OB EAQ CH's 12 and 13

The nurse is teaching a group of nursing students about the respiratory changes that take place during pregnancy. Which statement by a student indicates a need for additional teaching? 1. "Tidal volume decreases by 33%." 2. "The ligaments of the rib cage relax." 3. "Expiratory reserve volume decreases by 20%." 4. "Oxygen consumption increases by 20% to 40%." (EAQ - CH 12 and 13)

Correct answer: "Tidal volume decreases by 33%." Rationale: During pregnancy, a lot of changes in the maternal respiratory system occur, including a 33% increase in tidal volume. The ligaments of the rib cage relax due to increased levels of estrogen and progesterone. In addition, expiratory reserve volume decreases by 20% and oxygen consumption increases by 20% to 40% to compensate for the oxygen demand of the fetus.

A client tells the nurse, "I have been trying to conceive for the past two months. I missed my period this month but I had slight red spotting at the time I would usually have my period." What is the nurse's best response? 1. "You are not pregnant if you have any bleeding." 2. "You should try to conceive again." 3. "You should get a vaginal ultrasound scan done." 4. "You should take a pregnancy test after a week." (EAQ - CH 12 and 13)

Correct answer: "You should take a pregnancy test after a week." Rationale: The client is trying to conceive and has missed her period, which could indicate that she may be pregnant. Slight red spotting at the time of a missed menstrual period is normal and may be indicative of implantation bleeding or of a menstrual period, so a pregnancy test should be taken when the timing is right. Because it takes some time to detect hCG levels in the urine, the nurse should ask the client to take the pregnancy test after a week. The client is likely to be pregnant and thus the nurse should not ask the client to try conceiving this time. Pregnancy cannot be detected through vaginal ultrasound in early pregnancy.

The hormonal reports of a pregnant female reveal increased estrogen levels in the body. Which related signs would the nurse find in the patient? Select all that apply. 1. Mucoid discharge from the cervix 2. Heaviness in the patient's breast 3. Milk discharge from the patient's nipples 4. Decreased chest expansion of the patient 5. Well-defined pink blotches on the palm (EAQ - CH 12 and 13)

Correct answer: 1, 2, and 5 1. Mucoid discharge from the cervix 2. Heaviness in the patient's breast 5. Well-defined pink blotches on the palm Rationale: High levels of estrogen during pregnancy increase the production of cervical mucus. Therefore, pregnant women have copious white or gray cervical discharges. Increased estrogen levels increase the blood supply to the breasts, thereby causing breast heaviness. Well-defined pink blotches on the palm, which are referred to as palmar erythema, are also an effect of increased estrogen levels during pregnancy. Milk production is only possible when the baby has been delivered and there is a decreased estrogen level in the body. High levels of estrogen cause laxity of the ligaments of the rib cage, which increases chest expansion.

A pregnant woman has been prescribed folic acid by the primary health care provider. What explanation should the nurse give to the client about the importance of taking folic acid during pregnancy? 1. "Folic acid can prevent neural tube defects in the fetus." 2. "Folic acid helps in the formation of bones in the fetus." 3. "Folic acid prevents the onset of Rett syndrome in fetus." 4. "Folic acid helps in the formation of coagulation factors." (EAQ - CH 12 and 13)

Correct answer: 1. "Folic acid can prevent neural tube defects in the fetus." Rationale: Folic acid is required for the formation of the neural tube in the fetus. Therefore, folic acid is prescribed to the client during pregnancy to prevent neural tube defects. Calcium is required for the formation of bones in the fetus. Rett syndrome results from a protein mutation in a gene and has no relation to folic acid. Coagulation factors are formed by vitamin K after childbirth. Folic acid will not help in the formation of bone, prevention of Rett syndrome, or the formation of coagulating factors in the newborn.

A client in the twentieth week of pregnancy visits a clinic to learn about the development of the fetus. The client says to the nurse, "I am excited and I want to know what has developed in my child so far." What information should the nurse be able to tell to the client about the fetus? 1. "The fetus has hair on their scalp." 2. "The fetus has some sweat glands." 3. "The fetus has nasal cartilage." 4. "The fetus has sebaceous glands." (EAQ - CH 12 and 13)

Correct answer: 1. "The fetus has hair on their scalp." Rationale: Scalp hair appears after the 16th week of pregnancy along with the eyes, ear and nose. However, scalp hair is still in the developmental stage and is observed upon gross examination of the fetus. Sweat glands are formed at the 24th week of pregnancy. Nasal cartilage is observed after 40 weeks of pregnancy. Sebaceous glands are formed after 20 weeks of pregnancy.

A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman's current obstetric history, the nurse records what? 1. 4-1-2-0-2 2. 4-2-1-0-2 3. 4-1-1-0-2 4. 4-1-2-2-0

Correct answer: 1. 4-1-2-0-2 Rationale: Gravida (the first number) is 4 because this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and is described as: 4T: 1 = Term birth at 41 weeks of gestation (son) 4P: 2 = Preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) 4A: 0 = Abortion: none occurred 4L: 2 = Living children: her son and her daughter.

The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping what way? 1. In a side-lying position 2. On her back with a pillow under her knees 3. With the head of the bed elevated 4. On her abdomen (EAQ - CH 12 and 13)

Correct answer: 1. In a side-lying position Rationale: Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, thereby enhancing blood flow to the fetus. However, it is now known that either side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium will be diminished. Although lying with the head of the bed elevated is recommended and ideal for later in pregnancy, the woman must still maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women will find lying on the abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.

Upon reviewing the reports of a 12-week pregnant client, the nurse finds that the client has a low amniotic fluid volume. Which system does the nurse suspect to be affected in the fetus? 1. Renal system 2. Respiratory system 3. Cardiovascular system 4. Gastrointestinal system (EAQ - CH 12 and 13)

Correct answer: 1. Renal system Rationale: The amniotic fluid serves many functions and the volume of amniotic fluid is an important factor in the assessment of fetal well-being. Amniotic fluid volume of less than 300 ml (oligohydramnios) at term is associated with fetal renal abnormalities. Amniotic fluid volume of more than 2 L (hydramnios) near term is associated with malformations in the respiratory, cardiovascular, and gastrointestinal systems.

The nurse is assessing a group of pregnant women at a community health center. Which clients would be at highest risk for pregnancy-related complications? 1. The client with uncontrolled diabetes mellitus 2. The client who is of African-American descent 3. The client who is between 30 and 33 years old 4. The client with a history of alcohol consumption (EAQ - CH 12 and 13)

Correct answer: 1. The client with uncontrolled diabetes mellitus Rationale: Clients with uncontrolled diabetes are at a higher risk of complications associated with pregnancy. If the pregnant mother develops uncontrolled hyperglycemia, this may produce hyperglycemia in the fetus. This in turn stimulates fetal hyperinsulinemia and islet cell hyperplasia. Hyperinsulinemia prevents fetal lung maturation and places the neonate at an increased risk of respiratory distress. African-American clients have an increased chance of having dizygotic twins. They do not have an increased risk of pregnancy-related complications. Clients within the age group of 30 to 33 years are not at risk for complications associated with pregnancy. Alcohol consumption during pregnancy leads to respiratory complications and fetal alcohol syndrome. However, clients with a history of alcohol consumption do not usually have pregnancy-related complications.

