Maternity Success Questions (from book)

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. 5. Although polyuria may be a sign of diabetes or another illness, it is not highlighted as 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.

92. A woman has just completed her first trimester. Which of the following fetal structures can the nurse tell the woman are well formed at this time? Select all that apply. 1. Genitals. 2. Heart. 3. Fingers. 4. Alveoli. 5. Kidneys.

1, 2, 3, and 5 are correct. 1. Although not yet clearly visible on ultrasound, the genitalia are formed by the end of the first trimester. 2. The heart is formed by the end of the first trimester. 3. The fingers are formed by the end of the first trimester. 4. The alveoli will not be formed until well into the second trimester. 5. The kidneys are formed by the end of the first 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 first trimester, all major organs are completely formed. The maturation of the organ systems must, however, still occur

45. A nurse is working in the prenatal clinic. Which of the following findings seen in third-trimester pregnant women would the nurse consider to be within normal limits? Select all that apply. 1. Leg cramps. 2. Varicose veins. 3. Hemorrhoids. 4. Fainting spells. 5. Lordosis.

1, 2, 3, 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. 4. Fainting spells are not normal, although the client may feel faint when rising quickly from a lying position. 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-fiber foods and drink fluids to produce softer stools. The softer stools should decrease the irritation of the hemorrhoids.

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 first see a medical doctor for a complete checkup. 3. Women who wish to become pregnant should refrain from drinking any alcohol. 4. Women who wish to become pregnant should ask an obstetrician/gynecologist which over-the-counter medications should be avoided. Some—for example, acetaminophen—are safe to take, while others are not. 5. Women who wish to become pregnant should be counseled to stop smoking. TEST-TAKING TIP: Because the embryo is very sensitive during the first 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

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

1. Evening primrose has been shown tocause skin rash in some women. TEST-TAKING TIP: Even though eveningprimrose is a "natural" substance, it cancause side effects in some clients. Themost common side effect seen from theoil is a skin rash. Headaches and nauseahave also been seen.

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 positivesign of pregnancy. TEST-TAKING TIP: Positive signs of pregnancyare signs that irrefutably show that a fetus is in utero. An ultrasound of afetus is one positive sign and the fetalheartbeat is another positive sign.

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 aregistered 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 patients with PKU consume phenylalanine, a metabolite that affects cognitive centers in the brain is created in the body. If a pregnant woman who has PKU were to eat foods high in phenylalanine, her baby would develop severe mental retardation in utero.

23. The nurse working in an outpatient obstetric office assesses four primigravid clients. Which of the client findings should the nurse highlight for the physician? Select all that apply. 1. 17 weeks' gestation; denies feeling fetal movement. 2. 24 weeks' gestation; fundal height at the umbilicus. 3. 27 weeks' gestation; salivates excessively. 4. 34 weeks' gestation; experiences uterine cramping. 5. 37 weeks' gestation; complains of hemorrhoidal pain.

2 and 4 are correct. 1. It is common for primigravid women not to feel fetal movement until 19 to 20 weeks' gestation. 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. 3. Excessive salivation, called ptyalism, is an expected finding in pregnancy. 4. The woman may be going into preterm labor. 5. Hemorrhoids are commonly seen in pregnant women.

31. An 18-week gestation client telephones the obstetrician's office stating, "I'm really scared. I think I have breast cancer. My breasts are filled with tumors." The nurse should base the response on which of the following? 1. Breast cancer is often triggered by pregnancy. 2. Nodular breast tissue is normal during pregnancy. 3. The woman is exhibiting signs of a psychotic break. 4. Anxiety attacks are especially common in the second trimester.

2. Nodular breast tissue is normal inpregnancy. TEST-TAKING TIP: The high levels ofestrogen seen in pregnancy result in anumber of changes. The hypertrophyand hyperplasia of the breast tissue, inpreparation for neonatal lactation, aretwo of the changes.

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 lactationconsultant. TEST-TAKING TIP: Research on eversionexercises has shown that they are not effectiveplus breast manipulation canbring on contractions since oxytocin productionis stimulated. Lactation consultantsare breastfeeding specialists. A lactationconsultant would probablyrecommend that the client wear breastshields in her bra. The shields are madeof hard plastic and have a small holethrough which the nipple everts.

39. A 36-week gestation gravid client is complaining of dyspnea when lying flat. Which of the following is the likely clinical reason for this complaint? 1. Maternal hypertension. 2. Fundal height. 3. Hydramnios. 4. Congestive heart failure.

2. The fundal height is the likely causeof the woman's dyspnea. TEST-TAKING TIP: As the uterus enlarges,the woman's organs are impacted. At 36weeks, the fundus is at the level of thexiphoid process. The diaphragm is elevatedand the lungs are displaced. Whena client lies flat she has difficulty breathing.Most women use multiple pillows atnight for sleep. Whenever caring for apregnant woman, the nurse should elevatethe head of the bed.

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 canreduce backache pain. TEST-TAKING TIP: Pelvic tilt exercises helpto reduce backache pain. The client istaught to get into an optimal position—on the hands and knees is often best. Sheis then taught to force her back out whiletucking her head and buttocks under andholding that position for a few seconds,followed by holding the alternate positionfor a few seconds—arching her backwhile lifting her head and her buttockstoward the ceiling. These positions should be alternated repeatedly for about5 minutes. The exercises are very relaxingwhile also improving the muscle toneof the lower back.

