drug, as long as its use does not exceed the recommended dietary allowance. It has demonstrated no associated fetal risk. D) Not all medications are teratogenic.

1) A Chinese woman who is 12 weeks pregnant reports to the nurse that ginseng and bamboo leaves help reduce her anxiety. How should the nurse respond to this client? A) Advise the client to give up the bamboo leaves but to continue taking ginseng. B) Advise the client to discuss all herbal remedies with the provider. C) Tell the client that the provider thinks the remedies have no scientific foundation. D) Assess where the client obtains her remedy, and investigate the source.

Answer: B Explanation: A) The nurse should find out what medications and home remedies the client is using, and counsel the client regarding overall effects. B) The nurse should advise the client to discuss all medications (including herbal supplements) with the health care provider. C) It is not appropriate to tell the client that the provider thinks the remedies have no scientific foundation. D) It is outside the nurse's scope to assess the source of the herbs.

1) Nurses who are interacting with expectant families from a different culture or ethnic group can provide more effective, culturally sensitive nursing care by doing what? A) Recognizing that ultimately it is the family's right to make a woman's healthcare choices. B) Obtaining a medical interpreter of the language the client speaks. C) Evaluating whether the client's healthcare beliefs have any positive consequences for her health. D) Accepting personal biases, attitudes, stereotypes, and prejudices.

Answer: B Explanation: A) The nurse should recognize that ultimately it is the woman's right to make her own healthcare choices. B) The nurse should provide for the services of an interpreter if language barriers exist. C) The nurse should evaluate whether the client's healthcare beliefs have any potential negative consequences for her health. D) The nurse should identify personal biases, attitudes, stereotypes, and prejudices.

1) A client at 16 weeks' gestation has a hematocrit of 35%. Her prepregnancy hematocrit was 40%. Which statement by the nurse best explains this change? A) "Because of your pregnancy, you're not making enough red blood cells." B) "Because your blood volume has increased, your hematocrit count is lower." C) "This change could indicate a serious problem that might harm your baby." D) "You're not eating enough iron-rich foods like meat."

Answer: B Explanation: A) The pregnancy would not cause a decrease in the production of red blood cells. B) Hemoglobin and hematocrit levels drop in early to mid-pregnancy as a result of pregnancy-associated hemodilution. Because the plasma volume increase (50%) is greater than the erythrocyte increase (25%), the hematocrit decreases slightly. C) This change is referred to as physiologic anemia of pregnancy, and is not harmful to the fetus. D) The decreased hematocrit does not mean that the woman is not eating enough iron-rich foods. It is recommended that an iron supplement during pregnancy of 27 milligrams of iron be taken daily, and iron can be found in most prenatal supplements.

1) A pregnant client who swims 3-5 times per week asks the nurse whether she should stop this activity. What is the appropriate nursing response? A) "You should decrease the number of times you swim per week." B) "Continuing your exercise program would be beneficial." C) "You should discontinue your exercise program immediately." D) "You should consider a less strenuous type of exercise."

Answer: B Explanation: A) There is no need to decrease the number of times the client swims per week, because mild to moderate exercise is beneficial during pregnancy. B) Mild to moderate exercise is beneficial during pregnancy. Regular exercise-at least 30 minutes of moderate exercise daily or at least most days of the week-is preferred. C) Non-weight-bearing exercises, such as swimming or cycling, are recommended because they decrease the risk of injury and provide fitness with comfort. D) A moderate, rhythmic exercise routine involving large muscle groups such as swimming, cycling, or brisk walking is best.

1) A pregnant teenage client is diagnosed with iron-deficiency anemia. Which nutrient should the nurse encourage her to take to increase iron absorption? A) Vitamin A B) Vitamin C C) Vitamin D D) Vitamin E

Answer: B Explanation: A) While vitamin A is good for the body, it does not promote the absorption of iron. B) Vitamin C is known to enhance the absorption of iron from meat and nonmeat sources. C) While vitamin D is good for the body, it does not promote the absorption of iron. D) While vitamin E is good for the body, it does not promote the absorption of iron.