A client has missed her menses for 2 months and has a positive pregnancy test. The nurse should calculate that the delivery date will be 280 days calculated from what? 1. The first day of the last menstrual period 2. The 14th day of the last menstrual cycle 3. The day of implantation of the embryo 4. The day of fusion of the sperm and egg (EAQ - CH 12 and 13)

Correct answer: 1. The first day of the last menstrual period Rationale: Pregnancy lasts for approximately 280 days. The expected delivery date is calculated from the first day of last menstrual period. When the sperm comes in contact with the egg, the fusion of the cells occurs, followed by meiosis II. Until the 14th day, the ovum undergoes meiosis and divides to form a blastocyst. After fertilization, the zygote travels to the uterus and implants itself. This takes another 3 to 4 days. The level of human chorionic gonadotropin increases in 7 to 10 days after implantation. This can be detected by a pregnancy test. Therefore, the pregnancy period is not considered from the 14th day of the menstrual cycle, from the day of the implanted embryo, or from the day of fusion of the sperm and the egg.

The nurse is assessing a client who is 7 months pregnant. The nurse observes that there are increased chest movements and decreased abdominal movements while breathing. How does the nurse interpret this finding? 1. Normal finding during pregnancy. 2. Impaired diaphragm function. 3. Decreased abdominal muscle tone. 4. Presence of obstructive lung disorder (EAQ - CH 12 and 13)

Correct answer: 1.Normal finding during pregnancy. Rationale: Presence of obstructive lung disorder. Pregnant women have distended abdomens. This makes it difficult for the diaphragm to descend down during inspiration. Therefore, pregnant women have chest breathing. Thoracic breathing in advanced pregnancy occurs due to the action of the diaphragm. It does not mean that the patient has impaired diaphragm function. Abdominal muscle tone is decreased in pregnant women. The diaphragm is the primary muscle responsible for abdominal movements while breathing. Therefore, chest breathing would not indicate that the client has decreased abdominal muscle tone. Obstructive lung disorder may weaken the diaphragm. Chest breathing does not indicate that the patient has obstructive lung disorder.

The nurse examines the blood pressure (BP) of a client and records it as 180/80 mm Hg. What could be the mean arterial pressure of the client? Record your answer using a whole number.________ mm Hg (EAQ - CH 12 and 13)

Correct answer: 113 mm/Hg The BP of the client is 180/80 mm Hg, which means that the systolic blood pressure is 180 mm Hg and the diastolic blood pressure is 80 mm Hg. The mean arterial pressure of the client is calculated using the formula: systolic blood pressure + 2(diastolic blood pressure)/3. Thus, the mean arterial pressure of the patient would be {180 + 2(80)/3} = 113 mm Hg.

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? 1. "Many women imagine what their baby is like." 2. "A baby in utero does respond to the mother's voice." 3. "You'll need to ask the doctor if the baby can hear yet." 4. "Thinking that your baby hears will help you bond with the baby." (EAQ - CH 12 and 13)

Correct answer: 2. "A baby in utero does respond to the mother's voice." Rationale: Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice. Although it is accurate that many women imagine what their baby is like, it is not the most appropriate response. The nurse doesn't need to refer the client to the doctor; she can tell the mother that her fetus can hear at 24 weeks and can respond to the sound of her voice. "Thinking that your baby hears will help you bond with the baby" is not appropriate. It gives the impression that her baby cannot hear her. It also belittles the mother's interpretation of her fetus's behaviors.

Which time span delineates the appropriate length for a normal pregnancy? 1. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days 2. 10 lunar months, 9 calendar months, 40 weeks, 280 days 3. 9 calendar months, 10 lunar months, 42 weeks, 294 days 4. 9 calendar months, 38 weeks, 266 days (EAQ - CH 12 and 13)

Correct answer: 2. 10 lunar months, 9 calendar months, 40 weeks, 280 days Rationale: Pregnancy lasts approximately 10 lunar months, 9 calendar months, 40 weeks, 280 days. Nine lunar months is just short of a term pregnancy. Length of pregnancy is computed from the first day of the last menstrual period (LMP) until the day of birth; 294 days is longer than the average length of a pregnancy and would be considered postterm. Because conception occurs approximately 2 weeks after the first day of the LMP, this represents the postconception age of 266 days or 38 weeks. Postconception age is used in the discussion of fetal development.

A client had an abortion in her first pregnancy, gave birth at 39 weeks gestation during the second pregnancy, and gave birth to twins at 36 weeks gestation in her third pregnancy. How does the nurse denote the obstetric history of the patient in the GTPAL (gravidity, term, preterm, abortions, living children) system? 1. 3-2-0-0-3 2. 3-1-1-1-3 3. 3-1-0-2-3 4. 3-1-1-0-2 (EAQ - CH 12 and 13)

Correct answer: 2. 3-1-1-1-3 Rationale: The GTPAL system provides information about a woman's obstetric history. The first digit represents gravidity, the second digit represents the total number of term births, the third indicates the number of preterm births, the fourth identifies the number of abortions, and the fifth is the number of children currently alive. In this case, the client had three pregnancies, so gravidity is 3. The client had one term birth, so the second digit is 1. The client had a preterm birth in her third pregnancy, so the third digit is 1. The fourth digit is 1, because the client had an abortion in her first pregnancy, and the fifth digit is 3, because the client has three living children.

When does human chorionic gonadotropin (hCG) reach its maximum levels in a pregnant woman? 1. Between 30 to 50 days into the pregnancy 2. Between 50 to 70 days into the pregnancy 3. Between 70 to 90 days into the pregnancy 4. Between 90 to 100 days into the pregnancy (EAQ - CH 12 and 13)

Correct answer: 2. Between 50 to 70 days into the pregnancy rationale: The protein hormone hCG can be detected in the maternal serum by 8 to 10 days after conception, shortly after implantation. The hCG helps preserve the function of the ovarian corpus luteum and ensures the continued supply of estrogen and progesterone required to maintain pregnancy. The hCG reaches its maximum level at 50 to 70 days and then begins to decrease.The hCG levels are still increasing between 30 to 50 days of pregnancy; hCG levels will decrease at 70 to 90 days of pregnancy or at 90 to 100 days of pregnancy.

