Prep U Set 3

A woman in her sixth month of pregnancy comes in for her first prenatal examination. She complains today of headache and abdominal pain of several months' duration. She appears somewhat hurried or nervous. What questions would the nurse ask next? a) "Do you feel safe at home?" b) "Have you been eating properly and taking a prenatal vitamin?" c) "Do you have a family history of thyroid disease?" d) "How much activity have you been able to fit into your schedule?"

a) "Do you feel safe at home?" Rationale: All these questions are important when interviewing a pregnant woman. This picture may make you think of social problems such as domestic violence, substance abuse, or both. Asking more directed questions in these areas may be fruitful

A woman in week 40 of her pregnancy has developed a urinary tract infection (UTI). The nurse recognizes that which of the following treatments would be safe and appropriate to use with this client? (SATA) a) Ampicillin b) Amoxicillin c) Sulfonamides d) Cephalosporins e) Heparin f) Tetracyclines

a) Ampicillin b) Amoxicillin d) Cephalosporins

Amanda makes an appointment with an obstetrician. During the exam, the obstetrician notes that the uterine isthmus is soft. What is the name of this sign, and how is it classified? a) Hegar's sign; probable b) Chadwick's sign; presumptive c) Goodell's sign; probable d) Goodell's sign; presumptive

a) Hegar's sign; probable Rationale: Probable signs of pregnancy are those detected by a trained examiner. The examiner identifies Hegar's sign, softening of the uterine isthmus, and Goodell's sign, softening of the cervix, during the speculum and digital pelvic examinations.

A woman who is 26 weeks pregnant arrives for a follow-up visit. Which assessments, in addition to measuring fundal height and fetal heart rate, would the nurse expect to complete? (SATA) a) blood pressure b) weight c) blood glucose level d) edema e) urine testing

a) blood pressure b) weight c) blood glucose level e) urine testing Rationale: Up to the 28th week of gestation, follow-up visits involve assessment of the client's blood pressure and weight, urine testing for protein and glucose, along with fundal height and fetal heart rate. Between weeks 24 and 28, a blood glucose level is obtained. Assessment for edema is typically done between 29 and 36 weeks gestation

Which two tests are generally performed on urine at a prenatal visit? a) protein and glucose b) protein and sodium c) pH and glucose d) occult blood and protein

a) protein and glucose Rationale: Protein is assessed to help detect hypertension of pregnancy; glucose is assessed to help detect gestational diabetes.

A pregnant woman at 4 weeks' gestation who has preexisting diabetes mellitus visits her primary care provider for a check up. Which fetal complications might occur because of this maternal condition? (SATA) a) respiratory disorder b) congenital malformations c) macrosomia (oversized fetus) d) smaller than gestational age baby e) fetus with juvenile diabetes

a) respiratory disorder b) congenital malformations c) macrosomia (oversized fetus)

A woman in the last trimester of pregnancy reports sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she cannot sleep at all if she lies on her side. How would the nurse suggest she try sleeping? a) with a pillow under her right hip b) without a pillow c) with a pillow under both hips d) with a pillow under her shoulders

a) with a pillow under her right hip Rationale: Pregnancy places strain on the cardiovascular system with increased fluid in the lungs and heart. When the woman lies flat on her back the uterus and contents can compress the vena cava and aorta and reduce blood flow resulting in the light-headed and dizzy spells. Removal of the pillow would not affect the effects on the vena cava. A pillow under the shoulders would hurt the neck, and a pillow under both hips would exacerbate the light-headedness. (less)

Place the following events in the sequence the pregnant woman would experience them, from first to last. 1. quickening 2. labor 3. amennorhea 4. Braxton Hicks contractions 5. uterine enlargement

amennorhea uterine enlargement quickening Braxton Hicks contractions labor

A nurse should teach a client who is pregnant for the first time that she should be able to feel the baby move at about how many weeks gestation? a) 12 to 14 b) 18 to 20 c) 10 to 12 d) 14 to 16

b) 18 to 20

A woman in her first trimester of pregnancy is concerned about the effect that pregnancy will have on her appearance. She is fit but underweight, and she plans to restrict her weight gain as much as possible during pregnancy. How much weight should the nurse advise her to gain? a) 16 to 30 pounds (7.25 to 14 kilograms) b) 28 to 40 pounds (13 to 18 kilograms) c) 25 to 30 pounds (11 to 14 kilograms) d) 15 to 25 pounds (7 to 11 kilograms)

b) 28 to 40 pounds (13 to 18 kilograms) Rationale: The recommendation for average weight gain is 25 to 30 lbs (11 to 14 kilograms), the women who is underweight with a low BMI should gain 28 to 40 pounds (13 to 18) kilograms). Less than 28 pounds (13 kilograms) may hinder fetal development, and weight over 40 pounds (18 kilograms) may be dangerous to the mother

When a woman is planning pregnancy, what is her window around ovulation to have intercourse? a) 2 days before to 1 days after ovulation b) 5 days before to 2 days after ovulation c) 1 day before ovulation to 2 days after ovulation d) 3 days before or the day of ovulation

b) 5 days before to 2 days after ovulation Rationale: Sperm are able to live for up to 72 hours after ejaculation and the ovum remains fertile for a maximum of 48 hours after ovulation. The window of opportunity for conception is 5 days before to 2 days after ovulation.