1) Absolute contraindications to exercise while pregnant include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Abruptio placentae B) Placenta previa after 26 weeks' gestation C) Preeclampsia-eclampsia D) Cervical insufficiency (cerclage) E) Intrauterine growth restriction (I U G R)

Answer: B, C, D Explanation: A) Abruptio placentae is not an absolute contraindication to exercise. B) Placenta previa after 26 weeks' gestation is an absolute contraindication to exercise. C) Preeclampsia-eclampsia is an absolute contraindication to exercise. D) Cervical insufficiency (cerclage) is an absolute contraindication to exercise. E) Intrauterine growth restriction (I U G R) is not an absolute contraindication to exercise.

1) Intercourse is contraindicated if the pregnancy is vulnerable because of which diagnosis? A) Gestational diabetes B) Cervical insufficiency (cerclage) C) Abruptio placentae D) Placenta previa

Answer: D Explanation: A) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of gestational diabetes. B) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of cervical insufficiency (cerclage). C) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of abruptio placentae. D) Intercourse is contraindicated if the pregnancy is vulnerable because of the diagnosis of threatened spontaneous abortion, placenta previa, or the risk of preterm labor.

17) A pregnant client who is a lacto-vegetarian asks the nurse for assistance with her diet. What instruction should the nurse give? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Protein is important; therefore, the addition of one serving of meat a day is necessary." B) "A daily supplement of vitamin B12 is important." C) "The high fiber in a vegetarian diet is dangerous for pregnant women." D) "Eggs are important to add to your diet. Eat six eggs per week." E) "Milk products contain protein, but they are very low in iron."

Answer: B, E Explanation: A) Lacto-vegetarians do not eat meat, meat by-products, or eggs, and the nurse should not force this issue. Most vegetables must be combined with another food to form complete proteins. B) Supplementation may be recommended for vegans who have difficulty meeting the recommended amounts of vitamin B12 through food sources. C) The high fiber found in vegetarian diets actually is good for the pregnant woman who may be suffering from constipation. D) Lacto-vegetarians do not eat meat, meat by-products, or eggs, and the nurse should not force this issue. Most vegetables must be combined with another food to form complete proteins. E) Milk products will provide needed protein, but are not significant sources of iron.

1) The nurse has received a phone call from a multigravida who is 21 weeks pregnant and has not felt fetal movement yet. What is the best action for the nurse to take? A) Reassure the client that this is a normal finding in multigravidas. B) Suggest that she should feel for movement with her fingertips. C) Schedule an appointment for her with her physician for that same day. D) Tell her gently that her fetus is probably dead.

Answer: C Explanation: A) A lack of fetal movement is unusual at 21 weeks, and should be checked. B) Fetal movement can be actively palpated by the client's physician or a trained examiner, but is unlikely to be self-detected by the mother at this stage. C) Quickening, or the mother's perception of fetal movement, occurs about 18 to 20 weeks after the L M P in a primigravida (a woman who is pregnant for the first time) but may occur as early as 16 weeks in a multigravida (a woman who has been pregnant more than once). D) The fetus may or may not have died after or about the 20th week of pregnancy; however, telling the client that the fetus might have died in utero without confirmation of this fact is nontherapeutic.

18) A pregnant client confides to the nurse that she is eating laundry starch daily. The nurse should assess the client for which of the following? A) Alopecia B) Weight loss C) Iron deficiency anemia D) Fecal impaction

Answer: C Explanation: A) Alopecia, a condition that causes hair loss, is not associated with eating laundry starch. B) Weight gain is related to the client's eating laundry starch. C) Iron deficiency anemia is the most common concern with pica. The ingestion of laundry starch or certain types of clay may contribute to iron deficiency by replacing iron-containing foods from the diet or by interfering with iron absorption. D) Fecal impaction is associated with the eating of clay, not laundry starch.