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 TEST-TAKING TIP: Labor contractions oftenbegin in a woman's back, feelingmuch like a backache. The difference isthat labor contractions are intermittentand rhythmic. The client should be advisedto attend to any pains that comeand go and time them. She may be beginningthe labor process.

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 find a way to get through the pregnancy."

3. This is the best comment. It acknowledgesthe concerns that the client ishaving. TEST-TAKING TIP: Nurses have two roleswhen clients express concerns to them.First, the nurse must acknowledge theclient's concerns so that the client feelsaccepted and understood. Second, thenurse must help the client to problemsolve the situation. It is very important,however, that the acceptance precede theperiod of problem solving.

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 fibrosis is an autosomal recessive genetic disease so the client witha history of cystic fibrosis should bereferred to a genetic counselor. TEST-TAKING TIP: Virtually all diseases,chronic and acute, have some geneticcomponent, but the ability for the geneticcounselor to predict the impact ofmany diseases is very poor. Those illnesseswith clear hereditary patterns,however, do warrant referral to geneticcounselors. Cystic fibrosis has an autosomalrecessive inheritance pattern.

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 beexpressed late in pregnancy.TEST-TAKING TIP: Even though colostrumis present in the breasts in the latter partof the third trimester, it is important forwomen not to pump their breasts.Oxytocin, the hormone that promotesthe ejection of milk during lactation, isthe hormone of labor. Pumping of thebreasts, therefore, could stimulate theuterus to contract.

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.

ANS 1 1. High levels of the hormone chorionic gonadotropin in the bloodstream & urine of the woman is a probable sign of pregnancy 2. Oxytocin is the hormone of labor. It is not measured as a sign of pregnancy. 3. Prolactin is the hormone that stimulates lactogenesis immediately after delivery. It is not measured as a sign of pregnancy. 4. Luteinizing hormone is the hormone that stimulates ovulation. It is not measured as a 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.

58. A gravid woman who recently emigrated from mainland China is being seen at her first prenatal visit. She was never vaccinated in her home country. An injection to prevent which of the following communicable diseases should be administered to the woman during her pregnancy? 1. Influenza. 2. Mumps. 3. Rubella. 4. Varicella.

ANS 1 1. The woman should receive the influenza injection. The nasal spray, however, should not be administered to a pregnant woman. 2. The mumps vaccine should not be administered to the pregnant client. 3. The rubella vaccine should not be administered to the pregnant client. 4. The varicella vaccine should not be administered to the pregnant client. TEST-TAKING TIP: It is very important for pregnant women to be protected from the flu by receiving the inactivated influenza 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 flu. However, the live nasal flu 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 _Publication

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 fist. 4. Large tomato.

ANS 1 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. 2. A paperback book is too large. 3. A clenched fist is too large. 4. A large tomato is too large. TEST-TAKING TIP: The dietary recommendation of the protein group for moderately active women of childbearing age is the equivalent to 5 1⁄2 oz. of lean meat, fish, or fowl per day. A 1 oz equivalent is defined as 1 oz of meat, fish, 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.

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 fields are finally completely formed." 3. "The sex of the fetus can be clearly identified." 4. "The eyelids are unfused and begin to open and close."

ANS 1 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. 2. Lung development occurs much later than the morular stage. 3. The sex of the fetus is identified much later than the morular stage. 4. The fetal eyelids unfuse much later than the morular stage.

. 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.

ANS 1 1 Greasy foods should be avoided. 2 Saltine crackers should be eaten before rising. Drinking orange juice has not been recommended. 3 Although consuming ginger may help to alleviate the nausea and vomiting of pregnancy, neither cinnamon nor nutmeg has been shown to alleviate the symptoms 4 It is recommended that mothers eat small frequent meals throughout the day. 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.

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.

ANS 1 1. Birth plans help to facilitate communication between couples and their healthcare providers. 2. The type of pain medication the woman wishes to have during her labor and birth should be included in the birth plan, but the plan is not the location where the couple will learn about the medications. 3. The list of items that should be taken to the hospital for labor and delivery is separate from the birth plan, although the plan may include how the items will be used. The items are often placed in what is called a "goody" bag. 4. The birth plan should give any couple, whether their baby is being delivered vaginally or surgically, a sense of control over the labor and delivery process. 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.

ANS 1 1. Bologna should not be consumed during pregnancy unless it is thoroughly cooked. 2. Cantaloupe is an excellent source of vitamins A and C. 3. Asparagus is an excellent source of vitamin K and folic acid. 4. Popcorn is an excellent source of fiber, although if loaded with butter and salt is not the most healthy fiber choice. 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

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.

ANS 1 1. Ginger has been shown to be a safe antiemetic agent for pregnant women. 2. Sage has not been shown to reduce nausea and vomiting in pregnant women. 3. Cloves have not been shown to reduce nausea and vomiting in pregnant women. 4. Nutmeg has not been shown to reduce nausea and vomiting in pregnant women. TEST-TAKING TIP: Morning sickness and daytime nausea and vomiting are common complaints of pregnant women during the first 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 wome

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.