The nurse correctly identifies which of the following as the hormone that plays a central role in the release of milk from the breast ( let-down reflex)? a) Progesterone. b) Oxytocin. c) Prolactin. d) Estrogen.

b) Oxytocin. Rationale: Oxytocin, produced by the posterior pituitary gland, stimulates uterine contractions and the release of milk in the mammary glands (let-down reflex). Prolactin, a pituitary hormone, triggers and sustains milk production. Progesterone, produced by the corpus luteum and placenta, prepares the endometrium for implantation of the fertilized ovum, develops the mammary glands, and maintains the pregnancy. Estrogen is a female sex hormone produced by the ovaries and placenta

A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? (SATA) a) lack of exercise b) tubal transport c) ovulation d) diabetes e) impaired implantation

b) tubal transport c) ovulation e) impaired implantation

A client wants to know if she can engage in intercourse during pregnancy. Which information should the nurse confirm to ensure that sexual intercourse or orgasm is not contraindicated in the client? (SATA) a) Client does not have breast tenderness. b) Client does not have dependent edema. c) Client does not face a risk of threatened abortion. d) Client is not at risk for preterm labor. e) Client has experienced quickening.

c) Client does not face a risk of threatened abortion. d) Client is not at risk for preterm labor. Rationale: To confirm that intercourse or orgasm is not contraindicated in the pregnant client, the nurse should ensure that the client does not have placenta previa, and the client is not at risk for preterm labor or a threatened abortion. Breast tenderness and dependent edema are not contraindications for sexual intercourse in a pregnant client. Breast tenderness generally occurs in the first trimester of pregnancy. Dependent edema is a common vascular problem occurring during pregnancy

A pregnant woman in her second trimester comes to the prenatal clinic for a routine visit. She reports that she has a new kitten. The nurse would have the woman evaluated for which infection? a) cytomegalovirus b) herpes simplex virus c) toxoplasmosis d) parvovirus B19

c) toxoplasmosis Rationale: Toxoplasmosis is transferred by hand to mouth after touching cat feces while changing the litter box or through gardening in contaminated soil

A woman presents to the clinic in the first trimester of pregnancy. She has three children living at home. One of them was born prematurely at 34 weeks. The other two were full-term at birth. She has a history of one miscarriage. How does the nurse record her obstetric history on the chart using the GTPAL format? a) G4 T2 P1 A1 L3 b) G3 T2 P1 A1 L3 c) G4 T3 P0 A1 L3 d) G5 T2 P1 A1 L3

d) G5 T2 P1 A1 L3

A nurse needs to assess a female client for primary stage herpes simplex virus (HSV) infection. For which symptom related to this condition should the nurse assess? a) loss of hair or alopecia b) yellow-green vaginal discharge c) rashes on the face d) genital vesicular lesions

d) genital vesicular lesions

A client comes to the clinic with abdominal pain. Based on her history the nurse suspects endometriosis. The nurse expects to prepare the client for which evaluatory method to confirm this suspicion? a) hysterosalpingogram b) transvaginal ultrasound c) pelvic examination d) laparoscopy

d) laparoscopy Rationale: The only certain method of diagnosing endometriosis is by seeing it. Therefore, the nurse would expect to prepare the client for a laparoscopy. A pelvic examination and transvaginal ultrasound are done to assess for endometriosis but do not confirm its presence. Hysterosalpingography aids in identifying tubal problems resulting in infertility.

When providing preconception care to a client, the nurse would identify which medication as being safe to continue during pregnancy? a) famotidine b) lithium c) isotretinoin d) warfarin

a) famotidine Rationale: Famotidine is a category B drug that has been used frequently during pregnancy and does not appear to cause major birth defects or other fetal problems. Isotretinoin and warfarin are category X drugs and should never be taken during pregnancy. Lithium is a category D drug with clear health risks for the fetus and should be avoided during pregnancy.

During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy? a) influence of estrogen and blood vessel proliferation b) effects of regurgitation from relaxation of the cardiac sphincter c) increased venous pressure d) elevated progesterone levels

a) influence of estrogen and blood vessel proliferation Rationale: During pregnancy, the gums become hyperemic, swollen, and friable and tend to bleed easily. This change is influenced by estrogen and increased proliferation of blood vessels and circulation to the mouth. Elevated progesterone levels cause smooth muscle relaxation, which results in delayed gastric emptying and decreased peristalsis. Increased venous pressure contributes to the formation of hemorrhoids. Relaxation of the cardiac sphincter, in conjunction with slowed gastric emptying, leads to reflux due to regurgitation of the stomach contents into the upper esophagus

The nurse is preparing to administer medication therapy to a woman diagnosed with syphilis. The nurse would expect to administer: a) penicillin G. b) metronidazole. c) doxycycline. d) miconazole.

a) penicillin G. Rationale: Penicillin G is the drug of choice for treating syphilis. Miconazole is used to treat candidiasis. Metronidazole is used to treat trichomoniasis. Doxycycline is used to treat chlamydia.

Which nursing diagnosis would be most appropriate for a woman diagnosed with gestational hypertension? a) Ineffective tissue perfusion related to poor heart contraction b) Imbalanced nutrition related to decreased sodium levels c) Deficient fluid volume related to vasospasm of arteries d) Risk for injury related to fetal distress

c) Deficient fluid volume related to vasospasm of arteries

A pregnant client in her second trimester has a hemoglobin level of 11 g/dL. The nurse interprets this as indicating: a) greater-than-expected weight gain. b) a multiple gestation pregnancy. c) hemodilution of pregnancy. d) iron-deficiency anemia.

c) hemodilution of pregnancy. Rationale: During pregnancy, the RBC count increases however, there is a greater increase in the plasma volume as a result of hormonal factors and sodium and water retention. Thus, the plasma increase exceeds the increase in RBCs, resulting in hemodilution also called physiologic anemia of pregnancy. Changes in maternal iron levels would be more indicative of an iron-deficiency anemia. Although anemia may be present with a multiple gestation, an ultrasound would be a more reliable method of identifying it. Weight gain does not correlate with hgb levels