What is the rationale behind encouraging postpartum clients to nurse when they are producing colostrum? 1. Colostrum is rich in immunoglobulin G (IgG). 2. Colostrum is rich in immunoglobulin A (IgA). 3. Colostrum is rich in immunoglobulin D (IgD). 4. Colostrum is rich in immunoglobulin M (IgM). (EAQ - CH 12 and 13)

Correct answer: 2. Colostrum is rich in immunoglobulin A (IgA). A newborn baby does not have any IgA. However, colostrum, which is the precursor to breast milk, is rich in IgA. This substance provides passive immunity to the neonate. The antibody cannot pass placental barriers and, therefore, the fetus lacks this immunoglobulin. IgG provides passive acquired immunity against bacterial toxins and can cross placental barriers. IgD is produced in very low amounts and is seen in blood serum. IgD is not present in breast milk and passes through placental barriers. IgM can pass through the maternal placenta and reach the fetus. This antibody aids in response to the blood group antigens.

The nurse is developing a plan of care for a pregnant client. Which nursing intervention helps to ensure adequate blood supply to the fetus? 1. Encourage the client to lie down in the supine position. 2. Encourage the client to recline in the side lying position. 3. Encourage the client to do vigorous exercises regularly. 4. Encourage the client to decrease the intake of folic acid (EAQ - CH 12 and 13)

Correct answer: 2. Encourage the client to recline in the side lying position. Rationale: When the pregnant client reclines in a side-lying position, it facilitates optimal blood circulation to the uterus. When the pregnant client lies in the supine position, the pressure on the uterus compresses the inferior vena cava. This reduces the blood return to the right atrium and, in turn, causes decreased uterine circulation. This may lead to intrauterine growth restriction of the fetus. Excessive or vigorous maternal exercise diverts the blood away from the uterus to the skeletal muscles and this compromises placental circulation. A nurse would not advise a pregnant woman to decrease her folic acid intake, because this is an important vitamin for fetal development.

The nurse observes that the newborn has milky secretions from the nipples. What is the reason for this finding? 1. High levels of maternal insulin 2. High levels of maternal estrogen 3. Low levels of maternal thyroxine 4. Low levels of maternal progesterone (EAQ - CH 12 and 13)

Correct answer: 2. High levels of maternal estrogen Rationale: High levels of maternal estrogen stimulate mammary engorgement and cause secretion of fluid, called "witch's milk" in newborns of both sexes. High levels of maternal insulin may produce hypoglycemia in the newborn. Maternal thyroxine does not readily cross the placenta; hence its levels generally do not affect the newborn. Low levels of maternal progesterone help in the onset of labor.

The nurse is assessing a pregnant woman who has a child and is in the 25th week of pregnancy. What term is used to describe the woman? 1. Primipara 2. Multipara 3. Primigravida 4. Multigravida (EAQ - CH 12 and 13)

Correct answer: 2. Multipara rationale: A woman who has completed two or more pregnancies to 20 weeks of gestation or more is called a multipara. A woman who has completed one pregnancy with a fetus who reached 20 weeks of gestation is primipara. A woman who is pregnant for first time is primigravida. A woman who has completed two or more pregnancies is called a multigravida.

The nurse is assisting with an amniocentesis for a client during the 28th week of gestation. The Lecithin to sphingomyelin ratio (L/S ratio) is found to be 0.4:1. What will the nurse report after the test related to fetal lung development? 1. Fully developed, but the mother has developed diabetes mellitus. 2. Not completely developed and the mother has diabetes mellitus. 3. Fully developed and both the mother and the fetus are healthy. 4. Not completely developed, but the mother and fetus are healthy. (EAQ - CH 12 and 13)

Correct answer: 2. Not completely developed and the mother has diabetes mellitus. Rationale: The lecithin to sphingomyelin ratio is used to determine the fetal lung development. At the 26th week of pregnancy, the L/S ratio should be 1.2:1. If it is 0.4:1 (less than 1.2:1) it indicates incomplete fetal lung development. In a diabetic mother, high levels of insulin block the maturation of the lungs in the fetus. This indicates that mother is diabetic. If the L/S ratio is 1.2: 1 or better, then the report would indicate that the mother and fetus are healthy and the fetus has well-developed lungs. Therefore, the L/S ratio of 0.4:1 neither indicates that the fetal lungs are well developed nor that the mother and fetus are healthy.

Which mechanism aids in providing early passive immunity to the fetus? 1. Oogenesis 2. Pinocytosis 3. Hematopoiesis 4. Gametogenesis (EAQ - CH 12 and 13)

Correct answer: 2. Pinocytosis Rationale: Pinocytosis occurs when large molecules, such as albumin and gamma globulins, cross the placental membrane. This mechanism transfers the maternal immunoglobulins, which provide early passive immunity to the fetus. Oogenesis is the process of egg (ovum) formation, which begins during fetal life in the female. Hematopoiesis is the process of blood formation, which occurs in the yolk sac at the beginning of the third week of gestation. Gametogenesisincludes both oogenesis and spermatogenesis. These are the processes involved in the formation of ovum and sperm, respectively.

The nurse is providing preconception counseling to a client who is taking carbamazepine (Tegretol) for seizures. What instruction should the nurse) provide with respect to this drug? 1. Take carbamazepine (Tegretol) with alcohol. 2. Stop taking carbamazepine (Tegretol) and contact your neurologist for alternative medication. 3. Increase the dose of carbamazepine (Tegretol). 4. Decrease the dose of carbamazepine (Tegretol). (EAQ - CH 12 and 13)

Correct answer: 2. Stop taking carbamazepine (Tegretol) and contact your neurologist for alternative medication. Rationale: Carbamazepine (Tegretol) is an anticonvulsant drug that is a teratogen to the developing embryo and fetus, so clients who are pregnant or are planning to get pregnant should abstain from using it. Administering carbamazepine (Tegretol) with alcohol may synergize the lethal affects and is therefore prohibited. Increasing the dose of the drug may increase the adverse effects and may be lethal to the fetus. Decreasing the dose of the drug may not ensure safety of the client or the fetus.

The nurse is reviewing the diagnostic test results with a pregnant client and informs the client that she is going to have twins. Based on which diagnostic test did the nurse make such a conclusion? 1. Human placental lactogen 2. Ultrasound results 3. Cytogenetic testing 4. Amniotic fluid levels (EAQ - CH 12 and 13)

Correct answer: 2. Ultrasound results Rationale: Ultrasound scan, or fetal ultrasound, is the technique used for visualizing the fetus and the internal structures for prenatal analysis. In this technique, high frequency sound waves produce the image of the fetus without harming the fetal internal organs. Therefore, this technique is used in order to identify the presence of twins in the client's womb. Human placental lactogen changes the metabolism of the mother and supplies energy to the fetus. Cytogenetic testing helps to find genetic abnormalities, which are caused due to changes in the chromosomes. Amniotic fluid protects the fetus from injuries. These tests do not help to determine the presence of twins in the patient's womb.

