OB Exam 1 - Antepartum and Genetics Success Q's

119. The nurse suspects that a client is third spacing fluid. Which of the following signs will provide the nurse with the best evidence of this fact? 1. Client's blood pressure. 2. Client's appearance. 3. Client's weight. 4. Client's pulse rate.

3. Weight is the most important sign for the nurse to assess.

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.

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.

89. A 32-week-gestation client states that she "thinks" she is leaking amniotic fluid. Which of the following tests could be performed to determine whether the membranes had ruptured? 1. Fern test. 2. Biophysical profile. 3. Amniocentesis. 4. Kernig assessment.

1. A fern test is performed to assess for the presence of amniotic fluid.

5. A 32-week-gestation client was last seen in the prenatal client at 28 weeks' gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife? 1. Weight change from 128 pounds to 138 pounds. 2. Pulse rate change from 88 bpm to 92 bpm. 3. Blood pressure change from 120/80 to 118/78. 4. Respiratory rate change from 16 rpm to 20 rpm.

1. A weight gain of 10 pounds in a 4-week period is worrisome. The recommended weight gain during the second and third trimesters is approximately 1 pound per week.

102. A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women to prevent which of the following high-risk complications of pregnancy? 1. Preterm birth. 2. Gestational diabetes. 3. Macrosomic babies. 4. Polycythemia.

1. Adolescents are at high risk for preterm labor

7. A nurse remarks to a 38-week-gravid client, "It looks like your face and hands are swollen." The client responds, "Yes, you're right. Why do you ask?" The nurse's response is based on the fact that the changes may be caused by which of the following? 1. Altered glomerular filtration. 2. Cardiac failure. 3. Hepatic insufficiency. 4. Altered splenic circulation.

1. Altered glomerular filtration leads to protein loss and, subsequently, to fluid retention, which can lead to swelling in the face and hands.

85. A nurse is about to inject RhoGAM into an Rh-negative mother. Which of the following is the preferred site for the injection? 1. Deltoid. 2. Dorsogluteal. 3. Vastus lateralis. 4. Ventrogluteal.

1. Although the dosage can be administered in the gluteal muscles, the deltoid is the preferred site of the RhoGAM injection

15. In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches an 18-week-gravid client to call the office if she experiences which of the following? 1. Headache and decreased output. 2. Puffy feet. 3. Hemorrhoids and vaginal discharge. 4. Backache.

1. Headache and decreased output are signs of preeclampsia.

36. A woman is to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects of the therapy? Select all that apply. 1. Nausea and vomiting. 2. Abdominal pain. 3. Fatigue. 4. Light-headedness. 5. Breast tenderness.

1. Nausea and vomiting are common side effects. 2. Abdominal pain is a common side effect. The pain associated with the medication needs to be carefully monitored to differentiate it from the pain caused by the ectopic pregnancy itself. 3. Fatigue is a common side effect. 4. Light-headedness is a common side effect.

42. A client, 32 weeks' gestation with placenta previa, is on total bed rest. The physician expects her to be hospitalized on bed rest until her cesarean section, which is scheduled for 38 weeks' gestation. To prevent complications while in the hospital, the nurse should do which of the following? Select all that apply. 1. Perform passive range-of-motion exercises. 2. Restrict the fluid intake of the client. 3. Decorate the room with pictures of family. 4. Encourage the client to eat a high-fiber diet. 5. Teach the client deep-breathing exercises.

1. Passive range-of-motion will help to decrease the potential for muscle atrophy and thrombus formation. 3. This client is separated from family. The separation can lead to depression. Decorating the room and enabling family to visit freely is very important. 4. A high-fiber diet will help to maintain normal bowel function. 5. Deep breathing exercises are important to maintain the client's respiratory function.

60. A client has just done a fetal kick count assessment. She noted 6 movements during the past hour. If taught correctly, what should her next action be? 1. Nothing, because further action is not warranted. 2. Call the doctor to set up a nonstress test. 3. Redo the test during the next half hour. 4. Drink a glass of orange juice and redo the test.

1. She should do nothing because the woman should feel 3 or more counts in 1 hour.

55. A woman's glucose challenge test (GCT) results are 155 mg/dL at 1 hour post-glucose ingestion. Which of the following actions, as ordered by the physician, is appropriate? 1. Send the woman for a glucose tolerance test. 2. Teach the woman how to inject herself with insulin. 3. Notify the woman of the normal results. 4. Provide the woman with oral hypoglycemic agents

1. The 1-hour GCT results are above normal. She needs a 3-hour glucose tolerance test (GTT)

81. The laboratory reported the L/S ratio results from an amniocentesis as 1:1. How should the nurse interpret the result? 1. The baby is premature. 2. The mother is high risk for hemorrhage. 3. The infant has kernicterus. 4. The mother is high risk for eclampsia

1. The baby is preterm

41. A 12-week-gravid client presents in the emergency department with abdominal cramps and scant dark red bleeding. Which of the following signs/symptoms should the nurse assess this client for? Select all that apply. 1. Tachycardia. 2. Referred shoulder pain. 3. Headache. 4. Fetal heart dysrhythmias. 5. Hypertension.

1. The client should be assessed for tachycardia, which could indicate that the client is bleeding internally. 3. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. Although this client is only at 12 weeks' gestation, if she has a hydatidiform mole, she may be exhibiting signs of preeclampia, including headache and hypertension. 4. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. To determine whether or not the patient is carrying a viable fetus, the nurse should check the fetal heart rate. 5. This client's signs and symptoms are consistent with both spontaneous abortion and hydatidiform mole. Although this client is only 12 weeks' gestation, if she has a hydatidiform mole, she may be exhibiting signs of preeclampia, including headache and hypertension.

52. A type 1 diabetic gravida has developed polyhydramnios. The client should be taught to report which of the following? 1. Uterine contractions. 2. Reduced urinary output. 3. Marked fatigue. 4. Puerperal rash.

1. The client should be taught to observe for signs of preterm labor

77. A 39-year-old, 16-week-gravid woman has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences any of the following side effects? Select all that apply. 1. Fever or chills. 2. Lack of fetal movement. 3. Abdominal pain. 4. Rash or pruritus. 5. Vaginal bleeding.

1. The client should call her practitioner if she experiences fever or chills. 2. Because the fetus can be injured during an amniocentesis, the client should report either a decrease or an increase in fetal movement. 3. The client should report abdominal pain or cramping. An amniocentesis can precipitate preterm labor 5. The client should report any vaginal loss—blood or amniotic fluid. The placenta may become injured or the membranes may rupture during an amniocentesis.

51. A client who works as a waitress and is 35 weeks' gestation telephones the labor suite after getting home from work and states, "I am feeling tightening in my groin about every 5 to 6 minutes." Which of the following comments by the nurse is appropriate at this time? 1. "Please lie down and drink about four full glasses of water or juice." 2. "You are having false labor pains so you need not worry about them." 3. "It is essential that you get to the hospital immediately." 4. "That is very normal for someone who is on her feet all day."

1. The first intervention for preterm labor is hydration. Clients who are dehydrated are at high risk for preterm labor.

53. A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? 1. Excessive fetal urination. 2. Recurring hypoglycemic episodes. 3. Fetal sacral agenesis. 4. Placental vascular damage.

1. The hydramnios is likely a result of excessive fetal urination.

2. A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, the physician ordered the following four items. Which of the orders should the nurse perform first? 1. Assess deep tendon reflexes. 2. Obtain complete blood count. 3. Assess baseline weight. 4. Obtain routine urinalysis.

1. The nurse should check the client's patellar reflexes. The most common way to assess the deep tendon reflexes is to assess the patellar reflexes.

76. The physician has ordered a nonstress test (NST) to be done on a 41-week-gestation client. During the half-hour test, the nurse observed three periods of fetal heart accelerations that were 15 beats per minute above the baseline and that lasted 15 seconds each. No contractions were observed. Based on these results, what should the nurse do next? 1. Send the client home and report positive results to the MD. 2. Perform a nipple stimulation test to assess the fetal heart in response to contractions. 3. Prepare the client for induction with IV oxytocin or endocervical prostaglandins. 4. Place the client on her side with oxygen via face mask.

1. The nurse should report the positive results to the doctor.

116. An ultrasound has identified that a client's pregnancy is complicated by oligohydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. Dysplastic kidneys. 2. Coarctation of the aorta. 3. Hydrocephalus. 4. Hepatic cirrhosis

1. The nurse would expect that the baby has dysplastic kidneys

92. A gravid woman has been diagnosed with listeriosis. She eats rare meat and raw smoked seafood. Which of the following signs/symptoms would this woman exhibit? 1. Fever and muscle aches. 2. Rash and thrombocytopenia. 3. Petechiae and anemia. 4. Amnionitis and epistaxis.

1. The symptoms of listeriosis are similar to symptoms of the flu and include fever and muscle aches

58. A gravid woman, 36 weeks' gestation with type 1 diabetes, has just had a biophysical profile (BPP). Which of the following results should be reported to the obstetrician? 1. One fetal heart acceleration in 20 minutes. 2. Three episodes of fetal rhythmic breathing in 30 minutes. 3. Two episodes of fetal extension and flexion of 1 arm. 4. One amniotic fluid pocket measuring 3 cm.

1. There should be a minimum of 2 fetal heart accelerations in 20 minutes (approximately 1 every 10 minutes

50. A 30-week-gestation multigravida, G3 P1011, is admitted to the labor suite. She is contracting every 5 minutes × 40 seconds. Which of the comments by the client would be most informative regarding the etiology of the client's present condition? 1. "For the past day I have felt burning when I urinate." 2. "I have a daughter who is 2 years old." 3. "I jogged 11/2 miles this morning." 4. "My miscarriage happened a year ago today."

1. This is the most important statement made by the client

24. Which of the following long-term goals is appropriate for a client, 10 weeks' gestation, who is diagnosed with gestational trophoblastic disease (hydatidiform mole)? 1. Client will be cancer free 1 year from diagnosis. 2. Client will deliver her baby at full term without complications. 3. Client will be pain free 3 months after diagnosis. 4. Client will have normal hemoglobin and hematocrit at delivery.

1. This long-term goal is appropriate

20. A hospitalized gravida's blood work is: hematocrit 30% and hemoglobin 10 gm/dL. In light of the laboratory data, which of the following meal choices should the nurse recommend to this patient? 1. Chicken livers, sliced tomatoes, and dried apricots. 2. Cheese sandwich, tossed salad, and rice pudding. 3. Veggie burger, cucumber salad, and wedge of cantaloupe. 4. Bagel with cream cheese, pear, and hearts of lettuce.

1. This meal choice is high in iron and ascorbic acid. It would be an excellent lunch choice for this client who has a below normal hematocrit and hemoglobin.

16. Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? 1. G1 P0000, age 44 with history of diabetes mellitus. 2. G2 P0101, age 27 with history of rheumatic fever. 3. G3 P1102, age 25 with history of scoliosis. 4. G3 P1011, age 20 with history of celiac disease.

1. This primigravid client—age 44 and with a history of diabetes—is very high risk for preeclampsia.

54. A type 1 diabetic is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? 1. Need for less insulin than she normally injects. 2. An increased risk for hyperglycemic episodes. 3. Signs and symptoms of hydramnios. 4. A need to be hospitalized for fetal testing.

1. Type 1 diabetics often need less insulin during the first trimester than they did preconception.

72. A gravid woman has sickle cell anemia. Which of the following situations could precipitate a vaso-occlusive crisis in this woman? 1. Hypoxia. 2. Alkalosis. 3. Fluid overload. 4. Hyperglycemia.

1. Vaso-occlusive crises are precipitated by hypoxia in pregnant as well as nonpregnant sickle cell clients.

4. The nurse is evaluating the effectiveness of bed rest for a client with mild preeclampsia. Which of the following signs/symptoms would the nurse determine is a positive finding? 1. Weight loss. 2. 2+ proteinuria. 3. Decrease in plasma protein. 4. 3+ patellar reflexes.

