Prenatal Care/Antepartum

99. 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.

The correct order is 3, 1, 2, 4. 3. The blastocyst is developed about 6 days after fertilization and before implantation in the uterus has occurred. 1. The four-chambered heart is formed during the early part of the fi rst trimester. 2. Vernix caseosa is present during the latter half of pregnancy. 4. The testes descend in the scrotal sac about mid third trimester. TEST-TAKING TIP: Before putting these items into chronological order, the test taker should carefully analyze each choice. The blastocyst is developed by about day 6 after fertilization. The egg has yet even to implant into the uterine body at this point. The fetal heart develops during the early part of the fi rst trimester but after implantation. Vernix is present during the entire latter half of the pregnancy to protect the skin of the fetus. It appears, therefore, at about week 20. And, fi nally, the testes do not descend into the scrotal sac until mid third trimester. Indeed, male preterm babies are often birthed before the testes descend.

8. 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.

1 and 2 are correct. 1. It is too early in the pregnancy to provide anticipatory guidance about pain management during labor. 2. It is appropriate for the nurse to provide anticipatory guidance regarding methods to relieve back pain. TEST-TAKING TIP: This 10-week gravid client will be entering the second trimester in a couple of weeks. As the uterine body grows, the client is likely to experience backaches. It is appropriate for the nurse to provide information about this possibility and ways to relieve them.

6. 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. "You should repeat the test in one week."

1 and 2 are correct. 1. This response is inappropriate. It does not acknowledge the client's concerns. 2. This response is correct. Serum pregnancy tests are more sensitive than urine tests. TEST-TAKING TIP: 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. Similar to the urine tests on the market, qualitative serum tests detect whether or not the hormone is present, but they are still considered to be more accurate than urine tests.

9. A client asks the nurse what was meant when the physician told her she had a positive Chadwick sign. Which of the following information about the fi nding 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."

1 and 3 are correct. 1. Purplish stretch marks are called abdominal striae. 3. A positive Chadwick sign means that the client's cervix and vagina are a bluish color. It is a probable sign of pregnancy. TEST-TAKING TIP: Chadwick sign is a probable sign of pregnancy. The bluish coloration is a result of the increase in vascularization of the area in response to the high levels of circulating estrogen in the pregnant woman's system.

3. 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?"

1 and 3 are correct. 1. This is an important question, but it is not associated with health teaching. 3. This question is important to ask to determine a prenatal client's health teaching needs. TEST-TAKING TIP: When answering questions, it is essential that the test taker attend to the specifi c question that is being asked. All of the possible responses are questions that should be asked of a pregnant multigravida, but only one is related to the client's needs for health teaching.

4. 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."

1 and 4 are correct. 1. Weight gain of 0.8 to 1 lb per week is expected during the second and third trimesters only. 4. The weight gain is normal for the fi rst trimester. TEST-TAKING TIP: One of the assessments that aids healthcare practitioners in assessing the health and well-being of antenatal clients and their babies is weight gain. For women who enter the pregnancy with a normal weight for height, the expected weight gain is 3 to 5 lb for the entire fi rst trimester and approximately 0.8 to 1 lb per week from weeks 13 to 40. Women with a normal BMI, therefore, should gain between 25 and 35 lb during the entire pregnancy (see www.acog.org/ Resources-And-Publications/Committee -Opinions/Committee-on-Obstetric -Practice/Weight-Gain-During-Pregnancy).

7. A gravida, G1 P0000, is having her fi rst prenatal physical examination. Which of the following assessments should the nurse inform the client that she will have that day? Select all that apply. 1. Pap smear. 2. Mammogram. 3. Glucose tolerance test. 4. Biophysical profi le. 5. Complete blood count.

1 and 5 are correct. 1. The client will have a Pap smear done. 5. A complete blood count will be performed. TEST-TAKING TIP: At the fi rst prenatal visit, pregnant clients will undergo complete obstetrical and medical physical assessments. The assessments are performed to provide the healthcare practitioner with baseline data regarding the health and well-being of the woman as well as to inform the healthcare practitioner of any medical problems that the mother has that might affect the pregnancy. A breast examination will be performed by the practitioner to assess for abnormalities, but since mammograms are potentially harm-producing x-rays, they are ordered only in emergent cases.

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

1 and 5 are correct. 1. Women must fast for a minimum of 8 hours and a maximum of 16 hours prior to the test. 5. Smoking on the morning of the test can alter the results. TEST-TAKING TIP: The 75-gram OGTT is currently recommended as the screening test for gestational diabetes. Human placental lactogen (hPL) is an insulin antagonist. At approximately 24 weeks' gestation, hPL levels can adversely alter a pregnant woman's glucose metabolism. To determine whether a woman has developed gestational diabetes, the OGTT is performed (see www.diabetes .org/newsroom/press-releases/2010/ revised-standards-of-care-2011.html).

1. An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following fi ndings 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, and 4 are correct. 1. Amenorrhea is a presumptive sign of pregnancy. 2. Breast tenderness is a presumptive sign of pregnancy. 3. Quickening is a presumptive sign of pregnancy. 4. Frequent urination is a presumptive sign of pregnancy. TEST-TAKING TIP: There are three classifi cations of signs of pregnancy: presumptive, probable, and positive. Signs that are totally subjective, or presumptive, include amenorrhea, breast tenderness, quickening, and frequent urination. Signs that are objective, but not totally absolute, are termed probable and include alterations in uterine shape and size and softening of the cervix. Signs that are absolute, or positive, include hearing the fetal heartbeat, detecting fetal movement by a healthcare provider, and seeing ultrasound images of the fetal outline.

66. 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, and 4 are correct. 1. Convulsions are a danger sign of pregnancy. 2. Double vision is a danger sign of pregnancy. 3. Epigastric pain is a danger sign of pregnancy. 4. Persistent vomiting is a danger sign of pregnancy. TEST-TAKING TIP: The danger signs of pregnancy are signs or symptoms that can occur in an otherwise healthy pregnancy that are likely due to serious pregnancy complications. For example, double vision, epigastric pain, and blurred vision are symptoms of the hypertensive illnesses of pregnancy, and persistent vomiting is a symptom of hyperemesis gravidarum.

45. A nurse is working in the prenatal clinic. Which of the following fi ndings 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, and 5 are correct. 1. Although annoying, leg cramps are not pathological. 2. Varicose veins are normal, although client teaching may be needed. 3. Hemorrhoids are normal, although client teaching may be needed. 5. Lordosis, or change in the curvature of the spine, is normal, although patient teaching may be needed. TEST-TAKING TIP: There are a number of physical complaints that are "normal" during pregnancy. There are interventions, however, that can be taught to help to alleviate some of the discomforts. The test taker should be familiar with patient education information that should be conveyed regarding the physical complaints of pregnancy. For example, clients who complain of hemorrhoids should be encouraged to eat high-fi ber foods and drink fl uids to produce softer stools. The softer stools should decrease the irritation of the hemorrhoids.

