Lippincott Practice Q's Antepartal Care

Which of the following client statements indicates a need for additional teaching about self- care during pregnancy? 1. "I should use nonskid pads when I take a shower or bath." 2. "I should avoid using soap on my nipples to prevent drying." 3. "I should sit in a hot tub for 20 minutes to relax after working." 4. "I should avoid douching even if my vaginal secretions increase."

"I should sit in a hot tub for 20 minutes to relax after working."

The nurse is discussing dietary concerns with pregnant teens. Which of the following choices are convenient for teens yet nutritious for both the mother and fetus? Select all that apply. 1. Milkshake or yogurt with fresh fruit or granola bar. 2. Chicken nuggets with tater tots. 3. Cheese pizza with spinach and mushroom topping. 4. Peanut butter with crackers and a juice drink. 5. Buttery light popcorn with diet cola. 6. Cheeseburger with tomato, lettuce, pickle, ketchup, and baked potato.

1,3,4 Milkshake or yogurt with fresh fruit or granola bar. Cheese pizza with spinach and mushroom topping. Peanut butter with crackers and a juice drink.

A client asks the nurse why taking folic acid is so important before and during pregnancy. The nurse should instruct the client that: 1. "Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers." 2. "Eating foods with moderate amounts of folic acid helps regulate blood glucose levels." 3. "Folic acid consumption helps with the absorption of iron during pregnancy." 4. "Folic acid is needed to promote blood clotting and collagen formation in the newborn."

1. "Folic acid is important in preventing neural tube defects in newborns and preventing anemia in mothers."

An antenatal client is discussing her anemia with the nurse in the prenatal clinic. After a discus- sion about sources of iron to be incorporated into her daily meals, the nurse knows the client needs further instruction when she responds with which of the following? 1. "I can meet two goals when I drink milk, lots of iron and meeting my calcium needs at the same time." 2. "Drinking coffee, tea, and sodas decrease the absorption of iron." 3. "I can increase the absorption of iron by drinking orange juice when I eat." 4. Cream of wheat and molasses are excellent sources of iron."

1. "I can meet two goals when I drink milk, lots of iron and meeting my calcium needs at the same time."

Which of the following statements by the nurse would be most appropriate when responding to a primigravid client who asks, "What should I do about this brown discoloration across my nose and cheeks?" 1. "This usually disappears after delivery." 2. "It is a sign of skin melanoma." 3. "The discoloration is due to dilated capillaries." 4. "It will fade if you use a prescribed cream."

1. "This usually disappears after delivery."

A primiparous client at 10 weeks' gestation questions the nurse about the need for an ultra- sound. She states "I don't have health insurance and I can't afford it. I feel fi ne, so why should I have the test?" The nurse should incorporate which statements as the underlying reason for performing the ultrasound now? Select all that apply. 1. "We must view the gross anatomy of the fetus." 2. "We need to determine gestational age." 3. "We want to view the heart beating to deter- mine that the fetus is viable." 4. "We must determine fetal position." 5. "We must determine that there is a sufficient

1. "We must view the gross anatomy of the fetus." 2. "We need to determine gestational age."

When teaching a primigravid client at 24 weeks' gestation about the diagnostic tests to determine fetal well-being, which of the following should the nurse include? 1. A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity. 2. A reactive non stress test is an ominous sign and requires further evaluation with fetal echocardiography. 3. Contraction stress testing, performed on most pregnant women, can be initiated as early as 16 weeks' gestation. 4. Percutaneous umbilical blood sampling uses a needle inserted through the vagina to obtain a sample.

1. A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity.

When providing care to the client who has undergone a dilatation and curettage (D&C) after a spontaneous abortion, the nurse administers hydroxyzine (Vistaril) as ordered. Which of the fol- lowing is an expected outcome? 1. Absence of nausea. 2. Minimized pain. 3. Decreased uterine cramping. 4. Improved uterine contractility.