A student nurse measures the blood pressure (BP) of a client and records it as 170/90 mm Hg. On reassessment the charge nurse finds that the BP of the client is 110/70 mm Hg. What could be the reason for the error made by the student nurse in recording BP of the client? 1. Using a very large-sized cuff for measuring BP 2. Using a very small-sized cuff for measuring BP 3. Measuring the BP with the client in lying position 4. Measuring the BP 30 minutes after tobacco consumption (EAQ - CH 12 and 13)

Correct answer: 2. Using a very small-sized cuff for measuring BP Rationale: Proper cuff size is essential for obtaining accurate readings of blood pressure. False-high readings might be obtained when using a very small-sized cuff. Because the student nurse used a very small-sized cuff for measuring BP, the BP reading was falsely measured as 170/90 mm Hg. False-low readings can be a result of using a very large-sized cuff. BP readings would be low if the patient is in the lying position. Tobacco consumption also affects the blood pressure reading, and the client should be advised to not to consume tobacco 30 minutes before the BP measurement.

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse's instructions if she states that a positive sign of pregnancy is what? 1. a positive pregnancy test. 2. fetal movement palpated by the nurse-midwife. 3. Braxton Hicks contractions. 4. quickening. (EAQ - CH 12 and 13)

Correct answer: 2. fetal movement palpated by the nurse-midwife. Rationale: Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. A positive pregnancy test is a probable sign of pregnancy. Braxton Hicks contractions are a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.

The ultrasound reports of a pregnant client indicate that the fetal nose and ears are ossified. At what gestational age would this information become apparent? 1. 4 weeks 2. 12 weeks 3. 16 weeks 4. 20 weeks (EAQ - CH 12 and 13)

Correct answer: 20 weeks Rationale: In the ultrasound reports of a fetus at the 20-week gestation period, the nose and the sternum are ossified. The open neural tube forms during the 4th week of gestation. The fetus makes respiratory movements, moves all extremities, and changes position within the uterus during the 12th week of gestation. Oogenesis is established during 16th week.

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? 1. "We don't really know when such defects occur." 2. "It depends on what caused the defect." 3. "They occur between the third and fifth weeks of development." 4. "They usually occur in the first 2 weeks of development." (EAQ - CH 12 and 13)

Correct answer: 3. "They occur between the third and fifth weeks of development." Rationale: Blood vessel and blood formation begin in the third week, and the heart is developmentally complete in the fifth week. The nurse would be aware of when such defects occur. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begin in the third week, and the heart is developmentally complete in the fifth week.

Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? 1. Radioimmunoassay 2. Radioreceptor assay 3. Latex agglutination test 4. Enzyme-linked immunosorbent assay (ELISA) (EAQ - CH 12 and 13)

Correct answer: 4. Enzyme-linked immunosorbent assay (ELISA) Rathionale: OTC pregnancy tests use ELISA for its one-step, accurate results. The radioimmunoassay tests for the presence of hCG in serum or urine samples. This test must be performed in the laboratory. The radioreceptor assay is a serum test that measures the ability of a blood sample to inhibit the binding of hCG to receptors. The latex agglutination test in no way determines pregnancy. Rather it is done to detect specific antigens and antibodies.

A 5-month pregnant woman reports to the nurse that she feels dizzy after waking up in the morning. What advice does the nurse give to the client? 1. "Keep your legs elevated while sleeping." 2. "Try to spend less of your time sleeping." 3. "Try sleeping in the side lying (lateral) position." 4. "Use two pillows for your head while sleeping." (EAQ - CH 12 and 13)

Correct answer: 3. "Try sleeping in the side lying (lateral) position." Rationale: The client has supine hypotensive syndrome due to compression of the superior vena cava. This condition occurs in pregnant women who tend to sleep in the supine position. In order to avoid this compression, the nurse should ask the client to sleep in the lateral position. Elevation of the limbs will help in preventing limb edema in pregnant females. This would not be helpful in preventing the compression of the vena cava. A pregnant female needs adequate rest. Therefore, the nurse should not advise the client to spend less time sleeping. Using two pillows for the head is not advisable, because this can cause neck pain.

Which hematocrit (Hct) and hemoglobin (Hgb) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? 1. 38% Hct; 14 g/dl Hgb 2. 35% Hct; 13 g/dl Hgb 3. 33% Hct; 12 g/dl Hgb 4. 32% Hct; 10.5 g/dl Hgb (EAQ - CH 12 and 13)

Correct answer: 3. 33% Hct; 12 g/dl Hgb Rationale: 33% Hct; 12 g/dl Hgb represents the lowest acceptable value during the first and the third trimesters. 38% Hct; 14 g/dl Hgb is within normal limits in the nonpregnant woman. 35% Hct; 13 g/dl Hgb is within normal limits for a nonpregnant woman. 32% Hct; 10.5 g/dl Hgb represents the lowest acceptable value for the second trimester, when the hemodilution effect of blood volume expansion is at its peak.

A pregnant client visits a prenatal clinic and inquires about the expected date of delivery. How will the nurse assess the expected date of delivery of the client? 1. Schedule an abdominal ultrasound of the fetus. 2. Determine the lecithin to the sphingomyelin ratio. 3. Ask the client about the last menstrual period. 4. Detect the progesterone level in maternal serum. (EAQ - CH 12 and 13)

Correct answer: 3. Ask the client about the last menstrual period. Rationale: The nurse should know the client's last menstrual period (LMP) to determine the expected date of delivery. Usually pregnancy lasts for 280 days from the last menstrual period. The nurse can calculate the expected date of delivery by knowing the date of the last menstrual period. Ultrasonography is used to detect the development of the fetus during the different stages of pregnancy, but it cannot be used to determine the date of delivery. The lecithin to sphingomyelin ratio is used to determine the health or maturity of the fetus. Progesterone levels usually decrease during labor. The detection of progesterone does not give any information about the expected date of pregnancy.

The student nurse is giving a presentation about milestones in embryonic development. Which information should the student include? 1. At 8 weeks of gestation, primary lung and urethral buds appear. 2. At 12 weeks of gestation, the vagina is open or the testes are in position for descent into the scrotum. 3. At 20 weeks of gestation, the vernix caseosa and lanugo appear. 4. At 24 weeks of gestation, the skin is smooth, and subcutaneous fat is beginning to collect. (EAQ - CH 12 and 13)

Correct answer: 3. At 20 weeks of gestation, the vernix caseosa and lanugo appear. Rationale: Two milestones that occur at 20 weeks are the appearance of the vernix caseosa and lanugo. The primary lung and urethral buds appear at 6 weeks of gestation. The vagina is open or the testes are in position for descent into the scrotum at 16 weeks. The appearance of smooth skin occurs at 28 weeks, and subcutaneous fat begins to collect at 30 to 31 weeks.