92. A woman has just completed her fi rst 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, and 5 are correct. 1. Although not yet clearly visible on ultrasound, the genitalia are formed by the end of the fi rst trimester. 2. The heart is formed by the end of the fi rst trimester. 3. The fi ngers are formed by the end of the fi rst trimester. 5. The kidneys are formed by the end of the fi rst trimester. TEST-TAKING TIP: The test taker should be familiar with the basic developmental changes that occur during the three trimesters. In addition, the test taker should be able to develop a basic timeline of developmental milestones that occur during the pregnancy. By the conclusion of the fi rst trimester, all major organs are completely formed. The maturation of the organ systems must, however, still occur.

40. 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, and 3 are correct. 1. Frequency is seen once lightening, or the descent of the fetus into the pelvis, has occurred. 2. Heartburn is a common complaint of pregnant women. 3. Backaches are common complaints of pregnant women. TEST-TAKING TIP: This question is asking the test taker to differentiate between complaints that are expected during the third trimester and those that are abnormal. Heartburn and backaches are expected complaints. In addition, once lightening has occurred, frequent urination also returns. In each of the three cases, the signs do not indicate pathology. Both persistent headache and blurred vision, however, are signs that the woman may have developed a complication of pregnancy. If they should develop, the client should be advised to report them to the healthcare practitioner.

20. Which of the following fi ndings 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/m 2 . 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, and 4 are correct. 1. The BMI of 17 is of concern. This client is entering her pregnancy underweight. 2. The rubella titer results should be reported to the nurse midwife. 4. The hematocrit is below normal. TEST-TAKING TIP: Women who enter their pregnancies underweight, that is with a BMI less than 18.5 kg/m 2 , are encouraged to gain slightly more—28 to 40 lb— during their pregnancies than are women of normal weight who are encouraged to gain between 25 and 35 lb (see www .acog.org/Resources-And-Publications/ Committee-Opinions/Committee-on -Obstetric-Practice/Weight-Gain-During -Pregnancy). A rubella titer of 1:8 or less indicates that the woman is nonimmune to rubella. If exposed, she is, therefore, at risk of developing the disease. Because a woman is at high risk of becoming anemic during her pregnancy, it is important to identify any woman who enters her pregnancy with a below normal hematocrit.

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

1, 2, and 5 are correct. 1. Before attempting to become pregnant, it is very important that women begin taking daily multivitamin tablets. 2. Women who wish to become pregnant should fi rst see a medical doctor for a complete checkup. 5. Women who wish to become pregnant should be counseled to stop smoking. TEST-TAKING TIP: Because the embryo is very sensitive during the fi rst trimester of pregnancy, women should be advised to be vigilant about their health even before becoming pregnant. For example, folic acid, a vitamin in multivitamin tablets, helps to prevent neural tube defects in fetuses. Women of childbearing age often fail to go for complete physical examinations. It is important to discover the presence of any medical illnesses before the pregnancy begins, so women should be counseled to have a complete physical examination before stopping birth control methods.

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

32. A woman states that she frequently awakens with "painful leg cramps" during the night. Which of the following assessments should the nurse make? 1. Woman's exercise schedule. 2. Her Goodell sign. 3. Her Hegar sign. 4. Woman's dietary intake.

1. An evaluation of the client's exercise schedule should be performed. TEST-TAKING TIP: Leg cramps, which are very painful, are most likely related to the weight of the developing fetus in conjunction with circulatory changes in the extremities. Regular exercise—for example, walking accompanied by stretching of the extremities—can help to reduce the incidence of leg cramps (see http://americanpregnancy.org/pregnancy -health/leg-cramps-during-pregnancy).

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

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

55. 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 healthcare 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. Birth plans help to facilitate communication between couples and their healthcare providers. TEST-TAKING TIP: The earlier a birth plan is developed, the better. A pregnant woman and her partner must feel comfortable with the communication methods, physical care, and healthcare philosophies of their obstetrical healthcare provider. The birth plan is a means for everyone clearly to understand each step of the birthing process. When the client enters the hospital for delivery, the birth plan should be presented to the nursing staff to facilitate the communication during that transition.

82. 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. Bologna should not be consumed during pregnancy unless it is thoroughly cooked. TEST-TAKING TIP: Because pregnant women are slightly immunocompromised, they are especially susceptible to certain diseases. Deli meats, unless heated to steaming hot, can cause listeriosis. Pregnant women should avoid these foods. Other foods that contain Listeria monocytogenes that should be avoided are unpasteurized milk, soft cheese, and undercooked meats. Other food-borne pathogens, for example, Campylobacter and Cryptosporidium, can also cause serious illness in pregnant women (see www.fda.gov/Food/FoodborneIllness Contaminants/PeopleAtRisk/ucm312704 .htm).

57. 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 who experience ptyalism have an excess of saliva. They should be advised to be vigilant in the care of their teeth and gums. Ptyalism is often accompanied by gingivitis and nausea and vomiting. TEST-TAKING TIP: Ptyalism is related to the increase in vascular congestion of the mucous membranes from increased estrogen production. Women with increased salivation often also experience gingivitis, which is also related to estrogen production. In addition, ptyalism is seen in women with nausea and vomiting. Because of the caustic effects of gastric juices on the enamel of the teeth, the infl ammation seen in the gums, and the increased salivation, it is essential that the pregnant woman take special care of her teeth during pregnancy, including regular visits to the dentist and/or the dental hygienist.

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

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

87. 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. Ginger has been shown to be a safe antiemetic agent for pregnant women. TEST-TAKING TIP: Morning sickness and daytime nausea and vomiting are common complaints of pregnant women during the fi rst trimester. Ginger—consumed as ginger tea, ginger ale, and the like—has been shown to be a safe and an effective antinausea agent for many pregnant women.

5. 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. Greasy foods should be avoided TEST-TAKING TIP: Although many women experience nausea and vomiting or morning sickness upon rising, many women complain of nausea and/or vomiting at other times of the day. One theory that has been offered to explain this problem is that the body is ridding itself of teratogens that could potentially harm the fetus

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

1. Hearing a fetal heart rate is a positive sign of pregnancy. TEST-TAKING TIP: Positive signs of pregnancy are signs that irrefutably show that a fetus is in utero. An ultrasound of a fetus is one positive sign and the fetal heartbeat is another positive sign.

10. 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. High levels of the hormone chorionic gonadotropin in the bloodstream and urine of the woman is a probable sign of pregnancy. TEST-TAKING TIP: Human chorionic gonadotropin is produced by the fertilized egg. Its 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 the maintenance of the pregnancy.