1. Absence of nausea.

When caring for a primigravid client at 9 weeks' gestation who immigrated to the United States from Vietnam 1 year ago, the nurse would assess the client's diet for a defi ciency of which of the following? 1. Calcium. 2. Vitamin E. 3. Vitamin C. 4. Iodine.

1. Calcium.

A multigravid client at 36 weeks' gestation has been diagnosed with condylomata acuminata. Which of the following should the nurse include when teaching the client about the disorder and cur- rent therapies? 1. Cryotherapy may be used to remove the warts. 2. Podophyllin solution may be used to decrease the size of the warts. 3. A 25% trichloroacetic acid solution can eradicate the disorder. 4. Condylomata acuminata has been associated with ovarian cancer.

1. Cryotherapy may be used to remove the warts.

Which of the following recommendations would be the most appropriate preventive measure to suggest to a primigravid client at 30 weeks' gestation who is experiencing occasional heartburn? 1. Eat smaller and more frequent meals during the day. 2. Take a pinch of baking soda with water before meals. 3. Decrease fluid intake to four glasses daily. 4. Drink several cups of regular tea throughout the day.

1. Eat smaller and more frequent meals during the day.

A primigravid client has completed her first prenatal visit and blood work. Her laboratory test for the hepatitis B surface antigen (HBsAg) is posi- tive. The nurse can advise the client that the plan of care for this newborn will include? Select all that apply. 1. Hepatitis B immune globulin at birth. 2. Series of three hepatitis B vaccinations per recommended schedule.Hepatitis B screening when born. 3. Isolation of infant during hospitalization. 4. Universal precautions for mother and infant. 5. Contraindication for breast-feeding because the mother is HBsAg positive.

1. Hepatitis B immune globulin at birth. 2. Series of three hepatitis B vaccinations per recommended schedule. 5. Universal precautions for mother and infant.

When preparing a 20-year-old client who reports missing one menstrual period and suspects that she is pregnant for a radioimmunoassay preg- nancy test, the nurse should tell the client which of the following about this test? 1. It has a high degree of accuracy within 1 week after ovulation. 2. It is identical in nature to an over-the-counter home pregnancy test. 3. A positive result is considered a presumptive sign of pregnancy. 4. A urine sample is needed to obtain quicker results.

1. It has a high degree of accuracy within 1 week after ovulation.

The nurse is assessing fetal position for a 32-year-old client in her eighth month of pregnancy. As shown below, the fetal position can be described as which of the following? baby booty to the left face facing the right side of the pelvis 1. Left occipital transverse. 2. Left occipital anterior. 3. Right occipital transverse. 4. Right occipital anterior.

1. Left occipital transverse.

A primigravid client at 36 weeks' gesta- tion tells the nurse that she has been experiencing insomnia for the past 2 weeks. Which of the follow- ing suggestions would be most helpful? 1.Practice relaxation techniques before bedtime. 2. Drink a cup of hot chocolate before bedtime. 3. Drink a small glass of wine with dinner. 4. Exercise for 30 minutes just before bedtime.

1. Practice relaxation techniques before bedtime.

Which of the following statements best identifi es the rationale for why the nurse reinforces the need for continued prenatal care throughout the pregnancy with an adolescent primigravid client? 1. Pregnant adolescents are at high risk for pregnancy-induced hypertension. 2. Gestational diabetes during pregnancy commonly develops in adolescents. 3. Adolescents need additional instruction related to common discomforts. 4. The father of the baby is rarely involved in the pregnancy.

1. Pregnant adolescents are at high risk for pregnancy-induced hypertension.

While caring for a 24-year-old primigravid client scheduled for emergency surgery because of a probable ectopic pregnancy, the nurse should: 1. Prepare to witness an informed consent for surgery. 2. Assess the client for massive external bleeding. 3. Explain that the fallopian tube can be salvaged. 4. Monitor the client for uterine contractions.

