Alterations during pregnancy/The healthy pregnancy/reproduction/maternal nutrition

d (Rationale The joints of the pelvis relax because of hormonal​ influences, causing a waddling gait. The waddling gait is not associated with a low calcium intake. Changes in the center of gravity cause​ lordosis, not a waddling gait. The changes in the client​'s gait are due to​ hormones, not an underlying musculoskeletal disorder.)

A client at 32 weeks gestation is ambulating with a waddling gait. The nurse explains that this gait is due to which musculoskeletal​ change? a Changes in the center of gravity b Underlying musculoskeletal disorder c Low calcium intake d Relaxation of the pelvic joints

b (Rationale: Infectious diseases of the reproductive tract, such as PID, can cause scarring and tubal blockage. Rubella infection during childhood results in immunity to the disease. Smoking and alcohol present health risks to the woman, but do not obstruct the fallopian tubes.)

A client has an obstruction between the uterus and the fallopian tube. In obtaining a health history, the nurse collects data about which of the following that may have caused the problem? a Rubella infection prior to adolescence b Pelvic inflammatory disease (PID) caused by gonorrhea c Smoking 2 packs of cigarettes a day d Ingestion of 2 ounces of alcohol per day

a,b,c,d (Rationale ​Fatigue, increased​ appetite, back​ pain, nausea, and vomiting are all symptoms that may be experienced with couvade syndrome. Breast tenderness is not commonly experienced.)

A client in her second trimester of pregnancy tells the nurse that her spouse is demonstrating signs of pregnancy as well. The nurse identifies this as couvade syndrome. Which symptom is the spouse most likely​ experiencing? ​(Select all that​ apply.) a Increased appetite b Nausea and vomiting c Back pain d Fatigue e Breast tenderness

a (Rationale A client with a history of chronic hypertension is at an increased risk for developing GDM. Obesity and maternal age greater than 25 years would also place this client at risk for GDM. A history of sexually transmitted infections does not increase the risk of GDM.)

A client is seen for a prenatal visit at 18 weeks gestation and is scheduled for a glucose tolerance test​ (GTT) in the next month to determine if the client has developed gestational diabetes mellitus​ (GDM). Which item in the client​'s history places her at risk for developing​ GDM? a Chronic hypertension b Maternal age less than 25 years c History of sexually transmitted infection d Average weight for height

b,d,e (Rationale Detection of a fetal​ heartbeat, fetal movement detected by a healthcare​ provider, and a fetus observed by ultrasound are all positive indicators of pregnancy. Presence of linea nigra and Goodell sign are both probable indicators of pregnancy.)

A client learns that she is pregnant. Which indicator will the nurse anticipate as being​ positive? ​(Select all that ​apply.) a Presence of Goodell sign b Fetal movement detected by a health care provider c Presence of linea nigra d Detection of a fetal heartbeat e Fetus observed by ultrasound

b,e (Rationale Amenorrhea is a presumptive indicator of pregnancy. It is described by the​ client, but may be attributed to something other than pregnancy. Breast tenderness is a presumptive indicator of pregnancy. It is described by the​ client, but may be attributed to something other than pregnancy. A positive home pregnancy test is a probable indicator of​ pregnancy; it can be assessed by a healthcare provider but may also be attributed to something other than pregnancy. Abdominal enlargement is a probable indicator of​ pregnancy; it can be assessed by a healthcare provider but may also be attributed to something other than pregnancy. Fetal heartbeat detected with a Doppler is a positive sign of pregnancy.)

A client presents to the prenatal clinic and tells the nurse that she thinks she is pregnant. Which symptom described by the client would be considered a presumptive indicator of​ pregnancy? ​(Select all that​ apply.) a Fetal heartbeat detected with a Doppler b Breast tenderness c A positive home pregnancy test d Enlargement of the abdomen e Amenorrhea

b (Rationale Probable indicators of pregnancy are those objective signs or symptoms that a healthcare provider perceives. These signs may also be attributed to something other than pregnancy. Probable signs include Chadwick​ sign, Goodell​ sign, Hegar​ sign, abdominal​ enlargement, positive pregnancy​ test, ballottement, and skin pigmentation changes. Presumptive signs are subjective reports from the client. Positive signs are direct indicators of a pregnancy. The term possible is not used to describe pregnancy indicators.)

A client reports a positive pregnancy test at home. This is considered which type of pregnancy​ indicator? a Positive b Probable c Possible d Presumptive

d (Rationale During the first​ trimester, the father is often confused about the mood swings and changes that his partner is experiencing. In the second​ trimester, the father may feel anxiety about his role after the baby is born. This anxiety is typically not seen in the first trimester. The couple would attend childbirth classes during the​ third, not the​ first, trimester. The father viewing himself as pregnant typically occurs during the​ second, not the​ first, trimester.)

A client who is 8 weeks pregnant tells the nurse that she does not know what to expect regarding the father​'s ongoing feelings and reactions concerning the pregnancy. Which would be the nurse​'s most appropriate​ response? ​a "He may need to know what his role will be once the baby is​ born." b ​"He may view himself as being​ pregnant." ​c "He will want to attend childbirth classes with​ you." ​d "He may have a hard time understanding what you are going​ through."

b (Rationale Sibling classes for children ages 3 -12 are designed to make children feel that they are part of the birthing process by providing information on the birthing process and newborn behavior. They also provide an opportunity for children to express their feelings about the upcoming birth. The client should prepare the child for the new baby before​ delivery, not wait until she brings the baby home.)

A client who is at 32 weeks gestation with her second child asks the nurse how she should prepare her preschooler for the new baby. Which response by the nurse is most​ appropriate? ​a "Just introduce the child when you bring the baby​ home." b ​"You can enroll your preschooler in sibling​ classes." ​c "No preparation is​ needed; your child will eventually accept the new​ baby." d ​"Take your preschooler to a friend​'s house that has a​ baby."

d,e (Rationale Maternal insulin requirements fluctuate throughout​ pregnancy; after decreasing during the first​ trimester, they rise during the second and third trimester. During the second half of​ pregnancy, fetal growth accelerates and there is an increased utilization of glucose by the fetus. In response to​ this, the placental​ hormone, human placental lactogen​ (hPL), creates insulin resistance in the maternal tissues in order to have sufficient glucose available for the fetus. This increased insulin resistance can raise maternal insulin requirements. During​ labor, insulin requirements diminish from increased maternal energy expenditure.)

A client with type 2 diabetes mellitus requiring insulin has just learned she​'s pregnant. The nurse is teaching her about insulin requirements during pregnancy. Which guidelines should the nurse​ provide? ​(Select all that​ apply.) a ​"Insulin requirements don​'t change during pregnancy. Continue your current​ regimen." ​b "Insulin requirements usually increase greatly during the first​ trimester." ​c "Insulin requirements increase greatly during​ labor." ​d "Insulin requirements usually increase during the last two​ trimesters." e ​"Insulin requirements usually decrease during the first​ trimester."

d,e ( Rationale Antenatal testing helps ascertain fetal​ well-being, growth, and development during the prenatal period and allows for screening and detection of congenital abnormalities. Antenatal testing does not ensure a baby will be healthy. It gives an overall picture of the health of the​ fetus, but does not prevent the fetus from having​ abnormalities, such as birth defects. This statement provides false reassurance to the expecting mother. Ultrasounds are generally not​ painful, but this answer does not address the​ client's question of the reason for antenatal testing. The nurse should be prepared to provide initial education about antenatal testing. The nurse may refer the expecting couple to the medical provider for further explanation if needed.)

A client​ asks, "Why do I need an ultrasound and all of these tests while I am​ pregnant?" Which response by the nurse is the most appropriate regarding the purpose of antenatal​ testing? ​(Select all that​ apply.) a ​"I will ask the doctor to explain these tests to you​ later." ​b "These tests help make sure your baby is​ healthy." ​c "Ultrasounds are painless and your insurance will pay for​ it." ​d "These tests help us see how your baby is growing and​ developing." ​e "Tests such as ultrasounds can help screen for birth​ defects."

b (Rationale The ductus arteriosus allows most fetal blood to flow into the descending aorta to the lower body. This duct does not support blood flow to the​ brain, liver, or lungs of the developing fetus.)