ANS 1 1. The presence of the father at delivery should be nonnegotiable. 2. Whether or not a client would prefer to have an episiotomy should be discussed, but this may need to be a negotiable issue. 3. Whether or not a client would prefer to have an epidural should be discussed, but this may need to be a negotiable issue. 4. Whether or not a father will be allowed to take pictures during the delivery should be discussed, but this may need to be a negotiable issue. 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 definitely 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 finances now than before the pregnancy." 4. "My husband plays his favorite music for my belly so the baby will learn to like it."

ANS 1 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. 2. Some men do gain weight during pregnancy. This is viewed as a sympathetic response to the woman's weight gain. 3. Men often become much more concerned about the finances of the household during a woman's pregnancy. 4. The father is exhibiting a strong attachment to the unborn baby. 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, weig

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.

ANS 1 1. The woman should stay out of rooms that are being renovated. 2. The water should be tested for the presence of lead. If there is lead in the water, it is recommended that the water from the hot water tap not be consumed. 3. Unless mold has been found, there is no reason the client should refrain from entering the basement. 4. As long as she is feeling well, there is no reason the client should refrain from walking up the stairs. 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

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.

ANS 1 1. Turnip greens are calcium rich. 2. Green beans are not high in calcium. 3. Cantaloupes are not high in calcium. 4. Nectarines are not high in calcium. 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 fish that are eaten with the bones such as sardines.

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.

ANS 1 1.Surfactant is usually forming in the fetal lungs by the 36th week. 2. The eyes open and close at about 28 weeks. 3. Fetal respiratory movements begin at about 24 weeks. 4. The spinal column is completely formed well before the end of the first trimester. 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 first 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.

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

ANS 1 1.This statement is true. Organogenesis begins prior to the missed menstrual period. 2. Insurance companies do not require that a woman be preapproved to become pregnant. 3. This statement is untrue. Only women with specific physical complications may be counseled to limit the numbers of pregnancies that they should carry. 4. This statement is untrue. The cardiovascular system is stressed during each and every pregnancy. 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 definition. 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 definition of the term, therefore, is origin, or development, of the organ system

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, fish.

ANS 1 1.Tofu, legumes, and broccoli are excellent substitutes for the restricted foods. 2. Although corn, yams, and green beans are foods consistent with a vegan diet, they are not high either in protein or in iron. 3. Although potatoes, parsnips, and turnips are vegetables, they are not high either in protein or in iron. 4. These are examples of a vegan's 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 B12, 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.

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.

ANS 1 1Clients 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. 2. Ptyalism is not related to a change in blood pressure. 3. Ptyalism is not related to changes in the lower extremities. 4. Ptyalism is not related to the meat intake. 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 inflammation 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.

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 flour and figs.

ANS 2 1. Barley and brown rice are not good vitamin C sources. 2. Strawberries and potatoes are excellent sources of vitamin C, as are zucchini, blueberries, kiwi, green beans, green peas, and the like. 3. Buckwheat and lentils are not good vitamin C sources. 4. Wheat flour and figs are not good vitamin C sources. 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.

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.

ANS 2 1. Raisins contain some iron but they are not the best source of iron. 2. Hamburger contains the most iron. 3. Broccoli contains some iron but it is not the best source of iron. 4. Molasses contains some iron but it is not the best source of 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 nutrient

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 B2 (niacin). 4. Vitamin B12 (cobalamin).

ANS 2 1. Supplementation of vitamin C has not been shown to be harmful during pregnancy. 2. Vitamin D supplementation can be harmful during pregnancy. 3. Supplementation of the B vitamins has not been shown to be harmful during pregnancy. 4. Supplementation of the B vitamins has not been shown to 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.

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.

ANS 2 1. The fetal heart begins to beat during the first trimester, not when quickening is detected at 16 to 20 weeks. 2. Lanugo does cover the fetal body at approximately 20 weeks' gestation. 3. The kidneys secrete urine by about week 12, before quickening is detected. Amniotic fluid is composed predominantly of fetal urine. 4. Fingernails begin to form at about week 10 but do not completely cover the tips of the fingers until mid third trimester. 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 first trimester with all of the major organs functioning at a primitive level by week 12.

97. A woman who is seen in the prenatal clinic is found to be 8 weeks pregnant. She confides to the nurse that she is afraid her baby may be "permanently damaged because I had at least five beers the night I had sex." Which of the following responses by the nurse would be appropriate? 1. "I would let the doctor know that if I were you." 2. "It is unlikely that the baby was affected." 3. "Abortions during the first trimester are very safe." 4. "An ultrasound will tell you if the baby was affected."

ANS 2 1. The woman should be assured that it is unlikely that the fetus was affected. 2. This statement is true. 3. It is inappropriate for the nurse to suggest that the client seek an abortion. 4. The woman should be assured that it is unlikely that the fetus was affected. 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 floating 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-sufficient. 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.

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."

ANS 2 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. 3 This statement is correct, but because the woman's period is only 1 day late, the test may not be sensitive enough to detect the pregnancy. 4 The client could repeat the test, but since the more accurate serum test is available, it would be better for the nurse to recommend that action. At-home tests are reliable only if used correctly. 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.

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.

ANS 2 1. 2 tbsp of peanut butter = a 2 oz non-meat serving of protein. 2. 1 egg = a 1 oz non-meat serving of protein. 3. 1 cup of cooked lima beans = four 1 oz nonmeat servings of protein. 4. 3 ounces of nuts = six 1 oz nonmeat servings 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.

