Maternity exam 1

During the health assessment of a pregnant client who is 30 years old, the nurse discusses preventive breast care. Which recommendation would the nurse include?

"A breast examination by a health care provider can help detect if there are any structural problems that may affect breastfeeding."

To prepare his 4-year-old son for a new baby, a father should use which statement?

"A new baby will make our family bigger but not change our love for you."

A 37-year-old primigravida client at 40 weeks' gestation is seen in the clinic for a scheduled prenatal visit. The nurse predicts the woman is close to labor based on which assessment finding?

Nesting

The nurse is admitting an obstetric client in early labor. As the nurse assists the client into the bed, which assessment should the nurse prioritize?

Signs that birth is imminent

A nurse is providing care to a woman during the third stage of labor. Which finding would alert the nurse that the placenta is separating?

sudden gush of dark blood from the vagina

A prenatal nurse is conducting a class on healthy pregnancy and explains the role of placental hormones. Which statements would the nurse make? Select all that apply.

-Human chorionic gonadotropin is the basis for pregnancy tests. -Human placental lactogen participates in the development of maternal breasts for lactation. -Progesterone stimulates maternal metabolism and breast development. -Estrogen causes enlargement of a woman's breasts.

The nurse is completing the initial assessment at the prenatal visit of a pregnant client. Which question should the nurse prioritize when completing the review of systems?

"Have you had any urinary tract infections?"

During the first prenatal visit an extensive history is collected from the client. What is one part of this extensive history?

social history

Which positions would be most appropriate for the nurse to suggest as a comfort measure to a woman who is in the first stage of labor? Select all that apply.

walking with partner support straddling with forward leaning over a chair rocking back and forth with foot on chair

A client at 10 weeks gestation comes to the clinic for a prenatal follow up. The client reports experiencing morning sickness. She states, "It happens at any time of the day. Is there anything I can do?" Which suggestions by the nurse would be most helpful? Select all that apply

"Try eating some dry crackers before you getting out of bed in the morning." "Avoid any strong food odors as much as possible." "Limit your intake of fluids when you eat your meals."

A pregnant woman in the 36th week of gestation reports that her feet are quite swollen at the end of the day. After careful assessment, the nurse determines that this is an expected finding at this stage of pregnancy. Which intervention is appropriate for the nurse to suggest?

"Try elevating your legs when you sit."

After describing continuous internal electronic fetal monitoring to a laboring woman and her partner, which statement by the woman would indicate the need for additional teaching?

"Unfortunately, I'm going to have to stay quite still in bed while it is in place."

A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy?

Avoid wearing high heels, especially during late pregnancy.

The nurse is conducting the first prenatal assessment on a newly pregnant client. She shares with the nurse that she has 3 children, 2 born at full-term and one at 34 weeks' gestation. Her last pregnancy ended in a miscarriage. How should the nurse document this client's obstetrical history?

G5 T2 P1 A1 L3

A nurse is monitoring a fetal heart rate (FHR) pattern on her client in labor and notes a change from the earlier baseline FHR of 140 bpm to 168 bpm. The nurse is aware that which factors can result in fetal tachycardia? Select all that apply.

fetal movement fetal distress uteroplacental insufficiency maternal fever

A client's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is this client experiencing?

Presumptive

The nursing instructor is teaching a class on the structures vital to the development of the fetus. The instructor determines the class is successful when the class correctly chooses which fact concerning amniotic fluid?

Produced by fetal membranes

A client arrives at a health care facility in the latent phase of the first stage of labor. Which intervention should the nurse implement?

Provide emotional and physical support.

A client makes an appointment with an obstetrician and assessment reveals positive Hegar and Chadwick signs. What should the nurse teach the client about these results?

She is probably pregnant, but this must be confirmed by other means

A nurse is describing the events of labor to a group of pregnant women. Put the following events of labor as the nurse would explain them from first to last. All options must be used.

The cervix dilates to 2 cm. Cervix becomes fully effaced. Fetus continues descent. Crowning occurs. Placenta separates. Placenta is expelled.

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy?

Visualization of the gestational sac or fetus

A woman's amniotic fluid is noted to be cloudy. The nurse interprets this finding as:

a possible infection.