1) The nurse is providing prenatal care to an obese client who asks, "How much weight should I gain during my pregnancy?" Which response by the nurse is appropriate? A) "You should gain 15 to 25 pounds." B) "You should gain 25 to 35 pounds." C) "You should gain 11 to 20 pounds." D) "You should gain 28 to 40 pounds."

Answer: C Explanation: A) An overweight client should gain 15 to 25 pounds during pregnancy. B) A pregnant client who has a normal weight before pregnancy should gain 25 to 35 pounds during pregnancy. C) An obese client who becomes pregnant should gain 11 to 20 pounds during pregnancy. D) An underweight client should gain 28 to 40 pounds during pregnancy.

1) The pregnant client in her second trimester states, "I didn't know my breasts would become so large. How do I find a good bra?" The best answer for the nurse to give would be which of the following? A) "Avoid cotton fabrics and get an underwire bra; they fit everyone best." B) "Just buy a bra one cup size bigger than usual, and it will fit." C) "Look for wide straps and cups big enough for all of your breast tissue." D) "There isn't much you can do for comfort. Try not wearing a bra at all."

Answer: C Explanation: A) Cotton is comfortable during pregnancy when perspiration increases, because it does not retain heat and moisture. B) The client should be fitted for a well-fitting, supportive bra of an appropriate size. C) The nurse should instruct the client to get a bra that fits with straps that are wide and do not stretch, and a cup that holds all breast tissue comfortably. D) One can obtain a bra that fits and is comfortable. It is not necessary to be uncomfortable.

1) The nurse is teaching an early pregnancy class for clients in the first trimester of pregnancy. Which statement by a client requires immediate intervention by the nurse? A) "When my nausea is bad, I will drink some ginger tea." B) "The fatigue I am experiencing will improve in the second trimester." C) "It is normal for my vaginal discharge to be green." D) "I will urinate less often during the middle of my pregnancy."

Answer: C Explanation: A) Ginger helps nausea, and is safe for use during pregnancy. B) First-trimester fatigue is common; fatigue usually improves during the second trimester. C) Increased whitish vaginal discharge, called leukorrhea, is common in pregnancy. Green discharge is not a normal finding, and indicates a vaginal infection. D) Urinary frequency, a common discomfort of pregnancy, occurs early in pregnancy and again during the third trimester because of the pressure of the enlarging uterus on the bladder.

1) The nurse is listening to the fetal heart tones of a client at 37 weeks' gestation while the client is in a supine position. The client states, "I'm getting lightheaded and dizzy." What is the nurse's best action? A) Assist the client to sit up. B) Remind the client that she needs to lie still to hear the baby. C) Help the client turn onto her left side. Check the client's blood pressure

Answer: C Explanation: A) Having the client sit up will not offer the best and fastest relief. B) Having the client lie still will not improve the situation, and is not therapeutic. C) During pregnancy the enlarging uterus may put pressure on the vena cava when the woman is supine, resulting in supine hypotensive syndrome. This pressure interferes with returning blood flow and produces a marked decrease in blood pressure with accompanying dizziness, pallor, and clamminess, which can be corrected by having the woman lie on her left side. D) The client is hypotensive because she is at the end of pregnancy and lying supine. Checking her blood pressure will not relieve the situation.

1) A client who is experiencing her first pregnancy has just completed the initial prenatal examination with a certified nurse-midwife. Which statement indicates that the client needs additional information? A) "Because we heard the baby's heartbeat, I am undoubtedly pregnant." B) "Because I have had a positive pregnancy test, I am undoubtedly pregnant." C) "My last period was 2 months ago, which means I'm 2 months along." D) "The increased size of my uterus means that I am finally pregnant."