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 first? 1. Take a tour of hospital delivery areas. 2. Develop a preliminary birth plan. 3. Make appointments with three or four obstetric care providers. 4. Search the Internet for the malpractice histories of the providers.

ANS 2 1. Although the tour of the facility is important, this should not be the couple's first step. 2. It is best that a couple first develop a birth plan. 3. Although appointments should be made, this should not be the couple's first step. 4. Although the couple may wish to research the healthcare practitioner's malpractice history, this should not be the couple's first step. 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.

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

ANS 2 1. Chinese women typically do consume protein, especially rice and seafood. 2. Many Chinese women do believe in the "hot and cold" theory of life. 3. Chinese women are no more prone to anemia than other groups of women. 4. The belief that strawberries cause birth defects is not particularly associated with the Chinese populati

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-deficiency anemia. 3. Hypercalcemia. 4. Overexposure to zinc.

ANS 2 1. Hypothyroidism is not related to pica. 2. Iron-deficiency anemia is often seen in clients who engage in pica. 3. Hypercalcemia is not related to pica. 4. Overexposure to zinc is not related to pica.

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/mm3 to 15,000 cells/mm3. 3. Rise in potassium from 3.9 mEq/L to 5.2 mEq/L. 4. Rise in sodium from 137 mEq/L to 150 mEq/L.

ANS 2 1. The nurse would expect the hematocrit to drop. 2. The nurse would expect to see an elevated white blood cell count. 3. The nurse would not expect to see anabnormal potassium level. 4. The nurse would not expect to see anabnormal sodium level. 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 o

46. A 36-week gestation gravid lies flat on her back. Which of the following maternal signs/symptoms would the nurse expect to observe? 1. Hypertension. 2. Dizziness. 3. Rales. 4. Chloasma.

ANS 2 1. The nurse would expect to note hypotension rather than hypertension. 2. Dizziness is an expected finding. 3. The nurse would expect to see dyspnea, not rales. 4. The nurse would not expect to see any skin changes. 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.

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.

ANS 2 1. 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. 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. 3. 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. 4. 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 11⁄2 oz hard cheese. 3. 1 cup cottage cheese, 8 oz whole milk, 1 cup buttermilk, and 1⁄2 oz hard cheese. 4. 1⁄2 cup frozen yogurt, 8 oz skim milk, 4 oz cream cheese, and 11⁄2 cup cottage cheese.

ANS 2 1. This client consumed 25/6 servings: 4 oz whole milk = 1⁄2 serving; 2 oz hard cheese = 11/3 servings; 1 cup pudding made with milk = 1 serving; 2 oz of cream cheese = 0 dairy serving since cream cheese is a food in the fat group, not in the dairy group. 2. This client consumed 31⁄2 servings: 1 cup yogurt = 1 serving, 8 oz chocolate milk = 1 serving; 1 cup cottage cheese = 1⁄2 serving; and 11⁄2 oz hard cheese = 1 serving. 3. This client consumed 25⁄6 servings: 1 cup cottage cheese = 1⁄2 serving; 8 oz whole milk = 1 serving; 1 cup buttermilk = 1 serving; and 1⁄2 oz hard cheese = 1/3 serving. 4. This client consumed 21⁄4 servings: 1⁄2 cup frozen yogurt = 1⁄2 serving, 8 oz skim milk = 1 serving; 4 oz cream cheese = 0 serving; and 11⁄2 cup cottage cheese = 3⁄4 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 11⁄2 oz of hard cheese, 1 cup of yogurt, 2 cups of cottage cheese, and 11⁄2 cups of ice cream are all equal to one dairy servi

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?"

ANS 2 1. This is an appropriate question to ask the client. 2. It is inappropriate to ask the Muslim client about the name for the baby. 3. This is an appropriate question to ask the client. 4. This is an appropriate question to ask the client. TEST-TAKING TIP: Traditional Muslim couples will not tell anyone the baby's name until he or she has gone through the official 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.

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?"

ANS 2 1. This is an inappropriate statement to make. 2. The nurse should query the young woman about what she felt. 3. Even though this statement is correct, it is inappropriate to dismiss the young woman so abruptly. 4. This is an inappropriate statement to make. 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.

86. A woman confides in the nurse that she practices pica. Which of the following alternatives could the nurse suggest to the woman? 1. Replace laundry starch with salt. 2. Replace ice with frozen fruit juice. 3. Replace soap with cream cheese. 4. Replace soil with uncooked pie crust.

ANS 2 1. This is not an appropriate substitute. High levels of salt can lead to elevated blood pressure and fluid retention. 2. This is an excellent suggestion. Fruit juice, although high in sugar, does contain vitamins. 3. This is not an appropriate substitute. Cream cheese has little to no nutritional benefit. 4. This is not an appropriate substitute. Uncooked pie crust is high in fat and flour. It provides little to no nutritional benefit. 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

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 definitely be the same sex and have the same blood type.

ANS 2 1. This is true of monozygotic twins. 2. This is a true statement. Dizygotic twins result from two mature ova that are fertilized independently. 3. This is true of monozygotic twins. 4. This is true of monozygotic twins. 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 prefixes 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."

ANS 2 1. Unless a woman is at high risk for preterm labor, there is no reason to refrain from making love during pregnancy. Therefore, this is an inappropriate statement. 2. This is an accurate statement. 3. Unless a woman is at high risk for preterm labor, this is an inappropriate statement. 4. This is an inappropriate 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 relati

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.