A woman in her 16th week of pregnancy comes to the health center for a follow up visit. Which physiologic change would the nurse expect to assess? Select all that apply.

a uterus that is palpable colostrum that can be expelled from the nipples

A pregnant client in her 12th week of gestation has come to a health care center for a physical examination of her abdomen. Where should the nurse palpate for the fundus in this client?

at the symphysis pubis

A pregnant client at 26 weeks' gestation has arrived for a routine prenatal visit. Which assessments should the nurse prioritize? Select all that apply.

blood pressure weight urine testing blood glucose level

After learning that her fetus is in the LST position, the client asks the nurse what this means. Which structure will the nurse point out is presenting first?

buttocks

A nurse is providing care to a woman in labor. The nurse determines that the client has moved into the active phase based on which assessment findings? Select all that apply.

cervical dilation (dilatation) of 6 cm contractions lasting up to 60 seconds

A nurse is providing care to a woman in labor. The nurse determines that the client is in the active phase based on which assessment findings? Select all that apply.

cervical dilation of 6 cm contractions every 2 to 3 minutes

A young couple are concerned that their fetus may be born with sickle cell anemia. The nurse explains that the recessive traits of sickle-cell anemia can be determined by using which test?

chorionic villus sampling

A 40-year-old client is in her 10th week of pregnancy. So far, her pregnancy appears to be healthy, with no abnormal results from standard diagnostic tests. Because of her age, however, the nurse would anticipate that the client is a candidate for which diagnostic tests? Select all that apply. You Selected:

chorionic villus sampling amniocentesis cell-free DNA testing

A client is in her second trimester, and the health care provider has recommended she undergo an amniocentesis. The nurse explains that the procedure is used to diagnose which conditions? Select all that apply.

chromosomal abnormalities inborn errors of metabolism neural tube defects

A nurse is caring for a client in her fourth stage of labor. Which assessments would indicate normal physiologic changes occurring during the fourth stage of labor?

decreased intra-abdominal pressure well-contracted uterus in the midline mild uterine cramping and shivering

A nurse is caring for a client in her third stage of labor. The nurse would predict the placenta is separating from the uterus based on which assessment findings?

fresh gushing of blood from the vagina umbilical cord descending lower down a globular shaped uterus

A nurse is completing the assessment of a woman admitted to the labor and birth suite. Which information would the nurse expect to include as part of the physical assessment? Select all that apply.

fundal height measurement membrane status contraction pattern

The nurse is preparing the client for the routine laboratory tests that will be obtained at the first prenatal visit. Which test will the nurse prioritize at this visit?

hepatitis screen

If constipation is a problem for a woman during pregnancy, which measure would be best to recommend?

increased fiber intake

A nurse is caring for a client who is in the first stage of labor. The client is experiencing extreme pain due to the labor. The nurse understands that which factors are causing the extreme pain in the client? Select all that apply.

lower uterine segment distention stretching and tearing of structures dilation of the cervix

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called?

melasma (chloasma)

After teaching a group of pregnant women about fetal development and the events of each stage, the nurse determines that the teaching was successful when the women identify which stage? Select all that apply.

preembryonic umbilical fetal

A pregnant client in her second trimester visits a health care center. She informs the nurse that at times she experiences difficulty breathing. What would the nurse identify as the most likely cause of the client's report?

pressure on the diaphragm by the growing fetus

A pregnant client has come to a health care facility for a physical examination. Which assessments should a nurse perform when doing a physical examination of the head and neck?

previous injuries and sequelae limitations in range of motion thyroid gland enlargement

A pregnant client is excited that she is beginning to feel her baby move within her. The nurse explains that these first fetal movements are known as:

quickening.

A nurse is conducting an in-service program for a group of nurses working in the prenatal clinic. When discussing the theories about the onset of labor, the nurse points out which factor as a possible cause? Select all that apply.

release of oxytocin by the pituitary prostaglandin production in the myometrium

A nurse has been assisting a client who has been in labor. The nurse determines the client is moving into the transition phase based on which assessment findings?

strong desire to push irritability with restlessness

A number of inherited diseases can be detected in utero by amniocentesis. Which disease can be detected by this method?

trisomy 21 (Down syndrome)

A nurse is discussing the advantages and disadvantages of intermittent and continuous fetal heart rate monitoring with a colleague. What would the nurse cite as being able to be detected when using continuous monitoring but not intermittent monitoring?

types of decelerations variability

A woman in her third trimester is suffering from heartburn. What should the nurse advise her to do?

Eat small meals frequently rather than large meals.

A client is about 16 weeks' pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to this client's concern?