Answer: C Explanation: A) Hearing the fetal heart rate is a positive, or diagnostic, change of pregnancy, so this statement would not indicate the need for further teaching. B) A positive pregnancy test is a positive, or diagnostic, indication of pregnancy. This statement would not indicate the need for further teaching. C) Amenorrhea is a subjective, or presumptive, change of pregnancy, and is not a reliable indicator of pregnancy in the early months. This statement requires additional teaching. D) Increased uterine size is an objective, or probable, change of pregnancy.

1) Which statement, if made by a pregnant client, would indicate that she understands health promotion during pregnancy? A) "I lie down after eating to relieve heartburn." B) "I try to limit my fluid intake to 3 or 4 glasses each day." C) "I elevate my legs while sitting at my desk." D) "I am avoiding exercise to stay well rested."

Answer: C Explanation: A) Heartburn is gastroesophageal reflux, and will be exacerbated by lying down. B) At least 8-10 glasses of fluids should be consumed each day to maintain the increased blood volume of pregnancy. C) Elevating the legs can help decrease lower leg edema. D) Regular mild to moderate exercise has many benefits for pregnant women.

1) What is the increased vascularization causing the softening of the cervix known as? A) Hegar sign B) Chadwick sign C) Goodell sign D) McDonald sign

Answer: C Explanation: A) Hegar sign is a softening of the isthmus of the uterus. B) Increased vascularization causes blue-purple discoloration of the cervix known as Chadwick sign. C) Increased vascularization causes the softening of the cervix known as Goodell sign. D) McDonald sign is an ease in flexing the body of the uterus against the cervix.

1) During her first months of pregnancy, a client tells the nurse, "It seems like I have to go to the bathroom every 5 minutes." The nurse explains to the client that this is because of which of the following? A) The client probably has a urinary tract infection. B) Bladder capacity increases throughout pregnancy. C) The growing uterus puts pressure on the bladder. D) Some women are very sensitive to body function changes.

Answer: C Explanation: A) Increased frequency of urination in the first trimester of pregnancy does not indicate a urinary tract infection. B) Bladder capacity does not increase throughout pregnancy. C) During the first trimester, the growing uterus puts pressure on the bladder, producing urinary frequency until the second trimester, when the uterus becomes an abdominal organ. Near term, when the presenting part engages in the pelvis, pressure is again exerted on the bladder. D) Sensitivity is not the cause of an increased frequency of urination in the first trimester.

1) The nurse in a prenatal clinic finds that four clients have called with complaints related to their pregnancies. Which call should the nurse return first? A) Pregnant woman at 7 weeks' gestation reporting nasal stuffiness B) Pregnant woman at 38 weeks' gestation experiencing rectal itching and hemorrhoids C) Pregnant woman at 15 weeks' gestation with nausea and vomiting and a 15-pound weight loss D) Pregnant woman at 32 weeks' gestation treating constipation with prune juice

Answer: C Explanation: A) Nasal stuffiness is common in the first trimester as a result of increased estrogen. B) Hemorrhoids are common during pregnancy and often cause itching. C) The nurse should return this call first because this patient is the highest priority. A 15-pound weight loss is not an expected finding. Although some nausea is common, the woman who suffers from extreme nausea coupled with vomiting requires further assessment. D) Constipation during the third trimester is a common finding. Increased fluid and fiber from food sources are most effective in relieving constipation.

1) The nurse is assessing a pregnant client who reports nasal stuffiness and congestion. Which term will the nurse use to document this data in the medical record? A) Rales B) Epistaxis C) Rhinitis of pregnancy D) Pregnancy-induced asthma

Answer: C Explanation: A) Rales is not the term the nurse uses to document nasal stuffiness and congestion that occurs during pregnancy. B) Epistaxis is not the term the nurse uses to document nasal stuffiness and congestion that occurs during pregnancy. C) Rhinitis of pregnancy is the term that the nurse will use when documenting nasal stuffiness and congestion that often occurs during pregnancy. D) Pregnancy-induced asthma is not the term the nurse uses to document nasal stuffiness and congestion that occurs during pregnancy.