ANS 3 1. A positive pregnancy test will not necessarily promote fathers' interests in their partners' pregnancies. 2. Most fathers are very involved with their partners' pregnancies well before childbirth education classes begin. 3. Hearing the fetal heartbeat often increases fathers' interests in their partners' pregnancies. 4. Meeting the healthcare practitioner is unlikely to promote fathers' interests in their partners' pregnancies. TEST-TAKING TIP: Women who are in the first 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.

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.

ANS 3 1. Frozen yogurt, although relatively high in calories, is an excellent dairy source. Its intake should be encouraged. 2. Parmesan cheese is an excellent dairy source. Its intake should be encouraged. 3. The intake of gorgonzola cheese should be discouraged during pregnancy. 4. Chocolate milk, although relatively high in calories, is an excellent dairy source. Its intake should be encouraged if the client refuses to drink unflavored milk. 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.

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.

ANS 3 1. Linea nigra—the darkened area on the skin from the symphysis to the umbilicus—is a normal skin change seen in pregnancy. 2. Melasma—the "mask" of pregnancy—is a normal skin change seen in pregnancy. 3. Petechiae are pinpoint red or purple spots on the skin. They are seen in hemorrhagic conditions. 4. Spider nevi—benign radiating blood vessels— are normal skin changes seen in pregnancy. 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 melanin- producing 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 thrombocytopeni

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.

ANS 3 1. The foramen ovale is a hole between the atria. 2. The umbilical vein carries oxygen-rich blood. 3. The right atrium does contain both oxygen-rich and oxygen-poor blood. 4. The ductus venosus lies between the umbilical vein and the inferior vena cava, not between the aorta and the pulmonary artery. 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.

28. A client is 15 weeks pregnant. She calls the obstetric office to request a medication for a headache. The nurse answers the telephone. Which of the following is the nurse's best response? 1. "Because the organ systems in the baby are developing right now, 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."

ANS 3 1. The majority of the organ systems are developed before the end of the first trimester. This client is in her second trimester. 2. There are a number of over-the-counter medications that should be taken with care during pregnancy. 3. The physician will prescribe a medication that is safe to take during pregnancy. 4. There are oral medications that can be taken during pregnancy. Also, many medications administered rectally do enter the blood stream.

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 first-trimester abortion 2 years ago. She is currently pregnant. Which of the following portrays an accurate picture of this woman's gravidity and parity? 1. G4 P2121. 2. G4 P1212. 3. G5 P1122. 4. G5 P2211.

ANS 3 1. This does not reflect an accurate picture. 2. This does not reflect an accurate picture. 3. This accurately reflects this woman's gravidity and parity—G5 P1122. 4. This does not reflect an accurate picture. 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 first 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 first-trimester abortion, and is currently pregnant. Her parity (P1122) accurately reflects her obstetrical history: 1 full-term delivery (daughter at 39 weeks), 1 preterm delivery (son at 28 weeks), 2 abortions (1 miscarriage, 1 first-trime

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."

ANS 3 1. It is inappropriate to assume that the client and her family are happy about the pregnancy. 2. It is inappropriate to assume that the baby's father is still in the young woman's life. 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. 4. This information is important, but it is not the best statement to make initially.

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."

ANS 3 1. Although this is an accurate statement, this is not the most important communication for the nurse to make. 2. Fruit juices are good sources of folic acid, but this is not the most important communication for the nurse to make. 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. 4. Although this is an accurate statement, this is not the most important communication for the nurse to make.

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.

ANS 3 1. An allergy to strawberries is not the likely reason. 2. Strawberries have not been shown to cause birth defects. 3. The woman believes in old wives' tales. 4. A previous poor pregnancy outcome is not the likely reason. 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.

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.

ANS 3 1. The estimated date of delivery is June 27, 2016. 2. The estimated date of delivery is June 27, 2016. 3. The estimated date of delivery is June 27, 2016. 4. 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 confinement (EDC) or estimated date of delivery (EDD) from the last normal menstrual period (LMP). The nurse learns the date of the first 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. For the example given:

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 fluid volume assessment. 3. Vaginal and rectal cultures. 4. Karyotype analysis.

ANS 3 1. The oral glucose tolerance test (OGTT) is performed at approximately 24 weeks' gestation. 2. Amniotic fluid volume assessment is part of the biophysical profile (BPP). The BPP is performed when the healthcare practitioner is concerned about the health and well-being of the fetus. 3. Vaginal and rectal cultures are done at approximately 36 weeks' gestation. 4. Karyotype analysis or chromosomal analysis, if performed, is done early in pregnancy. 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 flora, she will be given IV antibiotics during labor to prevent vertical transmission to her baby at birth. GBS is often called "the baby killer."

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?

ANS 3 1. This is an important question, but it is not associated with health teaching. 2. 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. 4. This is an important question, but it is not associated with health teaching. TEST-TAKING TIP: When answering questions, it is essential that the test taker attend to the specific 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.

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 find it necessary to experiment with alternate positions. 4. Vaginal lubricant should be used sparingly throughout the pregnancy.