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

1. It is common for women to be ambivalent about their pregnancy during the first trimester. TEST-TAKING TIP: Even women who stop taking birth control pills to become pregnant are often startled and ambivalent when they actually get pregnant. This is not pathological. The women usually slowly accept the pregnancy and by 20 weeks' gestation are happy and enthusiastic

98. 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 is usually forming in the fetal lungs by the 36th week. TEST-TAKING TIP: The test taker should realize that this question is asking two things. First, the test taker needs to know what stage of pregnancy the woman is in when the fundal height is at the xiphoid process. Once the test taker realizes that the fundus reaches the xiphoid process at 36 weeks' gestation, he or she must determine what other change or process is likely to be occurring at 36 weeks. The spinal column is completely formed by the end of the fi rst trimester, fetal respiratory movements begin at about 24 weeks, and the eyes open and close at about 28 weeks. Surfactant, which is essential for mature lung function, is forming in the fetal lungs at about 36 weeks. It is important for the nurse to realize that babies who are born preterm are at high risk for a number of reasons, including lack of surfactant, lack of iron stores to sustain them during the early months of life, and lack of brown adipose tissue needed for thermoregulation.

35. 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) 98.6 º F/37 º C and third trimester T 99.2 º F/37.3 º C.

1. The blood pressure should not elevate during pregnancy. This change should be reported to the healthcare practitioner. TEST-TAKING TIP: The basal metabolic rate of the woman increases during pregnancy. As a result the nurse would expect to observe a respiratory rate of 20 to 24 rpm. High levels of progesterone in the body result in a decrease in the contractility of the smooth musculature throughout the body. This results in an increase in the pulse rate. In addition, progesterone is thermogenic, resulting in a slight rise in the woman's core body temperature.

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. The client is likely 12 weeks pregnant. At 12 weeks, the fundal height is at the top of the symphysis. TEST-TAKING TIP: The fundal height is assessed at every prenatal visit. It is an easy, noninvasive means of assessing fetal growth. The nurse should know that the top of the fundus is at the level of the symphysis at the end of the fi rst trimester.

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

1. The client with phenylketonuria (PKU) must receive counseling from a registered dietitian. TEST-TAKING TIP: PKU is a genetic disease that is characterized by the absence of the enzyme needed to metabolize phenylalanine, an essential amino acid. When clients 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 become severely developmentally disabled .

56. 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 the father at delivery should be nonnegotiable. TEST-TAKING TIP: Even though the birth plan should include issues like the use or nonuse of episiotomies, emergent issues during the delivery may lead to a sudden change in plans. For example, if a cesarean is needed for malpresentation, the issue of episiotomy is moot and the client will defi nitely need anesthesia. However, there are some issues that should be nonnegotiable. If the father wishes to be in the delivery room no matter the type of delivery or whether or not an emergent situation is occurring, that should be stated in the plan and accepted by the healthcare provider.

50. 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 fi nances now than before the pregnancy." 4. "My husband plays his favorite music for my belly so the baby will learn to like it."

1. The woman implies that she and her husband are not having sex. There is no need to refrain from sexual intercourse during a normal pregnancy—so the woman and her husband need further counseling. TEST-TAKING TIP: Couvade is the term given to a father's physiological responses to his partner's pregnancy. Men have been seen to exhibit a number of physical complaints/changes that simulate their partner's physical complaints/changes— for example, indigestion, weight gain, urinary frequency, and backache.

58. A gravid woman who recently emigrated from mainland China is being seen at her fi rst 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. Infl uenza. 2. Mumps. 3. Rubella. 4. Varicella.

1. The woman should receive the infl uenza injection. The nasal spray, however, should not be administered to a pregnant woman. TEST-TAKING TIP: It is very important for pregnant women to be protected from the fl u by receiving the inactivated infl uenza injection. The fetus will not be injured by the shot and the woman will be protected from the many sequelae that can develop from the fl u. However, the live nasal fl u spray should not be administered to pregnant women. It is contraindicated to vaccinate pregnant women with many other vaccines, including the measles-mumps-rubella (MMR) and the varicella vaccines (see http://acog.org/Resources_And _Publications/Committee_Opinions/ Committee_on_Obstetric_Practice/ Infl uenza_Vaccination_During _Pregnancy).

59. 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. The woman should stay out of rooms that are being renovated. TEST-TAKING TIP: Antique houses often contain lead-based paint and water piping that has been soldered with lead-based solder. Lead, when ingested either through the respiratory tract or the GI tract, can cause permanent damage to the central nervous system of the unborn child. It is very important, therefore, that the woman not breathe in the air in rooms that have recently been sanded. The paint aerosolizes and the lead can be inhaled. In addition, lead leaches into hot water more readily than into cold, so water from the cold tap should be consumed—but only after the water has run through the pipes for a minimum of 2 minutes.

94. 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 fi elds are fi nally completely formed." 3. "The sex of the fetus can be clearly identifi ed." 4. "The eyelids are unfused and begin to open and close."

1. This is a true statement. In the morula stage, about 2 to 4 days after fertilization, the fertilized egg has not yet implanted in the uterus. TEST-TAKING TIP: The morula is the undifferentiated ball of cells that migrates down the fallopian tube toward the uterine body. The morular stage lasts from about the 2nd to the 4th day after fertilization.

75. 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 fi st. 4. Large tomato.

1. This is an accurate statement. A serving of meat—typically a 2 to 3 oz serving—is approximately equal to a deck of cards. TEST-TAKING TIP: The dietary recommendation of the protein group for moderately active women of childbearing age is the equivalent to 5 ½ oz. of lean meat, fi sh, or fowl per day. A 1 oz equivalent is defi ned as 1 oz of meat, fi sh, or poultry or one egg. The average American diet well exceeds the recommended protein intake since most Americans consider a serving of meat to be much larger than a deck of cards. Additional and healthier sources of protein are peanut butter, nuts, or seeds and cooked beans or peas. It is recommended that 4 to 5 servings of these sources be consumed each week. It is also recommended that pregnant women eat at least 8 oz of seafood per week up to a maximum of 12 oz per week. (see http:// health.gov/dietaryguidelines/2015/ guidelines/chapter-1/a-closer-look-inside -healthy-eating-patterns/#subnav-4).

105. The nurse is reading an article that states that the maternal mortality rate in the United States in the year 2014 was 14. Which of the following statements would be an accurate interpretation of the statement? 1. In the year 2014, there were 14 maternal deaths in the United States per 100,000 live births. 2. In the year 2014, there were 14 maternal deaths in the United States per 100,000 women of childbearing age. 3. In the year 2014, there were 14 maternal deaths in the United States per 100,000 pregnancies. 4. In the year 2014, there were 14 maternal deaths in the United States per 100,000 women in the country.

1. This statement is correct. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births. TEST-TAKING TIP: One important indicator of the quality of health care in a country is its maternal mortality rate. The rate in the United States is very low as compared to many other countries in the world and yet well above other countries. For example, in 2013, the maternal mortality rate in the United States was 28/100,000 live births, while in Austria and Denmark the rate was 5/100,000 live births. However, in Sierra Leone the rate was 1,100 deaths per 100,000 live births. Although still much too high, the rate is declining around the world, especially in many developing countries (see http://apps.who.int/gho/ data/node.main.15).