1. Prepare to witness an informed consent for surgery.

When developing a teaching plan for a client who is 8 weeks pregnant, which of the following foods would the nurse suggest to meet the client's need for increased folic acid? 1. Spinach. 2. Bananas. 3. Seafood. 4. Yogurt.

1. Spinach.

A 30-year-old G 4, P 3 client at 30 weeks' gestation is admitted to the hospital for evaluation. The client has experienced two neonatal deaths because of hemolytic disease of the newborn. An amniocen- tesis is to be performed to evaluate bilirubin density. The nurse should obtain a specimen container that is which of the following? 1. Dark. 2. Clear. 3. Green. 4. Amber.

1. dark

A multigravid client who stands for long peri- ods while working in a factory visits the prenatal clinic at 35 weeks' gestation, stating, "The varicose veins in my legs have really been bothering me lately." Which of the following instructions would be helpful? 1. Perform slow contraction and relaxation of the feet and ankles twice daily. 2. Take frequent rest periods with the legs elevated above the hips. 3. Avoid support hose that reach above the leg varicosities. 4. Take a leave of absence from your job to avoid prolonged standing.

2. Take frequent rest periods with the legs elevated above the hips.

A 40-year-old client at 8 weeks' gestation has a 3-year-old child with Down syndrome. The nurse is discussing amniocentesis and chorionic villus sampling as genetic screening methods for the expected baby. The nurse is confi dent that the teaching has been understood when the client states which of the following? 1. "Each test identifies a different part of the infant's genetic makeup." 2. "Chorionic villus sampling can be performed earlier in pregnancy." 3. "The test results take the same length of time to be completed." 4. "Amniocentesis is a more dangerous proce- dure for the fetus."

2. "Chorionic villus sampling can be performed earlier in pregnancy."

A primigravid client at 32 weeks' gestation is enrolled in a breast-feeding class. Which of the fol- lowing statements indicate that the client understands the breast-feeding education? Select all that apply. 1. "My milk supply will be adequate sinceI have increased a whole bra size during pregnancy." 2. "I can hold my baby several different ways during feedings." 3. "If my infant latches on properly, I won't develop mastitis." 4. "If I breast-feed, my uterus will return to prepregnancy size more quickly." 5. "Breast milk can be expressed and stored at room temperature since it is natural." 6. "I need to feed my baby when I see feeding cues and not wait until she is crying."

2. "I can hold my baby several different ways during feedings." 4. "If I breast-feed, my uterus will return to prepregnancy size more quickly." 6. "I need to feed my baby when I see feeding cues and not wait until she is crying."

The nurse is teaching a new prenatal client about her iron defi ciency anemia during pregnancy. Which statement indicates that the client needs further instruction about her anemia? 1. "I will need to take iron supplements now." 2. "I may have anemia because my family is of Asian descent." 3. "I am considered anemic if my hemoglobin is below 11 g/dL." 4. "The workload on my heart is increased when there is not enough oxygen in my system."

2. "I may have anemia because my family is of Asian descent."

A 20-year-old married client with a positive pregnancy test states, "Is it really true? I can't believe I'm going to have a baby!" Which of the following responses by the nurse would be most appropriate at this time? 1. "Would you like some booklets on the preg- nancy experience?" 2. "Yes it is true. How does that make you feel?" 3. "You should be delighted that you are pregnant." 4. "Weren't you and your husband trying to have a baby?"

2. "Yes it is true. How does that make you feel?"

When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which of the follow- ing points? 1. Halfway between the client's symphysis pubis and umbilicus. 2. At about the level of the client's umbilicus. 3. Between the client's umbilicus and xiphoid process. 4. Near the client's xiphoid process and com- pressing the diaphragm.