ANS 3 1. Unless a woman is at high risk for preterm labor, has been diagnosed with placenta previa, or has preterm rupture of the membranes, sexual intercourse is not contraindicated. 2. Breast fondling should be discouraged only if the client is at high risk for preterm labor. 3. With increasing size of the uterine body, the couple may need counseling regarding alternate options for sexual intimacy. 4. There is no contraindication for vaginal lubricant use in pregnancy. As a matter of fact, with the increased discharge experienced by many mothers, lubricants are often not needed. 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 pregnancy period

49. A 34-week gestation woman calls the obstetric office stating, "Since last night I have had three nosebleeds." Which of the following responses by the nurse is appropriate? 1. "You should see the doctor to make sure you are not becoming severely anemic." 2. "Do you have a temperature?" 3. "One of the hormones of pregnancy makes the nasal passages prone to bleeds." 4. "Do you use any inhaled drugs?"

ANS 3 1. Unless nosebleeds are excessive, it is rare for them to lead to severe anemia. 2. Clients with nosebleeds rarely have temperature elevations. 3. This is an accurate statement. Hormonal changes in pregnancy make the nasal passages prone to bleeds. 4. Nosebleeds are an expected complication of pregnancy. ST-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.

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 finding would be appropriate for the nurse to convey at this time? 1. "It is a purplish stretch mark on your abdomen." 2. "It means that you are having heart palpitations." 3. "It is a bluish coloration of your cervix and vagina." 4. "It means the doctor heard abnormal sounds when you breathed in."

ANS 3 1. purplish stretch marks are called abdominal striae 2. Chadwick sign is not related to the heart muscle. 3. A positive Chadwick sign means that the client's cervix and vagina are a bluish color. It is a probable sign of pregnancy. 4. Chadwick sign is not related to the respiratory system.

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.

ANS 4 1. Although herbals are natural substances, there are many herbals that are unsafe for consumption during pregnancy. 2. Both licorice and cat's claw should be avoided during pregnancy. There is evidence that licorice may increase the incidence of preterm labor, and cat's claw has been used to prevent and to abort pregnancies. 3. There is not enough evidence to determine whether or not many herbals are safe in pregnancy. 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 definitive information on the safety of many herbals in pregnancy. No matter what is consumed by the mother, however, the healthcare practitioner should be consulted.

52. A client is 35 weeks' gestation. Which of the following findings would the nurse expect to see? 1. Nausea and vomiting. 2. Maternal ambivalence. 3. Fundal height 10 cm above the umbilicus. 4. Use of three pillows for sleep comfort.

ANS 4 1. 35-week gestation clients should not complain of nausea and vomiting. 2. 35-week gestation clients should not be ambivalent about their pregnancies. 3. At 35 weeks, the fundus should be 15 cm above the umbilicus. 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 findings at various points during the pregnancy—for example, nausea and vomiting are normal during the first 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 final 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 umbilicu

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 fish is good for me, so I make sure we eat it regularly." Which of the following responses by the nurse is appropriate? 1. "You are correct. Fish is very healthy for you." 2. "You can eat fish, but sushi is too salty to eat during pregnancy." 3. "Sushi is raw. Raw fish is especially high in mercury." 4. "It is recommended that fish be cooked to destroy harmful bacteria."

ANS 4 1. Fish is very healthy, but the recommendation is that the fish be well cooked. 2. Although pregnant women should not overeat salty foods, sushi should be avoided because it is raw, not because of its salt content. 3. All fish contain methylmercury, but there are some fish with such high levels that they should not be eaten at all, for example, swordfish, tilefish, king mackerel, and shark. The mercury level does not change when a fish is eaten cooked versus raw. 4. This is correct. It is recommended that during pregnancy the client eat only well-cooked fish. TEST-TAKING TIP: Fish is an excellent source of omega-3 oil and protein, but during pregnancy fish 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 (

81. A nurse has identified the following nursing diagnosis for a prenatal client: Altered nutrition: less than body requirements related to poor folic acid intake. Which of the following foods should the nurse suggest the client consume? 1. Potatoes and grapes. 2. Cranberries and squash. 3. Apples and corn. 4. Oranges and spinach.

ANS 4 1. Potatoes and grapes are not high in folic acid. 2. Cranberries and squash are not high in folic acid. 3. Apples and corn are not high in folic acid. 4. Oranges and spinach are excellent folic acid sources. TEST-TAKING TIP: The intake of folic acid is especially important during the first trimester of pregnancy to help to prevent structural defects, including spina bifida and gastroschisis. The best sources of folic acid are liver and dark green, leafy vegetables. Oranges and orange juice are also good sources.

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."

ANS 4 1. This is an inappropriate statement. The nurse should provide clients with accurate information when asked. 2. The sex is not established yet. 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.

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. B1 (thiamine). 2. B2 (niacin). 3. B6 (pyridoxine). 4. B12 (cobalamin).

ANS 4 1. Vitamin B12 (cobalamin) should be supplemented. 2. Vitamin B12 (cobalamin) should be supplemented. 3. Vitamin B12 (cobalamin) should be supplemented. 4. Vitamin B12 (cobalamin) should be supplemented. TEST-TAKING TIP: Vitamin B12 (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.

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 aprostaglandin substance in the body. Prostaglandins are responsible forreadying the cervix for dilation. TEST-TAKING TIP: Nurse midwives oftenrecommend complementary therapiesduring pregnancy as well as during laborand delivery. Nurse midwives usually believein promoting natural means formaintaining a healthy pregnancy and forstimulating labor. Evening primrose isone of those interventions.