A woman has just been prescribed clomiphene citrate to stimulate ovulation. Which possible effect should the nurse warn the woman about? a) elevation of her blood glucose level b) extensive bleeding during menstruation c) hypertension d) overstimulation of the ovary resulting in potential multiple births

d) overstimulation of the ovary resulting in potential multiple births Rationale: Therapy with clomiphene citrate may be used to stimulate ovulation. Administration of either clomiphene citrate or gonadotropins may overstimulate an ovary, causing multiple ova to come to maturity and possibly resulting in multiple births. The nurse should counsel women who receive these agents that this is a possibility. None of the other answers is a common effect of clomiphene citrate use

The clinical nurse specialist is conducting a program for a group of nurses working at the prenatal clinic. When describing the preembryonic stage of fetal development, the nurse describes the events of this stage. Place the events in their proper sequence as the nurse would describe them. 1. formation of blastocyst 2. formation of the zygote 3. formation of the morula 4. implantation 5. cleavage

formation of the zygote cleavage formation of the morula formation of blastocyst implantation Rationale: The preembryonic stage begins with fertilization and the formation of a zygote. Mitosis or cleavage occurs. After four cleavages, the 16 cells appear as a solid ball of cells or morula. With additional cell division, the morula divides into specialized cells, the blastocyst and trophoblast. The trophoblast attaches itself to the surface of the endometrium, and implantation occurs

How would the obstetric history be recorded for a pregnant woman if she has previously given birth to two infants at term and had one abortion at 12 weeks' gestation? a) gravida 4, para 3 b) gravida 4, para 2 c) gravida 3, para 3 d) gravida 3, para 2

b) gravida 4, para 2

The nurse explains to a pregnant client, who is anemic, that she will need to take vitamins with iron during her pregnancy. What are food would the nurse include on the client's diet plan? a) legumes b) meats c) grains d) dairy

b) meats Rationale: Grains are a source of iron but not as good a source as the heme iron of meats. The other choices should be avoided when taking the iron and vitamin supplement as milk and legumes decrease the absorption of iron

A pregnant woman and her partner present at her 12-week obstetrics visit, and they would like to know what the baby looks like. How should the nurse reply? a) "The pregnancy is in the fetal stage with an audible heartbeat and identifiable sex characteristics." b) "The pregnancy is in the embryonic stage with budlike structures for arms and legs; it is less than half an inch long." c) "The pregnancy is in the fetal stage with a beating heart and differentiated fingers and toes." d) "The pregnancy is in the fetal stage with fully shaped lungs and a defined skeletal system; it is 4 to 6 inches long."

a) "The pregnancy is in the fetal stage with an audible heartbeat and identifiable sex characteristics." Rationale: Fetal stage is from the beginning of the ninth week and continues until birth. At 12 weeks' gestation, most structures are fully developed but need time to grow. At the beginning of this stage, the fetus is about 50 mm long and weighs about 8 grams. By the end of the fetal stage, the fetus will be about 36 cm long and weigh approximately 3,400 grams.

Which factors are known to contribute to vaginal yeast infections? (SATA) a) High hormone levels during pregnancy b) excessive physical exercise c) poorly controlled diabetes d) use of oral contraceptives e) inflammation of Skene's and Bartholin's glands. f) recent antibiotic therapy

a) High hormone levels during pregnancy c) poorly controlled diabetes d) use of oral contraceptives f) recent antibiotic therapy Rationale: Reported risk factors for the overgrowth of C. albicans include recent antibiotic therapy, which suppresses the normal protective bacterial flora; high hormone levels owing to pregnancy or the use of oral contraceptives, which cause an increase in vaginal glycogen stores; and uncontrolled diabetes mellitus or HIV infection because they compromise the immune system. Exercise and glandular inflammation are not noted risk factors for yeast infections

The nurse is explaining the procedure for ultrasound to a pregnant client and is discussing the amniotic fluid and how they will determine if there is too much or too little fluid. The client asks about the purpose of the amniotic fluid. What should the nurse tell the client? (SATA) a) It provides symmetrical growth. b) It provides unrestricted movement. c) It produces hormones. d) It is for the physical protection of the growing fetus. e) It regulates temperature

a) It provides symmetrical growth. b) It provides unrestricted movement. d) It is for the physical protection of the growing fetus. e) It regulates temperature

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? (SATA) a) Teach the client meticulous handwashing. b) Assess hydration status of the client at each visit. c) Instruct the client to consume protein-rich food. d) Assess serum electrolyte levels of the client at each visit. e) Urge the client to drink 8 to 10 glasses of fluid daily.

a) Teach the client meticulous handwashing. b) Assess hydration status of the client at each visit. e) Urge the client to drink 8 to 10 glasses of fluid daily.

A 38-year-old client has one child with Tay-Sachs disease. She and her partner both carry the Tay-Sachs gene and did not intend to have more children, but she has just discovered that she is pregnant. She plans to have an abortion if tests show that the fetus has the Tay-Sachs gene. Which test will the primary care provider likely prescribe? a) chorionic villus sampling b) percutaneous umbilical blood sampling c) a multiple marker screening test d) amniocentesis

a) chorionic villus sampling Rationale: CVS is a newer procedure and can provide information on fetal chromosomal studies similar to an amniocentesis, but earlier in pregnancy. The CVS is typically performed between 8 and 12 weeks gestation. Given the disease in question, she would be able to determine the course of the pregnancy early in gestation. Multiple marker screen tests are done later in the pregnancy, as is amniocentesis. Percutaneous umbilical blood sampling examines the blood and is not the best source for chromosomal studies.