A client​'s ultrasound report indicates dysfunction of the ductus arteriosus in the fetus. The nurse anticipates that this abnormality may cause problems with blood flow to which part of the​ body? a Lungs b Lower body c Liver d Brain

a,b,d,e (Rationale A nonstress test​ (NST) is a method of assessing fetal​ well-being through heart rate reactivity using electronic fetal monitoring. Accelerations in the fetal heart rate with fetal movement indicate an adequate fetal response and general fetal​ well-being. An NST may be performed as part of a biophysical profile or separately to assess fetal​ well-being. Advantages of NST include that it is​ noninvasive, is easy to​ administer, and can be repeated as often as needed. A nonstress test takes 20-40 min to complete. A reactive NST indicates adequate oxygenation of the fetus. It refers to a fetal heart rate tracing that shows at least two accelerations 15 beats above​ baseline, lasting at least 15 s within a 20-​40-minperiod.)

A nurse is preparing a brochure about different types of antenatal testing. Which​ indicators, related to a fetal nonstress test​ (NST), are appropriate to​ include? ​(Select all that​ apply.) a A rise in the fetal heart rate is associated with fetal movement. b A reactive NST has two accelerations that are 15 beats above baseline for 15 s in 20 -40 min. c A nonstress test​ (NST) usually takes 2 -3 hours for completion. d The test is used to assess fetal heart rate pattern and oxygenation status. e The test is easy to perform and has no known side effects.

b,d (Rationale: The client who has effective teaching regarding the management of reproductive health and prevention of reproductive illness understands to practice safe sex to avoid STI's and to avoid cat litter boxes while pregnant to prevent toxoplasmosis infection. Pap smears are a vital test in detecting cervical cancer in women of reproductive age, and pregnant clients cannot have the MMR vaccine because it is a live attenuated vaccine. )

A nurse is reviewing with a client methods to prevent reproductive illnesses. The nurse knows that teaching has been effective when the client states: Select all that apply a "I will make sure to receive the MMR vaccine while I am currently pregnant." b "I will practice safe sex to prevent sexually transmitted infections." c "Pap smears are not necessary for the average woman of reproductive age." d "If I become pregnant I will have my husband change our cat's litter box."

b (Rationale Amniotic fluid acts as a cushion to protect the embryo against mechanical injury and trauma. Amniotic fluid allows for freedom of movement to promote embryonic or fetal growth and development. Oligohydramnios refers to amniotic fluid volume of less than​ 50% of the amount expected for gestational age or less than 400 mL at term. At​ term, the amniotic fluid volume should be between 700 and​ 1,000 mL.)

A nurse is teaching a prenatal group about amniotic fluid. Which statement by a participant indicates an understanding of factors associated with amniotic​ fluid? ​a "There will be about 30 mL of amniotic fluid present when the baby is​ born." ​b "The amniotic fluid acts as a cushion to protect the fetus from​ trauma." ​c "The fluid helps to prevent movement of the​ fetus, decreasing the chance of​ injury." ​d "Oligohydramnios means there is too much amniotic fluid for the​ baby."

c (Rationale Chadwick sign is due to increased cervical vascularity that causes the cervix to appear​ bluish, purple, or deep red. Goodell sign is the softening of the cervix. Hegar sign is the softening of the isthmus of the uterus. Ballottement is not a sign but the act of pushing the fetal presenting part out of the pelvis during a digital vaginal examination.)

A nurse midwife assesses a client at 14 weeks gestation. She inspects the mucous membranes of the cervix and finds them to be​ bluish-purple. The nurse would expect which sign as being documented by the nurse​ midwife? a Goodell sign b Ballottement sign c Chadwick sign d Hegar sign

b,c (Rationale: A nurse demonstrating culturally competent care would ask the client if there are certain practices that they expect to follow and would have information printed in the language of the client's choice. It is never appropriate for the nurse to require a client to reveal their place of worship or to discourage religious preferences. )

A nurse practicing culturally competent care to a prenatal patient demonstrates which action? Select all that apply a Requires clients to reveal what place of worship they attend. b Asks the woman if there are certain practices she expects to follow while she is pregnant. c Has information printed in the language of the client's choice. d Encourages clients to keep their religious preferences a secret as these are not an important aspect of reproductive health.

b (Rationale The mother who chooses to​ formula-feed her newborn should be counseled to reduce her daily caloric intake by 300 kcal. Her nutritional requirements will now return to prepregnancy levels. Eating 200 additional calories per day will cause the postpartum client to gain​ weight, not lose weight. The nurse should instruct the client on the basic principles of good nutrition and the importance of a​ well-balanced diet, not on the use of fad diets or the elimination of any food group to lose weight.)

A postpartum client who will be​ formula-feeding her baby wants to return to her prepregnancy weight as soon as possible. Which​ teaching point is most appropriate for the nurse to include based on the client​'s desire to lose weight post​ pregnancy? a Eat 200 additional calories per day. b Reduce daily caloric intake by 300 calories a day. c Experiment with​ low-carbohydrate, high-protein diets. d Limit dairy products and protein.

d (Rationale Ultrasound is commonly used in the first trimester to determine gestational age. Ultrasounds during the first trimester will not provide accurate information about the position of the fetus during delivery. This is better assessed with an ultrasound in the third trimester. Ultrasounds conducted during the second or third trimester may reveal the sex of the fetus. The fetus is not developed enough in the first trimester to determine the quantity of amniotic fluid. This is better assessed during the second or third trimester.)

A pregnant client in her first trimester is scheduled for an abdominal ultrasound. Which statement by the nurse most accurately reflects the reason for early ultrasound during​ pregnancy? a ​"The test will help determine if your baby is in good position for​ delivery." b ​"The test will help to determine the gender of your​ baby." ​c "The test will help to determine whether you have enough amniotic​ fluid." d ​"The test will help determine how many weeks pregnant you​ are."

c (Pica is the compulsive ingestion or craving of nonfood substances that have little to no nutritive value. The main concern with pica is that it interferes with proper nutrition and the absorption of nutrients from food that is eaten. Preterm labor and fetal death are not the main concerns with pica. Placenta previa is not associated with pica.)

A pregnant client reveals she practices pica. What is the nurse​'s primary concern about pica in caring for this​ client? a Preterm labor b Placenta previa c Interference with proper nutrition d Fetal death

a (Rationale Adolescents are more likely to welcome a pregnancy if they are from a country where early pregnancy is accepted and desired. In a culture that values higher​ education, early pregnancy can be viewed as a barrier to meeting higher education goals. Adolescents with low​ self-esteem may appear to be joyful about a pregnancy because they feel they will have someone to love them. This is a psychosocial issue related to​ pregnancy, not a cultural issue. Lower socioeconomic status is an economic risk factor for adolescent​ pregnancy, not a cultural factor.)

An adolescent from another country is having a prenatal assessment. Which cultural factor would explain why the client is looking forward to having the​ baby? a Early pregnancy is accepted. b Higher education is valued. c Poor​ self-esteem d Lower socioeconomic status

d (Rationale Couvade syndrome refers to the development of physical symptoms of​ pregnancy, such as​ fatigue, weight​ gain, and​ nausea, in the expecting father. The focusing phase occurs during the third​ trimester, when the parents become involved in preparing for the pregnancy. The moratorium phase occurs during the second trimester of pregnancy. It involves the formation of a bond with the unborn child. The father does not experience pseudopregnancy.)

An expecting father experiences weight gain and nausea. Which phenomenon is this client​ experiencing? a Moratorium phase b Focusing phase c Pseudopregnancy d Couvade syndrome

d (Rationale During​ pregnancy, estrogen enlarges the​ uterus, external​ genitalia, and the ductal system of the breasts. Human chorionic gonadotropin preserves the corpus luteum. Progesterone is essential for maintaining the pregnancy. Human placental lactogen assists in maintaining the​ fetus's glucose levels.)