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 (hPL) is aninsulin antagonist. TEST-TAKING TIP: hPL is produced by theplacenta. As the placenta grows, thehormone levels rise. At approximately24 weeks' gestation, the levels are highenough to impact glucose metabolism.If performed earlier, the GCT test mayresult in a false-negative result.

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."

4. Persistent headache should not beseen in pregnant women.TEST-TAKING TIP: This question is askingthe test taker to determine which complaintis not expected during the thirdtrimester. The nurse, therefore, mustknow which symptoms are normal duringthe third trimester in order to knowwhich symptoms are not normal duringthat period. Persistent headache can indicatethat the woman has developed acomplication of pregnancy

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's position.TEST-TAKING TIP: Because of the growthof the uterus, it is very difficult forwomen in the third trimester to breathein the supine position. During the prenatalvisit, the baby's heartbeat will bemonitored and the fundal height will beassessed. Both of these procedures cansafely be performed in the semi-Fowler'sposition.44. 2, 3, and 4 ar

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.

ANS 1 1 The client is likely 12 weeks pregnant. At 12 weeks, the fundal height is at the top of the symphysis. 2. The fundus is at the level of the umbilicus at 20 weeks' gestation. 3. The fundus is between the umbilicus and the xiphoid process at 28 weeks' gestation. 4. The fundus is at the level of the xiphoid process at 36 weeks' gestation.

104. Please place an "X" on the drawing of the cross section of a placenta at the site of gas exchange.

An "X" will be placed between the neonatal and maternal vessels where gas exchange occurs. TEST-TAKING TIP: It is important that the test taker have a complete understanding of the anatomy and the physiology of the placenta. Since this is the sole organ that maintains the health and well-being of the fetus, the nurse must be able to differentiate between the maternal portion and the fetal portion as well as the function of the structures.

29. A 20-week gestation client is being seen in the prenatal clinic. Place an "X" on the place on the abdomen where the nurse would expect the fundal height to be felt.

TEST-TAKING TIP: At 20 weeks' gestation,the fundal height should be felt at the umbilicus. About 8 weeks later, it is feltbetween the umbilicus and xiphoidprocess and at the xiphoid process at 36 weeks.

1. An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? Select all that apply. 1. Amenorrhea. 2. Breast tenderness. 3. Quickening. 4. Frequent urination. 5. Uterine growth.

ANS 1,2,3,4 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. 5 Uterine growth is a probable sign of pregnancy.

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

2 and 5 are correct. 1 Glucose levels should be within normal limits. 2 Fibrinogen levels will be elevated slightly in a 40-week pregnant woman because coagulation factors like fibrinogen increase to help prevent excessive blood loss during delivery. 3 Hematocrit levels are usually slightly lower. 4 Bilirubin levels should be within normal limits. 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.

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. 1. Urine glucose is performed at each visit, not the blood glucose. 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. 5. Ultrasounds are performed only when needed.

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.

ANS 4 1. Pasta is a low-fiber food. 2. Rice is a low-fiber food. 3. Dairy products are low-fiber foods. 4. Celery is an excellent food to reverse constipation. It is a high-fiber 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 fiber, such as fresh fruits and vegetables, are excellent suggestions.

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. 1. Women should be counseled to consume well done meat throughout their pregnancies. They should avoid eating rare meat. 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. 4. Women should be counseled to consume 8 to 12 oz of seafood each week. 5. Women should be counseled to consume no alcohol 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).

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.

ANS 1 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. 2. This statement is incorrect. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births, not of women of childbearing age. 3. This statement is incorrect. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births, not 100,000 pregnancies. 4. This statement is incorrect. The maternal mortality rate is the number of deaths of women as a result of the child

02. A woman delivers a fetal demise that has lanugo covering the entire body, nails that are present on the fingers and toes, but eyes that are still fused. Prior to the death, the mother stated that she had felt quickening. Based on this information, the nurse knows that the baby is about how many weeks' gestation? 1. 15 weeks. 2. 22 weeks. 3. 29 weeks. 4. 36 weeks.

ANS 2 1 15 weeks is too early for quickening. At 15 weeks, the fetus would not have lanugo 2 This fetus is about 22 weeks' gestation. Nails start to develop in the first 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. 3. The eyes are unfused by 29 weeks' gestation so the gestation is shorter than that. 4. The eyes are unfused by 29 weeks' gestation so the gestation is shorter than that. 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 specific period in fetal development. After an analysis, the only response that is plausible is choice 2.

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.

ANS 2 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. 3. The human papillomavirus vaccine is not administered during pregnancy. The CDC recommends its administration to boys and girls beginning at 11 years of age. 4. The varicella vaccine is never administered during pregnancy. The CDC recommends its administration at the beginning of the second year of a child's life. 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/pert

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.

ANS 3 1. Fingernails would likely be quite long. 2. Eyelashes would be present. 3. Because this baby is post-term, lanugo would likely not be present. 4. Milia would be present. TEST-TAKING TIP: Lanugo is a fine 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.

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 first breath. The baby's oxygen no longer has to come from you." 4. "The blood actually never mixes. Your blood supply and the baby's blood supply are completely separate."

ANS 4 1. This response is incorrect. The circulatory systems are never connected. 2. This response is incorrect. The blood never mixes. 3. This response is incorrect. The systems are never connected. 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.