While reviewing the ultrasound results of a pregnant client, the nurse observes the presence of two embryos. Both embryos have a common amnion and common chorion with one placenta. What complications might the nurse anticipate in the fetuses? 1. Decreased musculoskeletal development 2. Decreased endocrine system development 3. Decreased circulation of blood in the fetuses 4. Decreased glycogen storage in the fetal livers (EAQ - CH 12 and 13)

Correct answer: 3. Decreased circulation of blood in the fetuses Rationale: Rarely, division of the ovum occurs after the eighth day of fertilization. This leads to the formation of two embryos within a common amnion and a common chorion, and one placenta. Circulatory problems can occur if the umbilical cords become tangled. This can lead to fetal death of one or both babies. Having a common amnion and chorion with one placenta does not specifically affect musculoskeletal development. Decreased endocrine system development may occur due to alterations of the hormonal levels in the mother. Decreased glycogen storage may occur due to the impairment in the function of the livers of both fetuses; it is not related to having a common amnion and chorion with one placenta.

The nurse is monitoring the fetal heart rate of a pregnant client. Which fetal heart rate is indicative of adequate fetal oxygen supply? 1. Fetal heart rate is 90 beats/minute 2. Fetal heart rate is 100 beats/minute 3. Fetal heart rate is 130 beats/minute 4. Fetal heart rate is 170 beats/minute (EAQ - CH 12 and 13)

Correct answer: 3. Fetal heart rate is 130 beats/minute Rationale: The fetal heart rate needs to be at a certain level to ensure a sufficient oxygen supply to the infant from the maternal blood. An insufficient supply of oxygen leads to hypoxia in the fetus. If the fetal heart rate is from 110 beats/minute to 160 beats/minute, it indicates that the fetus has adequate circulation and is obtaining a sufficient amount of oxygen from the maternal blood. The fetus with a heart rate of 130 beats/minute is normal. Fetal heart rates of 90 beats/minute or100 beats/minute are indications of fetal bradycardia. A heart rate of 170 beats/minute in a fetus indicates tachycardia. Both conditions indicate impaired cardiac activity in the fetus.

Which presumptive signs (felt by the woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause? 1. Amenorrhea: stress, endocrine problems 2. Quickening: gas, peristalsis 3. Goodell sign: cervical polyps 4. Chadwick sign: pelvic congestion (EAQ - CH 12 and 13)

Correct answer: 3. Goodell sign: cervical polyps Rationale: Goodell sign might be the result of pelvic congestion, not polyps. Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Chadwick sign might be the result of pelvic congestion.

After reviewing a client's urine analysis report, the nurse finds that the client is pregnant. Based on the presence of which hormone did the nurse made such conclusion? 1. Estrogen 2. Progesterone 3. Human chorionic gonadotropin 4. Human chorionic somatomammotropin (EAQ - CH 12 and 13)

Correct answer: 3. Human chorionic gonadotropin Rationale: Human chorionic gonadotropin (hCG) is the hormone detected in the maternal serum around 8 to 10 days after conception. Therefore, the presence of human chorionic gonadotropin in the urine sample indicates that the client is pregnant. This hormone helps to maintain the levels of estrogen and progesterone during pregnancy. Estrogen and progesterone are steroid hormones. They are present in females. The levels of progesterone decrease during labor. Human chorionic somatomammotropin is a protein hormone secreted by the placenta. It is secreted only during pregnancy but it is not used to detect pregnancy, because it is not detected in the maternal serum.

The nurse is caring for a preterm infant with low levels of glucuronyl transferase enzyme. What disease risk may be increased in the infant? 1. Spina Bifida 2. Dehydration 3. Hyperbilirubinemia 4. Decreased Immunity (EAQ - CH 12 and 13)

Correct answer: 3. Hyperbilirubinemia Rationale: Glucuronyl transferase enzyme is responsible for the clearance of unconjugated bilirubin. Low levels of glucuronyl transferase enzyme would result in hyperbilirubinemia in the child. Spina bifida is the complication associated with impaired fusion of the vertebrae. Dehydration in the infant may lead to impaired renal function. If the mother chooses to not breastfeed, it may reduce immunity in the infant.

The primary health care provider finds that a pregnant client has low hematocrit values but does not consider the woman anemic. Why is the pregnant woman with low hemaotocrit values not considered anemic? 1. Hematocrit doesn't relate to anemia. 2. Anemia doesn't cause risk during pregnancy. 3. Plasma volume expands rapidly during pregnancy. 4 Erythrocyte production compensates for the low hematocrit (EAQ - CH 12 and 13)

Correct answer: 3. Plasma volume expands rapidly during pregnancy. Rationale: During pregnancy, low hematocrit values (37% to 47%) are generally observed due to plasma volume expanding faster than the rate of erythrocyte production. This phenomenon is known as physiologic anemia and is common during pregnancy. Hematocrit, or packed cell volume, is an indicator of anemia. Anemia causes a risk of growth restriction in the fetus, but physiologic anemia is common in pregnant women. Plasma expansion occurs at faster rate than erythrocyte production in pregnant women, resulting in low hematocrit values.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates what? 1. The fetus is at risk for Down syndrome. 2. The woman is at high risk for developing preterm labor. 3. The lung maturity of the fetus 4. Meconium is present in the amniotic fluid (EAQ - CH 12 and 13)

Correct answer: 3. The lung maturity of the fetus Rationale: The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. The presence of surface-active phospholipids is not an indication of Down syndrome. This result reveals that the fetal lungs are mature and in no way indicates risk for preterm labor. Meconium should not be present in the amniotic fluid.

The results of the three-dimensional ultrasound showed the presence of conjoined twins in the womb of a pregnant client. Which instruction should be given by the primary health care provider to the nurse during the delivery of the client's infant? 1. To obtain maternal serum screening of the client 2. To determine endometrial thickness in the client 3. To plan for a cesarean section to deliver the client 4. To administer prostaglandin inhibitors to the client (EAQ - CH 12 and 13)

Correct answer: 3. To plan for a cesarean section to deliver the client Rationale: Conjoined twins are monozygotic twins that have had incomplete embryonic division. Cesarean section is recommended for the client having conjoined twins, because it minimizes the trauma in both the mother and the fetus. Maternal serum screening is done during fetal development to detect genetic disorders. Endometrial thickness will not affect the delivery, so its thickness is not assessed before delivery. Prostaglandins are released during labor to induce the contraction of the uterus. The administration of prostaglandin inhibitors is fatal for both the mother and the fetus during labor, so they should not be used.

The student nurse asks the clinical coordinator, "When can the gender of the fetus be determined?" Which response given by the clinical coordinator indicates effective teaching? 1. 6th 2. 8th 3. 10th 4. 12th (EAQ - CH 12 and 13)

Correct answer: 4. 12th week Rationale: The male and female genitals are completely differentiated by the end of the 12th week of gestation. Therefore, during the 12th week of gestation the gender of the fetus can be determined.