1. Weight loss is a positive sign.

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 ounce serving size 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 cup 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 cup dry cereal = one 1 oz serving.

105. A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary health care practitioner? 1. Presence of striae gravidarum. 2. Dyspnea on exertion. 3. 4-pound weight gain in a month. 4. Patellar reflexes +2.

2. A client who is complaining of dyspnea on exertion is likely going into leftsided congestive heart failure.

28. A nurse is caring for four prenatal clients in the clinic. Which of the clients is high risk for placenta previa? Select all that apply. 1. Jogger with low body mass index. 2. Primigravida who smokes 1 pack of cigarettes per day. 3. Infertility client who is carrying in vitro triplets. 4. Registered professional nurse who works 12-hour shifts. 5. Police officer on foot patrol.

2. A smoker is high risk for placenta previa. 3. A woman carrying triplets is high risk for placenta previa.

109. A pregnant woman mentions to the clinic nurse that she and her husband enjoy working together on projects around the house and says, "I always wear protective gloves when I work." The nurse should advise the woman that even when she wears gloves, which of the following projects could be high risk to the baby's health? 1. Replacing a light fixture in the nursery. 2. Sanding the paint from an antique crib. 3. Planting tulip bulbs in the side garden. 4. Shoveling snow from the driveway.

2. Antique cribs are often painted with lead-based paint. This is a dangerous activity.

83. An ultrasound is being done on an Rh-negative woman. Which of the following pregnancy findings would indicate that the baby has developed erythroblastosis fetalis? 1. Caudal agenesis. 2. Cardiomegaly. 3. Oligohydramnios. 4. Hyperemia.

2. Cardiomegaly is one of the common signs of erythroblastosis fetalis.

90. A nurse is interviewing a prenatal client. Which of the following factors in the client's history should the nurse highlight for the health care practitioner? 1. That she is eighteen years old. 2. That she owns a cat and a dog. 3. That she eats peanut butter daily. 4. That she works as a surgeon.

2. Cat feces are a potential source of toxoplasmosis.

46. Which of the following pregnant clients is most high risk for preterm premature rupture of the membranes (PPROM)? Select all that apply. 1. 31 weeks' gestation with prolapsed mitral valve (PMV). 2. 32 weeks' gestation with urinary tract infection (UTI). 3. 33 weeks' gestation with twins post-in vitro fertilization (IVF). 4. 34 weeks' gestation with gestational diabetes (GDM). 5. 35 weeks' gestation with deep vein thrombosis (DVT

2. Clients with UTIs are high risk for PPROM. 3. Clients carrying twins, whether spontaneous or post-IVF, are at high risk for PPROM

33. A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following intramuscular medications would the nurse expect to administer? 1. Decadron (dexamethasone). 2. Amethopterin (methotrexate). 3. Pergonal (metotropin). 4. Prometrium (progesterone).

2. Methotrexate is the likely medication.

74. An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is high risk for which of the following complications of pregnancy? Select all that apply. 1. Placenta previa. 2. Gestational diabetes. 3. Abruptio placentae. 4. Preeclampsia. 5. Chromosomal defects

2. Obese clients are at high risk for gestational diabetes. 4. Obese clients are at high risk for preeclampsia

104. A 15-year-old client is being seen for her first prenatal visit. Because of this client's special nutritional needs, the nurse evaluates the client's intake of: 1. Protein and magnesium. 2. Calcium and iron. 3. Carbohydrates and zinc. 4. Pyroxidine and thiamine.

2. Pregnant adolescents' diets are often deficient in calcium and iron.

115. A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary health care provider is highest priority for the nurse to complete? 1. Obtain complete blood count. 2. Start intravenous with multivitamins. 3. Check admission weight. 4. Obtain urine for urinalysis

2. Starting an intravenous with multivitamins takes priority

87. At 28 weeks' gestation, an Rh-negative woman receives RhoGAM. Which of the following would indicate that the medication is effective? 1. The baby's Rh status changes to Rh-negative. 2. The mother produces no Rh antibodies. 3. The baby produces no Rh antibodies. 4. The mother's Rh status changes to Rh-positive.

2. That the mother produces no Rh antibodies is the goal of RhoGAM administration

80. A lecithin:sphingomyelin (L/S) ratio has been ordered by a pregnant woman's obstetrician. Which of the following data will the nurse learn from this test? 1. Coagulability of maternal blood. 2. Maturation of the fetal lungs. 3. Potential for fetal development of erythroblastosis fetalis. 4. Potential for maternal development of gestational diabetes.

2. The L/S ratio indicates the maturity of the fetal lungs.

94. Prenatal teaching for a pregnant woman should include instructions to do which of the following? 1. Refrain from touching her pet bird. 2. Wear gloves when gardening. 3. Cook pork until medium well done. 4. Avoid sleeping with the dog.

2. The client should be advised to wear gloves when gardening

62. A gestational diabetic, who requires insulin therapy to control her blood glucose levels, telephones the triage nurse complaining of dizziness and headache. Which of the following actions should the nurse take at this time? 1. Have the client proceed to the office to see her physician. 2. Advise the client to drink a glass of juice and then call back. 3. Instruct the client to inject herself with regular insulin. 4. Tell the client immediately to telephone her medical doctor.

2. The client should drink a 4-ounce glass of juice.

30. A client, G2 P1001, telephones the gynecology office complaining of left-sided pain. Which of the following questions by the triage nurse would help to determine whether the one-sided pain is due to an ectopic pregnancy? 1. "When did you have your pregnancy test done?" 2. "When was the first day of your last menstrual period?" 3. "Did you have any complications with your first pregnancy?" 4. "How old were you when you first got your period?"

2. The date of the last menstrual period will assist the nurse in determining how many weeks pregnant the client is.

57. In analyzing the need for health teaching in a client, G5 P4004 with gestational diabetes, the nurse should ask which of the following questions? 1. "How old were you at your first pregnancy?" 2. "Do you exercise regularly?" 3. "Is your partner diabetic?" 4. "Do you work outside of the home?"

2. The likelihood of developing either gestational or type 2 diabetes is reduced when clients exercise regularly.

6. A 24-week-gravid client is being seen in the prenatal clinic. She states, "I have had a terrible headache for the past 2 days." Which of the following is the most appropriate action for the nurse to perform next? 1. Inquire whether or not the client has allergies. 2. Take the woman's blood pressure. 3. Assess the woman's fundal height. 4. Ask the woman about stressors at work

2. The nurse should assess the client's blood pressure.

47. A client, G8 P3406, 14 weeks' gestation, is being seen in the prenatal clinic. During the nurse's prenatal teaching session, the nurse will emphasize that the woman should notify the obstetric office immediately if she notes which of the following? 1. Change in fetal movement. 2. Signs and symptoms of labor. 3. Swelling of feet and ankles. 4. Appearance of spider veins.

2. The nurse should emphasize the need for the client to notify the office of signs of preterm labor

117. An ultrasound has identified that a client's pregnancy is complicated by hydramnios. The nurse would expect that an ultrasound may show that the baby has which of the following structural defects? 1. Pulmonic stenosis. 2. Tracheoesophageal fistula. 3. Ventriculoseptal defect. 4. Developmental hip dysplasia.

2. The nurse would expect to find that the baby has tracheoesophageal fistula.

13. A 29-week-gestation woman diagnosed with severe preeclampsia is noted to have blood pressure of 170/112, 4+ proteinuria, and a weight gain of 10 pounds over the past 2 days. Which of the following signs/symptoms would the nurse also expect to see? 1. Fundal height of 32 cm. 2. Papilledema. 3. Patellar reflexes of +2. 4. Nystagmus.

2. The nurse would expect to see papilledema.

38. A gravid client is admitted with a diagnosis of third-trimester bleeding. It is priority for the nurse to assess for a change in which of the following vital signs? 1. Temperature. 2. Pulse. 3. Respirations. 4. Blood pressure.

2. The pulse is the highest priority in this situation

18. A client's 32-week clinic assessment was: BP 90/60; TPR 98.6°F, P 92, R 20; weight 145 lb; and urine negative for protein. Which of the following findings at the 34-week appointment should the nurse highlight for the certified nurse midwife? 1. BP 110/70; TPR 99.2°F, 88, 20. 2. Weight 155 lb; urine protein +2. 3. Urine protein trace; BP 88/56. 4. Weight 147 lb; TPR 99.0°F, 76, 18.

2. There has been a 10-lb weight gain in 2 weeks and a significant amount of protein is being spilled in the urine. This client should be brought to the attention of the primary caregiver.

113. The nurse is caring for a 32-week G8 P7007 with placenta previa. Which of the following interventions would the nurse expect to perform? Select all that apply. 1. Daily contraction stress tests. 2. Blood type and cross match. 3. Bed rest with passive range-of-motion exercises. 4. Daily serum electrolyte assessments. 5. Weekly biophysical profiles.

2. There should be blood available in the blood bank in case the woman begins to bleed. 3. The nurse would expect to keep the woman on bed rest with bathroom privileges only. 5. The nurse would expect that weekly biophysical profiles would be done to assess fetal well-being

111. A client has been diagnosed with pseudocyesis. Which of the following signs/ symptoms would the nurse expect to see? 1. 4+ pedal edema. 2. No fetal heartbeat. 3. Hematocrit above 40%. 4. Denial of quickening.

2. There will be no fetal heartbeat when a client has pseudocyesis

48. A woman, G4 P0210 and 12 weeks' gestation, has been admitted to the labor and delivery suite for a cerclage procedure. Which of the following long-term outcomes is appropriate for this client? 1. The client will gain less than 25 pounds during the pregnancy. 2. The client will deliver after 38 weeks' gestation. 3. The client will have a normal blood glucose throughout the pregnancy. 4. The client will deliver a baby that is appropriate for gestational age.

2. This client is at high risk for pregnancy loss. This is an appropriate long-term goal.

68. A 30-year-old gravida, G3 P1101, 6 weeks' gestation, states that her premature baby boy, born 8 years ago, died shortly after delivery from an infection secondary to spina bifida. Which of the following interventions is most important for this client? 1. Grief counseling. 2. Nutrition counseling. 3. Infection control counseling. 4. Genetic counseling

2. This client is in need of nutrition counseling.

23. A client being seen in the ED has an admitting medical diagnosis of: third-trimester bleeding: rule out placenta previa. Each time a nurse passes by the client's room, the woman asks, "Please tell me, do you think the baby will be all right?" Which of the following is an appropriate nursing diagnosis for this client? 1. Hopelessness related to possible fetal loss. 2. Anxiety related to inconclusive diagnosis. 3. Situational low self-esteem related to blood loss. 4. Potential for altered parenting related to inexperience.

2. This client is very anxious.

56. A 25-week-pregnant client, who had eaten a small breakfast, has been notified that her glucose challenge test results were 142 mg/dL 1 hour after ingesting the glucose. Which of the following is appropriate for the nurse to say at this time? 1. "Because you ate before the test, the results are invalid and will need to be repeated." 2. "Because your test results are higher than normal, you will have to have another, more specific test." 3. "Because of the results you will have to have weekly glycohemoglobin testing done." 4. "Because your results are within normal limits you need not worry about gestational diabetes."

2. This comment is appropriate. The client will be referred for a 3-hour glucose tolerance test

103. Which of the following would be the best approach to take with an unmarried 14-year-old girl who tells the nurse that she is undecided whether or not to maintain an unplanned pregnancy? 1. "You should consider an abortion since you are so young." 2. "It is a difficult decision. What have you thought about so far?" 3. "Studies show that babies living with teen mothers often become teen parents." 4. "Why don't you keep the pregnancy? You could always opt for adoption later."