91. 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. This statement is true. Organogenesis begins prior to the missed menstrual period. TEST-TAKING TIP: The test taker may be unfamiliar with the term "organogenesis . " To answer the question correctly, it is essential that the test taker be able to decipher the defi nition. It is important that the nurse break the word down into its parts to deduce the meaning. "Organo" means "organ" and "genesis" means "origin." The defi nition of the term, therefore, is origin, or development, of the organ systems.

69. 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, fi sh.

1. Tofu, legumes, and broccoli are excellent substitutes for the restricted foods. TEST-TAKING TIP: Vegans are vegetarians who eat absolutely no animal products. Since animal products are most clients' sources of protein, iron, and vitamin B 12 , it is necessary for vegans to be very careful to meet their increased needs by eating excellent sources of these nutrients. It is recommended that vegans meet with a registered dietitian early in their pregnancies to discuss diet choices.

74. 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. Turnip greens are calcium rich. TEST-TAKING TIP: There are a number of women who, for one reason or another, do not consume large quantities of dairy products. The nurse must be prepared to suggest alternate sources since dairy products are the best sources for calcium intake. Any of the dark green, leafy vegetables such as kale, spinach, collards, and turnip greens are excellent sources as are small fi sh that are eaten with the bones such as sardines.

107. A nurse is providing health education to a group of women who are planning to become pregnant. Which of the following actions should the nurse advise the women to take throughout their pregnancies? Select all that apply. 1. The women should avoid consuming well done meat. 2. The women should avoid traveling to locations where the zika virus is endemic. 3. The women should engage in a daily exercise program. 4. The women should consume one serving of seafood each day. 5. The women should drink beer and wine instead of spirits like whiskey and vodka.

2 and 3 are correct. 2. This statement is true. Throughout their pregnancies, women should avoid traveling to locations where the zika virus is endemic. 3. This statement is true. Women should engage in a daily exercise program throughout their pregnancies. TEST-TAKING TIP: Some babies born to mothers who contracted the zika virus during their pregnancies have delivered babies with small heads and brains, a syndrome called microcephaly. To reduce the potential of mothers being exposed to the virus, the Centers for Disease Control and Prevention (CDC) recommends that any woman who is pregnant or who is planning to become pregnant not travel to a zika endemic region. In addition, because the virus can be transmitted via sexual contact, the women's partners should also refrain from traveling to those regions. (see https://www.cdc.gov/zika/ pregnancy/index.html).

13. 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 and 4 are correct 2. The woman will likely complain of urinary frequency. 4. Most women complain of fatigue during the first trimester. TEST-TAKING TIP: During the first trimester, the body undergoes a number of important changes. The embryo is developing, the hormones of the body are increasing, and the maternal blood supply is increasing. To accomplish each of the tasks, the body uses energy. The mother is fatigued not only because the body is undergoing great change but also because the thyroid gland has not caught up with the increasing energy demands. In addition, because the organs are confined within the bony pelvis, the enlarging uterus prevents the bladder from expanding with large quantities of urine. As a result, the woman needs to urinate much more frequently than she did prior to becoming pregnant.

23. The nurse working in an outpatient obstetric offi ce assesses four primigravid clients. Which of the client fi ndings 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 and 4 are correct. 2. The fundal height at 24 weeks should be 4 cm above the umbilicus. The fundal height at the level of the umbilicus is expected at 20 weeks' gestation. 4. The woman may be going into preterm labor. TEST-TAKING TIP: It is important for the test taker to know the timing of key pregnancy changes as well as abnormal prenatal fi ndings. The mother should feel fetal movement by 20 weeks' gestation. Primigravidas often feel fetal movement later than multigravidas. Specifi c fundal height measurements are also expected at key times in the pregnancy. A baby delivered at 34 weeks' gestation is at high risk for many neonatal complications.

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

2 and 5 are correct. 2. Fibrinogen levels will be elevated slightly in a 40-week pregnant woman because coagulation factors like fi brinogen increase to help prevent excessive blood loss during delivery. 5. A 40-week pregnant woman's white blood cell count will be elevated above normal as a means of protecting her body from infection. TEST-TAKING TIP: During the latter part of the third trimester, coagulation factors increase in preparation for delivery. It is the body's means of protecting itself against a large loss of blood at delivery. In addition, the white blood cell count rises as a means of protecting the body from infection.

90. A woman asks the nurse about the function of amniotic fl uid. Which of the following statements by the woman indicates that the teaching was successful? Select all that apply. 1. The fl uid provides fetal nutrition. 2. The fl uid cushions the fetus from injury. 3. The fl uid enables the fetus to grow. 4. The fl uid provides the fetus with a stable thermal environment. 5. The fl uid enables the fetus to practice swallowing

2, 3, 4, and 5 are correct. 2. Amniotic fl uid does cushion the fetus from injury. 3. Amniotic fl uid enables the fetus's limbs and body to move freely so that the baby can grow unencumbered. 4. The amniotic fl uid is maintained at the mother's body temperature, providing the fetus with a neutral thermal environment. 5. The fetus does swallow the amniotic fl uid while in utero. TEST-TAKING TIP: The amniotic fl uid is produced primarily by the fetus as fetal urine. In addition to the functions noted above, the baby practices "breathing" the amniotic fl uid in and out of the lungs in preparation for breathing air in the extrauterine environment and "drinks" the amniotic fl uid in preparation for extrauterine feeding.

44. 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, and 4 are correct. 2. The blood pressure is assessed at each prenatal visit. 3. The fetal heart rate is assessed at each prenatal visit. Depending on the equipment available, it will be assessed mechanically via Doppler or manually via fetoscope. The fetal heart is audible via Doppler many weeks before it is audible via fetoscope. 4. Urine protein is performed at each prenatal visit. TEST-TAKING TIP: The test taker must read the question carefully. Although urine glucose assessments are done at each visit, blood glucoses are assessed only intermittently during the pregnancy. Similarly, although ultrasound assessments may be ordered intermittently during a pregnancy, they are not usually performed at every prenatal visit.

78. A nurse is discussing the serving sizes in the grain food group with a new prenatal client. Which of the following foods equals 1 oz. serving 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 ounce dry cereal.

2, 4, and 5 are correct. 2. 1 slice bread = one 1 oz serving. 4. 1 tortilla = one 1 oz serving. 5. 1 ounce dry cereal = one 1 oz serving. TEST-TAKING TIP: Moderately active women of childbearing age are recommended to consume six to eight servings of grain each day. However, one sandwich equals two servings since each slice of bread equals one 1 oz serving. Also, it is important to counsel women to eat whole grain foods rather than processed grains. More nutrients as well as more fi ber are obtained from whole grain foods.