Which testing should the nurse perform to determine if a client is pregnant? 1. Linkage testing 2. Molecular testing 3. Cytogenetic testing 4. Biochemical testing (EAQ - CH 12 and 13)

Correct answer: 4. Biochemical testing Rationale: Biochemical testing involves examining proteins and protein products of the genes. A pregnancy confirmation test involves the detection of human chronic gonadotropin (hCG), which is a protein hormone. Biochemical testing for hCG confirms pregnancy within 8 to 10 days of conception. Linkage testing, molecular testing, and cytogenic testing are not helpful in pregnancy testing. Linkage testing is helpful for identifying marker sequences corresponding with the affected gene. Molecular testing is the analysis of nucleic acids. Cytogenetic testing helps in detecting abnormalities in the chromosomes.

A 16-week pregnant client visits a prenatal clinic to observe her child's development by ultrasonography. What developmental characteristic will the nurse find in the fetus? 1. Appearance of the cerebral fissures 2. Presence of alveolar ducts and sacs 3. Primitive respiratory-like movement 4. Differentiation of general sense organs (EAQ - CH 12 and 13)

Correct answer: 4. Differentiation of general sense organs Rationale: Differentiation of the general sense organs occurs at 16 weeks of pregnancy. Because the client is in the 18th week of pregnancy, ultrasonography images can clearly show different sense organs. Cerebral fissures appear at the 28th week of pregnancy. Alveolar ducts and sacs are formed in the fetus in the 24th week of pregnancy. Primitive respiratory-like movement will start in the fetus from the 20th week of pregnancy

A pregnant client was found to have higher-than-normal levels of human chorionic gonadotropin (hCG). The client also reports excessive vomiting and mild vaginal bleeding. What risk does the nurse suspect in the client? 1. Miscarriage 2. Ectopic pregnancy 3. Intrauterine growth restriction 4. Gestational trophoblastic disease (EAQ - CH 12 and 13)

Correct answer: 4. Gestational trophoblastic disease Higher-than-normal levels of hCG are associated with abnormal gestation, such as a fetus with gestational trophoblastic disease, multiple gestation, or a fetus with Down syndrome. An abnormally slow increase in hCG, or lower levels of hCG, indicates miscarriage or ectopic pregnancy. Intrauterine growth restriction occurs due to poor placental perfusion or lack of adequate oxygen supply to the fetus.

After reviewing the lab reports of a female client, the nurse infers that the client is pregnant. Which lab finding indicates that the female is pregnant? 1. Decreased levels of insulin in the client 2. Increased levels of thyroxine in the client 3. Increased levels of follicle-stimulating hormone (FSH) 4. Increased levels of human chorionic gonadotropin (hCG) (EAQ - CH 12 and 13)

Correct answer: 4. Increased levels of human chorionic gonadotropin (hCG) Rationale: Human chorionic gonadotropin is the earliest biologic marker for pregnancy. The production of the β-subunit of hCG can be detected in the maternal serum or urine within 7 or 8 days after fertilization. Thus, the nurse can confirm the pregnancy status of a female by the increased levels of hCG. Decreased levels of insulin indicate the presence of diabetes. Thyroid abnormalities are confirmed by the increased levels of thyroxine hormone. A follicle-stimulating hormone (FSH) blood test is used in diagnosing abnormal menstrual bleeding and infertility.

A patient reports to the nurse that she had missed her period this month and suspects that she is a pregnant. What would be the most suitable nursing action for this patient? 1. Assess for Hegar sign 2. Assess for Chadwick sign 3. Obtain an order for a urine pregnancy test 4. Obtain an order for a serum pregnancy test (EAQ - CH 12 and 13)

Correct answer: 4. Obtain an order for a serum pregnancy test Rationale:Because the woman has missed her period, it is likely that the woman is 4 to 6 weeks pregnant. A serum pregnancy test helps in the earliest detection of pregnancy. This test can be used to detect pregnancy in women who are 4 weeks pregnant. Therefore, the nurse should ask the patient to take the serum pregnancy test. It is performed during weeks 4 to 12 of pregnancy. The Hegar sign and Chadwick sign will be observed during weeks 6 to 12 of pregnancy, and pelvic congestion may be another cause for such signs. A urine pregnancy test gives positive results during weeks 6 to 12 of pregnancy.

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, what should nurses be aware of? 1. With a dominant disorder, the likelihood of the second child also having the condition is 100%. 2, An autosomal recessive disease carries a one in eight risk of the second child also having the disorder. 3. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. 4. The risk factor remains the same no matter how many affected children are already in the family. (EAQ - CH 12 and 13)

Correct answer: 4. The risk factor remains the same no matter how many affected children are already in the family. Rationale: The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. In the case of maternal drug use, subsequent children would be at risk only if the mother continued to use drugs; the rate of risk would be difficult to calculate. Each pregnancy is an independent event.

During the prenatal examination of a pregnant woman, the nurse finds that the client has hemorrhoids. What does the nurse interpret from this finding? 1. The estrogen and progesterone levels are increased in the pregnant client. 2. The fetal blood is coursing through the umbilical cord in the pregnant client. 3. The estrogen and progesterone have caused cervical stimulation in the client. 4. The venous pressure has increased and there is reduced blood flow to the legs. (EAQ - CH 12 and 13)

Correct answer: 4. The venous pressure has increased and there is reduced blood flow to the legs. Rationale: The causes of hemorrhoids in the pregnant client are increased venous pressure and reduced blood flow to the legs. The enlarged uterus compresses the iliac veins and the inferior vena cava results in increased venous pressure. This increases the blood pressure in the anal vasculature, and predisposes a pregnant woman to have hemorrhoids. Increased levels of estrogen and progesterone cause fullness, heightened sensitivity, tingling, and heaviness of the breasts. The fetal blood coursing through the umbilical cord in the client causes the funic souffle sign of fetal heart rate. Cervical stimulation by estrogen and progesterone results in leucorrhea, which is the white or slightly gray mucoid discharge from the vagina with a faint musty odor.

The nurse reviews the lab reports of a female client and infers that the client has an ectopic pregnancy. What finding would prompt the nurse to consider this clinical diagnosis? 1. Very low levels of insulin 2. Very low levels of anemia 3. Very low levels of thrombocytopenia 4. Very low levels of human chorionic gonadotropin (hCG) (EAQ - CH 12 and 13)

Correct answer: 4. Very low levels of human chorionic gonadotropin (hCG) Rationale: Human chorionic gonadotropin (hCG) is produced by the fertilized ovum. Abnormally low levels of hCG indicate impending miscarriage or ectopic (tubal) pregnancy. Decreased levels of insulin are indicative of diabetes. Lower levels of RBC indicate anemia. Low levels of platelets indicate that the client may have impaired clotting ability. Diabetes, anemia, and thrombocytopenia are not conditions predisposing for ectopic pregnancy.

Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that what? 1. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing 2. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins 3. Identical twins are more common in Caucasian families 4. Fraternal twins are same gender, usually male (EAQ - CH 12 and 13)

Correct answers: 1. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing Rationale: Maternity nurses should know that twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference; fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender. Identical twins are the same gender.