2. At about the level of the client's umbilicus.

When planning a class for primigravid clients about the common discomforts of pregnancy, which of the following physiologic changes of pregnancy: 1. The temperature decreases slightly early in pregnancy. 2. Cardiac output increases by 25% to 50% during pregnancy. 3. The circulating fibrinogen level decreases as much as 50% during pregnancy. 4. The anterior pituitary gland secretes oxytocin late in pregnancy.

2. Cardiac output increases by 25% to 50% during pregnancy.

When performing Leopold's maneuvers on a primigravid client at 22 weeks' gestation, the nurse performs the first maneuver to do which of the following? 1. Locate the fetal back and spine. 2. Determine what is in the fundus. 3. Determine whether the fetal head is at the pelvic inlet. 4. Identify the degree of fetal descent and flexion.

2. Determine what is in the fundus.

When performing Leopold's maneuvers, which of the following would the nurse ask the client to do to ensure optimal comfort and accuracy? 1. Breathe deeply for 1 minute. 2. Empty her bladder. 3. Drink a full glass of water. 4. Lie on her left side.

2. Empty her bladder.

The nurse is reviewing results for clients who are having antenatal testing. The assessment data from which client warrants prompt notifi cation of the health care provider and a further plan of care? 1. Primigravida who reports fetal movement 6 times in 2 hours. 2. Multigravida who had a positive oxytocin challenge test. 3. Primigravida whose infant has a biophysical profile of 9. 4. Multigravida whose infant has a reactive non- stress test.

2. Multigravida who had a positive oxytocin challenge test.

After the nurse reviews the physician's explanation of amniocentesis with a multigravid cli- ent, which of the following indicates that the client understands a serious risk of the procedure.? 1. Premature rupture of the membranes. 2. Possible premature labor. 3. Fetal limb malformations. 4. Fetal organ malformation

2. Possible premature labor.

A 30-year-old multigravid client has missed three periods and now visits the prenatal clinic because she assumes she is pregnant. She is experi- encing enlargement of her abdomen, a positive preg- nancy test, and changes in the pigmentation on her face and abdomen. These assessment fi ndings refl ect this woman is experiencing a cluster of which signs of pregnancy? 1. Positive. 2. Probable. 3. Presumptive. 4. Diagnostic.

2. Probable.

A woman at 22 weeks' gestation has right upper quadrant pain radiating to her back. She rates the pain as 9 on a scale of 1 to 10 and says that it has occurred 2 times in the last week for about 4 hours at a time. She does not associate the pain with food. Which of the following nursing measures is the highest priority for this client? 1. Educate the client concerning changes occurring in the gallbladder as a result of pregnancy. 2. Refer the client to her health care provider for evaluation and treatment of the pain. 3. Discuss nutritional strategies to decrease the possibility of heartburn. 4. Support the client's use of acetaminophen (Tylenol) to relieve pain.

2. Refer the client to her health care provider for evaluation and treatment of the pain.

The nurse instructs a primigravid client to increase her intake of foods high in magnesium because of its role with which of the following? 1. Prevention of demineralization of the moth-er's bones. 2. Synthesis of proteins, nucleic acids, and fats. 3. Amino acid metabolism. 4. Synthesis of neural pathways in the fetus.

2. Synthesis of proteins, nucleic acids, and fats.

A primigravida at 8 weeks' gestation tells the nurse that she wants an amniocentesis because there is a history of Hemophilia A in her family. The nurse informs the client that she will need to wait until she is 15 weeks gestation for the amniocentesis. Which of the following provides the most appropriate rationale for the nurse's statement regarding amniocentesis at 15 weeks' gestation? 1. Fetal development needs to be complete before testing. 2. The volume of amniotic fluid needed for testing will be available by 15 weeks. 3. Cells indicating Hemophilia A are not produced until 15 weeks' gestation. 4. Fetal anomalies are associated with amnio- centesis prior to 15 weeks' gestation.