Anika Winters recently discovered that she is pregnant. During her first office​ visit, she complains that her external genitalia have enlarged since finding out she was going to be a mother. The nurse informs Anna that this enlargement has occurred because of which hormone that is stimulated during​ pregnancy? a Human placental lactogen​ (hPL) b Human chorionic gonadotropin​ (hCG) c Progesterone d Estrogen

b (Gestational diabetes mellitus controlled by diet is not associated with maternal or fetal​ complications, and pregnancy outcomes for these women are indistinguishable from the general population. Nurses understand the care of gestational diabetes and it is part of their role to provide counseling. Gestational diabetes may have serious consequences for the​ fetus, such as intrauterine growth​ restriction, macrosomia, symptomatic neonatal​ hypoglycemia, and fetal​ demise, if it is left uncontrolled.)

Ashley Estevez is 28 weeks pregnant and has been diagnosed with gestational diabetes. She tells the nurse that she is afraid her baby will not be healthy. What is the​ nurse's best response to reassure the​ client? a ​"Your pregnancy will be considered high risk from now on and you should be prepared to have a child with serious​ complications." b ​"We will help you to modify your diet to keep your blood sugar at normal levels. If you are careful to follow the diet and your blood sugars stay in the normal​ range, your baby will be​ healthy." ​c "It is not necessary to be concerned. The test is mostly to determine your risk of diabetes later in life. Diabetes does not have much effect on​ pregnancy." ​d "You should make an appointment in a few days to talk to the midwife about​ that."

b (Rationale African American​ ethnicity, age greater than> ​30, and multiple gestations are risk factors for peripartum cardiomyopathy. Mitral valve prolapse is usually asymptomatic and manifests as palpitations when symptoms occur. Sickle cell disease would have been identified at the first prenatal visit. Asthma is not accompanied by chest pain.)

A​ healthy, 34-year-old African American woman with a history of regular prenatal care during her pregnancy with twins is undergoing an induction of labor. She calls the nurse to her room and reports difficulty breathing and chest pain. The nurse suspects she may be experiencing which​ condition? a Asthma attack b Peripartum cardiomyopathy c Sickle cell crisis d Mitral valve prolapse

c (Rationale Ova are fertile for about 24​ hours; however, sperm can remain viable in the female reproductive tract for​ 48-72 hours​ (although they are fertile for only 24​ hours). Therefore, the best time for fertilization to occur would be 1 day before or after ovulation​ (a 48-hour​ window). Although the ovum is fertile for 24​ hours, this response would not address the​ client's question.)

Cherralene Lyons is a​ 22-year-old client who is currently trying to become pregnant. She asks the nurse to explain the time frame between ovulation and fertilization. The nurse bases the response to Cherralene on which​ rationale? a Three days on either side of ovulation is optimal for fertilization. b The ovum is fertile for only 18 hours. c Approximately 1 day before or after ovulation is optimal for fertilization. d A period of​ 48-72 hours after ovulation is ideal for fertilization.

d (Rationale Glycosuria is sometimes seen in pregnancy because of the kidneys​' inability to reabsorb all the glucose filtered by the glomeruli. Glycosuria may be normal or may indicate gestational​ diabetes, so the client should be further evaluated. Increasing fluids would not help with glycosuria. Glycosuria is not an indication for bed rest.)

During a routine prenatal​ visit, a client who is 24 weeks gestation is found to have glycosuria. After notifying the healthcare​ provider, which action should the nurse​ take? a Inform the client of the need for bed rest. b Instruct the client to increase fluid intake. c No action needs to be​ taken, as this is a normal finding. d Evaluate the client for gestational diabetes.

b (Rationale The unique nature of fetal circulation allows most fetal circulation to bypass the lungs and allows for most of the fetal blood to be shunted to the heart and brain)

During fetal​ circulation, most fetal blood is shunted away from which​ organ? a Brain b Lungs c Heart d Kidneys

b (Advantages of chorionic villus​ (CVS) sampling are that results are available within 24 hours and the diagnosis of​ anomalies, if​ present, can be made as early as 10 weeks gestation. CVS is performed at between 10 and 12 weeks​ gestation; testing any earlier increases the risk of fetal complications. CVS is an invasive testing procedure that involves sampling of the chorionic villi of the placenta. Fetal risks include limb​ reduction, rupture of​ membranes, spontaneous​ abortion, and Rh sensitization in​ Rh-negative women.)

How is chorionic villus sampling​ (CVS) beneficial for a pregnant woman and her​ fetus? a Noninvasive testing procedure b Time in which results become available c Occurs before 8 weeks gestation d No risk to developing fetus

d (Rationale Its higher affinity for oxygen allows fetal hemoglobin to carry​ 50% higher concentrations of oxygen than that of adults.)

How much more percentage of oxygen is carried in fetal hemoglobin when compared with adult ​hemoglobin? a 75 b 25 c 10 d 50

b,c,d (As long as a woman does not have any medical​ conditions, flying during pregnancy is safe. Some airlines have their own restrictions regarding pregnant​ passengers, so she should check with the airline. She should also stay hydrated and move around the cabin to prevent​ thrombophlebitis, but standing for long periods is not a good idea while pregnant.)

If a pregnant woman is planning to travel by​ airplane, you​ realize, as the​ nurse, that she should understand what​ behaviors? ​(Select all that​ apply). a Travel by car​ instead; flying while pregnant is unsafe. b Check with the airline to see if they have any specific travel restrictions during pregnancy. c Take time to move around the cabin. d Stay hydrated. e Stand as long as possible.

a,b,c,e (The nuchal translucency test​ (NTT) is a screening tool to assess fluid accumulation between the fetal cervical spine and the skin overlying the neck. A skinfolds measurement greater than 3 mm indicates an increased risk for Down syndrome. To diagnose an​ anomaly, an amniocentesis will be required after the NTT. Because this is a screening​ tool, there is the possibility of​ false-positive results. This information should be provided to the mother before testing to help her decide whether to have the testing. NT is performed only during weeks 11dash-13 of pregnancy.)

In preparing a client for a nuchal translucency test​ (NTT), what should the nurse include in the teaching​ plan? ​(Select all that​ apply.) a There may be​ false-positive results. b NTT is a screening​ test, not a diagnostic tool. c An amniocentesis may be needed after the NTT. d NTT is performed between 18 and 20 weeks​' gestation. e NTT is a noninvasive test.

c (Rationale The telophase of cellular division occurs when the cell divides into two daughter​ cells, each containing its own nucleus with 46 chromosomes and the same genetic makeup as the parent.​ Anaphase, interphase, and metaphase are other phases of cellular division.)

In which phase of cellular division does the cell divide into two daughter​ cells, each containing its own nucleus with 46 chromosomes and the same genetic makeup as its​ parent? a Metaphase b Interphase c Telophase d Anaphase

d (A nonreactive nonstress test requires repeating the test. Factors that may contribute to a nonreactive test include fetal sleep​ patterns, fetal​ hypoxia, maternal drug​ use, or congenital heart anomalies. The provider may be notified of an initial nonreactive stress​ test, but it is not standard practice to administer maternal oxygen in this case. There is no indication of fetal distress in the case​ presented, so it is not reasonable to anticipate a cesarean section delivery. Oxytocin is not administered as a component of nonstress testing.)

Janna Hall is having a nonstress test because she has recently been diagnosed with gestational diabetes. Her results indicate a nonreactive test. What is the​ nurse's initial nursing​ action? a Contact the operating room for urgent cesarean section. b Administer oxytocin. c Notify the provider and administer oxygen. d Repeat the nonstress test.

c (The nurse should counsel the client on the health effects pica could have on her and her baby. Although the nurse can recommend an​ over-the-counter laxative, once the client stops practicing​ pica, her constipation should resolve on its own. Pica is often cultural and common within the same family. This client should not need psychological help. Nurses should be nonjudgmental when counseling a woman on the effects of pica.)

Jasmine Williams complains of severe constipation at her regular prenatal visit. The nurse takes a nutritional​ history, and Ms. Williams divulges that she has been eating clay. What is the​ nurse's most appropriate​ response? a Tell Ms. Williams eating clay is disgusting and she should stop. b Prescribe a laxative. c Explain the health effects pica can have on Ms. Williams and her baby. d Refer Ms. Williams to a mental health professional. A medical provider assessing the fetal heart rate while examining a pregnant client during a prenatal visit.

b (Rationale During the moratorium phase in the second​ trimester, the father is bonding with the unborn child. This may lead to a fear of hurting the fetus during sexual intercourse. The announcement phase occurs during the first trimester and involves learning to cope with the reality of having a child. The focusing phase involves preparing for the birth of the child. Newborn phase is not a phase related to paternal bonding.)