77. Which of the following choices can the nurse teach a prenatal client is equivalent to a 1 oz. nonmeat serving of protein? 1. 2 tbsp peanut butter. 2. 1 egg. 3. 1 cup cooked lima beans. 4. 3 ounces mixed nuts

2. 1 egg = a 1 oz non-meat serving of protein . TEST-TAKING TIP: The test taker should refer to the U.S. Dietary Association information for up-to-date dietary recommendations. As more research information is forthcoming, dietary recommendations change. The current recommendations can be found at http:// health.gov/dietaryguidelines/2015/ guidelines/chapter-1/a-closer-look-inside -healthy-eating-patterns/#subnav-4 and http://health.gov/dietaryguidelines/2015/ guidelines/appendix-3

46. A 36-week gestation gravid lies fl at 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. Dizziness is an expected fi nding. TEST-TAKING TIP: Because the weight of the gravid uterus compresses the great vessels, the nurse would expect the client to become hypotensive and to complain of dizziness when lying supine. In addition, the fetal heart rate may drop. The blood supply to the head and other parts of the body, including the placenta, is diminished when the great vessels are compressed.

84. 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. Hamburger contains the most iron. TEST-TAKING TIP: Iron is present in most animal sources—seafood, meats, eggs— although it is not present in milk. There also is iron in vegetable sources, although not in the same concentration as in animal products. If the nurse is caring for a pregnant vegetarian, the nurse must counsel the client regarding good nonanimal sources of all nutrients.

85. 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-defi ciency anemia. 3. Hypercalcemia. 4. Overexposure to zinc.

2. Iron-defi ciency anemia is often seen in clients who engage in pica. TEST-TAKING TIP: Clients who engage in pica eat large quantities of nonfood items like ice, laundry starch, soap, and dirt. There are a number of problems related to pica, including teratogenesis related to eating foods harmful to the fetus. More commonly, the women fi ll up on items like ice instead of eating high-quality foods. This practice is often culturally related.

54. 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 fi rst? 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. It is best that a couple fi rst develop a birth plan. TEST-TAKING TIP: It is important for a couple's needs and wants to match their obstetrical care practitioner's philosophy of care. If, for example, the couple is interested in the possibility of having a water birth, it is important that the healthcare provider be willing to perform a water birth. If, however, the woman wants to be "completely pain-free," the healthcare provider must be willing to order pain medications throughout the labor and delivery. A birth plan will list the couples' many wishes.

47. The nurse is interviewing a 38-week gestation Muslim woman. Which of the following questions would be inappropriate for the nurse to ask? 1. "Do you plan to breastfeed your baby?" 2. "What do you plan to name the baby?" 3. "Which pediatrician do you plan to use?" 4. "How do you feel about having an episiotomy?"

2. It is inappropriate to ask the Muslim client about the name for the baby. TEST-TAKING TIP: Traditional Muslim couples will not tell anyone the baby's name until he or she has gone through the offi cial naming ceremony, called aqiqah . Babies are rarely named before a week of age. The parents need time to get to know their baby and decide on an appropriate name for him or her.

96. 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 does cover the fetal body at approximately 20 weeks' gestation. TEST-TAKING TIP: Although the test taker need not memorize all fetal developmental changes, it is important to have an understanding of major periods of development. For example, organogenesis occurs during the fi rst trimester with all of the major organs functioning at a primitive level by week 12.

80. A Chinese immigrant is being seen in the prenatal clinic. When providing nutrition counseling, which of the following factors should the nurse keep in mind? 1. Many Chinese eat very little protein. 2. Many Chinese believe pregnant women should eat cold foods. 3. Many Chinese are prone to anemia. 4. Many Chinese believe strawberries can cause birth defects.

2. Many Chinese women do believe in the "hot and cold" theory of life. TEST-TAKING TIP: Whenever a question specifi es that a client belongs to a specifi c cultural or ethnic group, the test taker should attend carefully to that information. It is very likely that the question is asking the test taker to discern cultural/ethnic differences to determine the test taker's cultural competence. Pregnancy is believed by many Chinese, as well as women from other cultures, to be a "hot period." To maintain the equilibrium of the body, therefore, pregnant women consume "cold" foods and drinks.

31. An 18-week gestation client telephones the obstetrician's offi ce stating, "I'm really scared. I think I have breast cancer. My breasts are fi lled 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. Nodular breast tissue is normal in pregnancy. TEST-TAKING TIP: The high levels of estrogen and progesterone seen in pregnancy result in a number of changes. The hypertrophy and hyperplasia of the breast tissue, in preparation for neonatal lactation, are two of the changes.

88. 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 fl our and fi gs.

2. Strawberries and potatoes are excellent sources of vitamin C, as are zucchini, blueberries, kiwi, green beans, green peas, and the like. TEST-TAKING TIP: The test taker must be prepared to answer basic nutrition questions related to the health of the pregnant woman. Even though citrus fruits are commonly thought of as the primary sources of vitamin C, the test taker should realize that virtually all fruits and vegetables contain the vitamin, while grains do not.

34. 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 client should be referred to a lactation consultant. TEST-TAKING TIP: Research on eversion exercises has shown that they are not effective, plus breast manipulation can bring on contractions since oxytocin production is stimulated. Lactation consultants are breastfeeding specialists who can assist women with breastfeeding after the baby's birth.

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

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

39. A 36-week gestation gravid client is complaining of dyspnea when lying fl at. 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. The fundal height is the likely cause of the woman's dyspnea. TEST-TAKING TIP: As the uterus enlarges, the woman's organs are affected. At 36 weeks, the fundus is at the level of the xiphoid process. The diaphragm is elevated and the lungs are displaced. When a client lies fl at she has diffi culty breathing. Most women use multiple pillows at night for sleep. Whenever caring for a pregnant woman, the nurse should elevate the head of the bed.

11. 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. The nurse should query the young woman about what she felt. TEST-TAKING TIP: Quickening, or subjective fetal movement, occurs between 16 and 20 weeks' gestation. At 10 weeks' gestation it would be impossible for the young woman to feel fetal movement. The nurse, therefore, should elicit more information from the teen to determine what she had felt.

51. 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/mm 3 to 15,000 cells/mm 3 . 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. The nurse would expect to see an elevated white blood cell count. TEST-TAKING TIP: At the end of the third trimester and through to the early postpartum period, a normal leukocytosis, or rise in white blood cell count, is seen. This is a natural physiological change that protects the woman's body from the invasion of pathogens during the birth process. The nurse should rely on a temperature elevation to determine whether or not the woman has an infection.

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

2. The pelvic tilt is an exercise that can reduce backache pain. TEST-TAKING TIP: Pelvic tilt exercises help to reduce backache pain. The client is taught to get into an optimal position— on the hands and knees is often best. She is then taught to force her back out while tucking her head and buttocks under and holding that position for a few seconds, followed by holding the alternate position for a few seconds—arching her back while lifting her head and her buttocks toward the ceiling. These positions should be alternated repeatedly for about 5 minutes. The exercises are very relaxing while also improving the muscle tone of the lower back.

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

2. The practitioner would expect to palpate an enlarged ovary. TEST-TAKING TIP: The cervix is long and thick to retain the pregnancy in the uterine cavity. The cervical mucus is thin and the vaginal wall is bluish in color as a result of elevated estrogen levels. The ovary is enlarged because the corpus luteum is still functioning.