2. The volume of amniotic fluid needed for testing will be available by 15 weeks.

A primigravid client at 8 weeks' gestation tells the nurse that since having had sexual relations with a new partner 2 weeks ago, she has noticed fl u-like symptoms, enlarged lymph nodes, and clusters of vesicles on her vagina. The nurse refers the client to a physician because the nurse suspects which of the following sexually transmitted diseases? 1. Gonorrhea. 2. Chlamydia trachomatis infection. 3. Syphilis. 4. Herpes genitalis.

4. Herpes genitalis.

Which of the following statements by a prim- igravid client scheduled for chorionic villi sampling indicates effective teaching about the procedure? 1. "A fiberoptic fetoscope will be inserted through a small incision into my uterus." 2. "I can't have anything to eat or drink after midnight on the day of the procedure." 3. "The procedure involves the insertion of a thin catheter into my uterus." 4. "I need to drink 32 to 40 oz of fluid 1 to2 hours before the procedure."

3. "The procedure involves the insertion of a thin catheter into my uterus."

A primigravid client asks the nurse if she can continue to have a glass of wine with dinner during her pregnancy. Which of the following would be the nurse's best response? 1. "The effects of alcohol on a fetus during pregnancy are unknown." 2. "You should limit your consumption to beer and wine." 3. "You should abstain from drinking alcoholic beverages." 4. "You may have 1 drink or 2 oz of alcohol per day."

3. "You should abstain from drinking alcoholic beverages."

A nurse is assigned to the obstetrical triage area. When beginning the assignment, the nurse is given a report about four clients waiting to be seen. Place the clients in the order in which the nurse should see them. 1. A primigravid client at 10 weeks' gestation complaining of not feeling well with nausea and vomiting, urinary frequency, and fatigue. 2. A multiparous client at 32 weeks' gesta-tion asking for assistance with finding a new physician. 3. A single mother at 4 months postpartum fear- ful of shaking her baby when he cries. 4. An antenatal client at 16 weeks' gestation who has occasional sharp pain on her left side radi- ating from her symphysis to her fundus.

3,4,1, 2 The first client to be seen should be the postpartum mother who is fearful of shaking her infant. Postpar- tum depression is a disorder that may occur during the first year postpartum but peaks at 4 weeks post- partum, prior to menses, or upon weaning. As a single mother, this client may not have support, a large factor putting women at risk. Other factors accentuat- ing risk include prior depressive or bipolar illness and self-dissatisfaction

On entering the room of a client who has undergone a dilatation and curettage (D&C) for a spontaneous abortion, the nurse fi nds the client cry- ing. Which of the following comments by the nurse would be most appropriate? 1."Are you having a great deal of uterine pain?" 2. "Commonly spontaneous abortion means a defective embryo." 3. "I'm truly sorry you lost your baby." 4. "You should try to get pregnant again as soon as possible."

3. "I'm truly sorry you lost your baby."

A primagravid client at 16 weeks' gestation has had an amniocentesis and has received teaching concerning signs and symptoms to report. Which statement indicates that the client needs further teaching? 1. "I need to call if I start to leak fluid from my vagina." 2. "If I start bleeding, I will need to call back." 3. "If my baby does not move, I need to call my health care provider." 4. "If I start running a fever, I should let the office know."

3. "If my baby does not move, I need to call my health care provider."

A primigravid client at 28 weeks' gestation tells the nurse that she and her husband wish to drive to visit relatives who live several hundred miles away. Which of the following recommenda- tions by the nurse would be best? 1. "Try to avoid traveling anywhere in the car during your third trimester." 2. "Limit the time you spend in the car to a maximum of 4 to 5 hours." 3. "Taking the trip is okay if you stop every 1 to 2 hours and walk." 4. "Avoid wearing your seat belt in the car to prevent injury to the fetus."

3. "Taking the trip is okay if you stop every 1 to 2 hours and walk."

A dilatation and curettage (D&C) is scheduled for a primigravid client admitted to the hospital at 10 weeks' gestation with abdominal cramping, bright red vaginal spotting, and passage of some of the products of conception. The nurse should assess the client further for the expression of which of the following feelings? 1. Ambivalence. 2. Anxiety. 3. Fear 4. Guilt.