Mr. and Mrs. Woodard are expecting their first child. They share with you that they have a fear of sexual intercourse and believe it could harm the fetus. Which phase of paternal bonding does this​ represent? a Announcement phase b Moratorium phase c Newborn phase d Focusing phase

b (Rationale There are three shunts that allow fetal blood to flow into the heart and​ brain, bypassing other organs in the body. The ductus venosus allows blood to flow from the umbilical vein into the​ heart, bypassing the liver. The foramen ovale connects the right and left atria. The ductus arteriosus allows blood flow from the aorta to the lower body. The umbilical vein is not a fetal shunt.)

Mrs. Chan is coming to the clinic for an initial prenatal visit. The nurse is teaching Mrs. Chan about process of fetal circulation. The nurse would explain to Mrs. Chan that most of the fetal blood bypasses the liver through which fetal​ shunt? a Foramen ovale b Ductus venosus c Ductus arteriosus d Umbilical vein

c (Rationale Mrs. Hernandez is exhibiting a positive sign of​ pregnancy, which is the palpation of fetal movements by the examiner. While she also has some presumptive and probable signs of​ pregnancy, the palpated movement of the fetus by the examiner is diagnostic of pregnancy.)

Mrs. Hernandez presents to the clinic stating that she believes she is pregnant. You note the following during​ assessment: client reports of nausea and​ vomiting, abdominal​ enlargement, and palpable fetal movement during the pelvic exam. Based on the​ indicators, which diagnosis do you anticipate for Mrs.​ Hernandez? a Presumptively pregnant b Not pregnant c Pregnant d Probably pregnant

c (Smoking any number of cigarettes while pregnant can have an adverse effect on the child. If the nurse suspects that a pregnant client is a​ smoker, the nurse should explain to her the risks to her unborn child and suggest ways she could quit.​ Twelve-step programs are generally used to help people quit alcohol or stop using illicit​ substances, not to quit smoking. Although it is not healthy for a woman to be smoking while​ pregnant, it is not helpful to tell a client that she should not be pregnant.)

Mrs. Meyers has just received a positive pregnancy test. The nurse notices that she smells like cigarettes even though she noted in her paperwork she is not a smoker. The nurse asks her again if she​ smokes, and she confesses she smokes less than half a pack a day. What type of information can the nurse provide to​ her? a Refer her to a​ 12-step rehabilitation program. b Tell her it is okay as long as she is not smoking more than 10 cigarettes a day. c Explain to her the negative effects that cigarettes could have on her pregnancy and refer her to a smoking cessation program. d Tell her she should not be pregnant if she is a smoker.

a (​Ptyalism, or increased​ salivation, may occur during pregnancy. Urinary frequency does occur during​ pregnancy, but that is a genitourinary complication. Diarrhea is not considered a common ailment of pregnancy.)

Ms. Radford tells you she is experiencing some gastrointestinal problems during her pregnancy. You anticipate she may report with which​ symptom? a Ptyalism b Diarrhea c Urinary frequency d Decreased salivation

b (Acknowledging her concerns and providing information that is both reassuring and factual is the best way to support the normal physiologic and psychological processes the mother experiences in the perinatal period. Telling the client not to worry or that she will get used to the idea of being pregnant is not therapeutic because it dismisses the​ client's concerns. Cesarean birth places the client at risk of injury through surgical complications and is not indicated unless the benefits clearly outweigh the risks)

Natasha Martin is a​ 19-year-old young woman at her intake visit for prenatal​ care, having found out 2 weeks before that she is pregnant with her first child. She tells the​ nurse, "I'm scared to have a baby. I think I might want to have a​ C-section. If a baby weighs 8​ pounds, doesn't it really damage the vaginal​ area?" What is the​ nurse's best​ response? ​a "It is so early in your pregnancy. You have plenty of time to get used to the idea of having a​ baby." ​b "I know it seems​ scary, but your body is designed to give birth without​ damage." ​c "I will schedule your next visit with your health care​ provider, who can plan the surgery for​ you." ​d "Don't worry. Your health care provider knows how to fix​ that."

c (Rationale In​ oligohydramnios, amniotic fluid is less than​ 50% of the amount expected for gestational age.)

Oligohydramnios is diagnosed when the amniotic fluid is less than which percent expected for gestational​ age? a 80 b 35 c 50 d 65

a (Rationale All clients should undergo a hemoglobin screen at their first prenatal visit to identify any variants. Clients of​ Mediterranean, Middle​ Eastern, African, and Indian descents are at a higher risk for inherited hemoglobinopathies and should be offered genetic counseling and screening for the father of the baby. Hemoglobin electrophoresis of the parents will identify variants. Gender does not play a role in inherited hemoglobinopathies. If the mother is heterozygous for a​ thalassemia, the baby may be homozygous through the​ father's genetic material.)

Sushila Patel is a​ 25-year-old woman who is at her first prenatal visit with her​ husband, Rajesh. She tells the nurse that anemia runs in her family and her uncle gets really sick and has to have blood transfusions. What is the​ nurse's best response to explain how this will affect the management of her​ pregnancy? ​a "At this​ visit, we will do labs that will tell us if your blood is abnormal. We can have you see a genetic counselor and test your husband too. The genetic counselor can determine whether your baby is at​ risk." b ​"This will only affect your baby if it is a boy. We can talk about it again after your anatomy​ ultrasound." ​c "There is no way for us to tell if your baby is at risk for​ that." ​d "If your blood count is​ normal, the baby should be​ fine."

d (All of these classes are useful for a teen​ parent, but a pregnancy in early adolescence is a major risk factor for repeat adolescent pregnancy. Contraception is a priority for this client.)

Teresa Gray is 15 years old and 36 weeks pregnant with her first baby. She lives with her mother and​ grandmother, who plan to help her with the baby. She tells the nurse that she has a hard time getting to the pregnancy classes that the nurse scheduled for her because her mother is at work during those times and Teresa​ doesn't like taking the bus. Which class should the nurse encourage Teresa to attend if she can get to only one of​ them? a Baby care b Participation for teen fathers ​c Driver's education d Birth control class

a,d,e (Rationale The federal government​'s WIC program provides nutritional education and counseling to​ low-income women and children. It also provides vouchers for nutritious​ foods, such as peanut​ butter, fruits,​ vegetables, and dairy foods. WIC does not provide vouchers for childcare or prenatal care.)

The WIC​ (Women, Infants, and​ Children) program provides​ low-income pregnant women with vouchers for​ what? ​(Select all that​ apply.) a Fruits and vegetables . b Childcare c Prenatal care d Peanut butter . e Dairy foods

a (Rationale Zinc is found in greatest concentration in​ meats, shellfish,​ poultry, legumes, and whole grains.​ Yogurt, bananas, and cabbage are high in other​ nutrients, but do not have significant levels of zinc.)

The nurse evaluates the diet of a pregnant client and finds that it is low in zinc. The nurse knows that zinc intake should increase during pregnancy to promote protein metabolism. Which food does the nurse suggest to the client to increase her intake of​ zinc? a Chicken b Cabbage c Bananas d Yogurt

c (Rationale Chromosomal mutations can occur during the second meiotic division. A nondisjunction occurs when an extra chromosome is added or deleted. A deletion occurs when a section of a chromosome is lost or broken. A translocation occurs if the broken segment becomes attached to another​ chromosome, usually its mate. Errors of implantation do not affect chromosomes.)

The nurse has received antenatal testing results on her client​'s ​fetus; they show a chromosomal nondisjunction. How can the nurse explain this phenomenon to the​ client? a The blastocyst was damaged during implantation. b A broken chromosomal segment became attached to another chromosome. c There was a problem with the meiotic division of the ovum and an extra chromosome was added. d A section of the chromosome is broken.

d (If a woman has gained too much weight during her​ pregnancy, she should be counseled to eat a​ nutritious, balanced diet. The nurse should focus on the quality of the​ woman's diet rather than the amount of weight she has gained. Although she may not seem to have eaten that much food in 24​ hours, the foods she has chosen are high in calories and do not provide a balanced diet. Pregnant women should not​ diet, but should focus on healthy eating choices.)

The nurse is assessing a pregnant​ client, Joy​ Stevens, who has come to the clinic for her​ 20-week prenatal checkup. Ms. Stevens has gained more than 30 lb.​ (13.6 kg) over her prepregnancy weight. The nurse takes a​ 24-hour diet recall history and learns that Ms. Stevens has eaten a doughnut for​ breakfast, a slice of pizza for​ lunch, and a hamburger with French fries for dinner. What recommendations does the nurse make to Ms. Stevens about her​ nutrition? a Tell her she needs to exercise more since her food intake does not seem like too much. b There is no recommendation to be made because nutrition counseling is not the​ nurse's responsibility. c Tell her to go on a diet. d Explain that she should focus on eating healthier​ foods, including fruits and vegetables.

c (Rationale Women who have low incomes may have difficulty meeting their nutritional needs due to a lack of financial resources. The client​'s diet may vary with​ age, marital​ status, and​ occupation, but these do not have the greatest impact on her nutritional status.)

The nurse is assessing the nutritional status of a client at 12 weeks gestation. The nurse asks the client about her lifestyle and eating habits. Which characteristic from the assessment data will have the greatest impact on the client​'s ​nutrition? a Occupation b Marital status c Income status d Age

b (Rationale Clients with gestational diabetes are​ 4-5 times more likely to develop gestational hypertension. Decreased oxygen​ saturation, tachycardia, and fever are not common in the third trimester in a woman with gestational diabetes mellitus.)

The nurse is aware that a client with gestational diabetes mellitus is most likely to exhibit which alteration in vital signs in the third​ trimester? a Decreased oxygen saturation b Hypertension c Fever d Tachycardia

d (Rationale Clients with sickle cell disease are at increased risk for urinary tract infection in pregnancy and should receive a urine culture in each trimester. Liver function is not affected by sickle cell disease. Amylase is a measure of pancreatic​ function, which is also not affected by sickle cell disease.)

The nurse is aware that additional laboratory screening is needed for clients with sickle cell disease. In addition to routine​ tests, which screening test would be​ appropriate? a Amylase b Liver function tests c Direct bilirubin d Urine culture

d (Rationale These results are normal with the exception of the​ 1-hr glucose tolerance test. The normal value is less than<140 ​mg/dL. This is a screening test. The client will not see the diabetic educator unless she is diagnosed with gestational diabetes. The diagnosis is made by administering an additional​ 3-hr glucose challenge.)

The nurse is calling a client to review lab results from the previous prenatal visit. The results include a​ 1-hr glucose tolerance test showing 154​ mg/dL, hemoglobin of 12​ g/dL, a negative HIV​ screen, and a nonreactive VDRL test. What counseling will the nurse include during this​ encounter? a Giving the client contact information for the diabetes educator b Advising the client to take an iron supplement c Reassuring the client that all screening tests are​ normal, and she should continue prenatal visits as scheduled d Advising the client to make an appointment as soon as possible for additional testing for gestational diabetes

c (Rationale The absence of menses is the earliest subjective symptom of pregnancy. A positive pregnancy​ test, abdominal​ enlargement, and the presence of Chadwick sign are all objective changes with pregnancy.)

The nurse is caring for a client who is experiencing nausea and vomiting. The nurse believes the client could be pregnant. Which subjective change should the nurse assess for in this​ client? a A pregnancy test b Presence of Chadwick sign c Last menstrual period d Abdominal enlargement

d (Rationale Class II cardiac heart disease is characterized by slight limitation of physical activity. It is asymptomatic at​ rest; symptoms occur with ordinary physical activity. Increased dyspnea at rest must be reported immediately because it may indicate increasing congestive heart failure. Mild ankle edema and weight gain of 1 pound a week are common during the third trimester. Emotional stress on the job can increase cardiac demand and should be reported only if the client experiences​ symptoms, such as palpations or irregular heart​ rate, indicating heart failure.)

The nurse is caring for a client with class II heart disease who is at 28 weeks gestation with her first pregnancy. The nurse teaches the client to immediately contact the healthcare provider if which condition​ occurs? a Mild ankle edema b Weight gain of 1 pound in a week c Emotional stress on the job d Increased dyspnea at rest

b (Rationale Pregnant women should avoid eating raw or undercooked​ meat, as this could place them at risk for contracting toxoplasmosis. The nurse should instruct the client to avoid eating cheeses made from unpasteurized milk to avoid contamination withListeria. The nurse should instruct the client to avoid eating any foods with raw​ eggs, such as cake batter or cookie dough. Pregnant women should not eat fish containing large amounts of mercury including​ swordfish, shark,​ tilefish, and king mackerel.)

The nurse is caring for a pregnant client who was seen in the emergency department with symptoms of a foodborne illness. Which practice will the nurse instruct the client to do based on the client​'s ​symptoms? a Limit tasting cake batter or cookie dough to a few times a week. b Avoid eating​ medium-cooked hamburgers. c Select swordfish when ordering at a restaurant. d Avoid eating cheese made from pasteurized milk.

b,d,e (Rationale The WIC​ (Women, Infants, and​ Children) program provides nutritional education and counseling to​ low-income women and children. The WIC program provides vouchers for dairy​ foods, whole-grain​ breads, cereals,​ juice, peanut​ butter, fruits, and vegetables. Women are able to receive assistance from this program throughout pregnancy and for 6 months after birth if formula​ feeding, and for a year if breastfeeding. Women of low income may qualify for a state food stamp​ program, but this is not affiliated with WIC. WIC is a program for​ low-income women and children.)

The nurse is caring for a pregnant client whose family has a very low income. The nurse discusses the​ Women, Infants, and Children​ (WIC) program with the client. Which services provided by this program should the nurse include in her​ teaching? ​(Select all that​ apply.) a All pregnant women are able to utilize the services of WIC. b WIC provides vouchers for certain foods. c WIC can provide food stamps for​ low-income women. d WIC provides nutritional education and counseling to women. e WIC services continue after pregnancy.

d (Rationale Adolescents may see pregnancy as a way to strike back at parents when they are angry. The access to and use of contraception will help to protect the adolescent from unplanned pregnancy. Teenage girls who are active in sports are less likely to become pregnant. Drug and alcohol use is a psychosocial risk factor for pregnancy. Participation in an activity that opposes drugs and alcohol will help prevent the use of these substances.)

The nurse is caring for an adolescent client who is seen in the clinic for a pelvic examination. Which client statement indicates to the nurse that there is a risk for​ pregnancy? a ​"I get my birth control pills from the free teen​ clinic." ​b "I joined the Students Against Drunk Driving club​ today." c ​"I will be tired after my volleyball game​ today." d ​"I want to run away from home​ sometimes."

c (Rationale: An ectopic pregnancy is the implantation of the fertilized ovum outside of the uterus. Pelvic Inflammatory Disease (PID) increases the chance of this condition. Clients with asthma, diabetes, or Multiple Sclerosis do not have an increased risk for an ectopic pregnancy. )

The nurse is counseling a client who has had an ectopic pregnancy. Which risk factor is associated with an increased chance of this condition? a Asthma b Diabetes c Pelvic Inflammatory Disease (PID) d Multiple Sclerosis

b (Rationale Exercise during pregnancy is healthy for most women. There are guidelines to​ follow, however. The nurse should advise at least 30 minutes of moderate exercise each day. A client who reports walking a total of 4 hours per day needs further assessment. The pregnant client should be educated to stop her routine when she feels tired.​ Swimming, walking, and bicycling are all appropriate forms of exercise. The pregnant client may have an altered center of gravity. Exercises should be completed with this in mind.)

The nurse is discussing exercise during pregnancy with a client who is at 30 weeks gestation. Which statement made by the client would require further assessment by the​ nurse? ​a "I am swimming 20 minutes each day at the​ YMCA." b ​"I walk on the treadmill for 4 hours a​ day." ​c "When I do my exercise​ video, I stop if I feel​ tired." ​d "I hold on to the handles when I am on the​ treadmill."

c (Rationale Human placental lactogen​ (hPL) (or human chorionic somatomammotropin​ [hCS]), stimulates maternal tissue insulin resistance during the second half of pregnancy. This is necessary to provide more glucose to the fetus. Human chorionic gonadotropin​ (hCG) is a glycoprotein that preserves the corpus​ luteum, making the endometrium more hospitable to the pregnancy. Estrogen enlarges the​ uterus, external​ genitalia, and the ductal system of the breasts. Progesterone is essential in maintaining the endometrium and reducing uterine muscle contractions to prevent spontaneous abortion.)

The nurse is educating a group of new nurses about placental development. What role does human placental lactogen​ (hPL) play in placental​ function? a Preserves the corpus​ luteum, making the endometrium more hospitable to the pregnancy. b Enlarges the​ uterus, external​ genitalia, and the ductal system of the breasts. c Stimulates maternal tissue insulin resistance during the second half of pregnancy. d Maintains the endometrium and reduces uterine muscle contractions to prevent spontaneous abortion.

c (Rationale The blastocyst implants in the uterine wall 7dash-10 days after fertilization.)

The nurse is educating a group of women about conception. During the​ session, the nurse identifies that implantation occurs how long after​ fertilization? a 24 hours b 2 weeks c 7 -10 days d 3 -5 days

b

The nurse is educating a pregnant client who is of normal​ pre-pregnancy weight about weight gain during pregnancy. What information should the nurse include when educating this​ client? a Weight gain needs to be up to 45 pounds. b Weight gain should be between 25 and 35 pounds. c Weight gain is the same for all women who are pregnant. d Weight gain is the same for a​ normal-weight woman as for an overweight woman.

a,c (Rationale: The glucose tolerance test is a standard screening test for all prenatal clients. A fasting plasma glucose level equal or greater than 92 mg/dl indicates gestational diabetes. The client should remain seated during the test as activity can alter the test results. It is inappropriate for a nurse to tell a client not to have an ordered test done. )

The nurse is educating a prenatal client on the glucose tolerance test ordered by the obstetrical provider. Which statement would the nurse include? (Select all that apply). a "This screening test is a standard part of prenatal care." b "A fasting plasma glucose level equal or greater than 85 mg/dl indicates gestational diabetes." c "You should remain seated during the test." d "This test is not standard, you do not need to have it done."

b (Rationale: When the pregnant woman lies supine, the enlarging uterus may press on the vena cava. This reduces blood flow to the right atrium; lowers blood pressure; and causes dizziness, pallor, and clamminess. It can be corrected by having the woman lie on her left side or by placing a pillow or wedge under her right hip as she lies in a supine position. )

The nurse is educating the pregnant client about the prevention of supine hypotensive syndrome. Which statement will the nurse include? a "The condition can be corrected by lying on your right side." b "The condition occurs when you are lying flat and your enlarging uterus presses on a major vein, causing a drop in your blood pressure." c "The condition occurs when you are on your stomach and your diaphragm is contracted, causing a drop in your blood pressure." d "You can prevent this by placing a pillow or wedge under your left hip when you are lying down."

c (Rationale: The psychological, cultural, and social ramifications of infertility can be extensive. The nurse ascertains the need for counseling and support during treatment. Medical insurance, allergies to seafood, and the female who works outside the home are not relevant to the question.)

The nurse is interviewing a client couple for an infertility work-up. Which topic will the nurse plan to discuss with the couple? a Whether the male has seafood allergies b Whether the couple has medical insurance c How infertility is affecting their lives d Whether the female works outside the home

d (Rationale ​High-risk sexual behavior​ (for example, having multiple sex partners and not using​ contraceptives) is a major factor contributing to teenage pregnancy. Oral​ sex, tobacco​ use, and pornography are not direct causes of pregnancy.)

The nurse is planning a teaching session at the local high school regarding teenage pregnancy. Which major risk factor will the nurse include in the​ presentation? a Oral sex b Access to pornography c Tobacco use ​d High-risk sexual behavior

a,b,c,d (Rationale Poverty is considered a factor that contributes to adolescent pregnancy. Up to 80dash-​85% of births to unmarried teens happen in economic levels below middle class. Lack of family support is considered a psychosocial factor that contributes to adolescent pregnancy. Many young women have a troubled history of drug use. Drug use is a psychosocial factor that puts young women at risk of pregnancy. Having multiple sexual partners increases the chances of pregnancy and sexually transmitted infections. Attending community college is not a factor that contributes to adolescent pregnancy but may cause pregnancies to be delayed.)

The nurse is preparing a health program for high school students. What should the nurse include as factors contributing to pregnancy in this age​ group? ​(Select all that​ apply.) a Drug use b Lack of family support c Poverty d Multiple sex partners e Attendance at community college

b (Rationale: Isoimmune hemolytic disease of the newborn occurs when the newborn's RBC's are attacked by antibodies from the mother. In order to help prevent this disease, pregnant women who are Rh negative will have the Indirect Coombs test done at 28 weeks gestation. If Rh antibodies are present, Rh immune globulin is not given. When Rh antibodies are present, the mother is considered sensitized. The Direct Coombs test is performed on babies, not the Indirect Coombs test. )

The nurse is providing education on isoimmune hemolytic disease of the newborn to a group of prenatal clients. Which statement will the nurse include? a "When Rh antibodies are present, the mother is considered unsensitized." b "Pregnant women who are Rh negative will have the Indirect Coombs test done at 28 weeks gestation." c "If Rh antibodies are present, Rh immune globulin is given." d "The Indirect Coombs test is performed on the baby of a mother who tests positive for Rh antibodies."

a (Rationale Obstetric​ factors, such as multifetal gestation and previous fetal​ loss, are indicators for antenatal testing. Mothers who are vegans may have special nutritional​ needs, but this factor alone does not indicate the need for fetal antenatal testing. Demographic factors such as age younger than 17 or older than 35 years may indicate the need for antenatal testing. A maternal age of 25 does not indicate that antenatal testing is needed. A maternal history of depression is not an indicator for antenatal testing. The mother should be monitored for signs and symptoms of depression.)

The nurse is reviewing the histories of four new prenatal clients. Which maternal risk factor could indicate the need for antenatal​ testing? a Mother with twin pregnancy b Maternal history of depression c Maternal age of 25 d Mother who is a vegan

b (Rationale Clients with symptomatic mitral valve prolapse may be prescribed propranolol. Warfarin is an anticoagulant and not used in pregnancy. Heparin is not indicated. Ardeparin can cause fetal malformations.)

The nurse is reviewing the medications for a client who is 14 weeks pregnant with her first child. The client​'s medical history is positive for mitral valve prolapse. Which medication would the nurse expect to be ordered for this​ client? a Warfarin​ (Coumadin) b Propranolol hydrochloride c Ardeparin​ (Normiflo) d Heparin

a,b,e (Rationale The innominate bones of the bony pelvis are made up of three fused​ bones: the​ ilium, the​ ischium, and the pubis. The sacrum is the bottom of the vertebral column and is made up of the five fused sacral vertebrae. The acetabulum is the point at which the​ ilium, ischium, and pubis meet to form the hip socket.)

The nurse is reviewing the structures of the bony pelvis and recognizes which structures as making up the innominate​ bones? ​(Select all that​ apply.) a Ilium b Ischium c Sacrum d Acetabulum e Pubis

a (Rationale: The female pelvis is made up of four bones: two innominate bones, the sacrum, and the coccyx. All other choices are incorrect.)

The nurse is teaching the student nurse about the role of the pelvis in childbearing. The nurse knows that the teaching has been effective when the student nurse states the bones in the pelvis include: a Two innominate bones, sacrum, and coccyx b Sacrum, femur, coccyx c Greater trochanter, sacrum, coccyx d One innominate bone, sacrum, and coccyx

a,b,e (Rationale As long as the woman has no complications or risk​ factors, the couple may continue to engage in sexual activity during her pregnancy.​ Complications, such as premature rupture of​ membranes, placenta​ previa, and signs of preterm​ labor, are all contraindications to sexual activity. While nausea may make a woman disinterested in sexual​ activity, it is not a contraindication.)