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

76. The nurse is evaluating the 24-hour dairy intake of four gravid clients. Which of the following clients consumed the highest number of dairy servings during 1 day? The client who consumed: 1. 4 oz whole milk, 2 oz hard cheese, 1 cup of pudding made with milk and 2 oz cream cheese. 2. 1 cup yogurt, 8 oz chocolate milk, 1 cup cottage cheese, and 1½ oz hard cheese. 3. 1 cup cottage cheese, 8 oz whole milk, 1 cup buttermilk, and ½ oz hard cheese. 4. ½ cup frozen yogurt, 8 oz skim milk, 4 oz cream cheese, and 1½ cup cottage cheese.

2. This client consumed 3½ servings: 1 cup yogurt = 1 serving, 8 oz chocolate milk = 1 serving; 1 cup cottage cheese = ½ serving; and 1½ oz hard cheese = 1 serving. TEST-TAKING TIP: It is essential that the test taker know which foods are placed in which food groups and the equivalent quantity of food that meets one serving size. For example, 1 cup of any type of milk—whole, skim, butter, or even chocolate—is equal to one dairy serving, while 1 ½ oz of hard cheese, 1 cup of yogurt, 2 cups of cottage cheese, and 1 ½ cups of ice cream are all equal to one dairy serving.

102. A woman delivers a fetal demise that has lanugo covering the entire body, nails that are present on the fi ngers 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. This fetus is about 22 weeks' gestation. Nails start to develop in the fi rst trimester, and lanugo starts to develop at about 20 weeks, but eyes remain fused until about 29 weeks. In addition, quickening occurs by week 20. TEST-TAKING TIP: The test taker should not panic when reading a question like the one in the scenario. This is an application question that requires the test taker to take things apart and put them back together again. Each of the signs is unique and relates to a specifi c period in fetal development. After an analysis, the only response that is plausible is choice 2.

95. 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 defi nitely be the same sex and have the same blood type.

2. This is a true statement. Dizygotic twins result from two mature ova that are fertilized independently. TEST-TAKING TIP: The best way for the test taker to differentiate between monozygotic twinning and dizygotic twinning is to remember the meaning of the prefi xes to the two words. "Mono" means "1." Monozygotic twins, therefore, originate from one fertilized ovum. The babies have the same DNA; therefore, they are the same sex. They share a placenta and chorion. "Di" means "2." Dizygotic twins arise from two separately fertilized eggs. Their genetic relationship is the same as if they were siblings born from different pregnancies.

53. 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. This is an accurate statement TEST-TAKING TIP: There is no contraindication to intercourse or to orgasm during pregnancy, unless it has been determined that a client is at high risk for preterm labor. Until late in pregnancy, there are very few oxytocin receptor sites on the uterine body. The woman will, therefore, not go into labor as a result of an orgasm during sexual relations.

86. A woman confi des 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. This is an excellent suggestion. Fruit juice, although high in sugar, does contain vitamins. TEST-TAKING TIP: Although the nurse might prefer that a client completely stop a behavior that the nurse deems unsafe or inappropriate, the client may disagree. The nurse, therefore, must attempt to provide a substitute for the client's behavior. Pica is a behavior that should be discouraged because of its potentially detrimental effects. If the client wishes to consume ice, an excellent alternative is ice pops, Italian ices, or iced fruit juice.

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

2. This is the defi nition of ballottement. TEST-TAKING TIP: Although this question discusses nurse-patient interaction, it is simply a defi nition question. The test taker is being asked to identify the defi nition of the word "ballottement."

106. A gravid client is counseled by her primary healthcare provider to have a vaccination during her third trimester of pregnancy. The client questions the healthcare provider's recommendation. Which of the following statements would be appropriate for the nurse to give the client? 1. "When received during pregnancy, the rotavirus vaccine helps to prevent dehydration in newborns." 2. "If you receive the tetanus, diphtheria, and acellular pertussis vaccine, your baby will be protected against whooping cough." 3. "When received during pregnancy, the human papillomavirus vaccine helps to prevent newborns from acquiring the sexually transmitted infection." 4. "If you receive the varicella vaccine, your baby will be protected from the chickenpox virus."

2. This statement is correct. The Centers for Disease Control and Prevention (CDC) recommends the administration of the Tdap vaccine to all pregnant women during the third trimester to provide their neonates with passive immunity to whooping cough. TEST-TAKING TIP: Neonates are especially at high risk for pertussis (whooping cough) because they do not begin receiving the vaccine until they are 2 months of age. To protect them from the disease, the CDC recommends that all pregnant women receive the Tdap vaccine in their third trimester and for all family members who will have close contact with the baby to have received the vaccine within the last 10 years (see www.cdc.gov/pertussis/pregnant/mom/ protection.html).

97. A woman who is seen in the prenatal clinic is found to be 8 weeks pregnant. She confi des to the nurse that she is afraid her baby may be "permanently damaged because I had at least fi ve 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 fi rst trimester are very safe." 4. "An ultrasound will tell you if the baby was affected."

2. This statement is true. TEST-TAKING TIP: The 2-week period between ovulation and implantation is often called "the all or nothing period." During that time, the fertilized egg/ embryo is fl oating freely in the woman's fallopian tubes toward the uterine body. The mother is not supplying the embryo with nutrients at this time. Rather, the embryo is self-suffi cient. If an insult occurs—for example, a teratogen is ingested or an abdominal x-ray is taken— the embryo is either destroyed or completely spared. And, since the pregnancy of the woman in the scenario was maintained, the nurse can assure her that the embryo was spared insult.

71. 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 B 2 (niacin). 4. Vitamin B 12 (cobalamin).

2. Vitamin D supplementation can be harmful during pregnancy. TEST-TAKING TIP: The water-soluble vitamins, if consumed in large quantities, have not been shown to be harmful during pregnancy. The body eliminates the excess quantities through the urine and stool. However, the fat-soluble vitamins—vitamins A, D, E, and K—can build up in the body. Vitamins A and D have been shown to be teratogenic to the fetus in megadoses.

101. 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 likely not be present. TEST-TAKING TIP: Lanugo is a fi ne hair that covers the body of the fetus. It begins to disappear at about 38 weeks and very likely has completely vanished by 41 weeks' gestation.

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

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

24. 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. Hearing the fetal heartbeat often increases fathers' interests in their partners' pregnancies. TEST-TAKING TIP: Women who are in the fi rst few weeks of pregnancy often experience a number of physical complaints—nausea and vomiting, fatigue, breast tenderness, and urinary frequency. Prospective fathers whose partners experience these complaints are often not very interested in the pregnancies. When the baby becomes "real," with a positive heartbeat or fetal movement, the fathers often become very excited.