4. Guilt.

Which of the following would be included in the teaching plan about pregnancy-related breast changes for a primigravid client? 1. Growth of the milk ducts is greatest during the first 8 weeks of gestation. 2. Enlargement of the breasts indicates adequate levels of progesterone. 3. Colostrum is usually secreted by about the 16th week of gestation. 4. Darkening of the areola occurs during the last month of pregnancy.

3. Colostrum is usually secreted by about the 16th week of gestation.

A client, approximately 11 weeks pregnant, and her husband are seen in the antepartal clinic. The client's husband tells the nurse that he has been experiencing nausea and vomiting and fatigue along with his wife. The nurse interprets these findings as suggesting that the client's husband is experiencing which of the following? 1. Ptyalism. 2. Mittelschmerz. 3. Couvade syndrome. 4. Pica.

3. Couvade syndrome.

A client in the triage area who is at 19 weeks' gestation states that she has not felt her baby move in the past week and no fetal heart tones are found. While evaluating this client, the nurse identifi es her as being at the highest risk for developing which problem? 1. Abruptio placentae. 2. Placenta previa. 3. Disseminated intravascular coagulation. 4. Threatened abortion.

3. Disseminated intravascular coagulation.

The nurse instructs a primigravid client about the importance of suffi cient vitamin A in her diet. The nurse knows that the instructions have been effective when the client indicates that she should include which of the following in her diet? 1. Buttermilk and cheese. 2. Strawberries and cantaloupe. 3. Egg yolks and squash. 4. Oranges and tomatoes.

3. Egg yolks and squash.

The health care provider at a prenatal clinic has ordered multivitamins for a woman who is 3 months' pregnant. The client calls the nurse to report that she has gone to the pharmacy to fi ll her prescription but is unable to buy it as it costs too much. The nurse should refer the client to: 1. The charge nurse. 2. The hospital finance office. 3. Her hospital social worker. 4. Her insurance company.

3. Her hospital social worker.

A newly diagnosed pregnant client tells the nurse, "If I'm going to have all of these discomforts, I'm not sure I want to be pregnant!" The nurse inter- prets the client's statement as an indication of which of the following? 1. Fear of pregnancy outcome. 2. Rejection of the pregnancy. 3. Normal ambivalence. 4. Inability to care for the newborn.

3. Normal ambivalence.

Which of the following recommendations would be most helpful to suggest to a primigravid client at 37 weeks' gestation who is complaining of leg cramps? 1.Change positions frequently throughout the day. 2. Alternately flex and extend the legs. 3. Straighten the knee and flex the toes toward the chin. 4. Lie prone in bed with the legs elevated.

3. Straighten the knee and flex the toes toward the chin.

When teaching a primigravid client how to do Kegel exercises, the nurse explains that the expected outcome of these exercises is to: 1. Prevent vulvar edema. 2. Alleviate lower back discomfort. 3. Strengthen the perineal muscles. 4. Strengthen the abdominal muscles.

3. Strengthen the perineal muscles.

To obtain the obstetric conjugate measurement, the nurse would do which of the following? 1. Add 1.5 cm to the transverse diameter. 2. First measure the angle of the pubic arch. 3. Subtract 1.5 to 2 cm from the diagonal conjugate. 4. Measure the diameter of the pelvic inlet

3. Subtract 1.5 to 2 cm from the diagonal conjugate.

After instructing a female client about the radioimmunoassay pregnancy test, the nurse deter- mines that the client understands the instructions when the client states that which of the following hormones is evaluated by this test? 1. Prolactin. 2. Follicle-stimulating hormone. 3. Luteinizing hormone. 4. Human chorionic gonadotropin (hCG).