A pregnant vegan reports that she eats lots of dark green leafy vegetables, legumes, citrus fruits, and berries. To ensure that her infant's nervous system will develop properly, what foods should the nurse recommend that she add to her diet? a) fortified cereals b) nuts, seeds, and chocolate c) carrots, sweet potatoes, and mangoes d) milk and cheese

a) fortified cereals Rationale: Vegans need increased grains to meet the amino acid needs during pregnancy. She should be encouraged to consume grains with legumes to meet these needs. The inclusion of dairy, fruit, vegetables, and nuts are necessary for a healthy diet

For which problem would the nurse be alert in a pregnant woman with gestational diabetes? a) hydramnios related to glucose/insulin imbalance b) hypotension related to glucose/insulin imbalance c) placenta previa related to diabetes mellitus d) cerebral vascular accident related to diabetes mellitus

a) hydramnios related to glucose/insulin imbalance Rationale: Hyperglycemia tends to lead to excessive amniotic fluid (hydramnios) because of osmotic pressure fluid shifts.

A clinic nurse explains to a client who is undergoing an infertility workup that the patency of her fallopian tubes will be checked. Which test is currently used to do this? a) hysterosalpingography b) computed tomography scan c) magnetic resonance imaging d) uterine biopsy

a) hysterosalpingography Rationale: Hysterosalpingography is radiologic examination with radiopaque contrast of the fallopian tubes. It is widely used to assess the patency of the fallopian tubes in women who are subfertile.

During a routine prenatal check up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which factors would alert the nurse to an increased risk? Select all that apply. a) previous history of spontaneous abortion b) client of African-American lineage c) younger maternal age at pregnancy d) maternal obesity with body mass index more than 35 e) previous birth of small for gestational age baby

a) previous history of spontaneous abortion b) client of African-American lineage d) maternal obesity with body mass index more than 35

A woman comes to the prenatal clinic suspecting that she is pregnant, and assessment reveals probable signs of pregnancy. Which findings would the nurse most likely assess? (SATA) a) softening of the cervix b) positive pregnancy test c) auscultation of a fetal heart beat d) ballottement e) ultrasound visualization of the fetus f) absence of menstruation

a) softening of the cervix b) positive pregnancy test d) ballottement Rationale: Probable signs of pregnancy include a positive pregnancy test, ballottement, and softening of the cervix (Goodell's sign). Ultrasound visualization of the fetus, auscultation of a fetal heart beat, and palpation of fetal movements are considered positive signs of pregnancy. Absence of menstruation is a presumptive sign of pregnancy.

A 33-year-old pregnant client asks the nurse about testing for birth defects that are safe for both her and her fetus. Which test would the nurse state as being safe and noninvasive? a) ultrasound b) CVS c) amniocentesis d) percutaneous umbilical cord sampling

a) ultrasound Rationale: The nurse would state that an ultrasound is a noninvasive test that is completely safe for both mother and child. Amniocentesis, CVS, and percutaneous umbilical cord sampling are invasive tests that are associated with maternal and fetal risk

A male client has undergone a semen analysis for evaluation of fertility. The nurse understands that which sperm count would suggest infertility? a) 75 million/mL b) 18 million/mL c) 50 million/mL d) 100 million /mL

b) 18 million/mL Rationale: A sperm count of fewer than 20 million spermatozoa per milliliter results in infertility. Normal sperm count ranges on average from 60 to 100 million /mL.

A nurse is caring for a pregnant client with eclamptic seizure. Which is a characteristic of eclampsia? a) Respirations are rapid during the seizure. b) Coma occurs after seizure. c) Muscle rigidity is followed by facial twitching. d) Respiration fails after the seizure.

b) Coma occurs after seizure.

A woman in her first trimester shares with the nurse that she has been experiencing terrible nausea when she gets up in the morning. Which actions should the nurse advise her to do? (SATA) a) Eat two regular meals later in the day. b) Delay breakfast until 10 or 11 AM. c) Try eating soups or vegetable drinks in the morning. d) Use a scopolamine patch. e) Suck on sourball candies. f) Eat some saltine crackers before rising in the morning.

b) Delay breakfast until 10 or 11 AM. c) Try eating soups or vegetable drinks in the morning. e) Suck on sourball candies. f) Eat some saltine crackers before rising in the morning. Rationale: The traditional solution for preventing nausea is for women to keep dry crackers, such as saltines, by their bedside and eat a few before rising as increasing carbohydrate intake seems to relieve nausea. Sucking on sourball candies may serve the same purpose. A woman can then eat a light breakfast or delay breakfast until 10 or 11 am, past the time her nausea seems to persist. To be certain she maintains a good food intake during pregnancy even in the face of nausea, urge her to be certain to compensate for any missed meals later in the day; thus, eating two regular meals later in the day would not be adequate and could lead to hypoglycemia. Caution women against self-medicating for nausea by using a scopolamine patch, a drug used for motion sickness, as it is not intended for long-term use.

A couple is being assessed for infertility. The male partner is required to collect a semen sample for analysis. What instruction should the nurse give him? a) Avoid strenuous activity for 24 hours before collecting the sample. b) Deliver sample for analysis within 1 to 2 hours after ejaculation. c) Collect a specimen by ejaculating into a condom or plastic bag. d) Abstain from sexual activity for 10 hours before collecting the sample.

b) Deliver sample for analysis within 1 to 2 hours after ejaculation. Rationale: The nurse should instruct the client to deliver the semen sample to the laboratory for analysis within 1 to 2 hours after ejaculation. The client should also be instructed to collect the sample in a specimen container, not a condom or plastic bag. The client needs to abstain from sexual activity for at least 24 hours before giving the sample, but he need not avoid strenuous activity

A woman accustomed to daily exercise reports late in her second trimester of pregnancy that she is experiencing "terrible" heartburn at night. What should the nurse advise her to do? a) Stop or severely curtail her exercise. b) Elevate the head of the bed by ten to 30 degrees. c) Seek emergency medical care. d) Take sodium bicarbonate.

b) Elevate the head of the bed by ten to 30 degrees. Rationale: Heartburn is a common problem worsening as the pregnancy progresses. The pregnancy hormones relax the lower esophageal sphincter resulting in increase heartburn. Elevation of the head of the bead will help maintain the acid from rising at night, and other nonpharmacologic interventions are available if needed. Exercise does not negatively impact heartburn and should be continued. The pregnant mother should not take any medication that is not prescribed by her primary care provider. Heartburn is not a medical emergency

During the development of the fetus, its chorionic villi eventually meet with an area of uterine tissue to form the placenta. Which statements accurately describe a function of the placenta? (SATA) a) It cushions the fetus against injury. b) It produces hormones that help maintain the pregnancy. c) It slows the maternal immune response. d) It carries waste away for excretion by the mother. e) It permits blood to bypass the right ventricle. f) It protects the umbilical cord.

b) It produces hormones that help maintain the pregnancy. c) It slows the maternal immune response. d) It carries waste away for excretion by the mother. Rationale: The placenta supplies the developing organism with food and oxygen, carries waste away for excretion by the mother, slows the maternal immune response so that the mother's body does not reject the fetal tissues, and produces hormones that help maintain the pregnancy. Wharton's jelly protects the umbilical cord and the foramen ovale permits most of the blood to bypass the right ventricle. The amniotic fluid cushions the fetus against injury.

A woman and her partner present at her first antenatal obstetrics appointment. She is 6 weeks pregnant. Her blood tests show that she is Rh negative, although she has not previously known this. She has no other children but suspects that she miscarried early in a pregnancy 2 years before. She felt fine afterward, so she never received medical attention for that suspected episode. Her partner reports that he is also Rh negative. What action will the nurse be likely to take? a) If an antibody screen is negative, the nurse will administer Rho(D) immune globulin to the client. b) The nurse will perform all normal procedures and follow-up tasks because the Rh status of the client and the child are not a concern at this time. c) The nurse will arrange for an amniocentesis to assess hemolytic disease in the fetus. d) If an antibody screen is positive, the nurse will administer RhoGAM to the client.

b) The nurse will perform all normal procedures and follow-up tasks because the Rh status of the client and the child are not a concern at this time. Rationale: If the woman is Rh negative and her partner is Rh negative, the fetus will also be Rh negative, and the woman will not require treatment with Rho(D) immune globulin. Therefore, the remaining options are incorrect

While the nurse is weighing a pregnant woman at a regularly scheduled OB visit, the client reports vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. She says this is her first pregnancy and she did not know this was what happened. What can the nurse tell her? a) This is not normal for pregnancy but the care provider might test her for a simple yeast infection. If it is a yeast infection, it can be treated with a single-dose suppository that will not harm the fetus. She should call immediately if she has any symptoms that do not seem normal to her. b) This is not normal for pregnancy; the care provider might test her for trichomoniasis. If it is trichomoniasis, she can be treated with an oral dose of metronidazole. She should call immediately if she has any symptoms that do not seem normal to her. c) This is not normal for pregnancy; the care provider might test her for gonorrhea. If it is gonorrhea, she and her partner will be treated with antibiotics; they might be treated with different medications because some antibiotics normally used to treat gonorrhea are damaging to the fetus. She should call immediately if she has any symptoms that do not seem normal to her. d) This is not normal for pregnancy; the care provider might test her for chlamydia. If it is chlamydia, she and her partner can be treated with a 7-day course of antibiotics. She should call immediately if she has any symptoms that do not seem normal to her.

b) This is not normal for pregnancy; the care provider might test her for trichomoniasis. If it is trichomoniasis, she can be treated with an oral dose of metronidazole. She should call immediately if she has any symptoms that do not seem normal to her. Rationale: Trichomoniasis is caused by a one-celled protozoa. The symptoms include large amounts of foamy, yellow-green vaginal discharge. Treatment is with metronidazole,

Rho(D) immune globulin will be prescribed for an Rh negative mother undergoing which test? a) nonstress test b) amniocentesis c) contraction test d) biophysical profile

b) amniocentesis Rationale: Amniocentesis is a procedure requiring a needle to enter into the amniotic sac. There is a risk of mixing of the fetal and maternal blood which could result in blood incompatibility. A contraction test, a nonstress test, and biophysical profile are not invasive, so there would be no indication for Rho(D) immune globulin to be administered

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called? a) pregnancy syndrome b) couvade syndrome c) cretinism d) pseudo pregnancy

b) couvade syndrome

Which definition best explains the term "subfertility/infertility"? a) failure to achieve pregnancy after 6 months of unprotected intercourse b) failure to achieve pregnancy after 1 year of unprotected intercourse c) inability to achieve pregnancy following a previous viable pregnancy d) inability to achieve pregnancy because of a known factor that prevents conception

b) failure to achieve pregnancy after 1 year of unprotected intercourse

The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which signs and symptoms would the nurse include? (SATA) a) urinary frequency in the third trimester b) headache with visual changes in the third trimester c) sudden leakage of fluid during the second trimester d) lower abdominal pain with shoulder pain in the first trimester e) backache during the second trimester f) nausea with vomiting during the first trimester

b) headache with visual changes in the third trimester c) sudden leakage of fluid during the second trimester d) lower abdominal pain with shoulder pain in the first trimester Rationale: Danger signs and symptoms that need to be reported immediately include headache with visual changes and sudden leakage of fluid in the second trimester and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy

The obstetrical nurse knows that a woman's hormone levels change dramatically during pregnancy. Which hormonal actions accurately represent these changes? (SATA) a) decreasing the blood supply to the GI tract and slowing peristaltic waves b) maintaining the endometrium so that the embryo can implant c) preparing the breasts for lactation, keeping the milk from coming in until birth occurs d) relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly e) causing changes in the mother's metabolism so that nutrients are available for both f) decreasing the mother's blood volume and red blood cell mass to increase oxygen

b) maintaining the endometrium so that the embryo can implant c) preparing the breasts for lactation, keeping the milk from coming in until birth occurs d) relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly e) causing changes in the mother's metabolism so that nutrients are available for both Rationale: The hormonal effects of pregnancy include the following: maintaining the endometrium so that the embryo can implant, causing changes in the mother's metabolism so that nutrients are available for both, relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly, preparing the breasts for lactation, keeping the milk from coming in until birth occurs, increasing the mother's blood volume and red blood cell mass to increase oxygen, and increasing the blood supply to the gastrointestinal tract and slowing peristaltic waves

A pregnant client with severe preeclampsia has developed HELLP syndrome. In addition to the observations necessary for preeclampsia, what other nursing intervention is critical for this client? a) maintaining a patent airway b) observation for bleeding c) monitoring for infection d) administration of a tocolytic, if prescribed

b) observation for bleeding

A nurse is instructing a pregnant woman about monitoring fetal movements and informs her that normally the fetus will move the same amount every day. The nurse adds that if the client notices an unusual increase or decrease in movement, this is a sign of what? a) cramping in the uterus and trying to get comfortable b) response to a need for oxygen c) fetal shifting of activity-sleep balance d) fetal heartburn

b) response to a need for oxygen Rationale: A fetus normally moves more or less the same amount every day. If there is an unusual increase or decrease in movement, the client should be examined because such a change suggests that the fetus is responding to a need for oxygen

When teaching a pregnant client about the physiologic changes of pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which underlying reason for the effect would the nurse include? a) The pregnant woman increases her dietary intake. b) Pancreatic function is affected by pregnancy. c) Glucose moves through the placenta to assist the fetus. d) Glucose is utilized more rapidly during a pregnancy.

c) Glucose moves through the placenta to assist the fetus. Rationale: The growing fetus has large needs for glucose, amino acids, and lipids, placing demands on maternal glucose stores. During the first half of pregnancy, much of the maternal glucose is diverted to the growing fetus. The pancreas continues to function during pregnancy. However, the placental hormones can affect maternal insulin levels. The demand for glucose by the fetus during pregnancy is high, but it is not necessarily used more rapidly. Placental hormones, not the woman's dietary intake, play a major role in glucose metabolism during pregnancy

Which nursing intervention should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client? a) Obtain and record vital signs of the client. b) Instruct the client to report the occurrence of fever. c) Instruct the client to refrain from emptying her bladder. d) Inform the client that she may feel hot initially.

c) Instruct the client to refrain from emptying her bladder. Rationale: When assessing fetal well-being through abdominal ultrasonography, the nurse should instruct the client to refrain from emptying her bladder. The nurse must ensure that abdominal ultrasonography is conducted on a full bladder and should inform the client that she is likely to feel cold, not hot, initially in the test

A nonstress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which statement by the client indicates understanding of the test results? a) The results indicate a contraction stress test is needed for evaluation. b) The test is nonreactive, which is reassuring. c) The fetal heart rate increases with activity and indicates fetal well-being. d) There is no evidence of congenital anomalies or deformities.

c) The fetal heart rate increases with activity and indicates fetal well-being. Rationale: A reactive NST for nonstress test is a noninvasive way to monitor fetal well-being. A reactive NST is a positive sign the fetus is tolerating pregnancy well by demonstrating heart rate increase with activity and indicating fetal well-being

When assessing a woman in her first trimester, which emotional response would the nurse expect to find? a) emotional lability b) introversion c) ambivalence d) acceptance

c) ambivalence Rationale: During the first trimester, the pregnant woman commonly experiences ambivalence, with conflicting feelings at the same time. Introversion heightens during the first and third trimesters when the woman's focus is on behaviors that will ensure a safe and healthy pregnancy outcome. Acceptance usually occurs during the second trimester. Emotional lability (mood swings) is characteristic throughout a woman's pregnancy

On what day during pregnancy does the embryo implant on the uterine surface? a) the 14th day of a "typical" menstrual cycle b) ten days after the start of the menstrual flow c) eight days after ovulation d) four days after ovulation

c) eight days after ovulation Rationale: After floating free in the uterine cavity for about 4 days, the zygote implants on the uterine surface on about the 8th day; thereafter it is termed an embryo.