1) The prenatal client in her third trimester tells the clinic nurse that she works 8 hours a day as a cashier and stands when at work. What response by the nurse is best? A) "No problem. Your baby will be fine." B) "Do you get regular breaks for eating?" C) "Your risk of poor pregnancy outcomes may be higher." D) "Standing might increase ankle swelling."

Answer: C Explanation: A) Standing more than 3 hours a day increases the risk of preterm labor. To be therapeutic in communication, avoid false reassurance. B) Although breaks for eating are important for pregnant employees, it is more important to tell the client about the increased risks associated with standing more than 3 hours a day. C) Pregnant women who are employed in jobs that require prolonged standing (more than 3 hours) may be at risk for poor pregnancy outcomes. D) Although this is true, it is less important than teaching the client about the risks of preterm labor from standing more than 3 hours a day.

1) The nurse is providing care to a pregnant client who is experiencing an increase in white, thick, and "cottage-cheese-like" vaginal discharge. Based on this data, which diagnosis does the nurse anticipate for this client? A) Syphilis B) Gonorrhea C) Moniliasis D) Chlamydia

Answer: C Explanation: A) The assessment data does not support the diagnosis of syphilis. B) The assessment data does not support the diagnosis of gonorrhea. C) Vaginal secretions during pregnancy are often thick, white and acidic which increase the client's risk for moniliasis, a common yeast infection during pregnancy. D) The assessment data does not support the diagnosis of chlamydia.

1) A client with a normal prepregnancy weight asks why she has been told to gain 25-35 pounds during her pregnancy while her underweight friend was told to gain more weight. What should the nurse tell the client the recommended weight gain is during pregnancy? A) 25-35 pounds, regardless of a client's prepregnant weight B) More than 25-35 pounds for an overweight woman C) Up to 40 pounds for an underweight woman D) The same for a normal weight woman as for an overweight woman

Answer: C Explanation: A) The recommended total weight gain during pregnancy for a woman of normal weight before pregnancy is 25 to 35 pounds. B) For women who were overweight before becoming pregnant, the recommended gain is 15 to 25 pounds. C) Prepregnant weight determines the recommended weight gain during pregnancy. Underweight women are advised to gain 28-40 pounds. D) Women of normal weight should gain 25-35 pounds during pregnancy, whereas overweight women should limit their weight gain to 15-25 pounds during pregnancy.

1) The nurse is presenting a class of important "dos and don'ts" during pregnancy, including travel considerations. What method of travel does the nurse recommend as most appropriate for a client in her 25th week of pregnancy? A) Automobile B) Airplane C) Train D) None; this client should not travel

Answer: C Explanation: A) Travel by automobile can be especially fatiguing, aggravating many of the discomforts of pregnancy. The pregnant woman needs frequent opportunities to get out of the car and walk. B) Occasional flying is considered safe in the absence of any obstetric or medical complications. However, those women who have medical or obstetric complications, such as poorly controlled diabetes, sickle cell disease, or preeclampsia, and those women with placental abnormalities or who are at risk for preterm birth are advised to avoid flying during pregnancy. Before flying, the pregnant woman should check with her particular airline to see if it has any travel restrictions. C) As pregnancy progresses, travel by train is generally recommended for long distances. D) If medical or pregnancy complications are not present, there are no restrictions on travel. Pregnant women should avoid travel if there is a history of bleeding or preeclampsia, or if multiple births are anticipated.