To reassure and educate pregnant women about changes in their blood pressure, maternity nurses should be aware that: 1. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. 2. Shifting the woman's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. 3. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. 4. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy. (EAQ - CH 12 and 13)

Correct answer: 4. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy. Rationale: Compression of the iliac veins and inferior vena cava by the uterus also can lead to varicose veins in the legs and vulva. The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases.

Why does the evaluation of abnormal Papanicolaou (Pap) tests during pregnancy become complicated? 1. The cervix is larger. 2. The cervix is more oval in shape. 3. The cervix is more soft and velvety. 4. The squamocolumnar junction is located away from cervix. (EAQ - CH 12 and 13)

Correct answer: 4.The squamocolumnar junction is located away from cervix. Rationale: Papanicolaou (Pap) tests are important in all pregnant women because of high incidence of cervical cancers during pregnancy. During pregnancy, the squamocolumnar junction, which is a site for collecting cervical cancer cells during screening, is located away from cervix due to changes caused by pregnancy. The increased size of the cervix does not cause difficulty during Pap tests. The cervix becomes more oval in the horizontal plane after delivery. Softening of the cervix doesn't hinder Papanicolaou tests.

The genetic test results of a pregnant client show that the fetus has a chromosomal defect that has been known to affect mesodermal development. What risks can be expected in the fetus after birth? 1. Congenital anomalies related to lung structures 2. Congenital anomalies related to the skin's function 3. Congenital anomalies related to the nervous system 4. Congenital anomalies related to the vertebral column (EAQ - CH 12 and 13)

Correct answer: Congenital anomalies related to the vertebral column Rationale: The vertebral column is formed from the mesoderm of the embryo. Therefore, any defect affecting the mesoderm may result in congenital anomalies of the vertebral column and ribs. The lungs are formed from the endoderm of the embryo. The skin and the nervous system are formed from the ectodermal layer of the embryo.

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as what? 1. Hegar sign 2. McDonald sign 3. Chadwick sign 4. Goodell sign (EAQ - CH 12 and 13)

Correct answer: Hegar sign Rationale: At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy.

Which sign of pregnancy may manifest as an increase of urinary frequency in the client? 1. Hegar sign 2. Goodell sign 3. Ballottement 4. Chadwick sign (EAQ - CH 12 and 13)

Correct answer: Hegar sign Rationale: Hegar sign is characterized by softening and compressibility of the lower uterine segment (uterine isthmus), which is observed at approximately 6 weeks of gestation. The uterine fundus presses on the urinary bladder, causing the woman to have increased urinary frequency. Goodell sign is characterized by softening of the cervical tip. Ballottement is a technique of palpating the fetus by bouncing it gently and feeling the rebound. The deepened violet-bluish color of the vaginal mucosa and cervix is the characteristic feature of Chadwick sign.

A maternity nurse should be aware of which fact about amniotic fluid? 1. It serves as a source of oral fluid and as a repository for waste from the fetus. 2. The volume remains about the same throughout the term of a healthy pregnancy. 3. A volume of less than 300 ml is associated with gastrointestinal malformations. 4. A volume of more than 2 L is associated with fetal renal abnormalities. (EAQ - CH 12 and 13)

Correct answer: It serves as a source of oral fluid and as a repository for waste from the fetus. Rationale: Amniotic fluid is a source of oral fluid and a repository for waste from the fetus. It also cushions the fetus and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

The nurse is assisting the health care provider with a client in labor. The nurse concludes that the placental blood flow is reduced. What assessment finding would lead the nurse to conclude this? 1. Increased maternal blood pressure 2. Prolonged contractions 3. Impaired fetal respiratory movement 4. Slow decrease in progesterone levels (EAQ - CH 12 and 13)

Correct answer: Prolonged contractions Rationale: Braxton Hicks contractions generally enhance blood flow to the placenta. However, if the contractions are prolonged, the blood flow to the placenta can become restricted. Increased maternal blood pressure does not affect the placental blood flow. Fetal respiratory movements are not associated with the placental circulation. Progesterone levels are usually high during pregnancy; they do not affect the blood flow to placenta.

The nurse reviews the obstetric history of a pregnant woman and notes the GTPAL (gravidity, term, preterm, abortions, living children) for the woman is "1-0-1-0-1." What does the nurse infer from this? 1. The woman was pregnant twice, gave birth at the 35th week, and the baby survived. 2. The woman was pregnant once and gave birth to twins at the 36th week of pregnancy. 3. The woman was pregnant once, gave birth at the 35th week, and the baby survived. 4. The woman was pregnant twice and had miscarriage at 10 weeks during second pregnancy. (EAQ - CH 12 and 13)

Correct answer: The woman was pregnant once, gave birth at the 35th week, and the baby survived. Rationale: If the woman was pregnant only (gravidity-1), gave birth at week 35 (term-0), had one preterm delivery (preterm-1), had no abortions (abortion-0), and the baby survived (living children-1), then the GTPAL should be "1-0-1-0-1." If the woman was pregnant twice, gave birth at the 35th week during both pregnancies, and both babies survived, then the GTPAL would be "2-0-2-0-2." If the woman was pregnant once, gave birth to twins at the 36th week, then the GTPAL would be "1-0-2-0-2." The GTPAL would be "2-1-0-1-1" if the woman was pregnant twice, had one term pregnancy, but the second pregnancy ended in miscarriage at 10 weeks.

A client who is in the second trimester of pregnancy reports dizziness and fatigue. Which laboratory findings indicate that the client is anemic? 1. Hematocrit value of 35% 2. Hematocrit value of 40% 3. Hemoglobin value of 11 g/dl 4. Hemoglobin value of 10 g/dl (EAQ - CH 12 and 13)

Correct answer:4. Hemoglobin value of 10 g/dl Rationale: The decrease in normal hemoglobin values (12 to 16 g/dl blood) and hematocrit values (37% to 47%) due to rapid expansion of plasma is referred to as physiologic anemia. If the hemoglobin value drops to 11 g/dl or less during the first or third trimester, or less than 10.5 g/dl during the second trimester, or if the hematocrit decreases to 32% or less, the woman is considered anemic. A hemoglobin value of 10 g/dl indicates that the patient is anemic. A hematocrit value of 35% does not indicate that the patient is anemic, and 40% is a normal value. In the first or third trimester, a hemoglobin value of 11% indicates that the patient is not anemic. Hemoglobin value of more than 10.5g/dl in the second trimester is not considered anemia.