The nurse knows that what conditions are contraindications to sexual activity during​ pregnancy? ​(Select all that​ apply.) a Premature rupture of membranes b Placenta previa c There are no contraindications. d Nausea e Signs of preterm labor

b (Rationale: During pregnancy, increased estrogen production results in an increase and thickening of vaginal secretions. The uterus grows by cell hypertrophy, or cell enlargement, not by adding many new cells. Breasts that are red and hard, or dilation of the cervix in the second trimester, are abnormal findings)

The nurse teaches the client about which normal changes that occur in the reproductive system during pregnancy? a The uterus will grow by adding many new cells. b Vaginal secretions will increase and thicken. c The cervix will begin to dilate in the second trimester. d The breasts will become red and hard.

a,b,c (Rationale Couples may have many questions about sexual activity during pregnancy. This is safe for most​ couples; however, there are some contraindications. A pregnant client who experiences premature rupture of membranes is advised to discontinue sexual activity. The client with placenta previa is advised to maintain pelvic rest and stop sexual activity due to the increased risks of bleeding. Sexual activity may aggravate or increase the occurrence of preterm labor in a client who is at risk. There is no contraindication to sexual activity caused by gestational diabetes. Twin gestation is not a contraindication for sexual​ activity, unless there are other risk factors present such as signs of preterm labor.)

The nurse will recommend pelvic rest and no sexual activity for what types of complications during​ pregnancy? ​(Select all that​ apply.) a Placenta previa b Premature rupture of membranes c Signs of preterm labor d Twin gestation e Gestational diabetes

d ( Feedback Rationale: Beginning about the fourth week of pregnancy, vasocongestion in the pelvic area results in a bluish color to the vulva called Chadwick's sign. Hegar's sign is softening of the lower uterine segment; Goodell's sign is a softening of the cervix; and McDonald's sign is an ease in flexing the body of the uterus against the cervix)

The obstetrical provider examining a client at the first prenatal care appointment indicates the client's vaginal mucosa has a bluish tint. The nurse understands that this finding is called: a Hegar's sign b Goodell's sign c McDonald's sign d Chadwick's sign

d (Rationale For a woman of appropriate prepregnancy​ weight, 25 -35 lbs ​(11.3 -15.9 ​kg) of weight gain is recommended for optimal fetal growth and development. If the client asks a​ "why" question, it should be answered directly. Inadequate weight gain can lead to decreased fetal growth and development. Vitamin intake is related to the types of food​ consumed, not to caloric intake and weight gain.)

The prenatal clinic nurse is caring for an​ 18-year-old client who is at 10 weeks gestation in her first pregnancy. The client is 64 in.​ (1.6 m) tall and weighs 115 lb​ (52 kg). The client asks the nurse why she is supposed to gain so much weight during the pregnancy. What is the best response by the​ nurse? ​a "It's what your certified​ nurse-midwife recommended for​ you." ​b "Inadequate weight gain delays lactation after​ delivery." ​c "Weight gain is important to ensure that you get enough​ vitamins." d ​"Gaining 25 to 35 pounds is recommended for healthy fetal​ growth."

b (Rationale The sperm and ovum each contain 22 autosomes and 1 sex chromosome. The ovum contains an X sex chromosome and the sperm contains either an X or a Y sex chromosome. The genetic material combines at the same​ time, resulting in a total of 46 chromosomes. Two of these are sex chromosomes and 44 are the combined autosomes.)

The sperm and ovum each contain how many​ autosomes? a 46 b 22 c 44 d 24

b,c,d,e (Teens in the lower socioeconomic levels tend to maintain their pregnancies. Up to 80dash-​85% of births to unmarried teens happen in economic levels below middle class. Teenage girls who are active in school sports and are mentored are less likely to become pregnant. A pregnancy in early adolescence increases the likelihood of an additional pregnancy while a teenager. Teens who lack the support and the security of a family home are more likely to demonstrate​ high-risk behaviors. A teen with poor​ self-esteem may see the pregnancy as proof that she is loved by someone.)

What are risk factors for adolescent​ pregnancy? ​(Select all that​ apply.) a Excessive focus on sports b Previous pregnancy c Dysfunctional family relationships d Poor​ self-esteem e Poverty

a,d (Reasons for performing ultrasound during the first trimester​ include: to confirm a​ pregnancy, to verify the location of the​ pregnancy, to determine gestation​ age, to confirm the viability of the​ pregnancy, and to assist with amniocentesis. Ultrasound may be used to determine the gender of the fetus and estimate amniotic fluid​ volume, but not until the second trimester.)

What indications would call for a woman to have an ultrasound test during the first trimester of​ pregnancy? ​(Select all that​ apply.) a To verify location of the pregnancy b To estimate amniotic fluid volume c To assist with amniocentesis d To confirm pregnancy viability e To determine gender of the fetus

c (The cervical softening associated with pregnancy is referred to as Goodell sign. Chadwick sign is indicated by the increased vascularity and bluish coloration of the endocervical canal during pregnancy. Softening of the lower uterine segment is known as Hegar sign. The Brudzinski sign relates to spinal meningitis.)

What is the cervical softening of pregnancy​ called? a Chadwick sign b Hegar sign c Goodell sign d Brudzinski sign

b (Rationale Anemia in pregnancy is defined as hemoglobin levels of less than 11​ g/dL. Anemia is anticipated in pregnancy because of increased plasma volume so hemoglobin above 11​ g/dL is considered normal. The diagnosis is not based on symptoms. Below 7​ g/dL is severe anemia.)

What is the definition of anemia in​ pregnancy? a Hemoglobin of less than 13​ g/dL b Hemoglobin of less than 11​ g/dL c Hemoglobin of less than 7​ g/dL d Exhibiting symptoms of anemia regardless of laboratory values

d (Carbohydrates are the main source of energy for the body. Carbohydrates should account for 55 -​60% of daily caloric intake.)

What percentage of a pregnant client​'s daily caloric intake should be​ carbohydrates? a Pregnant women should restrict their carbohydrate consumption. b 30 -​40% c 15 -​20% d 55 -​60%

a,c,d (Rationale ​FSH, LH, and prolactin are produced in the anterior pituitary gland. GnRH is produced in the hypothalamus. Estrogen is produced in the corpus luteum of the ovaries and the placenta.)

When teaching about the female reproductive​ cycle, the nurse explains that the anterior pituitary gland produces which​ hormone? ​(Select all that​ apply.) a Prolactin ​b Gonadotropin-releasing hormone​ (GnRH) c Luteinizing hormone​ (LH) d ​Follicle-stimulating hormone​ (FSH) e Estrogen

b (Rationale: An independent intervention is one in which the nurse may provide without a physician order while a collaborative intervention involves both the nurse and another member of the healthcare team. The nurse assisting in pain management, by repositioning the client and administering the ordered analgesic, is the only option that is both an independent and a collaborative intervention. )

Which action is both an independent and a collaborative intervention for the client with an ectopic pregnancy? a The nurse administers the ordered IV solution and analgesic to the patient. b The nurse assists in pain management by repositioning the client and administering the ordered analgesic. c There are no interventions that are both independent and collaborative. d The nurse provides tissue to the client and allows the client to have her privacy.

a,c,e (Known risk factors for gestational diabetes mellitus​ (GDM) include​ obesity, chronic​ hypertension, family history of​ diabetes, maternal age greater than​ 25, previous infant birth weight greater than​ 4,000 g, and gestational GDM in a previous pregnancy. Maternal age of less than 25 years is not considered a risk factor. Nutrition and weight are important during​ pregnancy, but being underweight is not a risk factor for GDM)

Which are risk factors for gestational diabetes mellitus​ (GDM)? ​(Select all that​ apply.) a Family history of diabetes b Underweight for height c GDM in previous pregnancy GDM d Maternal age less than 25 e Chronic hypertension

c,d,e (Rationale ​Maternal-fetal exchange of gases and nutrients occurs through the metabolic functions of the placenta. The exchange occurs in the intervillous spaces within the cotyledons of the placenta. Excretion is also a metabolic function of the placenta. The placenta does produce​ hormones, but this secretion is considered an endocrine function of the​ placenta, not metabolic. Red blood cells are produced by the​ liver, not the placenta.)