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

A woman is to undergo chorionic villus sampling as part of a risk assessment for genetic disorders. What statement would the nurse include when describing this test to the woman?

"A small piece of tissue from the fetal placenta will be removed and analyzed."

A woman visits the prenatal clinic and is noted to have oligohydramnios. The client asks, "Why is this fluid important anyway?" Which statements would be included in the nurse's response? Select all that apply.

"Amniotic fluid helps maintain your baby's body temperature." "Too little amniotic fluid is linked with placental problems." "It is associated with having babies with low birth weight." "It acts like a cushion protecting your baby from trauma that may occur."

A client who is six weeks' pregnant asks the prenatal nurse, "What development has taken place with my baby by now?" Which information should the nurse include in the response? Select all that apply.

"By week 3 there would be the beginning development of the brain, spinal cord, and heart." "By week 4 the arms and legs begin to grow and develop." "By week 5 the heart now beats and the eyes and ears can be seen." "By week 6 the lungs begin forming and the baby circulation is established."

A young couple who underwent preconceptual genetic counseling and testing have learned that they are at high risk for having a child with Down syndrome. They have decided not to have children. What would be the most appropriate response for the nurse to give? "I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center." "I appreciate your decision, but I urge you to think through this further. Having a child, even one with Down syndrome, is so rewarding." "I understand and support your decision. The risk is just not worth it." "I think you made the right decision. After all, I never had children, and I'm perfectly happy."

"I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center."

A pregnant client is admitted to the labor and birth unit in the first stage of labor. A nurse reviews a pregnant client's birth plan. Which response from the client would indicate to the nurse that further teaching is indicated?

"I will remain in my bed for my labor and birth like last time."

A physically fit 30-year-old woman in her first trimester would like to continue exercising during pregnancy. She says she normally jogs, but has been thinking about taking up cycling. She also would like to know how much exercise she should get. Which instructions should the nurse give to the client? Select all that apply.

-Exercise three times weekly for 30 consecutive minutes. -Include warm-up and cool-down exercises. -Avoid sports that involve body contact. -Avoid taking up a new sport, such as cycling, during pregnancy. -Try walking, which is an excellent exercise option during pregnancy.

The nurse is putting together information for a nutritional class for nullipara women. Which information would be most important for the nurse to include?

-Increase consumption of fruits, vegetables, and whole grains. -Avoid the intake of alcohol. -Decrease intake of saturated fats, trans fats, and cholesterol.

An obstetrical nurse is conducting a program for pregnant women who are in their first trimester. The program focuses on the changes occurring in the woman's body as a result of the pregnancy. When describing the effect of changing hormonal levels, which information would the nurse most likely include? Select all that apply.

-Maintenance of the endometrium so that the embryo can implant -Maternal metabolic changes to make nutrients available for mother and fetus -Relaxation of the ligaments that connect the pelvic bones, allowing them to spread slightly -Preparing the breasts for lactation, keeping the milk from coming in until birth occurs

After teaching a class about conception, the nursing instructor asks the attendees to explain the process of fertilization. Which statements indicate the students need additional teaching? Select all that apply. "I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center." "I appreciate your decision, but I urge you to think through this further. Having a child, even one with Down syndrome, is so rewarding." "I understand and support your decision. The risk is just not worth it." "I think you made the right decision. After all, I never had children, and I'm perfectly happy."

-Sperm are viable for only about 48 hours after ejaculation. -Sperm are able to fertilize the ovum up to 12 hours after ejaculation, and the ovum remains fertile for at least 24 hours after ovulation.

A client's recent prenatal ultrasound assessment reveals a normal placenta. Which outcomes would the nurse expect? Select all that apply.

-The hormones made by the placenta support fetal growth. -The placenta protects the fetus from an immune attack created by the mother. -The placenta produces hormones that ready the fetus for extrauterine life.

At a prenatal class, the nurse educator describes the function of the placenta. What information would the nurse likely include? Select all that apply. The placenta makes hormones to control the way the fetus is supplied with nutrients and oxygen. The placenta ensures that the fetus is protected from all teratogens. The placenta removes the waste products that the fetus produces. The placenta stimulates the mother to bring more food to the placenta. The placenta produces hormones that ready fetal organs for life outside the uterus. The placenta acts as a barrier between the mother and fetus.