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) 98.6oF/37oC and third trimester T 99.2oF/37.3oC.

during pregnancy. This changeshould be reported to the health carepractitioner. TEST-TAKING TIP: The basal metabolicrate of the woman increases during pregnancy.As a result the nurse would expectto observe a respiratory rate of 20 to 24rpm. High levels of progesterone in thebody result in a decrease in the contractilityof the smooth musculaturethroughout the body. This results in anincrease in the pulse rate. In addition,progesterone is thermogenic, resulting ina slight rise in the woman's core bodytemperature.

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 duringthe first trimester. TEST-TAKING TIP: Even women who stoptaking birth control pills in order to becomepregnant are often startled andambivalent when they actually get pregnant.This is not pathological. Thewomen usually slowly accept the pregnancyand, by 20 weeks' gestation, arehappy and enthusiastic about the

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

2. The practitioner would expect topalpate an enlarged ovary. TEST-TAKING TIP: The cervix is long andthick in order to retain the pregnancy inthe uterine cavity. The cervical mucus isthin and the vaginal wall is bluish incolor as a result of elevated estrogenlevels. The ovary is enlarged because thecorpus luteum is still functioning.

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 ofclients in the second trimester. TEST-TAKING TIP: Although clients in thesecond trimester do experience somephysical discomfort, such as leg cramps and backaches, most women feel well.They no longer are fatigued, nauseous,and so on as in the first trimester, butthe baby is not so large as to cause significantcomplaints like dyspnea or therecurrence of urinary frequency.

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

ANS 1 & 5 1 The client will have a Pap smear done. A mammogram will not be performed. 2 A glucose assessment will likely be performed at the end of the second trimester. 3 A biophysical profile may be done but not until the third trimester. 4 A complete blood count will be performed.

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 influence on your partner's eating habits." 4. "I am so glad to see that you are taking so much interest in your partner's pregnancy."

ANS 4 1. Although this is an accurate statement, it is inappropriate at this time. 2. Although this is an accurate statement, it is inappropriate at this time. 3. It is never appropriate to make this statement. 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 si

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

.2, 3, 4, and 5 are correct. 1. The umbilical cord, not the amniotic fluid, delivers nutrition to the developing fetus. 2. Amniotic fluid does cushion the fetus from injury. 3. Amniotic fluid enables the fetus's limbs and body to move freely so that the baby can grow unencumbered. 4. The amniotic fluid is maintained at the mother's body temperature, providing the fetus with a neutral thermal environment. 5. The fetus does swallow the amniotic fluid while in utero.

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 & 4 are correct. 1. Weight gain of 0.8 to 1 lb per week is expected during the second and third trimesters only. 2. A weight gain of 3 to 5 lb is expected during the entire first trimester. 3. Since the client's height is not stated, there is no way to know whether or not the client is underweight. 4. The weight gain is normal for the first trimester.

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 first 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. 2. No urine test is performed. 3. The client will be given 75 grams of glucose in a liquid form upon arrival at the laboratory. 4. The OGTT is a fasting test. Women should neither eat nor drink prior to arriving at the laboratory. 5. Smoking on the morning of the test can alter the results.

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. 2. It is inappropriate for a prospective father to engage in promiscuity. 3. Hypertension in a prospective father should be investigated. 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 affiliation 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.

42. Which finding 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 finding. TEST-TAKING TIP: By the end of the secondtrimester, the blood supply of thewoman increases by approximately 50%.This increase is necessary in order forthe client to be able to perfuse the placenta.There is a concurrent increase inred blood cell production, but the vastmajority of women are unable to producethe red blood cells in sufficient numbersto keep pace with the increase in bloodvolume. As a result, clients develop whatis commonly called "physiological anemiaof pregnancy." A hematocrit of 32% isconsidered normal for a pregnantwoman.

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. 1. Backaches usually do not develop until the second trimester of pregnancy. 2. The woman will likely complain of urinary frequency. 3. Dyspnea is associated with the third trimester of pregnancy. 4. Most women complain of fatigue during the first trimester. 5. Diarrhea is not a complaint normally heard from prenatal clients.

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. 1. 1 bagel = two or more 1 oz servings (depending on the size of the bagel). 2. 1 slice bread = one 1 oz serving. 3. 1 cup cooked pasta = two 1 oz servings. 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 fiber are obtained from whole grain foods.

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 definition of ballottement. TEST-TAKING TIP: Although this questiondiscusses nurse-patient interaction, it issimply a definition question. The testtaker is being asked to identify the definitionof the word ballottement.

20. Which of the following findings in an 8-week gestation client, G2 P1001, should the nurse highlight for the nurse midwife? Select all that apply. 1. Body mass index of 17 kg/m2. 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.

20. 1. The BMI of 17 is of concern. This client is entering her pregnancy underweight. TEST-TAKING TIP: Women who enter theirpregnancies underweight are encouragedto gain slightly more—35 to 45 lb—during their pregnancies than are womenof normal weight who are encouraged togain 25 to 35 lb.

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

ANS 2 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. 3. It is too early in the pregnancy to provide anticipatory guidance about breastfeeding positions. 4. It is too early in the pregnancy to provide anticipatory guidance about characteristics of the newborn.

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 first 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 first 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, finally, the testes do not descend into the scrotal sac until mid third trimester. Indeed, male preterm babies often birthed before the testes descend.