2. This is an excellent response. The question opens the door for the teenager to discuss her feelings and thoughts.

120. A client is being admitted to the labor suite with a diagnosis of eclampsia. The fetal heart rate tracing shows moderate variability with early decelerations. Which of the following actions by the nurse is appropriate at this time? 1. Tape a tongue blade to the head of the bed. 2. Pad the side rails and head of the bed. 3. Provide the client with needed stimulation. 4. Provide the client with grief counseling

2. This is appropriate. The side rails and the headboard should be padded.

63. A diabetic client is to receive 5 units regular and 15 units NPH insulin at 0800. To administer the medication appropriately, what should the nurse do? 1. Draw 5 units regular in one syringe and 15 units NPH in a second syringe and inject in different locations. 2. Draw 5 units regular first and 15 units NPH second into the same syringe and inject. 3. Draw 15 units NPH first and 5 units regular second into the same syringe and inject. 4. Mix 5 units regular and 15 units NPH in a vial before drawing the full 20 units into a syringe and inject.

2. This is the appropriate method. The regular insulin should be drawn up first and then the NPH insulin in the same syringe

82. A client is being taught fetal kick counting. Which of the following should be included in the patient teaching? 1. The woman should choose a time when her baby is least active. 2. The woman should lie on her side with her head elevated about 30°. 3. The woman should report fetal kick counts of greater than 10 in an hour. 4. The woman should refrain from eating immediately before counting.

2. This is the best position for perfusing the placenta.

71. A pregnant woman, 24 weeks' gestation, who has been diagnosed with severe choledocholithiasis is scheduled for a cholecystectomy. In addition to routine surgical and post-surgical care, the nurses should pay special attention to which of the following? Select all that apply. 1. The baby will be delivered by cesarean section at the same time as the cholescystectomy surgery. 2. The woman should be placed in the lateral recumbent position during the surgical procedure. 3. The post-anesthesia care nurse should monitor the woman carefully for nausea and vomiting. 4. The post-anesthesia care nurse should monitor the woman carefully for hemorrhage at the surgical site. 5. Antiembolic stockings should be placed on the woman's legs in the post-anesthesia care unit.

2. This response is correct. The woman should be maintained in the lateral recumbent position during the surgery because, if laid flat, the gravid uterus would compress the great vessels and impede the return of blood to the heart. 3. This response is correct. The woman would be at high risk for postoperative vomiting and for postoperative gas pains for 2 reasons: progesterone slows gastric motility and the stomach and intestines are displaced by the gravid uterus. 5. This response is correct. After the surgery antiembolic stockings should be placed on the client for the entire time that she is immobile.

26. Which of the following findings would the nurse expect to see when assessing a firsttrimester gravida suspected of having gestational trophoblastic disease (hydatidiform mole) that the nurse would not expect to see when assessing a first-trimester gravida with a normal pregnancy? Select all that apply. 1. Hematocrit 39%. 2. Grape-like clusters passed from the vagina. 3. Markedly elevated blood pressure. 4. White blood cell count 8,000/mm3. 5. Hypertrophied breast tissue.

2. Women with hydatidiform mole often expel grape-like clusters from the vagina. 3. Although signs and symptoms of preeclampsia usually appear only after a pregnancy has reached 20 weeks or later, preeclampsia is seen in the first trimester of pregnancy in women with hydatidiform mole

45. A nurse is performing an assessment on four 22-week-pregnant clients. The nurse reports to the obstetrician that which of the clients may be carrying twins? 1. The client who states that she feels huge. 2. The client with a weight gain of 13 pounds. 3. The client whose fundal height measurement is 26 cm. 4. The client whose alpha-fetoprotein level is one-half normal.

3. It is possible that this client is carrying twins.

84. A woman is to receive RhoGAM at 28 weeks' gestation. Which of the following actions must the nurse perform before giving the injection? 1. Validate that the baby is Rh-negative. 2. Assess that the direct Coombs' test is positive. 3. Verify the identity of the woman. 4. Reconstitute the globulin with sterile water.

3. Although this is an important action that must be taken before the administration of any medication, it is especially critical in this situation

14. A client with mild preeclampsia who has been advised to be on bed rest at home asks why doing so is necessary. Which of the following is the best response for the nurse to give the client? 1. "Bed rest will help you to conserve energy for your labor." 2. "Bed rest will help to relieve your nausea and anorexia." 3. "Reclining will increase the amount of oxygen that your baby gets." 4. "The position change will prevent the placenta from separating."

3. Bed rest, especially side-lying, helps to improve perfusion to the placenta

17. The nurse has assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment? 1. 10 weeks' gestation, complains of fatigue with nausea and vomiting. 2. 26 weeks' gestation, complains of ankle edema and chloasma. 3. 32 weeks' gestation, complains of epigastric pain and facial edema. 4. 37 weeks' gestation, complains of bleeding gums and urinary frequency

3. Epigastric pain and facial edema are not normal. This client should be referred to the nurse midwife.

86. A woman is recovering at the gynecologist's office following a late first-trimester spontaneous abortion. At this time, it is essential for the nurse to check which of the following? 1. Maternal rubella titer. 2. Past obstetric history. 3. Maternal blood type. 4. Cervical patency.

3. It is essential that the woman's blood type be assessed.

3. A nurse is counseling a preeclamptic client about her diet. Which should the nurse encourage the woman to do? 1. Restrict sodium intake. 2. Increase intake of fluids. 3. Eat a well-balanced diet. 4. Avoid simple sugars.

3. It is important for the client to eat a well-balanced diet.

101. A 14-year-old woman is seeking obstetric care. Which of the following is an appropriate nursing care goal for this young woman? The young woman will: 1. Bring her partner to all prenatal visits. 2. Terminate the pregnancy. 3. Continue her education. 4. Undergo prenatal chromosomal analysis.

3. It is important for the young woman to work toward completing the tasks of adolescence at the same time that she is engaged in maintaining a healthy pregnancy. She should continue her education.

21. A woman has just been admitted to the emergency department subsequent to a head-on automobile accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which of the following complications of pregnancy? Select all that apply. 1. Placenta previa. 2. Transverse fetal lie. 3. Placental abruption. 4. Severe preeclampsia. 5. Preterm labor

3. Placental abruption may develop as a result of the auto accident. 5. The woman may go into preterm labor after an auto accident

49. A woman, G5 P0401, is in the post-anesthesia care unit (PACU) after a cervical cerclage procedure. During the immediate postprocedure period, what should the nurse carefully monitor this client for? 1. Hyperthermia. 2. Hypotension. 3. Uterine contractions. 4. Fetal heart dysrhythmias.

3. Preterm labor is a complication in the immediate postprocedure period.

29. A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis? 1. Dark brown rectal bleeding. 2. Severe nausea and vomiting. 3. Sharp unilateral pain. 4. Marked hyperthermia.

3. Sharp unilateral pain is a common symptom of a ruptured ectopic.

39. A gravid client, G6 P5005, 24 weeks' gestation, has been admitted to the hospital for placenta previa. Which of the following is an appropriate long-term goal for this client? 1. The client will state an understanding of need for complete bed rest. 2. The client will have a reactive nonstress test on day 2 of hospitalization. 3. The client will be symptom free until at least 37 weeks' gestation. 4. The client will call her children shortly after admission.

3. That the client be symptom-free until at least 37 weeks' gestation is a longterm goal.

64. The nurse caring for a type 1 diabetic client who wishes to become pregnant notes that the client's glycohemoglobin, or glycosylated hemoglobin (HgbA1c), result was 15% today and the fasting blood glucose result was 100 mg/dL. Which of the following interpretations by the nurse is correct in relation to these data? 1. The client has been hyperglycemic for the past 3 months and is hyperglycemic today. 2. The client has been normoglycemic for the past 3 months and is normoglycemic today. 3. The client has been hyperglycemic for the past 3 months and is normoglycemic today. 4. The client has been normoglycemic for the past 3 months and is hyperglycemic today.

3. The client has been hyperglycemic for 3 months but is normoglycemic today

99. A 14-year-old woman is seeking obstetric care. Which of the following vital signs must be monitored very carefully during this woman's pregnancy? 1. Heart rate. 2. Respiratory rate. 3. Blood pressure. 4. Temperature.

3. The client's blood pressure is the most important vital sign.

25. Which of the following findings should the nurse expect when assessing a client, 8 weeks' gestation, with gestational trophoblastic disease (hydatidiform mole)? 1. Protracted pain. 2. Variable fetal heart decelerations. 3. Dark brown vaginal bleeding. 4. Suicidal ideations.

3. The condition is usually diagnosed after a client complains of brown vaginal discharge early in the "pregnancy."

78. Which of the following would indicate that a nipple stimulation test is creating the desired effect? 1. The woman's inverted nipples become erect. 2. The woman's nipple and breast tissue hypertrophy. 3. The woman's uterus contracts 3 times in 10 minutes. 4. The woman's cervix dilates 2 centimeters in 3 hours.

3. The nipples are stimulated with the goal of achieving a q 3-minute contraction pattern.

100. A 16-year-old woman is being seen for the first time in the obstetric office. Which of the following comments by the young woman is highest priority for the nurse to respond to? 1. "My favorite lunch is a burger with fries." 2. "I've been dating my new boyfriend for 2 weeks." 3. "On weekends we go out and drink a few beers." 4. "I dropped out of school about 3 months ago."

3. The nurse must respond to this comment. This young woman is repeatedly exposing her fetus to alcohol

96. A client, 37 weeks' gestation, has been advised that she is positive for group B streptococci. Which of the following comments by the nurse is appropriate at this time? 1. "The doctor will prescribe intravenous antibiotics for you. A visiting nurse will administer them to you in your home." 2. "You are very high risk for an intrauterine infection. It is important for you to check your temperature every day." 3. "The bacteria are living in your vagina. They will not hurt you but we will give you medicine in labor to protect your baby from getting sick." 4. "This bacteria causes scarlet fever. If you notice that your tongue becomes very red and that you feel feverish you should call the doctor immediately."

3. This answer is correct. Exposure to group B strep is very dangerous for neonates

88. It is discovered that a 28-week-gestation gravid is leaking amniotic fluid. Before the client is sent home on bed rest, the nurse teaches her which of the following? 1. Perform a nitrazine test every morning upon awakening. 2. Immediately report any breast tenderness to the primary health care practitioner. 3. Abstain from engaging in vaginal intercourse for the rest of the pregnancy. 4. Carefully weigh all of her saturated peripads.

3. This client must abstain from vaginal intercourse for the remainder of the pregnancy.

69. A gravid woman, who is 42 weeks' gestation, has just had a 20-minute nonstress test (NST). Which of the following results would the nurse interpret as a reactive test? 1. Moderate fetal heart baseline variability. 2. Maternal heart rate accelerations to 140 bpm lasting at least 20 seconds. 3. Two fetal heart accelerations of 15 bpm lasting at least 15 seconds. 4. Absence of maternal premature ventricular contractions

3. This is the definition of a reactive nonstress test—there are two fetal heart accelerations of 15 bpm lasting 15 or more seconds during a 20-minute period.

107. A woman enters the prenatal clinic accompanied by her partner. When she is asked by the nurse about her reason for seeking care, the woman looks down as her partner states, "She says she thinks she's pregnant. She constantly complains of feeling tired. And her vomiting is disgusting!" Which of the following is the priority action for the nurse to perform? 1. Ask the woman what times of the day her fatigue seems to be most severe. 2. Recommend to the couple that they have a pregnancy test done as soon as possible. 3. Continue the interview of the woman in private. 4. Offer suggestions on ways to decrease the vomiting.

3. This is the priority action. The nurse should escort the client to a location where the partner cannot follow.

10. A client is admitted to the hospital with severe preeclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform? 1. Strike the woman's patellar tendon. 2. Palpate the woman's ankle. 3. Dorsiflex the woman's foot. 4. Position the woman's feet flat on the floor.

3. To assess clonus, the nurse should dorsiflex the woman's foot.

93. A patient who is 24 weeks pregnant has been diagnosed with syphilis. She asks the nurse how the infection will affect the baby. The nurse's response should be based on which of the following? 1. She is high risk for premature rupture of the membranes. 2. The baby will be born with congenital syphilis. 3. Penicillin therapy will reduce the risk to the fetus. 4. The fetus will likely be born with a cardiac defect.

3. Usually a single shot of penicillin, administered to the mother, will cure her and protect the baby.

112. Which of the following clients is highest risk for pseudocyesis? 1. The client with lymphatic cancer. 2. The client with celiac disease. 3. The client with multiple miscarriages. 4. The client with grand multiparity

3. Women who have had a number of miscarriages are at high risk for pseudocyesis.

27. Which finding should the nurse expect when assessing a client with placenta previa? 1. Severe occipital headache. 2. History of thyroid cancer. 3. Previous premature delivery. 4. Painless vaginal bleeding.

4. Painless vaginal bleeding is often the only symptom of placenta previa

12. A 26-week-gestation woman is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein. 3. Bloody stools. 4. Epigastric pain.

4. Epigastric pain is associated with the liver involvement of HELLP syndrome.

79. The nurse notes that the results of a gravid woman's contraction stress test are equivocal. How should the nurse interpret the findings? 1. Baby is acidotic and should be delivered. 2. Fetal heart rate accelerated once during the test. 3. Baby is preterm but the heart rate is normal. 4. Additional data are needed to make a diagnosis.

4. Equivocal results are difficult to interpret. Additional information is needed

65. An insulin-dependent diabetic woman will require higher doses of insulin as which of the following pregnancy hormones increases in her body? 1. Estrogen. 2. Progesterone. 3. Human chorionic gonadotropin. 4. Human placental lactogen.

4. Human placental lactogen is an insulin antagonist, so the client will require higher doses of insulin as the level of placental lactogen increases.

37. The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? 1. Take the client's temperature. 2. Document the time of the client's last meal. 3. Obtain urine for urinalysis and culture. 4. Assess for complaint of dizziness or weakness.

4. It is most important for the nurse to assess for complaints of dizziness or weakness.

66. A client has just been diagnosed with gestational diabetes. She cries, "Oh no! I will never be able to give myself shots!!" Which of the following responses by the nurse is appropriate at this time? 1. "I am sure you can learn for your baby." 2. "I will work with you until you feel comfortable giving yourself the insulin." 3. "We will be giving you pills for the diabetes." 4. "If you follow your diet and exercise you will probably need no insulin."

4. It is unlikely that this client will need any medication. Diet and exercise will probably control the diabetes

108. The nurse is providing health teaching to a group of women of childbearing age. One woman, who states that she is a smoker, asks about smoking's impact on the pregnancy. The nurse responds that which of the following fetal complications can develop if the mother smokes? 1. Genetic changes in the fetal reproductive system. 2. Extensive central nervous system damage. 3. Addiction to the nicotine inhaled from the cigarette. 4. Fetal intrauterine growth restriction.

4. Smoking in pregnancy does cause fetal intrauterine growth restriction.

40. Which of the following statements is appropriate for the nurse to say to a patient with a complete placenta previa? 1. "During the first phase of labor you will do slow chest breathing." 2. "You should ambulate in the halls at least two times each day." 3. "The doctor will deliver you once you reach 25 weeks' gestation." 4. "It is important that you inform me if you become constipated."

4. Straining at stool can result in enough pressure to result in placental bleeding.

98. Nurses working in obstetric clinics know that, in general, teen pregnancies are high risk because of which of the following? 1. High probability of chromosomal anomalies. 2. High oral intake of manganese and zinc. 3. High numbers of post-term deliveries. 4. High incidence of late prenatal care registration.

4. Teens are likely to delay entry into the health care system.

91. A pregnant Latina is being seen in the prenatal clinic with diarrhea, fever, stiff neck, and headache. Upon inquiry, the nurse learns that the woman drinks unpasteurized milk and eats soft cheese daily. For which of the following bacterial infections should this woman be assessed? 1. Staphylococcus aureus. 2. Streptococcus albicans. 3. Pseudomonas aeruginosa. 4. Listeria monocytogenes.

4. The client is likely suffering from listeriosis, an infection caused by Listeria monocytogenes bacteria

97. Which of the following nursing diagnoses would be most appropriate for a 15-year-old woman who is in her first trimester of pregnancy? 1. Sleep pattern disturbance related to discomforts of pregnancy. 2. Knowledge deficit related to care of infants. 3. Anxiety related to fear of labor and delivery. 4. Ineffective individual coping related to developmental level

4. The developmental tasks of adolescence are often in conflict with the tasks of pregnancy. This nursing diagnosis is the most appropriate.

8. A client has severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to assess the fetus for which of the following? 1. Severe anemia. 2. Hypoprothrombinemia. 3. Craniosynostosis. 4. Intrauterine growth restriction.

4. The fetus should be assessed for intrauterine growth restriction

114. A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following lab values would be consistent with this diagnosis? 1. pO2 90, pCO2 35, HCO3 19 mEq/L, pH 7.30. 2. pO2 100, pCO2 30, HCO3 21 mEq/L, pH 7.50. 3. pO2 60, pCO2 50, HCO3 28 mEq/L, pH 7.30. 4. pO2 90, pCO2 45, HCO3 30 mEq/L, pH 7.50.

4. This client is in metabolic alkalosis. This is consistent with a diagnosis of hyperemesis gravidarum.

106. During a prenatal examination, the nurse notes scarring on and around the woman's genitalia. Which of the following questions is most important for the nurse to ask in relation to this observation? 1. "Have you ever had surgery on your genital area?" 2. "Have you worn any piercings in your genital area?" 3. "Have you had a tattoo removed from your genital area?" 4. "Have you ever been forced to have sex without your permission?"

4. This is an essential question for the nurse to ask.

1. During a prenatal interview, a client tells the nurse, "My mother told me she had toxemia during her pregnancy and almost died!" Which of the following questions should the nurse ask in response to this statement? 1. "Does your mother have a cardiac condition?" 2. "Did your mother tell you what she was toxic from?" 3. "Does your mother have diabetes now?" 4. "Did your mother say whether she had a seizure or not?"

4. This is the appropriate question. The nurse is asking whether or not the client's mother developed eclampsia

19. A nurse is caring for a 25-year-old client who has just had a spontaneous first trimester abortion. Which of the following comments by the nurse is appropriate? 1. "You can try again very soon." 2. "It is probably better this way." 3. "At least you weren't very far along." 4. "I'm here to talk if you would like."

4. This statement is appropriate. The nurse is offering his or her assistance to the client.

75. An obese client is being seen by the nurse during her prenatal visit. Which of the following comments by the nurse is appropriate at this time? 1. "We will want you to gain the same amount of weight we would encourage any pregnant woman to gain." 2. "To have a healthy baby we suggest that you go on a weight reduction diet right away." 3. "To prevent birth defects we suggest that you gain weight during the first trimester and then maintain your weight for the rest of the pregnancy." 4. "We suggest that you gain weight throughout your pregnancy but not quite as much as other women."

4. This statement is true. Normal weight clients are encouraged to gain between 25 and 35 pounds

43. A gravid woman is carrying monochorionic twins. For which of the following complications should this pregnancy be monitored? 1. Oligohydramnios. 2. Placenta previa. 3. Cephalopelvic disproportion. 4. Twin-to-twin transfusion.

4. Twin-to-twin transfusion is a relatively common complication of monozygotic twin pregnancies.

35. A woman is to receive methotrexate IM for an ectopic pregnancy. The drug reference states that the recommended safe dose of the medicine is 50 mg/m2. She weighs 52 kg and is 148 cm tall. What is the maximum safe dose, in mg, of methotrexate that this woman can receive? (If rounding is needed, please round to the nearest tenth.) ______ mg

73 mg

34. A woman who has been diagnosed with an ectopic pregnancy is to receive methotrexate 50 mg/m2 IM. The woman weighs 136 lb and is 5 ft 4 in tall. What is the maximum safe dose, in mg, of methotrexate that this woman can receive? (If rounding is needed, please round to the nearest tenth.) ______ mg

83.5 mg

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 1. Clients who experience ptyalism have an excess of saliva. They should be advised to be vigilant in the care of their teeth and gums. Ptyalism is often accompanied by gingivitis and nausea and vomiting. 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.

32. A woman states that she frequently awakens with "painful leg cramps" during the night. Which of the following assessments should the nurse make? 1. Dietary evaluation. 2. Goodell's sign. 3. Hegar's sign. 4. Posture evaluation.

ANS 1 1. A dietary evaluation is indicated since painful leg cramps can be caused by consuming too little calcium or too much phosphorus. 2. Goodell's sign is a physiological finding— a softened cervix. 3. Hegar's sign is a physiological finding—a softened uterine isthmus. 4. It is not necessary to evaluate the woman's posture.

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

ANS 1 1. Anemia is an expected finding. 2. The client should not be thrombocytopenic. Although some women do develop idiopathic thrombocytopenia of pregnancy, this is a complication of pregnancy. 3. The nurse would not expect to see polycythemia. 4. The nurse would not expect to see hyperbilirubinemia

57. A client has just had an amniocentesis to determine whether her baby has an inheritable genetic disease. Which of the following interventions is highest priority at this time? 1. Assess the fetal heart rate. 2. Check the client's temperature. 3. Acknowledge the client's anxiety about the possible findings. 4. Answer questions regarding the genetic abnormality.

ANS 1 1. Assessing the fetal heart rate is the highest priority since, although rare, the fetus may have been injured during the procedure. 2. Taking the client's temperature is not the most important action to take at this time. 3. Psychosocial issues are always significant, but they must take a back seat to physiological assessments. 4. It is important to answer all questions posed by clients but, again, these should be answered only after physiological interventions are completed.

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.

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."

ANS 4 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 within normal for the first trimester.

104. Please place an "X" on the drawing of the cross section of a placenta at the site of gas exchange. *review picture on pg 103**

An "X" will be placed between the neo - natal and maternal vessels where gas exchange occurs. *View diagram in book pg 124*

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.

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.

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. *pic on pg 93 success book**

The "X" should be placed at the level of the umbilicus. 4th line from bottom

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 challenge test. 4. Biophysical profile. 5. Complete blood count.

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

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/ mm2. 2. Rubella titer of 1:8. 3. Blood pressure of 100/60 mm Hg. 4. Hematocrit of 30%. 5. Hemoglobin of 13.2 g/dL.

1, 2, and 4 are correct. 1. The BMI of 17 is of concern. This client is entering her pregnancy underweight. 2. The rubella titer results should be reported to the nurse midwife. 3. This blood pressure is normal. 4. The hematocrit is below normal. 5. This hemoglobin is normal.

9. A gravid client with 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for which of the following? 1. Grand mal seizure. 2. High platelet count. 3. Explosive diarrhea. 4. Fractured pelvis.

1. Clients with severe preeclampsia are high risk for seizure.

44. On ultrasound, it is noted that the pregnancy of a hospitalized woman who is carrying monochorionic twins is complicated by twin-to-twin transfusion. The nurse should carefully monitor this client for which of the following? 1. Rapid fundal growth. 2. Vaginal bleeding. 3. Projectile vomiting. 4. Congestive heart failure

1. Fundal growth is often accelerated.

110. A gravid client, 25 years old, is diagnosed with gallstones. She asks her nurse, "Aren't I too young to get gallstones?" The nurse bases her response on which of the following? 1. Progesterone slows emptying of the gallbladder, making gravid women high risk for the disease. 2. Gallbladder disease has a strong genetic component, so the woman should be advised to see a genetic counselor. 3. Older women are no more prone to gallstones than are younger women. 4. Gallbladder disease is related to a high dietary intake of carbohydrates

1. Progesterone is a hormone that relaxes smooth muscle. This action leads to the delayed emptying of the gallbladder during pregnancy.

95. A child has been diagnosed with rubella. What must the pediatric nurse teach the child's parents to do? 1. Notify any exposed pregnant friends. 2. Give penicillin po every 6 hours for 10 full days. 3. Observe the child for signs of respiratory distress. 4. Administer diphenhydramine every 4 hours as needed.

1. Rubella is a teratogenic disease. The parents should notify any pregnant friends.

70. A woman, G1 P0000, is 40 weeks' gestation. Her Bishop score is 4. Which of the following complementary therapies do midwives frequently recommend to clients in similar situations? Select all that apply. 1. Sexual intercourse. 2. Aromatherapy. 3. Breast stimulation. 4. Ingestion of castor oil. 5. Aerobic exercise.

1. Sexual intercourse has been recommended to women as a means of increasing their Bishop score. 3. Midwives have recommended that women employ breast stimulation as a means of stimulating labor. 4. Midwives have recommended that women ingest castor oil as a means of increasing their Bishop score

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.

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.

59. A gravid client, 27 weeks' gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this client? 1. Oral hypoglycemic agents. 2. Diet control with exercise. 3. Regular insulin injections. 4. Inhaled insulin.

2. About 95% of gestational diabetic clients are managed with diet and exercise alone

67. An insulin-dependent diabetic, G3 P0200, 38 weeks' gestation, is being seen in the labor and delivery suite in metabolic disequilibrium. The nurse knows that which of the following maternal blood values is most high risk to her unborn baby? 1. Glucose 150 mg/dL. 2. pH 7.25. 3. pCO2 34 mm Hg. 4. Hemoglobin A1c 10%.

2. Acidosis is fatal to the fetus. This is the most important finding.

22. A 25-year-old client is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The nurse would expect the doctor to write an order to prepare the client for which of the following? 1. Cervical cerclage. 2. Amniocentesis. 3. Nonstress testing. 4. Dilation and curettage.

4. Dilation and curettage (D&C) is performed on a client with an incomplete abortion

32. A woman, 8 weeks pregnant, is admitted to the obstetric unit with a diagnosis of threatened abortion. Which of the following tests would help to determine whether the woman is carrying a viable or a nonviable pregnancy? 1. Luteinizing hormone level. 2. Endometrial biopsy. 3. Hysterosalpinogram. 4. Serum progesterone level.

4. Serum progesterone will provide information on the viability of a pregnancy

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.

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.

27. The glucose challenge screening test is performed at or after 24 weeks' gestation to assess for the maternal physiological response to which of the following pregnancy hormones? 1. Estrogen. 2. Progesterone. 3. Human placental lactogen. 4. Human chorionic gonadotropin.

ANS 3 1. Estrogen levels are not related to glucose metabolism. 2. Progesterone levels are not related to glucose metabolism. 3. Human placental lactogen is an insulin antagonist. 4. Human chorionic gonadotropin levels are not related to glucose metabolism.

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. Vanilla yogurt. 2. Parmesan cheese. 3. Gorgonzola cheese. 4. Chocolate milk.

ANS 3 1. Yogurt 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.

68. A woman is informed that she is a carrier for Tay-Sachs disease, an autosomal recessive illness. What is her phenotype? 1. She has one recessive gene and one normal gene. 2. She has two recessive genes. 3. She exhibits all symptoms of the disease. 4. She exhibits no symptoms of the disease.

ANS 4 1. This is the woman's genotype. It is not the woman's phenotype. 2. This is the genotype of a person with Tay-Sachs disease. 3. This is the phenotype of a person with Tay-Sachs disease. 4. This is the woman's phenotype.

72. A vegan is being counseled regarding vitamin intake. It is essential that this woman supplement 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.

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.

61. A woman is planning to become pregnant. Which of the following actions should she be counseled to take before stopping 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. It is very important that women before attempting to become pregnant 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.

61. A nurse who is caring for a pregnant diabetic should carefully monitor the client for which of the following? Select all that apply. 1. Urinary tract infection. 2. Multiple gestation. 3. Metabolic acidosis. 4. Pathological hypotension. 5. Hypolipidemia

1. Pregnant diabetic clients are particularly at high risk for urinary tract infections. 3. Pregnant diabetic clients are at high risk for acidosis.

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.

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.

ANS 4 1. Nausea is commonly seen in the first trimester but should have resolved by the time the second trimester begins. 2. Dyspnea is commonly seen in the third trimester, not the second trimester. 3. Urinary frequency is commonly seen in the first trimester and late in the third trimester, but it is not related to the second trimester. 4. Leg cramping is often a complaint of clients in the second trimester.

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.

1, 2, 3, and 4 are correct. 1. Amenorrhea is a presumptive sign of pregnancy. 2. Breast tenderness is a presumptive sign of pregnancy. 3. Quickening is a presumptive sign of pregnancy. 4. Frequent urination is a presumptive sign of pregnancy. 5. Uterine growth is a probable sign of pregnancy.

11. The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal? 1. +1. 2. +2. 3. +3. 4. +4.

3. +3 reflexes are defined as slightly brisker than normal or slightly hyperreflexic.

118. A client, 8 weeks pregnant, has been diagnosed with a bicornuate uterus. Which of the following signs should the nurse teach the client to carefully monitor for? 1. Hyperthermia. 2. Palpitations. 3. Cramping. 4. Oliguria.

3. A bicornuate uterus will predispose a client to cramping and preterm labor.

73. A gravid woman with sickle cell anemia is admitted in vaso-occlusive crisis. Which of the following is the priority intervention that the nurse must perform? 1. Administer narcotic analgesics. 2. Apply heat to swollen joints. 3. Place on strict bed rest. 4. Infuse intravenous solution.

4. Administering intravenous fluids is the priority action

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. Diarrhea. 2. Pedal edema. 3. Blurred vision. 4. Tinnitus.

ANS 1 1. Evening primrose has been shown to cause skin rash in some women. 2. Evening primrose has not been shown to cause pedal edema. 3. Evening primrose has not been shown to cause blurred vision. 4. Evening primrose has not been shown to cause tinnitus.

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's sign. 4. Montgomery gland enlargements.

ANS 1 1. Hearing a fetal heart rate is a positive sign of pregnancy. 2. A positive pregnancy test is a probable sign of pregnancy. 3. A positive Chadwick's sign is a probable sign of pregnancy. 4. Montgomery gland enlargement is a presumptive sign of pregnancy

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 formed 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

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.

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.

105. The nurse is reading an article that states that the maternal mortality rate in the United States in the year 2000 was 17. Which of the following statements would be an accurate interpretation of the statement? 1. There were 17 maternal deaths in the United States in 2,000 per 100,000 live births. 2. There were 17 maternal deaths in the United States in 2,000 per 100,000 women of childbearing age. 3. There were 17 maternal deaths in the United States in 2,000 per 100,000 pregnancies. 4. There were 17 maternal deaths in the United States in 2,000 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 childbearing period per 100,000 live births.

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 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.

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 vegetables, 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

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.

102. 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.

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.

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 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 population

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

ANS 2 1. It is unlikely that the woman is hypertensive. 2. The fundal height is the likely cause of the woman's dyspnea. 3. It is unlikely that the woman has hydramnios. 4. It is unlikely that the woman has congestive heart failure.

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.

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.

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.

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 5 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.

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; the 2 oz of cream cheese = 0 dairy servings 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.

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.

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. 3. This is true of monozygotic twins. 4. This is true of monozygotic twins.

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

ANS 2 1. 4 tbsp of peanut butter = two 2 oz protein servings. 2. 2 eggs = one 2 oz protein serving. 3. 1 cup of cooked lima beans = two 2 oz protein servings. 4. 2 ounces of nuts = two 2 oz protein servings.

70. When assessing the fruit intake of a pregnant client, the nurse notes that the client usually eats 1 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.

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.

63. Which of the following skin changes should the nurse highlight for a pregnant woman's health care 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.

64. A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2012. Using Nagele's rule, the nurse calculates the client's estimated date of delivery as: 1. May 30, 2013. 2. June 20, 2013. 3. June 27, 2013. 4. July 3, 2013.

ANS 3 1. The estimated date of delivery is June 27, 2013. 2. The estimated date of delivery is June 27, 2013. 3. The estimated date of delivery is June 27, 2013. 4. The estimated date of delivery is June 27, 2013.

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.

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.

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 high risk for preterm labor, she has been diagnosed with placenta previa, or she has preterm rupture of the membranes, sexual intercourse is not contraindicated. 2. Breast fondling should be discouraged only if the client is 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.

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 health care 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 health care practitioner of what she is consuming, including food, medicines, herbals, and all other substances.

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.

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: 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.

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.

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.

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.

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.

52. A woman is a carrier for hemophilia A, an X-linked recessive illness. Her husband has a normal genotype. The nurse can advise the couple that the probability that their daughter will have the disease is: 1. 0% probability. 2. 25% probability. 3. 50% probability. 4. 75% probability.

ANS 1 1. The probability of the couple having a daughter with hemophilia A is 0%. 2. The probability of the couple having a daughter with hemophilia A is 0%. 3. The probability of the couple having a daughter with hemophilia A is 0%. 4. The probability of the couple having a daughter with hemophilia A is 0%.

82. A woman whose blood type is O- (negative) states, "My husband is AB+ (positive)." The mother queries the nurse about what blood type the baby will have. Which of the following blood types should the nurse advise the mother that the baby may have? Select all that apply. 1. "Your baby could be type O+ (positive)." 2. "Your baby could be type O- (negative)." 3. "Your baby could be type AB- (negative)." 4. "Your baby could be type A+ (positive)." 5. "Your baby could be type B- (negative)."

4 and 5 are correct. 1. This response is incorrect. The baby will be either type A or type B. Type O is the recessive. 2. This response is incorrect. The baby will be either type A or type B. Type O is the recessive. 3. This response is incorrect. The offspring cannot be type AB since the mother is type O. 4. The baby could be blood type AO (type A) and, if the father is heterozygous for the Rh factor, the baby could be either Rh+ (positive) or Rh- (negative). 5. The baby could be type BO (type B) and, if the father is heterozygous for the Rh factor, the baby could be either Rh+ (positive) or Rh- (negative).

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.

81. A male client has green color blindness, an X-linked recessive genetic disorder. His wife has no affected genes. Which of the following statements by the nurse is true regarding the couple's potential for having a child who is color blind? 1. All male children will be color blind. 2. All female children will be color blind. 3. All male children will be carriers for color blindness. 4. All female children will be carriers for color blindness.

ANS 4 1. This response is incorrect. None of their male children will be green color blind. 2. This response is incorrect. None of their female children will be green color blind. 3. This response is incorrect. Males do not carry X-linked recessive traits. 4. This response is correct. All of the females will be carriers

69. During a genetic evaluation, it is discovered that the woman is carrying one autosomal dominant gene for a serious late adult-onset disease, while her partner's history is unremarkable. Based on this information, which of the following family members should be considered high risk and in need of genetic counseling? Select all that apply. 1. The woman's fetus. 2. The woman's sisters. 3. The woman's brothers. 4. The woman's parents. 5. The woman's partner.

1, 2, 3, and 4 are correct. 1. The woman's fetus has a 1 in 2, or 50%, probability of having the gene. 2. The woman's sisters have a 1 in 2, or 50%, probability of having the gene. 3. The woman's brothers have a 1 in 2, or 50%, probability of having the gene. 4. One of the woman's parents definitely has the gene. Since the age of onset can be as late as age 50, the parents' symptoms may not yet have appeared. 5. It is unlikely that the woman's partner has the gene.

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. Leg cramps are normal, although the client's diet should be assessed. 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.

40. The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that are within normal limits during the latter half of the pregnancy. Which of the following comments by the client indicates that teaching was successful? Select all that apply. 1. "During the third trimester I may experience frequent urination." 2. "During the third trimester I may experience heartburn." 3. "During the third trimester I may experience nagging backaches." 4. "During the third trimester I may experience persistent headache." 5. "During the third trimester I may experience blurred vision."

1, 2, and 3 are correct. 1. Frequency is seen once lightening, or the descent of the fetus into the pelvis, has occurred. 2. Heartburn is a common complaint of pregnant women. 3. Backaches are common complaints of pregnant women. 4. Persistent headache should not be seen in pregnant women. 5. Pregnant women should not complain of blurred vision.

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.

55. A 10-week gravid states that her sister's son has been diagnosed with an X-linked recessive disease, Duchenne muscular dystrophy. She questions the nurse about the disease. Which of the following responses is appropriate for the nurse to make? 1. "Because Duchenne muscular dystrophy is inherited through the woman, it is advisable for you to see a genetic counselor." 2. "Duchenne muscular dystrophy usually occurs as a spontaneous mutation. It is very unlikely that your fetus is affected." 3. "Your child could acquire Duchenne muscular dystrophy only if both you and your husband carried the gene. You need to check your husband's family history." 4. "If you were to have an amniocentesis and it were to be positive for Duchenne muscular dystrophy, I could recommend you to an excellent abortion counselor."

ANS 1 1. Because Duchenne muscular dystrophy is X-linked, if her sister is a carrier, she too may be a carrier. She should see a genetic counselor. 2. It is unlikely that Duchenne muscular dystrophy developed as a spontaneous mutation. 3. Duchenne muscular dystrophy is X-linked, so the father's genetics will not affect the outcome. 4. This response is inappropriate. The decision to abort a child with a disease is up to the parents. Each set of parents must be allowed to make the decision for themselves. Their decision is likely to be based on many things, including their ability to care for a mentally retarded child and the knowledge that their child is affected by a genetic disease. The nurse cannot make the assumption that the parents will decide to abort an affected child.

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 health care 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 health care 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.

5. Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following? 1. Avoid eating greasy foods. 2. Drink orange juice before rising. 3. Consume 1 teaspoon of nutmeg each morning. 4. Eat 3 large meals plus a bedtime snack.

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

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

ANS 1 1. It is common for women to be ambivalent about their pregnancy during the first trimester. 2. The nurse should be concerned if he or she were to see an 8-week-pregnant client who exhibited signs of depression. 3. The nurse should be concerned if he or she were to see an 8-week-pregnant client who exhibited signs of anxiety. 4. It is unusual for women at 8 weeks' gestation to exhibit signs of ecstasy

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 and third trimester T 99.2ºF.

ANS 1 1. The blood pressure should not elevate during pregnancy. This change should be reported to the health care practitioner. 2. An increase in the respiratory rate is expected. 3. An increase in the heart rate is expected. 4. A slight increase in temperature is expected.

14. 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. *see picture pg 90 success*

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.

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's syndrome. 4. The woman diagnosed with myasthenia gravis.

ANS 1 1. The client with phenylketonuria (PKU) must receive counseling from a registered dietitian. 2. The client with Graves' disease does not require strict nutrition counseling. 3. The client with Cushing's syndrome does not require strict diet counseling. 4. The client with myasthenia gravis does not require strict diet counseling.

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.

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.

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. 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.

70. Which statement by a gravid client who is a carrier for Duchenne muscular dystrophy, an X-linked recessive disease, indicates that she understands the implications of her status? 1. "If I have a girl, she will be healthy." 2. "None of my children will be at risk of the disease." 3. "If I have a boy, he will be a carrier." 4. "I am going to abort my fetus because it will be affected."

ANS 1 1. This response is correct. As can be seen on the Punnett square, female children of carriers may carry the disease but do not express the disease. 2. This response is incorrect. Male children are at risk of the disease. 3. This response is incorrect. Only females are carriers of X-linked diseases. 4. This response is incorrect. When reviewing X-linked recessive inheritance, the test taker must discuss the male and female probabilities independently. If the fetus is a female, she will be healthy—either with two normal genes or as a carrier. The probability of the males being affected, however, is 50/50—either healthy with two normal genes or with disease because of the normal Y mated with an affected "x." Accordingly, as can be seen in the square below, the probability of a male being affected is 50%.

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 and 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.

53. At her first prenatal visit, a woman relates that her maternal aunt has cystic fibrosis (CF), an autosomal recessive illness. Which of the following comments is appropriate for the nurse to make at this time? 1. "We can check to see whether or not you are a carrier for cystic fibrosis." 2. "It is unnecessary for you to worry since your aunt is not a direct relation." 3. "You should have an amniocentesis to see whether or not your child has the disease." 4. "Please ask your mother whether she has ever had any symptoms of cystic fibrosis."

ANS 1 1. It is possible that this woman is a carrier for cystic fibrosis. A genetic evaluation can be done to determine that possibility. 2. The affected gene could have been transmitted to both the woman's mother and to the aunt. 3. Only if both this woman and her partner are carriers is there a possibility of their child having CF. And even if that were the case, the probability of the fetus having the disease would be 1 in 4, or 25%, because CF is an autosomal recessive disease. 4. This response is inappropriate. The mother could be a carrier of the CF gene (carriers are symptom free) so the client should be tested.

49. A pregnant woman and her husband are both heterozygous for achondroplastic dwarfism, an autosomal dominant disease. The nurse advises the couple that their unborn child has which of the following probabilities of being of normal stature? 1. 25% probability. 2. 50% probability. 3. 75% probability. 4. 100% probability.

ANS 1 1. The child has a 25% probability of being of normal stature. 2. The child has a 25% probability of being of normal stature. 3. The child has a 25% probability of being of normal stature. 4. The child has a 25% probability of being of normal stature. After doing a Punnett square

46. The nurse is creating a pedigree from a client's family history. Which of the following symbols should the nurse use to represent a female? 1. Circle. 2. Square. 3. Triangle. 4. Diamond.

ANS 1 1. The circle is the symbol used to represent the female. 2. The square is the symbol used to represent the male. 3. The triangle is the symbol used to represent a stillborn. 4. The diamond is the symbol used to represent a child of unknown sex.

58. Once oogenesis is complete, the resultant gamete cell contains how many chromosomes? 1. 23. 2. 46. 3. 47. 4. 92.

ANS 1 1. The haploid number of chromosomes is 23, the normal number of chromosomes in the gamete—in this case, in the ovum. 2. The diploid number of chromosomes is 46, the normal number of chromosomes in the somatic cells of human beings. 3. Aneuploidy is characterized by a chromosomal number that is not equal to a multiple of the haploid number—that is, the number of chromosomes in the cell is NOT equal to 23, 46, 69, 92, and so on. Trisomy 21 (47 chromosomes) is an example of an aneuploid number, as is a chromosome number of 48 or 49. 4. Polyploidy is characterized by a chromosomal number that is equal to twice, three times, four times, and so on, of the diploid number—that is, the number of chromosomes in the cell is equal to 92 (2 × 46), 138 (3 × 46), and so on.

60. A genetic counselor's report states, "The genetic nomenclature for this fetus is 46, XX." How should the nurse who reads this report interpret the cytogenetic results? 1. The baby is female with a normal number of chromosomes. 2. The baby is hermaphroditic male with female chromosomes. 3. The baby is male with an undisclosed genetic anomaly. 4. There is insufficient information to answer this question.

ANS 1 1. This response is correct. The normal number of chromosomes is present— 46—and the child is a female—XX. 2. This response is incorrect. Hermaphrodites exhibit both male and female organs and characteristics. Hermaphroditism may be caused by a number of things, including an environmental insult or a genetic mutation. 3. This response is incorrect. An example of a male with a genetic defect is 46,XY,16p13.3. The child is a male—XY—and the defect, as indicated in the nomenclature, is on the p arm of the 16th chromosome at location 13.3. 4. There is sufficient information to answer this question.

85. A client is being interviewed prior to becoming pregnant. She states that she has a disease that is transmitted by mitochondrial inheritance. Which of the following statements is consistent with the client's disease? 1. 100% of her children will be affected. 2. Only her female children will be affected. 3. Each fetus will have a 50% probability of being affected. 4. A fetus will be affected only if it inherits a similar gene from its father.

ANS 1 1. This statement is accurate. All of the woman's children will be affected. 2. This statement is incorrect. All of the woman's children will be affected. 3. This statement is incorrect. All of the woman's children will be affected. 4. This statement is incorrect. All of the woman's children will be affected.

63. A 25-year-old woman, G0 P0000, enters the infertility clinic stating that she has just learned she is positive for the BRCA1 and the BRCA2 genes. She asks the nurse what her options are for getting pregnant and breastfeeding her baby. The nurse should base her reply on which of the following? 1. Fertility of women who carry the BRCA1 and BRCA2 genes is similar to that of unaffected women. 2. Women with these genes should be advised not to have children because the children could inherit the defective genes. 3. Women with these genes should have their ovaries removed as soon as possible to prevent ovarian cancer. 4. Lactation is contraindicated for women who carry the BRCA1 and BRCA 2 genes.

ANS 1 1. This statement is true. Female clients who are BRCA1 or BRCA2 positive have similar fertility rates to those who are BRCA1 or BRCA2 negative. 2. This statement is incorrect. Nurses provide information. It is inappropriate for nurses to counsel clients whether or not to have children based on the client's genotype. 3. The decision to have an oophorectomy is the client's. The nurse's role is to provide the client with information regarding the genetic profile. 4. Lactation is not contraindicated for these 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.

ANS 2 1. Although breast cancer is hormonally driven, it is rare to see its development during pregnancy. 2. Nodular breast tissue is normal in pregnancy. 3. The woman is not exhibiting psychotic behavior. 4. Anxiety attacks are not common during pregnancy.

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.

ANS 2 1. Although some women do have difficulty breastfeeding, many women with inverted nipples are able to breastfeed with little to no problem. 2. The client should be referred to a lactation consultant. 3. There is no need to telephone the labor unit. However, it would be appropriate to document the finding on the client's prenatal record. 4. It is not recommended that exercises be done to evert the nipples.

89. What is the rationale for testing all neonates for maple syrup urine disease (MSUD) when only 1 in 100,000-300,000 children will be born with the disease? 1. To encourage the parents to have genetic testing done. 2. To prevent neurological disease in affected children. 3. To reduce the amount of money insurance companies must pay for sick MSUD children. 4. To persuade pharmaceutical companies to develop medications to treat children with MSUD.

ANS 2 1. Although the parents should seek genetic counseling before getting pregnant in the future, this is not the rationale for newborn testing. 2. This is the rationale for newborn testing for maple syrup urine disease. It is done to prevent neurological disease in affected children. 3. This is a benefit of many of the newborn tests, but it is not the primary rationale. The cost-benefit ratio (in terms of money) does not always support newborn testing. In very rare diseases like MSUD, the cost of testing is often higher than the cost of care for any affected children. 4. This is not a rationale for newborn testing

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 health care practitioner's malpractice history, this should not be the couple's first step.

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.

ANS 2 1. Ballottement is not related to the mucous plug. 2. This is the definition of ballottement. 3. Palpating fetal parts is not related to ballottement. 4. Fetal position is not related to ballottement

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.

67. A nurse has just taken a family history on a 10-week gravid client and created the family pedigree shown below. Each of the darkened symbols represents a person with a serious illness. Which of the following actions should the nurse take at this time? 1. Advise the woman that she should have an amniocentesis. 2. Encourage the doctor to send her for genetic counseling. 3. Ask the woman if she knew any of the relatives who died. 4. Inform the woman that her pedigree appears normal. *picture on pg 25 success book*

ANS 2 1. It is too soon to advise a client to have amniocentesis. Although the pedigree shows an autosomal dominant inheritance pattern, a genetic counselor should analyze the pedigree. 2. This is appropriate. All nurses should have a basic understanding of genetic information, but genetic counselors are the experts in this area. 3. This information may be relevant but should be asked carefully within a coun - seling session. It is best for a genetic counselor to ask the questions. 4. This response is inappropriate. The pedigree shows an autosomal dominant inheritance pattern.

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.

ANS 2 1. The Kegel exercises are done to promote the muscle tone of the perineal muscles. 2. The pelvic tilt is an exercise that can reduce backache pain. 3. Leg lifts will not help to reduce backache pain. 4. Crunches will not help to reduce backache pain.

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.

ANS 2 1. The cervix should be long and thick. 2. The practitioner would expect to palpate an enlarged ovary. 3. The cervical mucus should be thin. 4. The vaginal wall should be bluish in color.

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 an abnormal potassium level. 4. The nurse would not expect to see an abnormal sodium level.

66. A woman who has had multiple miscarriages is advised to go through genetic testing. The client asks the nurse the rationale for this recommendation. The nurse should base his or her response on which of the following? 1. The woman's pedigree may exhibit a mitochondrial inheritance pattern. 2. The majority of miscarriages are caused by genetic defects. 3. A woman's chromosomal pattern determines her fertility. 4. There is a genetic marker that detects the presence of an incompetent cervix.

ANS 2 1. The pedigree should be analyzed for any and all abnormal inheritance patterns. 2. This is true. The incidence of miscarriage is very high, about 1 out of every 5 pregnancies, and the majority of miscarriages are related to a genetic defect. 3. A woman's fertility is determined by many factors. 4. This statement is not true. There is no genetic marker for incompetent cervix.

61. The nurse is analyzing the three-generation pedigree below. In which generation is the proband? 1. I. 2. II. 3. III. 4. There is not enough information to answer this question. *view picture pg 23 success book*

ANS 2 1. The proband is not in generation I. 2. The proband is in generation II. The proband, or first member of a family to be diagnosed with a specific medical/ genetic problem, is identified in a pedigree by an arrow. 3. The proband is not in generation III. 4. There is sufficient information to answer the question. The proband is the member of the family who is identified by an arrow

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.

88. Which of the following is an attainable short-term goal for an 8-week gravid client who has a family history of cystic fibrosis? 1. Have a sweat chloride test done. 2. Seek out genetic counseling. 3. Undergo chorionic villus sampling. 4. Be seen by a pulmonologist.

ANS 2 1. This goal is inappropriate. The client has a family history of cystic fibrosis. She does not have the disease. 2. This goal is appropriate. Since the client has a family history of the disease, she should seek genetic counseling. 3. This goal is inappropriate. It is unnecessary to have CVS unless both the mother and the father are found to be carriers of cystic fibrosis. 4. This goal is inappropriate. The client has a family history of cystic fibrosis. She does not have the disease.

83. A client's amniocentesis results were reported as 46, XY. Her obstetrician informed her at the time that everything "looks good." Shortly after birth the baby is diagnosed with cerebral palsy. Which of the following responses will explain this result? 1. It is likely that the client received the wrong amniocentesis results. 2. Cerebral palsy is not a genetic disease. 3. The genes that cause cerebral palsy have not yet been discovered. 4. The genetics lab failed to test for cerebral palsy.

ANS 2 1. This information is unsupported by the scenario. Cerebral palsy is not a genetic defect and is not detected through amniocentesis. 2. Cerebral palsy is not a genetic disease. It is caused by a hypoxic injury that can occur at any time during pregnancy, labor and delivery, or the postdelivery period. 3. Cerebral palsy is not a genetic disease. It is caused by a hypoxic injury that can occur at any time during pregnancy, labor and delivery, or the postdelivery period. 4. Cerebral palsy is not a genetic disease. It is caused by a hypoxic injury that can occur at any time during pregnancy, labor and delivery, or the postdelivery period.

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.

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.

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."

ANS 2 1. This response ignores and dismisses the client's concerns as unimportant. 2. This is a true statement. 3. Although active labor is usually more uncomfortable than the normal aches and pains of pregnancy, that is not necessarily true of prodromal labor or the latent phase of labor. 4. The nurse is making an assumption here. This may not be the client's concern at all.

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.

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. "My recommendation would be to 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 are. 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.

72. A woman asks the obstetrician's nurse about cord blood banking. Which of the following responses by the nurse would be best? 1. "I think it would be best to ask the doctor to tell you about that." 2. "The cord blood is frozen in case your baby develops a serious illness in the future." 3. "The doctors could transfuse anyone who gets into a bad accident with the blood." 4. "Cord blood banking is very expensive and the blood is rarely ever used."

ANS 2 1. This response is inappropriate. The client has asked the nurse for information regarding cord blood banking. 2. This statement is correct. The baby's umbilical cord blood is kept by a cord blood bank to be used if and when the baby should develop a serious illness like leukemia. 3. The blood is not used in the same way that general blood donations are used. It is used to treat catastrophic illnesses. 4. This response is true, but it does not provide the client with the information she needs to make an informed decision.

59. Based on the karyotype shown below, which of the following conclusions can the nurse make about the female baby? 1. She has a genetically normal karyotype. 2. She has trisomy 21. 3. She has fragile X syndrome. 4. She has an autosomal monosomy. *view pic on pg 23 success book*

ANS 2 1. This response is incorrect. The baby has Down syndrome. 2. This response is correct. The baby has 3 number 21 chromosomes. 3. This response is incorrect. The fetus has an aneuploid number of chromosomes. There is no evidence of a fragile segment on the long arm of the X chromosome. 4. This response is incorrect. All of the autosomes are paired.

65. A woman, who has undergone amniocentesis, has been notified that her baby is XX with a 14/21 robertsonian chromosomal translocation. The nurse helps the woman to understand which of the following? 1. The baby will have a number of serious genetic defects. 2. It is likely that the baby will be unable to have children when she grows up. 3. Chromosomal translocations are common and rarely problematic. 4. An abortion will probably be the best decision under the circumstances.

ANS 2 1. This response is incorrect. The child will likely be a normal-appearing female. 2. Because there is a translocation in the child's chromosomal pattern, the child's gametes will likely contain an abnormal amount of genetic material and the child will be infertile. 3. Translocations are usually not problematic for the first generation, but they can lead to significant defects and/or infertility in the next generation. 4. The client must decide for herself whether or not to abort the fetus.

73. A 3-month-old baby has been diagnosed with cystic fibrosis (CF). The mother says, "How could this happen? I had an amniocentesis during my pregnancy and everything was supposed to be normal!" What must the nurse understand about this situation? 1. Cystic fibrosis cannot be diagnosed by amniocentesis. 2. The baby may have an uncommon genetic variant of the disease. 3. It is possible that the laboratory technician made an error. 4. Instead of obtaining fetal cells the doctor probably harvested maternal cells.

ANS 2 1. This statement is not accurate. Cystic fibrosis can be detected via amniocentesis. 2. This response is likely. The genetic tests that are performed check only for the most common genetic variants of many diseases, including CF. If the baby were positive for an uncommon variant, it would be missed. 3. It is unlikely that the lab tech made a mistake. 4. Although it is possible, it is unlikely that maternal cells were harvested rather than fetal cells.

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 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 high risk for preterm labor, this is an inappropriate statement. 4. This is an inappropriate statement

74. The nurse discusses the results of a 3-generation pedigree with the proband who has breast cancer. Which of the following information must the nurse consider? 1. The proband should have a complete genetic analysis done. 2. The proband is the first member of the family to be diagnosed. 3. The proband's first degree relatives should be included in the discussion. 4. The proband's sisters will likely develop breast cancer during their lives.

ANS 2 1. Until the pedigree is fully analyzed, the need for a complete genetic analysis is uncertain. 2. This statement is true. The proband is the first individual in any family to be identified with a disorder. 3. This is not correct. Genetic information is confidential. Only if the proband agrees can others be included in the discussion. Plus, the proband's relatives may or may not be interested in discussing their potential of acquiring a genetic disease. 4. It is virtually impossible to determine if and when someone will develop breast cancer even if a genetic screen has been performed.

9. A client asks the nurse what was meant when the physician told her she had a positive Chadwick's 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's sign is not related to the heart muscle. 3. A positive Chadwick's sign means that the client's cervix and vagina are a bluish color. It is a probable sign of pregnancy. 4. Chadwick's sign is not related to the respiratory system.

51. A client, G4 P4004, states that her husband has just been diagnosed with polycystic kidney disease (PKD), an autosomal dominant disease. The husband is heterozygous for PKD, while the client has no PKD genes. The client states, "I have not had our children tested because they have such a slim chance of inheriting the disease. We intend to wait until they are teenagers to do the testing." The nurse should base her reply on which of the following? 1. Because affected individuals rarely exhibit symptoms before age 60, the children should be allowed to wait until they are adults to be tested. 2. The woman may be exhibiting signs of denial since each of the couple's children has a 50/50 chance of developing the disease. 3. Because the majority of the renal cysts that develop in affected individuals are harmless, it is completely unnecessary to have the children tested. 4. The woman's husband should be seen by a genetic specialist since he is the person who is carrying the affected gene.

ANS 2 1. Symptoms usually appear in affected individuals in their 30s or 40s, but the symptoms can appear as early as childhood. 2. This response is correct. As can be seen by the Punnett square results, the children have a 50/50 chance of developing PKD. Since the capital A connotes the dominant gene, the child needs only one affected gene to exhibit the disease. 3. This statement is untrue. PKD can be a very serious illness. Some patients with the disease will require dialysis and/or kidney transplants. 4. This statement is inappropriate. The husband's genotype is already known.

84. Most children born into families look similar but are not exactly the same. The children appear different because homologous chromosomes exchange genetic material at which of the following? 1. Centromere. 2. Chiasma. 3. Chromatid. 4. Codon.

ANS 2 1. The centromere is the site where sister chromatids attach during cell division. 2. A chiasma is the site where crossing over between nonsister chromatids takes place. At this site, genetic material is swapped between the chromatids. 3. A chromatid is one strand of a duplicated chromosome. Sister chromatids are attached at the chromosome's centromere. 4. A codon is a triad of messenger RNA that encodes for a specific amino acid in a protein.

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.

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 health care practitioner is unlikely to promote fathers' interests in their partners' pregnancies.

62. A woman is seeking genetic counseling during her pregnancy. She has a strong family history of diabetes mellitus. She wishes to have an amniocentesis to determine whether she is carrying a baby who will "develop diabetes." Which of the following replies would be most appropriate for the nurse to make? 1. "Doctors don't do amniocenteses to detect diabetes." 2. "Diabetes cannot be diagnosed by looking at the genes." 3. "Although diabetes does have a genetic component, diet and exercise also determine whether or not someone is diabetic." 4. "Even if the baby doesn't carry the genes for diabetes, the baby could still develop the disease."

ANS 3 1. Although this response is accurate, it is an inappropriate response for the nurse to make. 2. Although this response is accurate, it is an inappropriate response for the nurse to make. 3. This response is accurate. Diabetes is one of the many diseases that has both a genetic and an environmental component. 4. Although this response is accurate, it is an inappropriate response for the nurse to make.

71. A man has inherited the gene for familial adenomatous polyposis (FAP), an autosomal dominant disease. He and his wife wish to have a baby. Which of the following would provide the couple with the highest probability of conceiving a healthy child? 1. Amniocentesis. 2. Chorionic villus sampling. 3. Pre-implantation genetic diagnosis. 4. Gamete intrafallopian transfer.

ANS 3 1. Amniocentesis will provide the couple with information regarding the genetics of a fetus in utero. 2. CVS will provide the couple with information regarding the genetics of a fetus in utero. 3. Pre-implantation genetic diagnosis will provide the couple with the highest probability of conceiving a healthy child. 4. GIFT is a type of infertility procedure.

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

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.

48. Which of the following client responses indicates that the nurse's teaching about care following chorionic villus sampling (CVS) has been successful? 1. If the baby stops moving, the woman should immediately go to the hospital. 2. The woman should take oral terbutaline every 2 hours for the next day. 3. If the woman starts to bleed or to contract, she should call her physician. 4. The woman should stay on complete bed rest for the next 48 hours.

ANS 3 1. CVS is performed well before mothers feel quickening. 2. Tocolytics, such as terbutaline, are not routinely administered following CVS. 3. The mother should notify the doctor if she begins to bleed or contract. 4. It is unnecessary for the mother to stay on complete bed rest following a CVS.

36. A nurse midwife has advised a 39-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.

ANS 3 1. Evening primrose does not affect back strain. 2. Evening primrose does not affect lactation. 3. Evening primrose converts to a prostaglandin substance in the body. Prostaglandins are responsible for readying the cervix for dilation 4. Evening primrose does not affect the development of hemorrhoids.

47. A woman has been advised that the reason she has had a number of spontaneous abortions is because she has an inheritable mutation. Which of the following situations is consistent with this statement? 1. A client developed skin cancer after being exposed to the sun. 2. A client developed colon cancer from an inherited dominant gene. 3. A reciprocal translocation was reported on a client's genetic analysis. 4. A client's left arm failed to develop when she was a fetus.

ANS 3 1. The DNA in the client's skin cells did mutate, but the mutation will not affect the client's fertility because the woman's ovaries were not affected. 2. The inherited gene affects a client's risk of contracting colon cancer. It will not affect fertility. 3. A reciprocal translocation can result in infertility. 4. Failure of one arm to develop in utero is related to an environmental insult rather than a genetic insult.

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

ANS 3 1. The glucose challenge test is performed at approximately 24 weeks' gestation. 2. Amniotic fluid volume assessment is part of the biophysical profile (BPP). The BPP is performed only when the health care 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.

64. A woman asks a nurse about presymptomatic genetic testing for Huntington's disease. The nurse should base her response on which of the following? 1. There is no genetic marker for Huntington's disease. 2. Presymptomatic testing cannot predict whether or not the gene will be expressed. 3. If the woman is positive for the gene for Huntington's, she will develop the disease later in life. 4. If the woman is negative for the gene, her children should be tested to see whether or not they are carriers.

ANS 3 1. There is a genetic marker for Huntington's disease. 2. In the case of Huntington's disease, if a person has the gene and lives long enough, there is virtually a 100% probability he or she will develop the disease. The gene has a high degree of expressivity, or, in other words, people who carry the gene will develop the disease. 3. This answer is correct, if a person has the gene and lives long enough, virtually 100% of the time the disease will develop and progress. 4. There is no carrier state when a disease is transmitted via a dominant inheritance pattern, as is Huntington's disease.

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."

ANS 3 1. This comment is inappropriate. First of all, everything may not turn out all right. In addition, the comment ignores the client's concerns. 2. This is a possible plan, but first the nurse should acknowledge the client's feelings. 3. This is the best comment. It acknowledges the concerns that the client is having. 4. This comment is inappropriate. First of all, it assumes that the father of the baby is in the picture and second, it ignores the client's concerns.

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.

80. The nurse is counseling a pregnant couple who are both carriers for phenylketonuria (PKU), an autosomal recessive disease. Which of the following comments by the nurse is appropriate? 1. "I wish I could give you good news, but because this is your first pregnancy, your child will definitely have PKU." 2. "Congratulations, you must feel relieved that the odds of having a sick child are so small." 3. "There is a 2 out of 4 chance that your child will be a carrier like both of you." 4. "There is a 2 out of 4 chance that your child will have PKU."

ANS 3 1. This response is inappropriate. Each and every pregnancy carries the same probability of being affected. 2. This response is inappropriate. It is impossible for a nurse to know how a couple will respond to the probability that their fetus will be affected. 3. This response is accurate. 4. This response is inaccurate. There is a 1 out of 4 chance that the baby will inherit both recessive genes and have the disease.

77. A woman who is a carrier for sickle cell anemia is advised that if her baby has two recessive genes, the penetrance of the disease is 100%, but the expressivity is variable. Which of the following explanations will clarify this communication for the mother? All babies with 2 recessive sickle cell genes will: 1. Develop painful vaso-occlusive crises during their first year of life. 2. Exhibit at least some signs of the disease while in the neonatal nursery. 3. Show some symptoms of the disease but the severity of the symptoms will be individual. 4. Be diagnosed with sickle cell trait but will be healthy and disease-free throughout their lives.

ANS 3 1. This response is incorrect. No one can make such a prediction. 2. Neonates virtually never exhibit signs of sickle cell because fetal hemoglobin does not sickle. 3. This response is correct. Babies with two recessive sickle cell genes will show some symptoms of the disease but the severity of the symptoms will be individual. 4. This response is incorrect. Virtually all children with sickle cell anemia will exhibit some symptoms during their lives.

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.

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.

22. A pregnant woman must have a glucose challenge test (GCT). Which of the following should be included in the preprocedure teaching? 1. Fast for 12 hours before the test. 2. Bring a urine specimen to the laboratory on the day of the test. 3. Be prepared to have 4 blood specimens taken on the day of the test. 4. The test should take one hour to complete.

ANS 4 1. Although some labs request that patients fast, the GCT is a nonfasting test. 2. It is unnecessary to take a urine sample to the lab on the day of testing. 3. Only one blood specimen is taken on the day of the test. 4. The test does take about 1 hour to complete.

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's.

ANS 4 1. Although the orthopneic position is a safe position for the client to be placed in, a prenatal examination cannot be performed in this position. 2. Although the lateral-recumbent position is a safe position for the client to be placed in, a prenatal examination cannot be performed in this position. In addition, the pregnant abdomen may not enable the client fully to attain this position. 3. Although the Sims' position is a safe position for the client to be placed in, a prenatal examination cannot be performed in this position, and the pregnant abdomen may not enable the client fully to attain this position. 4. The client should be placed in a semi- Fowler's position

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."

ANS 4 1. Cerebral palsy is not a genetic disease. 2. Hypertensive conditions can be genetically based, but a family history of hypertension does not warrant referral to a genetic counselor. 3. Asthma can be genetically based but a family history of asthma does not warrant referral to a genetic counselor. 4. Cystic fibrosis is an autosomal recessive genetic disease, so the client with a family history of cystic fibrosis should be referred to a genetic counselor.

56. The genetic counselor informs a couple that they have a 25% probability of getting pregnant with a child with a severe genetic disease. The couple asks the nurse exactly what that means. Which of the following responses by the nurse is appropriate? 1. Their first child will have the genetic disease. 2. If they have four children, one of the children will have the disease. 3. Their fourth child will have the genetic disease. 4. Whenever they get pregnant, the fetus may have the disease.

ANS 4 1. Each pregnancy has its own probability so it is impossible to predict which, if any, child will or will not have the disease. 2. Each pregnancy has its own probability so it is possible for all or none of the children to have the disease. 3. Each pregnancy has its own probability so it is impossible to predict which, if any, child will or will not have the disease. 4. This is true. Every time the woman gets pregnant there is a possibility (25% chance) that she is carrying a child with the disease.

50. A couple inquires about the inheritance of Huntington's disease (HD) because the prospective father's mother is dying of the illness. There is no history of the disease in his partner's family. The man has never been tested for HD. Which of the following responses by the nurse is appropriate? 1. "Because HD is an autosomal dominant disease, each and every one of your children will have a 1 in 4 chance of having the disease." 2. "Because only one of you has a family history of HD, the probability of any of your children having the disease is less than 10%." 3. "Because HD is such a devastating disease, if there is any chance of passing the gene along, it would be advisable for you to adopt." 4. "Because neither of you has been tested for HD, the most information I can give you is that each and every one of your children may have the disease."

ANS 4 1. If the prospective father possesses the gene, the probability of their children inheriting the gene is 1 in 2, or 50%. As the man has not been tested, it is impossible to determine the probabilities. 2. This statement is completely false. 3. It is improper for the nurse to recommend that the clients not have children. It is the couple's choice whether or not to get pregnant. It is the nurse's responsibility to give information that is as accurate as possible. 4. This statement is correct. No specific information can be given until or unless the potential father decides to be tested.

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.

ANS 4 1. It is unlikely that the client has a galactocele. 2. The woman should not pump her breasts during pregnancy. 3. Colostrum is normally seen at this time and naturally can be a number of colors, including whitish, yellowish, reddish, and brownish. 4. It is normal for colostrum to be expressed late in pregnancy

86. A client wants to undergo amniocentesis because she has a family history of breast cancer. Which of the following choices is the most important information for the nurse to discuss with the client regarding the request? 1. The breast cancer gene is highly penetrant. 2. The breast cancer gene has moderate expressivity. 3. The amniocentesis could result in a miscarriage. 4. The majority of breast cancers are not inherited.

ANS 4 1. The breast cancer genes are highly penetrant, but this is not the most important information 2. The breast cancer genes are moderately expressive, but this is not the most important information. 3. Amniocentesis does, although rarely, end in miscarriage, but this is not the most important information. 4. The most important information for the nurse to provide the client is that the vast majority of cases of breast cancer are not inherited.

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, it is risky to take medicine." 2. "You can take any of the over-the-counter medications because they are all safe in pregnancy." 3. "The physician will prescribe a category 'X' medication for you." 4. "You can take acetaminophen because it is a category 'B' medicine."

ANS 4 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. Category "X" medications have been shown to be teratogenic. 4. Category "B" medications have been shown to be safe to take throughout pregnancy.

87. A woman is pregnant. During amniocentesis it is discovered that her child has Down syndrome with a mosaic chromosomal configuration. She asks the nurse what that means. What is the nurse's best response? 1. "Instead of two number 21 chromosomes, your child has three." 2. "Your baby's number 21 chromosomes have black and white bands on them." 3. "Some of your baby's number 21 chromosomes are longer than others." 4. "Some of your baby's cells have two number 21 chromosomes and some have three."

ANS 4 1. This is the definition of Down syndrome, but not of Down syndrome with mosaic chromosomal configuration. 2. All chromosomes are banded. 3. The number 21 chromosomes are of normal length in Down syndrome 4. Mosaicism is characterized by the fact that some of the cells of the body have the abnormal number of chromosomes but some of the cells have the normal number. This may happen with rapid disjunction. In Down syndrome, it means that some of the cells have three number 21 chromosomes and some have the normal number of two number 21 chromosomes. Mosaicism is not specific to Down syndrome but can occur with other chromosomal abnormalities.

54. A woman asks the nurse, "My nuchal fold scan results were abnormal. What does that mean?" Which of the following comments is appropriate for the nurse to make at this time? 1. "I am sorry to tell you that your baby will be born with a serious deformity." 2. "The results show that your child will have cri du chat syndrome." 3. "The test is done to see if you are high risk for preterm labor." 4. "An abnormal test indicates that your baby may have Down syndrome."

ANS 4 1. This response is inappropriate. The nuchal fold scan is done either late in the first trimester or with the quad second trimester screen. A fetal genetic evaluation (amniocentesis or percutaneous umbilical blood sampling [PUBS]) must be done before a definitive diagnosis can be made. A genetic analysis is the only absolute diagnostic tool. 2. Cri du chat syndrome is a mental retar - dation disease caused by a deletion on chromosome 5. The nuchal fold scan does not screen for chromosomal deletions. It is done to assess for trisomy chromosomal diseases. 3. The first-trimester assessment screens for Down syndrome. It does not screen for preterm labor risk. 4. This statement is true, but the definitive diagnosis can be made only via genetic testing.