1) The client is at 6 weeks' gestation, and is spotting. The client had an ectopic pregnancy 1 year ago, so the nurse anticipates that the physician will order which intervention? A) A urine pregnancy test B) The client to be seen next week for a full examination C) An antiserum pregnancy test D) An ultrasound

Answer: C Explanation: A) Urine pregnancy tests are not quantifiable. B) It is not appropriate to wait until next week to see the client. C) A β-Subunit radioimmunoassay (R I A) uses an antiserum with specificity for the β-subunit of h C G in blood plasma. This test may not only detect pregnancy but also detect an ectopic pregnancy or trophoblastic disease. D) An ultrasound may be used to diagnose an ectopic pregnancy, but would not be needed now.

1) The nurse assessing a pregnant African American woman in the first trimester understands that a cultural practice is which of the following? A) Use of herbs like dandelion during pregnancy to increase lactation B) Drinking ginseng tea for faintness C) Eating clay to supply dietary minerals D) Consulting a spiritual advisor to ensure a healthy pregnancy and birth

Answer: C Explanation: A) Use of dandelion is a practice of American Indians. B) Asian women who are pregnant often drink ginseng tea. C) African American pregnant women may be guided by their extended family into common practices such as geophagia, the ingestion of dirt or clay, which is believed to alleviate mineral deficiencies. D) Consulting a spiritual advisor is common among Navajo and many other Native American cultures.

2) The pregnant client cannot tolerate milk or meat. What would the nurse recommend to the client to assist in meeting protein needs? A) Wheat bread and pasta B) Ice cream and peanut butter C) Eggs and tofu D) Beans and potatoes

Answer: C Explanation: A) Wheat bread and pasta are not sources of complete protein. B) Ice cream is a milk by-product, and would not be tolerated by this client. C) The best food choices that are nondairy and complete proteins alone are eggs and tofu. D) Beans and potatoes would not provide the client with adequate protein.

1) Which of the following drugs and drug categories can cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies? A) Category C: Zidovudine B) Category B: Penicillin C) Category X: Isotretinoin D) Category A: Vitamin C

Answer: C Explanation: A) Zidovudine does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies. B) Penicillin does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies. C) Isotretinoin (Accutane), the acne medication, can cause multiple central nervous system (C N S), facial, and cardiovascular anomalies. D) Vitamin C does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies.

1) Which of the following is common in many non-Western cultures and is on the increase in the United States? A) Ceremonial rituals and rites B) Cultural assessment C) Cultural values D) Co-sleeping

Answer: D Explanation: A) A universal tendency exists to create ceremonial rituals and rites around important life events. B) Healthcare professionals are becoming increasingly aware of the importance of addressing cultural, physiologic, and psychologic needs in the prenatal assessment in order to provide culture-specific healthcare during pregnancy. C) Identification of cultural values is useful in planning and providing culturally sensitive care. D) Some parents advocate cosleeping or bed sharing (one or both parents sleeping with their baby or young child). Cosleeping, which is common in many non-Western cultures, is on the increase in the United States.

20) e nurse is working with a pregnant 14-year-old. Which statement indicates that additional education is required? A) "Because I am still growing, I need more calories than a pregnant adult." B) "I need to eat fruit and vegetables every day to get enough vitamins." C) "My favorite food is pizza, and I eat it once a week." D) "Because I don't eat breakfast, I'll have to eat more at supper."

Answer: D Explanation: A) Caloric needs of pregnant adolescents vary widely. Figures as high as 50 kcal/kg have been suggested for young, growing teens who are very active physically. B) Eating a variety of fruits and vegetables helps ensure adequate intake of vitamins and some minerals. C) Pizza is not contraindicated during pregnancy. Eating a food once per week will not lead to nutritional imbalance. D) Pregnant young adolescents should eat breakfast to ensure that adequate calorie and protein intake is achieved. In assessing the diet of the pregnant adolescent, the nurse should consider the eating pattern over time, not simply a single day's intake.