4. Human chorionic gonadotropin (hCG).

A multigravid client at 32 weeks' gestation has experienced hemolytic disease of the newborn in a previous pregnancy. The nurse should prepare the client for frequent antibody titer evaluations obtained from which of the following? 1. Placental blood. 2. Amniotic fluid. 3. Fetal blood. 4. Maternal blood.

4. Maternal blood.

The nurse assesses a woman at 24 weeks' gestation and is unable to find the fetal heart beat. The fetal heart beat was heard at the cli- ent's last visit 4 weeks ago. According to priority, the nurse should do the following tasks in which order? 1. Call the health care provider. 2. Explain that the fetal heart beat could not be found at this time. 3. Obtain different equipment and recheck. 4. Ask client if baby is or has been moving.

4, 3, 2, 1 Ask client if baby is or has been moving. Obtain different equipment and recheck. Explain that the fetal heart beat could not be found at this time. Call the health care provider.

A primigravid adolescent client at approxi- mately 15 weeks' gestation who is visiting the prenatal clinic with her mother is to undergo alphafetoprotein (AFP) screening. When developing the teaching plan for this client, the nurse should include which of the following? 1. Ultrasonography usually accompanies AFP testing. 2. Results are usually very accurate until 20 weeks' gestation. 3. A clean-catch midstream urine specimen is needed. 4. Increased levels of AFP are associated with neural tube defects.

4. Increased levels of AFP are associated with neural tube defects.

After instructing a primigravid client about desired weight gain during pregnancy, the nurse determines that the teaching has been successful when the client states which of the following? 1. "A total weight gain of approximately 20 lb (9 kg) is recommended." 2. "A weight gain of 6.6 lb (3 kg) in the second and third trimesters is considered normal." 3. "A weight gain of about 12 lb (5.5 kg) every trimester is recommended." 4. "Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average."

4. "Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average."

A woman who has had asthma since she was a child and it is under control when the client takes her medication correctly and consistently is now pregnant for the first time. Which of the following client statements concerning asthma during pregnancy indicates the need for further instruction? 1."I need to continue taking my asthma medication as prescribed." 2. "It is my goal to prevent or limit asthma attacks." 3. "During an asthma attack, oxygen needs con- tinue to be high for mother and fetus." 4. "Bronchodilators should be used only when necessary because of the risk they present to the fetus."

4. "Bronchodilators should be used only when necessary because of the risk they present to the fetus."

An antenatal client receives education concerning medications that are safe to use during pregnancy. The nurse evaluates the client's understanding of the instructions and determines that she needs further information when she states which of the following? 1. "If I am constipated, Milk of Magnesia is okay but mineral oil is not." 2. "If I have heartburn, it is safe to use Tums, Rolaids, Mylanta, and Maalox." 3. "I can take Tylenol if I have a headache." 4. "If I need to have a bowel movement, Ex-Lax is preferred."

4. "If I need to have a bowel movement, Ex-Lax is preferred."

During a routine clinic visit, a 25-year-old multigravid client who initiated prenatal care at 10 weeks' gestation and is now in her third trimes- ter states, "I've been having strange dreams about the baby. Last week I dreamed he was covered with hair." The nurse should tell the mother: 1. "Dreams like the ones that you describe are very unusual. Please tell me more about them." 2. "Commonly when a mother has these dreams, she is trying to cope with becoming a parent." 3. "Dreams about the baby late in pregnancy usually mean that labor is about to begin soon." 4. "It's not uncommon to have dreams about the baby, particularly in the third trimester."

4. "It's not uncommon to have dreams about the baby, particularly in the third trimester."

After conducting a presentation to a group of adolescent parents on the topic of adolescent pregnancy, the nurse determines that one of the parents needs further instruction when the parent says that adolescents are at greater risk for which of the following? 1. Denial of the pregnancy. 2. Low-birth-weight infant. 3. Cephalopelvic disproportion. 4. Congenital anomalies.