-The placenta makes hormones to control the way the fetus is supplied with nutrients and oxygen. -The placenta removes the waste products that the fetus produces. -The placenta stimulates the mother to bring more food to the placenta. -The placenta produces hormones that ready fetal organs for life outside the uterus

The nurse educator describes the key changes that happen to the newborn's heart and lungs at birth. Which information would the nurse likely include? Select all that apply.

-With the newborn's first breaths, the lungs inflate, increasing blood flow to the lungs. -The foramen ovale closes within 1 to 2 hours after birth and permanently by 6 months. -The ductus venosus closes with the clamping of the umbilical cord. -The ductus arteriosus closes in response to the increase in oxygen levels with the first breaths.

A woman carries a recessive gene for sickle cell anemia. If her sexual partner also has this recessive gene, the chance that her first child will develop sickle cell anemia is:

1 in 4.

Fetal heart rate monitoring reveals baseline tachycardia in the fetus. Which rate would be most likely?

164 beats per minute

The nursing instructor is pointing out to a group of nursing students the various findings which are expected during a normal assessment of a pregnant client. The instructor determines the session is successful when the students correctly provide which gestational week that the examiner should be able to feel fetal movement?

22

A 23-year-old female has come to the clinic for her first prenatal visit. After the examination reveals no concerns and potential low-risk pregnancy, the nurse discusses nutritional needs for her and her growing baby. As per the Institute of Medicine, the nurse suggests the client take which amount of ferrous iron daily?

27 mg

A client in her first trimester is concerned about how weight gain will affect her appearance and questions the nurse concerning dietary restrictions. How much weight gain should the nurse point out will be safe for this client with a low BMI? ×

28 to 40 pounds (13 to 18 kilograms)

A woman in her first trimester shares with the nurse that she has been experiencing terrible nausea when she gets up in the morning. Which action should the nurse suggest? Select all that apply.

Eat some saltine crackers before rising in the morning. Suck on sour candies. Delay breakfast until 10 or 11 AM. Try eating a snack before bedtime

At her prenatal visit a client reports that she cannot find any shoes that are comfortable. Assessment of her legs reveals dependent edema. The nurse suggests that the client attempt which actions to help reduce the edema? Select all that apply.

Elevate feet and legs when sitting or lying. Avoid foods high in sodium, sugar, and fats. Drink 6 to 8 glasses of water each day.

The nurse has determined that based on the client's physical examination she is at high risk for developing varicose veins. Which suggestions might the nurse teach the client to help reduce her risk? Select all that apply.

Elevate the feet and legs. Walk daily. Use thigh-high support hose.

A nurse is monitoring a woman in labor. When interpreting the assessment findings, an increase in which finding would the nurse identify as a deviation from the expected body response?

Blood glucose levels

The nurse encourages a woman in labor to ambulate based on the understanding that ambulating does what? Select all that apply.

Enlists the aid of gravity to move the fetus Enhances the effectiveness of contractions Increases the urge to push during the second stage. Encourages rotation of the fetus helps the fetus line up with the angle of the pelvis.

A nurse is assigned to care for a pregnant client as she undergoes a nonstress test. Place the steps involved in conducting the nonstress test in the correct order from first to last. All options must be used.

Client consumes a meal. Client placed in left lateral recumbent position. External electronic fetal-monitoring device applied. Client is handed an event marker. Fetal monitor strip marked for fetal movement.

The nurse will be performing the Leopold's maneuver to determine the position of the fetus. List in order the steps that the nurse would take. All options must be used.

Determine presentation. Determine position. Confirm presentation. Determine attitude.

A client expresses concerns that her grandmothers had complicated pregnancies. What principles of the Healthy People 2020 initiative should the nurse enact in order to allay the fears of the client? Select all that apply.

Ensure that birth of high-risk infants happens in settings able to care for them. Prenatal risk factors are identified early and reduced. Those at risk of having a preterm births are supported in order to delay early births. Infant illnesses, disabilities, and death will be reduced with proper care.

A nurse is describing the development of the fetus to a group of pregnant women. When describing the function of the placenta, which information would the nurse most likely include? Select all that apply.

It supplies oxygen and nutrients to the fetus. It produces hormones that help maintain the pregnancy. It carries waste away for excretion by the mother.

A pregnant client in her third trimester is diagnosed with supine hypotension syndrome. What would the nurse instruct the client to do?

Lie laterally, preferably on the left side.