Which are the metabolic functions of the​ placenta? ​(Select all that​ apply.) a Hormone production b Red blood cell production c Nutrition d Excretion e Fetal gas exchange

a,b (Rationale Aortic rupture is an adverse effect that may be seen with Marfan syndrome. Peripartum cardiomyopathy​ is, by​ definition, cardiac failure. Mitral valve prolapse is usually asymptomatic. Surgically corrected cardiac malformations are generally unaffected by pregnancy.​ Beta-thalassemia is a blood​ disorder, not a cardiac disorder.)

Which cardiac disorders may result in maternal death in the perinatal​ period? ​(Select all that​ apply.) a Peripartum cardiomyopathy b Marfan syndrome c Mitral valve prolapse d Surgically corrected congenital anomalies ​e Beta-thalassemia

d (The mask of​ pregnancy, or​ chloasma, is a​ blotchy, brownish discoloration of the skin over the​ forehead, cheeks, and bridge of the nose. Linea nigra refers to the darkened line over the midline of the abdomen extending from the umbilicus to the pubic area. Lordosis is an abnormal curvature of the spine in relation to the​ pregnancy, not a skin change. Striae​ gravidarum, or stretch​ marks, are linear tears in the connective tissues of the​ abdomen, breasts,​ buttocks, or thighs.)

Which change of pregnancy involves a brownish discoloration of the​ forehead? a Lordosis b Linea nigra c Striae gravidarum d Chloasma

d (Hypoglycemia can occur in the newborn once the umbilical cord is cut. This leaves the newborn with a diminishing supply of glucose but an excessive supply of circulating insulin. Hyperbilirubinemia may occur if the newborn​'s immature liver cannot metabolize bilirubin. Since it occurs after 20 weeks​ gestation, gestational diabetes is not associated with spontaneous abortion. Neither hypoxia nor hypertension is an effect seen in the newborn whose mother had gestational diabetes mellitus.)

Which condition occurs in the initial newborn period due to maternal​ diabetes? a Hypobilirubinemia b Hypoxia c Hypertension d Hypoglycemia

b,d,e (It may be helpful for the nurse to provide anticipatory guidance on the discomforts the pregnant woman might encounter during her pregnancy. Among them are leg​ cramps, heartburn, and nasal stuffiness and nosebleeds. Most pregnant women do not experience excessive energy or dry mouth.)

Which discomforts can the nurse tell a woman she might experience during her​ pregnancy? ​(Select all that​ apply.) a Dry mouth b Nasal stuffiness and nosebleeds c Excessive energy d Leg cramps e Heartburn

b (Rationale Kegel exercises strengthen the perineal muscles and can help prevent​ cystocele, rectocele, uterine​ prolapse, and stress incontinence later in life. Pelvic tilt exercises are useful for relieving back​ pain, partial​ sit-ups can strengthen the abdominal​ muscles, and swimming is a good form of general exercise while pregnant.)

Which exercise can the nurse recommend to a pregnant woman to strengthen her perineal​ muscles? a Pelvic tilt exercises b Kegel exercises c Swimming d Partial​ sit-ups

a,b,c,d (Rationale A woman​'s ability to adapt psychologically to pregnancy depends on a variety of​ factors, including maternal​ age, psychosocial​ support, socioeconomic​ status, and cultural beliefs. Developmental age affects the ability to adapt to​ pregnancy; an adolescent may have difficulty with this task. Adequate support is needed to experience the role transitions of pregnancy. Poverty and unemployment may negatively affect pregnancy outcomes. Cultural beliefs affect health care practices during pregnancy. The gender of the fetus should not affect a woman​'s ability to adapt to pregnancy.)

Which factors affect the ability of the pregnant woman to adapt to​ pregnancy? ​(Select all that​ apply.) a Socioeconomic status b Maternal age c Psychosocial support d Cultural beliefs e Gender of the fetus

d (Older mothers are at a greater risk for having a baby with Down syndrome and should be offered genetic counseling and screening. Babies of mothers with diabetes are at higher risk for macrosomia. Polydactyly is often familial. Club feet are not known to be more common in babies born to women older than 35.)

Which fetal abnormalities are more likely when the mother is over 35 years of​ age? a Macrosomia b Polydactyly c Club feet d Down syndrome

a,b,c,e (Rationale Presumptive indicators of pregnancy are those subjective signs or symptoms that a woman reports. These signs may be attributed to something other than pregnancy. They include​ amenorrhea, breast​ tenderness, fatigue, and urinary frequency.)

Which sign and symptom is considered a presumptive indicator of​ pregnancy? ​(Select all that​ apply.) a Fatigue b Amenorrhea c Urinary frequency d Abdominal enlargement e Breast tenderness

a,b (Rationale: Because some semen is released before ejaculation, coitus interruptus has an 18% failure rate and would not be considered a highly effective means of preventing pregnancy. Not having other sex partners and wanting children later are not relevant to this problem. Coitus interruptus is both inexpensive and natural, even if not always effective. )

Which statement by the client could indicate a potential problem for the couple planning to use coitus interruptus? (Select all that apply.) a "I really do not want to get pregnant right now, so we need a very effective method." b "I can always pull out before I ejaculate." c "We don't have any other sex partners." d "We want a contraceptive method that is inexpensive and natural." e "We want to have three children eventually."

a (Rationale Bulimia is a condition characterized by binge eating followed by purging. Because women with bulimia are often a normal​ weight, it is difficult to recognize those who have the condition. Women with​ anorexia, not​ bulimia, are often underweight. Bulimia causes​ pregnancy-related problems because it affects nutrient absorption and in turn affects fetal growth and development.)

Why might it be difficult for the prenatal nurse to recognize bulimia in a pregnant​ woman? a Women with bulimia are often a normal weight. b Women with bulimia are often very underweight. c Pregnancy hides weight gain. d Bulimia does not cause​ pregnancy-related problems.

c (Toxoplasmosis is a disease caused by a protozoan found in undercooked or raw meat that could have devastating effects on the fetus. Salmonella and Listeria can be contracted through raw eggs and dairy products. Large amounts of mercury can sometimes be found in certain types of​ fish, and pregnant women should be counseled to consume only the amounts recommended by government guidelines.)

Why should the prenatal nurse counsel a pregnant woman to avoid eating undercooked​ meat? a It would put her at risk for Listeria monocytogenes. b It would put her at risk for Salmonella poisoning. c It would put her at risk for toxoplasmosis. d It would put her at risk for mercury poisoning.

b,c,e (Rationale Reproductive system changes during pregnancy include uterine enlargement with an increase in uterine muscle​ fibers, secretion of progesterone from the corpus​ luteum, and prominent superficial veins developing on the breasts. Vaginal tissue softens and vascularity​ increases, resulting in Chadwick​ sign; pH becomes acidic. Estrogen triggers formation of the mucus plug that seals the endocervical canal.)

he nurse is completing an assessment on a woman who is at 10 weeks gestation. The nurse is aware that which anatomic and physiologic changes occur in​ pregnancy? ​(Select all that​ apply.) a Vaginal tissue firms with a decrease in vascularity. b Uterine enlargement occurs with an increase in uterine muscle fibers. c Corpus luteum secretes progesterone that supports the pregnancy. d Progesterone triggers the cervix to produce thick mucus. e Superficial veins on the breasts become more prominent.

d (Rationale The startle reflex is present at 24 weeks of development. Fetal heart tones are audible between 17 and 20 weeks. The lungs start producing surfactant between 30 and 34 weeks. Vernix caseosa begins to disappear at 38 -40 weeks.)

he nurse is reviewing fetal development with a woman who is 24 weeks pregnant. Which milestone should the nurse expect at this stage of the​ pregnancy? a Vernix caseosa is disappearing. b Fetal heart tones are audible. c Lungs are producing surfactant. d Threshold of fetal viability.