When preparing a presentation for a group of pregnant women about fetal circulation, the nurse would explain that which structure is primarily responsible for ensuring that highly oxygenated blood reaches the fetal brain? a) ductus arteriosus b) ductus venosus c) foramen ovale d) umbilical vein

c) foramen ovale Rationale: The ductus venosus provides a passageway for oxygenated blood from the umbilical vein to reach the inferior vena cava. The ductus arteriosus is a shunt that receives deoxygenated blood and transports it to the descending aorta. The umbilical vein carries oxygenated blood from the placenta to the fetus. The foramen ovale deflects blood from the vena cava into the left atrium, then left ventricle, into the ascending aorta and into the head and upper body so that the brain receives blood with the highest level of oxygenation

A pregnant woman needs an update in her immunizations. Which vaccination would the nurse ensure that the woman receives? a) mumps b) rubella c) hepatitis B d) measles

c) hepatitis B Rationale: Hepatitis B vaccine should be considered during pregnancy. Immunizations for measles, mumps, and rubella are contraindicated during pregnancy.

Which change in insulin is most likely to occur in a woman during pregnancy? a) enhanced secretion from normal b) unavailable because it is used by the fetus c) less effective than normal d) not released because of pressure on the pancreas

c) less effective than normal Rationale: Somatotropin released by the placenta makes insulin less effective. This is a safeguard against hypoglycemia.

A client's maternal serum alpha-fetoprotein (MSAFP) level was unusually elevated at 17 weeks. The nurse suspects which condition? a) Down syndrome b) fetal hypoxia c) open spinal defects d) maternal hypertension

c) open spinal defects Rationale:Elevated MSAFP levels are associated with open neural tube defects. Fetal hypoxia would be noted with fetal heart rate tracings and via nonstress and contraction stress testing.

A couple in their mid-30s are at their primary care provider's office because they have been unable to conceive for 3 years. They already have one child who is 4 years of age. The care provider explains to them that they are dealing with what kind of infertility? a) primary infertility b) There is no name for different kinds of infertility. c) secondary infertility d) tertiary infertility

c) secondary infertility Rationale: There are two main types of infertility: primary and secondary. A couple who has never been able to conceive has primary infertility, whereas a couple who has been able to conceive in the past but is currently unable to do so has secondary infertility.

A woman is going to have in vitro fertilization. When preparing her for this, the nurse would make which statement? a) "You will need to select a surrogate mother." b) "This is dangerous if there is ovarian cancer in your family." c) "Most procedures are effective the first time tried." d) "It can be done with frozen donor sperm."

d) "It can be done with frozen donor sperm." Rationale: Fresh or frozen sperm may be used. The success of in vitro fertilization is not related to the incidence of ovarian cancer in the family. Often more than one attempt is needed before successful implantation

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week? a) 2/3 lb (.30 kg) b) 1.5 lb (.68 kg) c) 2 lb (.90 kg) d) 1 lb (.45 kg)

d) 1 lb (.45 kg) Rationale: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (.45 kg) per week. Overweight women should gain about 2/3 lb (.30 kg) per week.

The nurse is explaining to a primigravida how the zygote becomes implanted into the uterus. How would the nurse describe the structure formed in this process known as the blastocyst? a) The endometrium is enriched in nutrients in preparation for pregnancy. b) A ball of about 16 identical cells is formed when the zygote divides. c) A group of cells is forming what will become the embryo. d) First one, then two layers of cells surround a fluid-filled space.

d) First one, then two layers of cells surround a fluid-filled space. Rationale: The zygote divides rapidly, until it forms a ball of about 16 identical cells, which is then called a morula. The morula is then swept down the fallopian tube and into the uterus, a process that takes approximately 7 to 9 days. The lining of the uterus, or endometrium, has become rich in nutrients in preparation for the pregnancy. Just before the morula reaches the uterus, the cells begin to form layers; first one, then two layers surround a fluid-filled space, called a blastocyst. Another group of cells form what will become the embryo

A client's maternal serum alpha-fetoprotein (MSAFP) screening results show that her MSAFP levels are high. What is the best response by the nurse? a) The test may have been run during the wrong weeks gestation. b) Her child is at risk for Down syndrome. c) Her child is at risk for neural tube defects. d) Further test are required based on the results.

d) Further test are required based on the results. Rationale: Alpha-fetoprotein is a protein manufactured by the fetus. The woman's blood contains small amounts of this protein during pregnancy. The blood test is run between 16 and 20 weeks' gestation; an abnormal level indicates a need for further testing to determine the risks her fetus may face.

A client who is trying not to get pregnant calls the nurse on Saturday at 11 a.m. reporting that she had unprotected sex on Thursday at 10 p.m.. She believes she has just ovulated and wants to verify that she has no risk of pregnancy. What can the nurse tell her? a) If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Monday. b) If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 10 p.m. on Sunday. c) Because she did not ovulate before the unprotected coitus, she will not get pregnant. d) If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Sunday.

d) If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Sunday. Rationale: A single ovum is released from the ovary 14 days before the next menstrual period. It lives approximately 24 hours. The client's fertile period would be from Saturday at 11 a.m. to Monday at 11 a.m. During any other time frame, it would be unlikely that she would become pregnant

Which statement would the nurse include in the teaching plan for a pregnant woman related to changes in the uterus? a) Uterine growth occurs because of an increase in the number of cells in the uterus. b) The uterus reaches its maximum height in the abdomen at 39 weeks. c) The uterus moves into the abdomen by the second month of pregnancy. d) The uterus changes from a pear-shaped organ to an oval one.

d) The uterus changes from a pear-shaped organ to an oval one. Rationale: The uterus starts as a pear-shaped organ and becomes oval as length increases over width. Uterine growth is primarily related to an increase in size of the myometrial cells. The uterus remains in the pelvic cavity for the first 3 months, after which it progressively ascends into the abdomen. The uterus reaches its highest level at the xiphoid process at approximately 36 weeks. Between 38 to 40 weeks, fundal height drops as the fetus begins to descend and engage into the pelvis.

Many factors influence how a woman adapts psychologically to pregnancy. What is the psychological adaptation the woman must come to terms with during the second trimester? a) prepare for labor and birth b) prepare for parenthood c) accept the pregnancy d) accept the baby

d) accept the baby Rationale: Gradually, as the pregnancy progresses, she comes to have a sense of the child as his or her own separate entity. This acceptance may be enhanced when she first hears the fetal heartbeat, when she feels the baby move inside her, or when she sees the fetal image during a sonogram

A client is admitted at 22 weeks' gestation with advanced cervical dilatation to 5 centimeters, cervical insufficiency, and a visible amniotic sac at the cervical opening. What is the primary goal for this client at this point? a) notification of social support for loss of pregnancy b) education on causes of cervical insufficiency for the future c) give birth vaginally d) bed rest to maintain pregnancy as long as possible

d) bed rest to maintain pregnancy as long as possible Rationale: At 22 weeks' gestation, the fetus is not viable. The woman would be placed on bed rest, total, with every attempt made to halt any further progression of dilatation as long as possible. The nurse would not want this fetus to be born vaginally at this stage of gestation. It is not the nurse's responsibility to notify the client's social support of a possible loss of the pregnancy. It is not appropriate at this time to educate the mother on causes of cervical insufficiency for future pregnancies.

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client? a) inefficient protein metabolism b) constipation c) tooth fracture d) iron-deficiency anemia

d) iron-deficiency anemia Rationale: Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which finding would the lead the nurse to suspect that the client is having an adverse effect associated with this drug? a) gastrointestinal bleeding b) blurred vision c) sweating d) tachycardia

d) tachycardia

A nurse is assessing a client diagnosed with mild preeclampsia. The nurse suspects that the client has developed severe preeclampsia based on which finding? a) proteinuria of 300 mg/24 hours b) mild facial edema c) mild hand edema d) urine output of less than 400 mL/24 hours

d) urine output of less than 400 mL/24 hours

Inability to conceive can be very stressful on a couple. What is one psychological aspect of infertility? a) Loss of intimacy b) Growth of intimacy c) Emotional stability d) Couple becomes closer

a) Loss of intimacy Rationale: Intimacy, love, and support—essential components of a couple's sexual relationship—may be lost because intercourse takes on a clinical and mechanical tone.

As a rule, women can receive chemotherapy in the second and third trimesters without adverse fetal effects. a) False b) True

b) True

A nurse is explaining to a group of nursing students that eclampsia or seizures in pregnant women are preceded by an acute increase in maternal blood pressure. What are features of an acute increase in blood pressure? (SATA) a) hyperglycemia b) blurring of vision c) hypereflexia d) proteinuria e) auditory hallucinations

b) blurring of vision c) hypereflexia d) proteinuria

A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication? a) postterm birth b) congenital anomalies c) maternal hypotension d) fetal nonimmune hydrops

b) congenital anomalies

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care? a) clear liquid diet b) nothing by mouth c) total parenteral nutrition d) administration of labetalol

b) nothing by mouth

A client in her second trimester of pregnancy arrives at a health care facility reporting heartburn. What instructions should the nurse offer to help the client deal with heartburn? (SATA) a) Avoid overeating. b) Limit consumption of food before bedtime. c) Avoid use of antacids. d) Consume lots of liquids before bedtime. e) Sleep in a semi-Fowler's position.

a) Avoid overeating. b) Limit consumption of food before bedtime. e) Sleep in a semi-Fowler's position.

The nurse is required to assess a client for HELLP syndrome. Which are the signs and symptoms of this condition? (SATA) a) upper right quadrant pain b) oliguria c) blood pressure higher than 160/110 mm Hg d) epigastric pain e) hyperbilirubinemia

a) upper right quadrant pain d) epigastric pain e) hyperbilirubinemia

What is the main purpose of the chorionic villi? a) Form the tissues that will become the placenta. b) Produce amniotic fluid. c) Provide an exchange site for the exchange of nutrients and wastes. d) Adhere the blastocyst to the endometrial lining.

c) Provide an exchange site for the exchange of nutrients and wastes. Rationale: The chorionic villi eventually become the fetal part of the placenta where the exchange of nutrients and wastes occurs.

Amniotic fluid does not grow stagnant because: a) amniotic fluid is constantly absorbed by the chorion. b) the fetal urine increases the bulk of amniotic fluid. c) amniotic fluid is constantly formed by the amnion. d) amniotic fluid circulates through the chorionic villi.

c) amniotic fluid is constantly formed by the amnion. Rationale: Amniotic fluid is formed by the amnion; a main portion of it is swallowed by the fetus and then excreted by the fetus back into the fluid area. The fluid is constantly being produced and filtered

Gestational diabetes occurs around the 24th week of gestation. When should every woman be screened for gestational diabetes? a) between 28 and 32 weeks' gestation b) between 20 and 24 weeks' gestation c) between 24 and 28 weeks' gestation d) between 16 and 20 weeks' gestation

c) between 24 and 28 weeks' gestation

A woman at 9 weeks' gestation is admitted to the obstetrical unit for hyperemesis gravidarum. What priority intervention should the nurse anticipate? a) bed rest with bathroom privileges b) administration of antiemetics c) IV rehydration d) NPO for 24 hours

d) NPO for 24 hours Rationale: The initial priority intervention is to stop all food and fluids by mouth until the vomiting has stopped. The next steps will depend on the severity of the hyperemesis gravidarum. Use of medications should be based on the severity of the hyperemesis gravidarum and only under orders as most medications are pregnancy category C. IV rehydration may be ordered by the primary care provider