4. Congenital anomalies.

During a visit to the prenatal clinic, a preg- nant client at 32 weeks' gestation complains of heartburn. The client needs further instruction when she says she must do what? 1. Avoid highly seasoned foods. 2. Avoid laying down right after eating. 3. Eat small, frequent meals. 4. Consume liquids only between meals.

4. Consume liquids only between meals.

Examination of a primigravid client com- plaining of increased vaginal secretions since becoming pregnant reveals clear, highly acidic vaginal secretions. The client denies any perineal itching or burning. The nurse interprets these findings as a response related to which of the following? 1. A decrease in vaginal glycogen stores. 2. Development of a sexually transmitted disease. 3. Prevention of expulsion of the cervical mucus plug. 4. Control of the growth of pathologic bacteria.

4. Control of the growth of pathologic bacteria.

Rho(D) immune globulin (RhoGAM) is ordered for a client before she is discharged after a spontaneous abortion. The nurse instructs the cli- ent that this drug is used to prevent which of the following? 1. Development of a future Rh-positive fetus. 2. An antibody response to Rh-negative blood. 3. A future pregnancy resulting in abortion. 4. Development of Rh-positive antibodies.

4. Development of Rh-positive antibodies.

A 36-year-old primigravid client at 22 weeks' gestation without any complications to date is being seen in the clinic for a routine visit. The nurse should assess the client's fundal height to: 1. Determine the level of uterine activity. 2. Identify the need for increased weight gain. 3. Assess the location of the placenta. 4. Estimate the fetal gestational age.

4. Estimate the fetal gestational age.

Following a positive pregnancy test, a client begins discussing the changes that will occur in the next several months with the nurse. The nurse should include which of the following information about changes the client can anticipate in the fi rst trimester? 1. Differentiating the self from the fetus. 2. Enjoying the role of nurturer. 3. Preparing for the reality of parenthood. 4. Experiencing ambivalence about pregnancy.

4. Experiencing ambivalence about pregnancy.

Using Nägele's rule for a client whose last normal menstrual period began on May 10, the nurse determines that the client's estimated date of delivery would be which of the following? 1. January 13. 2. January 17. 3. February 13. 4. February 17.

4. February 17

An antenatal primagravid client has just been informed that she is carrying twins. The plan of care includes educating the client concerning factors that put her at risk for problems during the pregnancy. The nurse realizes the client needs further instruc- tion when she indicates carrying twins puts her at risk for which of the following? 1. Preterm labor. 2. Twin-to-twin transfusion. 3. Anemia. 4. Group B Streptococcus.

4. Group B Streptococcus.

A 34-year-old multiparous client at 16 weeks' gestation who received regular prenatal care for all of her previous pregnancies tells the nurse that she has already felt the baby move. The nurse interprets this as which of the following? 1. The possibility that the client is carrying twins. 2. Unusual because most multiparous clients do not experience quickening until 30 weeks' gestation. 3. Evidence that the client's estimated date of delivery is probably off by a few weeks. 4. Normal because multiparous clients can expe- rience quickening between 14 and 20 weeks' gestation.

4. Normal because multiparous clients can experience quickening between 14 and 20 weeks' gestation.

After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which of the following hormones is produced by the placenta? 1. Estrogen. 2. Progesterone. 3. Human chorionic gonadotropin (hCG). 4. Testosterone.

4. Testosterone.

Which diagnostic test would be the most important to have for a primigravid client in the second trimester of her pregnancy? 1. Culdocentesis to detect abnormalities. 2. Chorionic villus sampling. 3. Ultrasound testing. 4. α-fetoprotein (AFP) testing.

4. α-fetoprotein (AFP) testing.

A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She is complaining of dyspnea with exertion and being very tired. Her vital signs are 98, 80, 20, BP 116/72. She has + 2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac classification according to the New York Heart Association Cardiac Disease classification? 1.ClassI. 2.ClassII. 3. Class III. 4.ClassIV.

Class II.