27. A 75-gram oral glucose tolerance test (OGTT) is ordered at or after 24 weeks' gestation for a pregnant client to assess her physiological response to which of the following pregnancy hormones? 1. Estrogen. 2. Progesterone. 3. Human placental lactogen. 4. Human chorionic gonadotropin.

3. Human placental lactogen is an insulin antagonist. TEST-TAKING TIP: hPL is produced by the placenta. As the placenta grows, the hormone levels rise. At approximately 24 weeks' gestation, the levels are high enough to affect glucose metabolism. If performed earlier, the OGTT may result in a false-negative result.

12. 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. It is important for the nurse to ask the young woman how she feels about being pregnant. She may decide not to continue with the pregnancy. TEST-TAKING TIP: Some pregnant women are happy about their pregnancy, some are sad, and still others are frightened. At the initial interview, it is essential that the nurse not assume that the woman will respond in any particular way. The nurse must ask open-ended questions to elicit the woman's feelings about the pregnancy.

70. When assessing the fruit intake of a pregnant client, the nurse notes that the client usually eats one 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. It is recommended that pregnant clients eat whole fruits rather than consume large quantities of fruit juice. This is the most important statement for the nurse to make. TEST-TAKING TIP: It is recommended that moderately active women of childbearing age consume the equivalent of at least 2 cups of fruit per day. Approximately 8 oz of fruit juice equals 1 cup of fruit. Fruit juices, however, are rarely made of 100% juice and almost always contain added sugar. In addition, the client is not receiving the benefi t of the fi ber that is contained in the whole fruit. The nurse should compliment the client on her fruit intake but encourage her to consume whole fruits rather than large quantities of juice ( see http://health.gov/ dietaryguidelines/2015/guidelines/ chapter-1/a-closer-look-inside-healthy -eating-patterns).

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

3. Petechiae are pinpoint red or purple spots on the skin. They are seen in hemorrhagic conditions. TEST-TAKING TIP: There are many skin changes that occur normally during pregnancy. Most of the changes—such as linea nigra, melasma, and hyperpigmentation of the areolae—are related to an increase in the melaninproducing bodies of the skin as a result of stimulation by the female hormones estrogen and progesterone. The presence of petechiae is usually related to a pathological condition, such as thrombocytopenia.

64. A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2015. Using Nagele rule, the nurse calculates the client's estimated date of delivery as: 1. May 30, 2016. 2. June 20, 2016. 3. June 27, 2016. 4. July 3, 2016.

3. The estimated date of delivery is June 27, 2016. TEST-TAKING TIP: Nagele rule is a simple method used to calculate a client's estimated date of confi nement (EDC) or estimated date of delivery (EDD) from the last normal menstrual period (LMP). The nurse learns the date of the fi rst day of the last menstrual period from the client. He or she then subtracts 3 months from the date, adds 7 days to the date, and adjusts the year, if needed.

89. 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. Frozen yogurt. 2. Parmesan cheese. 3. Gorgonzola cheese. 4. Chocolate milk.

3. The intake of gorgonzola cheese should be discouraged during pregnancy. TEST-TAKING TIP: Gorgonzola cheese is a soft cheese. Soft cheeses often harbor Listeria monocytogenes , the organism that causes listeriosis. Pregnant women are at high risk of developing this infection because they are slightly immunosuppressed. The adult disease can assume many forms, including meningitis, pneumonia, and sepsis. Pregnant women who develop the disease often deliver stillborn babies or babies who are at risk of dying postdelivery from fulminant disease. Any dairy product that is not pasteurized should be avoided.

28. A client is 15 weeks pregnant. She calls the obstetric offi ce to request a medication for a headache. The nurse answers the telephone. Which of the following is the nurse's best response? 1. "Because the organ systems in the baby are developing right now, you may take no medication." 2. "You can take any of the over-the-counter medications because they are all safe in pregnancy." 3. "The physician will prescribe a medication for you that has been shown not to cause any fetal injuries." 4. "The physician will prescribe a rectal suppository because the medicine will not enter your blood stream."

3. The physician will prescribe a medication that is safe to take during pregnancy. TEST-TAKING TIP: It is important for pregnant women to contact their healthcare practitioners to fi nd out which medications are safe to take during pregnancy and which medications must be avoided. All medications are reviewed for their safe ingestion during pregnancy. Although medications used to be given a "pregnancy category" of A, B, C, D, or X, that no longer is true. Rather, strict guidelines have been developed to standardize pregnancy information included on medication labels (see www.fda.gov/downloads/drugs/ guidancecomplianceregulatory information/guidances/ucm425398.pdf). Drugs that cause structural defects are called teratogens because they have defi nitely been shown to cause fetal damage.

93. 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. The right atrium does contain both oxygen-rich and oxygen-poor blood TEST-TAKING TIP: The test taker should have an understanding of fetal circulation. One principle to remember when studying the circulation of the fetus is that the majority of fetal blood bypasses the lungs since the baby is receiving oxygen-rich blood directly from the placenta via the umbilical vein. The location of the three ducts—ductus venosus, formen ovale, ductus arteriosus—therefore enable the blood to bypass the lungs.

100. 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."

3. The sex is not established yet. 4. This statement is true. The sex is not visible yet. TEST-TAKING TIP: The genitourinary system is the last organ system to fully develop. Before 12 weeks, both female and male genitalia are present. The sex is determined genetically, but it is as yet impossible to determine the sex visually. If the embryo secretes testosterone, the male sex organs mature and the female organs recede. If the embryo does not secrete testosterone, the male sex organs recede and the female organs mature. At 8 weeks, it is not possible visually to determine the sex of the fetus.

60. After nutrition counseling, a woman, G3 P1101, proclaims that she certainly can't eat any strawberries during her pregnancy. Which of the following is the likely reason for this statement? 1. The woman is allergic to strawberries. 2. Strawberries have been shown to cause birth defects. 3. The woman believes in old wives' tales. 4. The premature baby died because the woman ate strawberries.

3. The woman believes in old wives' tales. TEST-TAKING TIP: There are a number of old wives' tales that pregnant women believe in and live by. One of the common tales relates to the ingestion of strawberries: Women who eat strawberries have babies with strawberry marks on their bodies. Unless belief in old wives' tales has the potential to affect the health of the baby and/or mother, it is ill advised and unnecessary to argue with the mother about her beliefs.

67. 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 fi rst-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. This accurately refl ects this woman's gravidity and parity—G5 P1122. TEST-TAKING TIP: Gravidity refers to pregnancy and parity refers to delivery. Every time a woman is pregnant, it is counted as one gravida (G). The results of each pregnancy are then documented as a para (P) in the following order: The fi rst number refers to full-term births or births at or greater than 38 weeks' gestation; the second number refers to preterm births or births between 20 and 37 weeks' gestation; the third number refers to abortions, whether spontaneous or therapeutic; and the fourth number refers to the number of living children. The client has been pregnant 5 times (G5); she birthed 1 son, 1 daughter, had 1 miscarriage, had 1 fi rst-trimester abortion, and is currently pregnant. Her parity (P1122) accurately refl ects her obstetrical history: 1 full-term delivery (daughter at 39 weeks), 1 preterm delivery (son at 28 weeks), 2 abortions (1 miscarriage, 1 fi rst-trimester abortion), and, fi nally, 2 living children.

49. A 34-week gestation woman calls the obstetric offi ce 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. This is an accurate statement. Hormonal changes in pregnancy make the nasal passages prone to bleeds TEST-TAKING TIP: Estrogen, one of the important hormones of pregnancy, promotes vasocongestion of the mucous membranes of the body. Increased vascular perfusion of the mucous membranes of the gynecological system is essential for the developing fetus to survive. The vasocongestion occurs in all of the mucous membranes of the body, however, leading to many complaints including nosebleeds and gingival bleeding.

16. 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 fi nd a way to get through the pregnancy."

3. This is the best comment. It acknowledges the concerns that the client is having. TEST-TAKING TIP: Nurses have two roles when clients express concerns to them. First, the nurse must acknowledge the client's concerns so that the client feels accepted and understood. Second, the nurse must help the client to problem solve the situation. It is very important, however, that the acceptance precede the period of problem solving.

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

3. Vaginal and rectal cultures are done at approximately 36 weeks' gestation. TEST-TAKING TIP: Vaginal and rectal cultures are done to assess for the presence of group B streptococcal (GBS) bacteria in the woman's vagina and rectum. If the woman has GBS as part of her normal fl ora, she will be given IV antibiotics during labor to prevent vertical transmission to her baby at birth. GBS is often called "the baby killer."

62. 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 fi nd 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. TEST-TAKING TIP: Pregnancy lasts 10 lunar months. It is essential that the nurse counsel clients on ways to maintain health and well-being in the many facets of their lives. Sexual intimacy is one of the important aspects of a married couple's life together. The couple can be counseled to use alternate positions, engage in mutual masturbation, or discover other means to satisfy their needs for sexual expression during the pregnancy period.

73. 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. Celery is an excellent food to reverse constipation. It is a high-fi ber food. TEST-TAKING TIP: Most women complain of constipation during pregnancy. Progesterone, a muscle relaxant, is responsible for a slowing of the digestive system. It is important, therefore, to recommend foods to pregnant clients that will help to alleviate the problem. Foods high in fi ber, such as fresh fruits and vegetables, are excellent suggestions.

18. 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. Cystic fi brosis is an autosomal recessive genetic disease, so the client with a family history of cystic fi brosis should be referred to a genetic counselor. TEST-TAKING TIP: Virtually all diseases— chronic and acute—have some genetic component, but the ability for the genetic counselor to predict the impact of many diseases is very poor. Those illnesses with clear hereditary patterns, however, do warrant referral to genetic counselors. Cystic fi brosis is inherited via an autosomal recessive inheritance pattern.

79. 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 healthcare practitioner.

4. Every woman should advise her healthcare practitioner of what she is consuming, including food, medicines, herbals, and all other substances. TEST-TAKING TIP: Herbals are not regulated by the Food and Drug Administration (FDA). There is some information on selected herbals at the National Institutes of Health Web site— http://nccam.nih.gov/health—but because research on pregnant women is particularly sensitive there is very little defi nitive information on the safety of many herbals in pregnancy. No matter what is consumed by the mother, however, the healthcare practitioner should be consulted.

81. A nurse has identifi ed 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. Oranges and spinach are excellent folic acid sources. TEST-TAKING TIP: The intake of folic acid is especially important during the fi rst trimester of pregnancy to help to prevent structural defects, including spina bifi da and gastroschisis. The best sources of folic acid are liver and dark green, leafy vegetables. Oranges and orange juice are also good sources.

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

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

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

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

103. 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 fi rst 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. The blood supplies are completely separate. TEST-TAKING TIP: It is important to understand the relationship between the maternal vascular system and the fetal system. There is a maternal portion to the placenta and a fetal portion of the placenta. By the time the placenta is fully functioning, at about 12 weeks' gestation, fetal blood vessels have burrowed into the decidual lining and maternal vessels have burrowed into the chorionic layer. The vessels, therefore, lie next to each other. Gases and nutrients, then, move across the membranes of the vessels to provide the baby with needed substances and for the mother to dispose of waste products.

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

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

52. A client is 35 weeks' gestation. Which of the following fi ndings 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. The use of three pillows for sleep comfort is often seen in clients who are 35 weeks' gestation. TEST-TAKING TIP: It is essential that the test taker differentiate between normal and abnormal fi ndings at various points during the pregnancy—for example, nausea and vomiting are normal during the fi rst trimester but not during the second or third trimester. The fundal height measurement is also important to remember. From 20 weeks' gestation— when the fundal height is usually at the same height as the umbilicus—to 36 weeks' gestation—when the fi nal height is at the xiphoid process—the height measures are approximately the same number of centimeters above the symphysis as the number of weeks of fetal gestation. For example, at 24 weeks' gestation, the height is usually 24 cm above the symphysis or 4 cm above the umbilicus, and at 35 weeks' gestation, the height is usually 35 cm above the symphysis, or 15 cm above the umbilicus.

68. 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 infl uence 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. This is an appropriate comment to make at this time. TEST-TAKING TIP: This father is exhibiting a sign of couvade, that is, weight gain. This is a positive response since it shows that he is exhibiting a sympathetic response to his partner's pregnancy. In addition, this father is accompanying his partner to the prenatal visit, another positive sign.

83. 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 fi sh 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 fi sh, but sushi is too salty to eat during pregnancy." 3. "Sushi is raw. Raw fi sh is especially high in mercury." 4. "It is recommended that fi sh be cooked to destroy harmful bacteria."

4. This is correct. It is recommended that during pregnancy the client eat only well-cooked fi sh. TEST-TAKING TIP: Fish is an excellent source of omega-3 oil and protein, but during pregnancy fi sh should be eaten well cooked to avoid ingestion of pathogens. It is recommended that pregnant women consume 8 to 12 oz of seafood per week. No more than 12 oz per week is recommended, however, to reduce the potential of consuming toxic levels of methylmercury (see http:// americanpregnancy.org/pregnancy-health/ foods-to-avoid-during-pregnancy).

72. A vegan is being counseled regarding vitamin intake. It is essential that this woman supplement her intake of which of the following B vitamins? 1. B 1 (thiamine). 2. B 2 (niacin). 3. B 6 (pyridoxine). 4. B 12 (cobalamin).

4. Vitamin B 12 (cobalamin) should be supplemented. TEST-TAKING TIP: Vitamin B 12 (cobalamin) is found almost exclusively in animal products—meat, dairy, eggs. Since vegans do not consume animal products and the vitamin is not in most nonanimal sources, it is strongly recommended that vegans supplement that vitamin. Those who take in too little of the vitamin are susceptible to anemia and nervous system disorders. In addition, the vitamin is especially important during pregnancy since it is essential for DNA synthesis.