The nursing instructor is teaching a session on how labor starts. The instructor determines the session is successful when the class correctly chooses which causative factor that initiates labor?

Prostaglandins may be the causative factor of labor.

The nurse is monitoring a client who is in active labor. The nurse will carefully monitor which phase of the involuntary uterine contraction to ensure the fetus is progressing adequately? You Selected:

Relaxation

A nurse caring for a client in labor has asked her to perform Lamaze breathing techniques to avoid pain. Which should the nurse keep in mind to promote effective Lamaze-method breathing?

Remain quiet during client's period of imagery.

The nurse is helping a pregnant client adapt psychologically. What outcome best demonstrates that the client has successfully adapted to the second trimester?

The client accepts the reality and uniqueness of the baby.

A nurse is reviewing the obstetric history of a pregnant woman who has come to the clinic for a visit. The history reveals that the woman is "gravida 3, para 2". Which interpretation by the nurse would be appropriate?

Two previous pregnancies, two children born at term, and currently pregnant

Down syndrome may occur because of a translocation defect. This means the:

additional chromosome was inherited because it was attached to a normal chromosome.

A pregnant client has come to a clinic for a pelvic examination. What assessments should a nurse perform when examining external genitalia?

any infection due to hematomas, varicosities, and inflammation

Which action is a priority when caring for a woman during the fourth stage of labor?

assessing the uterine fundus

A nurse is assisting with the birth of a newborn. The fetal head has just emerged. Which action would be performed next?

checking for the cord around the neck

The nurse has just administered morphine 2 mg IV to a laboring client. Which change in the fetal heart rate pattern would the nurse prioritize?

decreased variability

A 24-year-old client who is planning to become pregnant comes to the clinic for an evaluation. When assessing the client, which finding would alert the nurse to implement measures to reduce the client's risk for problems during pregnancy? Select all that apply.

drinks wine 3 to 4 times/week uses ibuprofen daily

A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which effect?

respiratory depression

Place the cardinal movements of labor in the order in which they occur from first to last. All options must be used.

engagement, then descent flexion internal rotation extension external rotation expulsion

During a prenatal class for a group of new mothers, the nurse is describing the hormones produced by the placenta. What hormones would the nurse include? Select all that apply.

estriol relaxin progestin human chorionic somatomammotropin

A nurse is providing care to a pregnant client who is 9 weeks gestation. The client reports that her breasts have become quite tender. She says, "I know my breasts are going to get bigger, but I didn't think that it would be uncomfortable." The nurse offers suggestions to address this discomfort, based on the understanding that this change is the result of which hormones? Select all that apply.

estrogen progesterone

A pregnant client states she was unable to breastfeed her last child because her breasts did not produce milk. She desires to breastfeed this child. Which hormones would the nurse monitor to during this pregnancy?

estrogen and human placental lactogen (hPL)

What is a positive sign of pregnancy?

fetal movement felt by examiner

A nurse is teaching a group of nursing students about the mechanism of labor when the fetus is in a cephalic presentation. The nurse determines the session is successful when the students correctly place the following events in which order? All options must be used.

flexion internal rotation extension external rotation expulsion

One vitamin has been identified as helping to prevent neural tube defects when consumed in adequate amounts before conception through the early weeks of pregnancy. Which vitamin is it?

folic acid

A nurse is reviewing the medical record of a pregnant woman and notes that she is gravida II. The nurse interprets this to indicate the number of:

pregnancies.

A new dad is alarmed at the shape of his newborn's head. Assessment reveals swelling at the area of the presenting part. The swelling crosses the suture lines. The nurse suspects which condition?

molding

A lactose intolerant client is concerned about getting enough calcium in her diet. Which foods could the nurse suggest she include in her diet to increase her calcium intake?

peanuts almonds broccoli molasses

A woman comes to the clinic reporting her period is late and she is wondering if she is pregnant. Which assessment findings by the nurse would indicate she is exhibiting probable signs of pregnancy? Select all that apply.

positive pregnancy test ballottement softening of the cervix

After conducting a review class on the labor and birth process for a group of nurses working in the community clinic, the nurse determines that the teaching was successful when the group identifies which factors as affecting the labor process? Select all that apply.

powers passenger patience

A pregnant woman is scheduled for chorionic villus sampling. The nurse is describing the procedure and the potential for complications. When providing care to the client after the testing, the nurse would be alert for which complication as the most common?

vaginal bleeding cramping