1) A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest? A) Point the toes of the affected leg B) Increase intake of protein-rich foods C) Limit activity for several days D) Flex the foot to stretch the calf

Answer: D Explanation: A) Leg cramps are exacerbated by pointing the toes. B) Leg cramps often result from an imbalance in the calcium-phosphorus ratio, not from a lack of protein-rich foods. C) Leg cramps are not caused by excess activity. D) The nurse should advise the client to practice dorsiflexion of her feet to stretch the affected muscle.

21) When preparing nutritional instruction, which pregnant client would the nurse consider the highest priority? A) 40-year-old gravida 2 B) 22-year-old primigravida C) 35-year-old gravida 4 D) 15-year-old nulligravida

Answer: D Explanation: A) The 40-year-old woman has completed her growth cycle, and her body can focus on diverting nutrition to the fetus. B) The 22-year-old woman has completed her growth cycle, and her body can focus on diverting nutrition to the fetus. C) The 35-year-old woman has completed her growth cycle, and her body can focus on diverting nutrition to the fetus. D) An expectant adolescent must meet the nutritional needs for her own growth in addition to the nutritional needs of pregnancy.

1) The client at 30 weeks' gestation with her first child is upset. She tells the prenatal clinic nurse that she is excited to become a mother, and has been thinking about what kind of parent she will be. But her mother has told her that she doesn't want to be a grandmother because she doesn't feel old enough, while her husband has said that the pregnancy doesn't feel real to him yet, and he will become excited when the baby is actually here. What is the most likely explanation for what is happening within this family? A) Her husband will not attach with this child and will not be a good father. B) Her mother is rejecting the role of grandparent, and will not help out. C) The client is not progressing through the developmental tasks of pregnancy. D) The family members are adjusting to the role change at their own paces.

Answer: D Explanation: A) The expectant father must first deal with the reality of the pregnancy and then struggle to gain recognition as a parent from his partner, family, friends, coworkers, society-and from his baby as well. B) Younger grandparents leading active lives may not demonstrate as much interest as the young couple would like. C) This is a false statement. The client is at the stage of seeking acceptance of this child by others, which first will be her partner and other family members. D) This is a true statement. With each pregnancy, routines and family dynamics are altered, requiring readjustment and realignment.

1) A woman calls the clinic and tells a nurse that she thinks she might be pregnant. She wants to use a home pregnancy test before going to the clinic, and asks the nurse how to use it correctly. What information should the nurse give? A) The false-positive rate of these tests is quite high. B) If the results are negative, the woman should repeat the test in 2 weeks if she has not started her menstrual period. C) A negative result merely indicates growing trophoblastic tissue and not necessarily a uterine pregnancy. D) The client should follow up with a healthcare provider after taking the home pregnancy test.

Answer: D Explanation: A) The false-positive rate of these tests is quite low. B) If the results are negative, the woman should repeat the test in 1 week if she has not started her menstrual period. C) A positive result merely indicates growing trophoblastic tissue and not necessarily a uterine pregnancy. D) It is important that clients remember that the tests are not always accurate and they should follow up with a healthcare provider.

1) The nurse is providing care to a client who is entering the second trimester of pregnancy. Which client statement does the nurse anticipate when assessing this client? A) "We picked out a name for a boy and for a girl." B) "We bought the baby's crib and car seat this past weekend." C) "I am so uncomfortable all the time and I can't seem to sleep at night." D) "I am angry with my husband for not showing more interest in my pregnancy."

Answer: D Explanation: A) The nurse would expect this client statement during the third, not second, trimester of pregnancy. B) The nurse would expect this client statement during the third, not second, trimester of pregnancy. C) The nurse would expect this client statement during the third, not second, trimester of pregnancy. The nurse would expect this statement during the second trimester of pregnancy

1) The nurse is assessing a pregnant client during a scheduled prenatal visit who reports dizziness and clamminess when lying in bed each morning. Which statement by the nurse is appropriate based on this data? A) "The doctor may order an amniocentesis to determine if the fetus is healthy." B) "This information indicates that you are developing gestational hypertension." C) "Be sure to sit up slowly and stay sitting for several minutes prior to getting up." "Try lying on your left side to enhance blood flow, which will help your symptoms

Answer: D Explanation: A) This data does not warrant an amniocentesis. B) This data does not support the diagnosis of gestational hypertension. C) This statement is appropriate for a client who is experiencing orthostatic hypotension and is not appropriate for the data assessed. The data suggests that the client is experiencing supine hypotension, which is often corrected by having the client lie on her left side

1) The partner of a client at 16 weeks' gestation accompanies her to the clinic. The partner tells the nurse that the baby just doesn't seem real to him, and he is having a hard time relating to his partner's fatigue and food aversions. Which statement would be best for the nurse to make? A) "If you would concentrate harder, you'd be aware of the reality of this pregnancy." B) "My husband had no problem with this. What was your childhood like?" C) "You might need professional psychological counseling. Ask your physician." D) "Many men feel this way. Feeling the baby move in a few weeks will help make it real to you."

Answer: D Explanation: A) This is inappropriate for the nurse say. B) This is an inappropriate comment for the nurse to make. C) The partner's feelings are not indicative of psychological pathology. D) Initially, expectant fathers may have ambivalent feelings. The extent of ambivalence depends on many factors, including the father's relationship with his partner, his previous experience with pregnancy, his age, his economic stability, and whether the pregnancy was planned. The expectant father must first deal with the reality of the pregnancy and then struggle to gain recognition as a parent from his partner, family, friends, coworkers, society-and from his baby as well.

1) The nurse is caring for a pregnant client. The client's husband has come to the prenatal visit. Which question is best for the nurse to use to assess the father's adaptation to the pregnancy? A) "What kind of work do you do?" B) "What furniture have you gotten for the baby?" C) "How moody has your wife been lately?" D) "How are you feeling about becoming a father?"

Answer: D Explanation: A) What kind of work the husband does is not an indicator of his adaptation to the pregnancy. B) What furniture has been obtained is not an indicator of the father's adaptation to the pregnancy. C) The husband's perceptions of his wife's moodiness are not an indicator of the father's adaptation to the pregnancy. D) A husband's adaptation to pregnancy includes his feelings about impending fatherhood.

1) It is 1 week before a pregnant client's due date. The nurse notes on the chart that the client's pulse rate was 74-80 before pregnancy. Today, the client's pulse rate at rest is 90. What action should the nurse should take? A) Chart the findings. B) Notify the physician of tachycardia. C) Prepare the client for an electrocardiogram (E K G). D) Prepare the client for transport to the hospital

Answer: a Explanation: A) The pulse rate frequently increases during pregnancy, although the amount varies from almost no increase to an increase of 10 to 15 beats per minute. This is a normal response, and does not indicate a need for emergency measures or treatment. B) This pulse rate in a near-term client is not considered to be tachycardia. C) This pulse rate in a near-term client does not indicate a need for emergency measures or treatment. D) This client does not need to go to the hospital.

1) The client in the prenatal clinic tells the nurse that she is sure she is pregnant because she has not had a menstrual cycle for 3 months, and her breasts are getting bigger. What response by the nurse is best? A) "Lack of menses and breast enlargement are presumptive signs of pregnancy." B) "The changes you are describing are definitely indicators that you are pregnant." C) "Lack of menses can be caused by many things. We need to do a pregnancy test." D) "You're probably not pregnant, but we can check it out if you like."

swer: C Explanation: A) Although a lack of menses and breast enlargement are presumptive signs of pregnancy, the nurse should not state this without explaining that these symptoms also can be caused by other conditions. B) This statement is false because amenorrhea and breast enlargement can be caused by other conditions. C) This is a true statement, and addresses that these changes could be caused by conditions other than pregnancy. D) While lack of menses and breast enlargement might not be caused by pregnancy, they likely are the result of pregnancy, and it is inappropriate for the nurse to suggest the client is not pregnant.