The student nurse asks the clinical coordinator about the physiologic process of conception. Which statements should the clinical coordinator include in the teaching? Select all that apply. 1. It is the first phase in the process of a woman becoming pregnant. 2. It involves the removal of the protective coat from the sperm head. 3. It is the fusion of the sperm cell and the egg cell to form a zygote. 4. It defines the process of differentiation in the primary germ layer. 5. It includes the process of the embryo adhering to the uterine wall. 6. It is the process of developing organ systems and external features. (EAQ - CH 12 and 13)

Correct answers: 1 and 3 1. It is the first phase in the process of a woman becoming pregnant. 3. It is the fusion of the sperm cell and the egg cell to form a zygote. Rationale: Conception is the very first step and involves the fusion of the sperm and the egg cell to form a zygote. This is considered the beginning of pregnancy. The process of removing a protective coat on the sperm head is called capacitation. It occurs prior to conception due to physiologic changes. The primary germ layer is differentiated into three layers three weeks after conception. The process in which the embryo adheres to the wall of the uterus is called implantation. This occurs after conception. Organ systems and external features are developed after differentiation of the primary germ layer. this takes place after conception.

The nurse should teach a pregnant woman that which substances are teratogens? Select all that apply. 1. Cigarette smoke 2. Isotretinoin (Retin A) 3. Vitamin C 4. Salicylic acid 5. Rubella (EAQ - CH 12 and 13)

Correct answers: 1, 2, and 5 1. Cigarette smoke 2. Isotretinoin (Retin A) 5. Rubella Rationale:: Cigarette smoke, Retin A, and rubella are known teratogens. Vitamin C and salicylic acid are not known teratogens.

What are the characteristics of the Goodell sign? Select all that apply. 1. Hypertrophy 2. Hyperplasia 3. Decreased friability 4. Decreased vascularity 5. Softening of the cervical tip (EAQ - CH 12 and 13)

Correct answers: 1, 2, and 5 Rationale: The Goodell sign is a probable sign of pregnancy, which is observed beginning in the sixth week of pregnancy. Hypertrophy refers to the enlargement of the preexisting elastic tissue. Hyperplasia refers to formation of new fibroelastic tissue. Hypertrophy and hyperplasia of the cervix, in addition to softening of the cervical tip, are the main observations of the Goodell sign. Friability of the cervix is increased, which may result in slight bleeding after vaginal examination. Increased vascularity of the cervix and vagina is also a characteristic feature of the Goodell sign.

What signs should the nurse include in the lesson while explaining the presumptive signs of pregnancy to a group of women? Select all that apply. 1. Fatigue 2. Hegar sign 3. Quickening 4. Amenorrhea 5. Ballottement (EAQ - CH 12 and 13)

Correct answers: 1, 3, and 4 1. Fatigue 3. Quickening 4. Amenorrhea Rationale: The changes that occur during pregnancy are classified into three categories, namely presumptive, probable, and positive signs of pregnancy. Presumptive signs of pregnancy are the signs or changes felt by the women which may have other causes other than pregnancy. Fatigue, quickening, and amenorrhea are some of the presumptive signs of pregnancy. The Hegar sign is a probable sign of pregnancy but can potentially be caused by something other than pregnancy. The Hegar sign indicates the compressibility of the lower uterine segment, which cannot be felt by the woman. Ballottement is a technique of palpating a fetus by inserting a finger into the vagina, bouncing it gently, and feeling the fetus rebound and it is a probable sign of pregnancy.

The nursing instructor is educating a student nurse about the hormone human chorionic somatomammotropin (hCS). What points should the instructor teach the student nurse? Select all that apply. 1. It facilitates glucose transport across the placental membrane. 2. It promotes growth of the uterus and uteroplacental blood flow. 3. It maintains the endometrium and decreases uterine contractility. 4. It stimulates breast development in order to prepare for lactation. 5. It stimulates maternal metabolism to supply nutrients to the fetus. (EAQ - CH 12 and 13)

Correct answers: 1, 4, and 5 1. It facilitates glucose transport across the placental membrane. 4. It stimulates breast development in order to prepare for lactation. 5. It stimulates maternal metabolism to supply nutrients to the fetus. Rationale: Human chorionic somatomammotropin (hCS) is a protein hormone produced by the placenta. It facilitates glucose transport across the placental membrane, stimulates breast development to prepare for lactation, and accelerates maternal metabolism to supply needed nutrients to the fetus. Estrogen produced by the placenta stimulates uterine growth and uteroplacental blood flow. Progesterone, which maintains the endometrium and decreases the contractility of the uterus, is another proteinaceous hormone produced by the placenta.

The nurse is teaching a group of women about home pregnancy tests. Which instruction does the nurse include in the lesson? Select all that apply. 1. Use the last-voided evening urine specimen. 2. Follow the manufacturer's instructions carefully. 3. Contact your primary health care provider for follow-up if the test result is negative. 4. Repeat the test (if negative) after a week, if amenorrhea persists. 5. Contact your primary health care provider for follow-up if the test result is positive. (EAQ - CH 12 and 13)

Correct answers: 2, 4, 5 2. Follow the manufacturer's instructions carefully. 4. Repeat the test (if negative) after a week, if amenorrhea persists. 5. Contact your primary health care provider for follow-up if the test result is positive. Rationale: In her teaching about home pregnancy tests, the nurse should reinforce the need to follow the manufacturer's instructions carefully in order to get correct results. The test should be repeated after a week if a woman has still not had a period after a negative result. If the test result is positive, the woman should contact her primary health care provider for follow-up. The first-voided, not the last-voided, morning urine specimen should be used for pregnancy testing. If the test result is negative and the women still has not had a period, the women should contact her primary health care provider.

After reviewing the lab reports of a 5-month pregnant female, the nurse tells the patient that her condition is normal. Which findings enabled the nurse to conclude that the patient is healthy? Select all that apply. 1. The patient's bladder has a capacity of 1000 ml. 2. The hemoglobin value is 13 g/dl in the patient. 3. The total serum protein value is 5.1 g/dl in the patient. 4. The mean corpuscular hemoglobin value is 30 pg. 5. The mean corpuscular hemoglobin concentration is 34 g/dl. (EAQ - CH 12 and 13)

Correct answers: 2, 4, and 5 2. The hemoglobin value is 13 g/dl in the patient. 4. The mean corpuscular hemoglobin value is 30 pg. 5. The mean corpuscular hemoglobin concentration is 34 g/dl. Rationale: The laboratory findings may indicate the health condition of the patient. The hemoglobin value is 13 g/dl, which is within the normal range (greater than 11 g/dl). The mean corpuscular hemoglobin value of 30 pg (normal range = 27-31 pg) and the mean corpuscular hemoglobin concentration of 34 g/dl (normal range = 32-36 g/dl) also imply normal findings. The bladder capacity of 1000 ml is less than the normal value (1500 ml). The total serum protein value of 5.1 g/dl is not within the normal range (5.5-7.5 g/dl). These findings would not indicate that the patient is normal.

The nurse educator is teaching the student nurse about the viability of a 23-week preterm infant. Which factors would limit the survival of this infant? Select all that apply. 1. Endocrine system function 2. Tooth enamel development 3. Lung oxygenation capability 4. Central nervous system (CNS) function 5. Peripheral nervous system (PNS) function (EAQ - CH 12 and 13)

Correct answers: 3 and 4 3. Lung oxygenation capability 4. Central nervous system (CNS) function Rationale: