Maternal-Child Exam 1 Practice Questions

A couple who recently emigrated from Israel tells a nurse in the prenatal clinic that they are concerned about a genetic disease that is prevalent among Jewish people. Which genetic screening should the nurse expect the health care provider to recommend to determine the possibility of the couple's child's inheriting the disease? 1 Cystic fibrosis 2 Phenylketonuria 3 Turner syndrome 4 Tay-Sachs disease

4 Tay-Sachs disease is a genetic disorder transmitted as an autosomal recessive trait that occurs primarily among Ashkenazi Jews. Tay-Sachs disease does not have a higher prevalence in the Jewish population.

A 37-year-old woman agrees to have a prenatal test done to diagnose fetal defects. There is a history of Down syndrome in her family, and this is her first pregnancy. Which invasive prenatal test provides the earliest diagnosis and rapid test results? 1 Nonstress test 2 Amniocentesis 3 Chorionic villus sampling 4 Percutaneous umbilical blood sampling

3 Chorionic villus sampling may be performed between 10 and 12 weeks' gestation. Amniocentesis may be performed after 14 weeks' gestation, when sufficient amniotic fluid is available. Direct access to the fetal circulation with percutaneous umbilical blood sampling may be performed during the second and third trimesters. The nonstress test, which is not invasive, is a technique used for antepartum evaluation of the fetus; it does not reveal fetal defects.

A pregnant woman tells a nurse in the prenatal clinic that she knows that folic acid is very important during pregnancy and that she is taking a prescribed supplement. She asks the nurse what foods contain folic acid (folate) so she may add them to her diet in its natural form. Which foods should the nurse recommend? Select all that apply. 1 Beef and fish 2 Milk and cheese 3 Chicken and turkey 4 Black and pinto beans 5 Enriched bread and pasta

4, 5 Legumes contain large amounts of folate, as do enriched grain products. Beef and fish do not contain an adequate amount of folate. Milk and cheese do not contain adequate amounts of folate; nor does fowl.

A client who is visiting the prenatal clinic for the first time has a serology test for toxoplasmosis. What information about the client's activities in the history indicates to the nurse that there is a need for this test? 1 The client takes care of a cat. 2 The client works as a dog trainer. 3 The client uses chemical cleaners. 4 The client consumes raw vegetables

1 Toxoplasmosis is caused by a protozoal parasite; cats acquire the organism by ingesting infected mice or birds, and the cysts are found in their feces. Working with cats, not dogs, poses a potential problem with toxoplasmosis. Chemical cleaners may be teratogenic, but they do not cause toxoplasmosis. Eating raw vegetables of any kind does not cause toxoplasmosis.

A client at 16 weeks' gestation calls the nurse at the prenatal clinic and states that her partner just told her that he has genital herpes. What should the nurse include when teaching the client about sexual activity? 1 Condoms must be used when the couple is having intercourse. 2 Sexual abstinence should be practiced during the last 6 weeks. 3 It will be necessary to refrain from sexual contact during pregnancy. 4 Meticulous cleaning of the vaginal area after intercourse is essential.

2 Abstinence during the 4 to 6 weeks before term is the best way to avoid contracting the virus and having an outbreak before the birth. Because the herpes virus is smaller than the pores of a condom, this type of protection has limited effectiveness. Abstinence is necessary only when disease symptoms are present in the partner and during the last 4 to 6 weeks of pregnancy. Washing is not sufficient to prevent contraction of this virus; contact already has been made.

During her first visit to the prenatal clinic a client is found to be obese. During the ensuing 5 months, the client has not been successful adhering to her nutritional plan. Which finding indicates to the nurse that the client has been successful during the sixth month? 1 Weight loss of 1 lb 2 Weight gain of 2 lb 3 No change in weight from last month 4 The client's statement that she lost weight last week

2 Although obese, the client must gain weight to meet the fetus's nutritional needs, and this weight gain is appropriate. Weight loss is contraindicated during pregnancy because it may interfere with fetal growth and development. Maintaining the same weight from last month to this month may indicate that the nutritional needs of the fetus are not being met. The client's statement that she lost weight last week does not constitute objective data.

A client arrives at the prenatal clinic and tells the nurse that she thinks that she is pregnant. The first day of the client's last menstrual period (LMP) was September 14, 2011. Using Nägele's rule, what day of June 2012 is the client's estimated date of birth (EDB)? Record your answer using a whole number for the day of the month.

21 Add 7 days to the 1st day of the LMP and subtract 3 months.

A client who is at 12 weeks' gestation tells a nurse at the prenatal clinic that she is experiencing severe nausea and frequent vomiting. The nurse suspects that the client has hyperemesis gravidarum. What factor is frequently associated with this disorder? 1 History of cholecystitis 2 Large amount of amniotic fluid 3 High level of chorionic gonadotropin 4 Decreased secretion of hydrochloric acid

3 A high level of chorionic gonadotropin is frequently associated with severe vomiting during pregnancy and may result in hyperemesis gravidarum. A high level may also occur in the presence of a hydatidiform mole or multiple pregnancy. Cholecystitis is unrelated to this problem. Hydramnios (excessive amniotic fluid) is associated with multiple gestations and some fetal abnormalities. There are no data to indicate that there is decreased gastric acid secretion during the first trimester, and this is not the cause of hyperemesis gravidarum.

During a physical in the prenatal clinic the client's vaginal mucosa is noted to have a purplish discoloration. What sign should the nurse document in the client's clinical record? 1 Hegar 2 Goodell 3 Chadwick 4 Braxton Hicks

3 A purplish coloration, called the Chadwick sign, results from the increased vascularity and blood vessel engorgement of the vagina. The Hegar sign is softening of the lower uterine segment. The Goodell sign is softening of the cervix. After the fourth month of pregnancy, irregular, painless uterine contractions, called Braxton Hicks contractions, can be felt through the abdominal wall.

A client tells a nurse in the prenatal clinic that she has vaginal staining but no pain. Her history reveals amenorrhea for the last 2 months and pregnancy confirmation after her first missed period. What type of abortion is suspected? 1 Missed 2 Inevitable 3 Threatened 4 Incomplete

3 Spotting in the first trimester may indicate that the client is having a threatened abortion; any client with the possibility of hemorrhage should not be left alone, so her admission to the hospital helps ensure her safety. A missed abortion may not cause any outward signs or symptoms, except that the signs of pregnancy disappear. An inevitable abortion can be confirmed only if vaginal examination reveals cervical dilation. With an incomplete abortion some, but not all, of the products of conception have been expelled.

While the client is in active labor with twins and the cervix is 5 cm dilates, the nurse observes contractions occurring at a rate of every 7 to 8 minutes in a 30-minute period. Which of the following would be the nurse's most appropriate action? A. Note the fetal heart rate patterns B. Notify the physician immediately C. Administer oxygen at 6 liters by mask D. Have the client pant-blow during the contractions

B. Notify the physician immediately The nurse should contact the physician immediately because the client is most likely experiencing hypotonic uterine contractions. These contractions tend to be painful but ineffective. The usual treatment is oxytocin augmentation, unless cephalopelvic disproportion exists.

A woman is being seen in the prenatal clinic at 36 weeks' gestation. The nurse is reviewing signs and symptoms that should be reported to health care provider with the mother. Which signs and symptoms require further evaluation by the health care provider? Select all that apply. 1 Decreased urine output 2 Blurred vision with spots 3 Urinary frequency without dysuria 4 Heartburn after eating a fatty meal 5 Contractions that are regular and 5 minutes apart 6 Shortness of breath after climbing a flight of stairs

1, 2, 5 Decreased urine output, blurred vision, and severe headache may occur with pregnancy-associated hypertension. Contractions that become regular are associated with the onset of labor. Preparatory (Braxton Hicks) contractions ease when the client walks. Swelling of the face and hands is a warning sign. Urinary frequency occurs in the first trimester and again in the third trimester as the uterus settles back into the pelvis. The weight of the uterus may delay emptying of the stomach and make heartburn a more frequent problem. Shortness of breath would be expected after the client climbs a flight of stairs.

On her first visit to the prenatal clinic, a client tells the nurse she is ambivalent about continuing the pregnancy. Why does the nurse conclude that the client is experiencing a crisis? 1 Mood changes occur during pregnancy. 2 Pregnancy is a period of change and adjustment to change. 3 Hormonal and physiologic changes occur during pregnancy. 4 Pregnancy changes the future parents' relationship with each other

2 Expected periods of marked change and adjustment are called developmental crises. Mood changes are transient; they are similar to previous mood changes and should not affect the client's ability to cope. Hormonal and physiologic changes occur throughout the life cycle of a mature woman and should not now be classified as a crisis. Pregnancy becomes a crisis if the client's partner withdraws support.

A 16-year-old adolescent visits the prenatal clinic because she has missed three menstrual periods. Before her physical examination she says, "I don't know what the problem is, but I can't be pregnant." What is the nurse's most therapeutic response? 1 "Many young women are irregular at your age." 2 "You probably are pregnant if you had intercourse." 3 "Why did you decide to come to the prenatal clinic?" 4 "Should I ask the health care provider to talk to you?"

3 Asking the client why she came to the prenatal clinic points out reality and allows the client to elaborate. Although it is true that many young women's periods are irregular, stating this does not encourage further communication. Telling the client that she is probably pregnant implies that the nurse does not believe the client and will probably cut off further communication. Asking whether the nurse should have the health care provider talk to the client abdicates the nurse's responsibility; also, it may cut off further communication.

A nurse is planning a prenatal class about the changes that occur during pregnancy and the necessity of routine health care throughout pregnancy. Which cardiovascular compensatory mechanisms should the nurse explain will occur? Select all that apply. 1 Systemic vasodilation 2 Increased blood volume 3 Increased blood pressure 4 Increased cardiac output 5 Enlargement of the heart 6 Decreased erythrocyte pr

2, 4, 5 Blood volume increases to meet the metabolic demands of pregnancy. Increased cardiac output is necessary to accommodate the increased blood volume needed to meet the demands of the growing fetus. Cardiac hypertrophy is a result of the demands made by the increased blood volume and cardiac output. Systemic vasodilation is not expected. There is little variation in blood pressure but a slight decrease during the second trimester. Erythrocyte production increases; because the plasma volume increases more than the red blood cell count, the hematocrit is lower.

A client in the prenatal clinic is diagnosed with preeclampsia. What clinical findings support this diagnosis? 1 Increased blood pressure of 150/100 mm Hg 2 Increased blood pressure that is accompanied by a headache 3 Blood pressure above the baseline that fluctuates with each reading 4 Blood pressure higher than 140 mm Hg systolic accompanied by proteinuria

4 A blood pressure higher than 140 mm Hg systolic and 90 mm Hg diastolic along with proteinuria is diagnostic of preeclampsia; assessments should be performed twice, 4 to 6 hours apart. Hypertension alone does not support a diagnosis of preeclampsia. Hypertension accompanied by a headache is not necessarily indicative of preeclampsia. Blood pressure above the baseline and fluctuating with each reading may occur at any time, not specifically in a client with gestational hypertension.

A nurse in the prenatal clinic is assessing a woman at 34 weeks' gestation. The client's blood pressure is 166/100 mm Hg and her urine is +3 for protein. She states that she has a severe headache and occasional blurred vision. Her baseline blood pressure was 100/62 mm Hg. What is the priority nursing action? 1 Arranging transportation to the hospital 2 Obtaining a prescription for an antihypertensive 3 Rechecking the blood pressure within 30 minutes 4 Obtaining a prescription for acetaminophen to relieve the headache

1 The client has severe preeclampsia, which develops suddenly with a blood pressure of 160/110 mm Hg or higher and proteinuria of +2 to +3 or more. Severe headache and blurred vision are typical symptoms. The client needs immediate treatment to prevent eclampsia. There is no time to obtain or administer antihypertensive medication. This is an emergency situation; waiting 30 minutes to recheck the blood pressure will put both client and fetus in further danger. Having acetaminophen prescribed to relieve the headache is unsafe and places both client and fetus in jeopardy.

A pregnant client is asking the nurse when she will gain the most weight. At which time during prenatal development should the nurse tell the client to expect the greatest fetal and maternal weight gain? 1 Third trimester 2 Second trimester 3 First eight weeks 4 Implantation period

1 The third trimester is the period in which the fetus stores deposits of fat. There is growth, but fat deposition does not occur in the second trimester. The first 8 weeks is the period of organogenesis, when cells differentiate into major organ systems. The implantation period is the period of the blastocyst, when initial cell division takes place.

While conducting prenatal teaching, a nurse should explain to clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. What causes this increase? 1 Decreased metabolic rate 2 Increased production of estrogen 3 Secretion from the Bartholin glands 4 Supply of sodium chloride to the vaginal cells

2 Increased estrogen production during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells. Increased metabolism leads to systemic changes but does not increase vaginal discharge. The amount of secretion from the Bartholin glands, which lubricates the vagina during intercourse, remains unchanged during pregnancy. There is no additional supply of sodium chloride to the vaginal cells during pregnancy.

A client visits the prenatal clinic because her menstrual period is late. Her last period was April 5. Testing confirms that she is pregnant. According to Nägele's rule, what date should the nurse provide as the expected date of birth (EDB)? 1 January 5 2 January 12 3 January 19 4 January 26

2 January 12 is the EDB. Using Nägele's rule, subtract 3 months and add 7 days from the client's last menstrual period. January 5, January 19, and January 26th all represent inaccurate applications of Nägele's rule.

During her first prenatal visit a client tells the nurse that she needed an exchange transfusion when she was born because of Rh incompatibility. She asks the nurse whether her baby will need one also. How should the nurse respond? 1 "Your baby has a 50% chance of being affected." 2 "You should have no problem, because you're Rh positive." 3 "You'll be given RhoGAM, which will prevent the development of antibodies." 4 "Your baby's cord blood will be tested to determine whether there's going to be a problem."

2 Rh incompatibility occurs if the mother is Rh negative and becomes sensitized and the infant is Rh positive. Because the client had Rh incompatibility, she is Rh positive, and her infant will not be affected. There is no chance that the newborn will have Rh incompatibility. RhoGAM is given to an unsensitized Rh-negative mother who had an Rh-positive infant to prevent her from becoming sensitized if she has another Rh-positive infant. The Coombs test is performed if the mother is Rh negative and the infant is Rh positive

During a client's first visit to the prenatal clinic, a nurse discusses a pregnancy diet. The client states that her mother told her that she should restrict her salt intake. What is the nurse's best response? 1 "Your mother is always correct. You should use less salt to prevent swelling during pregnancy." 2 "Because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet." 3 "Salt is an essential nutrient that is naturally reduced by the body's estrogen. There's no reason to restrict salt in your diet." 4 "We no longer recommend that salt intake be as restricted as much as in the past, but you still shouldn't add salt to your food."

2 Sodium is needed to maintain body water balance; sodium requirements increase slightly during pregnancy to accommodate the increased blood volume. A healthy pregnant woman should not limit her sodium intake. Using less salt could be detrimental to the client's health. Sodium, although essential, is not a nutrient but a mineral. There are no restrictions on salt intake during a healthy pregnancy without compelling indications.

During a routine prenatal visit, a client tells a nurse that she gets leg cramps. What condition does the nurse suspect, and what suggestion is made to correct the problem? 1 Hypercalcemia; avoid eating hard cheeses. 2 Hypocalcemia; increase her intake of milk. 3 Hyperkalemia; consult her health care provider. 4 Hypokalemia; increase intake of green leafy vegetables

2 The most likely cause is a disturbance in the ratio of calcium to phosphorus, with the amount of serum calcium reduced and the serum phosphorus increased; milk and other dairy products are excellent sources of calcium. Leg cramps are related to hypocalcemia, not to hypercalcemia. An increased potassium level manifests as muscle weakness. A low potassium level is evidenced by fatigue and muscle weakness.

A client at 7 weeks' gestation tells a nurse in the prenatal clinic that she is sick every morning with nausea and vomiting and adds that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of the: 1 Fifth month 2 Third month 3 Fourth month 4 Second month

2 Because of a decrease in chorionic gonadotropin, morning sickness seldom persists beyond the first trimester. Morning sickness usually ends at the end of the third month, when the chorionic gonadotropin level falls. It is still present in the second month because of the high level of chorionic gonadotropin.

A client is to undergo a tuberculin test as part of her prenatal workup. Before administering the test, what information about the client should the nurse obtain? 1 Whether she has had a previous tuberculin test 2 Whether the client is prone to respiratory diseases 3 Whether an earlier tuberculin test's result was positive 4 Whether the client's family has a history of tuberculosis

3 A tuberculin test should not be administered to a client with a previous positive result on a tuberculin test because a severe reaction may occur at the test site in a previously sensitized individual. It is more important to know whether the test result was positive than whether a test was performed. Being prone to respiratory diseases is not a contraindication to having a tuberculin test unless the client is infected with tuberculosis. Although a family history may have involved exposure of the client to tuberculosis, the client may not have had a positive tuberculin test result; also many years may have elapsed since the exposure.

A client at 38 weeks' gestation is admitted to the prenatal unit with preeclampsia. A loading dose of magnesium sulfate is administered, and the dosage is subsequently lowered to a maintenance dosage. What is the most important parameter for the nurse to assess while monitoring the client for magnesium sulfate toxicity? 1 Pulse rate 2 Daily weight 3 Patellar reflex 4 Blood pressure

3 An absence of deep tendon reflexes is one of the first signs of magnesium sulfate toxicity. Magnesium sulfate interferes with the release of acetylcholine at the synapses, thereby decreasing neuromuscular irritability. Magnesium sulfate toxicity cannot be determined by alterations in the maternal heart rate or blood pressure. Diuresis and its related weight loss are signs of the therapeutic effect of magnesium sulfate.

A nurse is reviewing the obstetric history of a client who had an abruptio placentae. What prenatal condition does the nurse expect the client to have had? 1 Cardiac disease 2 Hyperthyroidism 3 Gestational hypertension 4 Cephalopelvic disproportion

3 Hypertension during pregnancy leads to vasospasm; this in turn causes the placenta to tear away from the uterine wall (abruptio placentae). Generally cardiac disease does not cause abruptio placentae. Hyperthyroidism may cause an endocrine disturbance in the infant but does not affect blood supply to the uterus. Cephalopelvic disproportion may affect the birth of the fetus but does not affect the placenta. Test-Taking Tip: Read the question carefully before looking at the answers. 1) Determine what the question is really asking; look for key words. 2) Read each answer thoroughly and see if it completely covers the material asked by the question. 3) Narrow the choices by immediately eliminating answers you know are incorrect.

A nurse in the prenatal clinic assesses clients for signs of preeclampsia. What sign, other than increased blood pressure, may indicate preeclampsia? 1 Positive nonstress test 2 Negative contraction stress test 3 Weight gain of 6 lb in 1 month 4 Fetal heart rate below 120 beats/min

3 In preeclampsia, renal blood flow and the glomerular filtration rate are decreased, resulting in fluid retention and rapid weight gain. A positive nonstress test and negative contraction stress test each indicate fetal well-being. The fetal heart rate in a healthy fetus ranges from 110 to 160 beats/min.

A pregnant woman with a history of heart disease visits the prenatal clinic at the end of her second trimester. What does the nurse anticipate about the care she will need? 1 Preparation for a cesarean birth 2 Bedrest during the last trimester 3 Prophylactic antibiotics at the time of birth 4 Increasing dosages of cardiac medications as pregnancy progresses

3 Prophylactic antibiotics are given to clients with heart disease to reduce their risk for bacterial endocarditis. A vaginal birth, with a shortened second stage and an assisted birth involving forceps or vacuum extraction, is preferred. The data do not indicate which class of heart disease the client has; if it is class I and there is no cardiac decompensation, activities may be restricted but bedrest is not necessary. Increasing the dosages of the client's cardiac medications may or may not be necessary; dosages are based on each individual's response to the stress imposed by pregnancy.

A client who is at 26 weeks' gestation tells a nurse at the prenatal clinic that she has pain during urination, back tenderness, and pink-tinged urine. A diagnosis of pyelonephritis is made. What is the most important nursing intervention at this time? 1 Limiting fluid intake 2 Examining the urine for protein 3 Checking for signs of preterm labor 4 Maintaining her on a moderate-sodium diet

3 Pyelonephritis often causes preterm labor, leading to increased neonatal morbidity and mortality. Fluids should be increased; the inflammatory process may lead to fever, dehydration, and an accumulation of toxins. Proteinuria occurs with preeclampsia; the client's signs and symptoms are indicative of a kidney infection. A moderate-sodium diet is not relevant to the client's problem.

A client asks the nurse at the prenatal clinic whether she may continue to have sexual relations while pregnant. What is one indication that the client should refrain from intercourse during pregnancy? 1 Fetal tachycardia 2 Presence of leukorrhea 3 Premature rupture of membranes 4 Imminence of the estimated date of birth

3 Ruptured membranes leave the products of conception exposed to bacterial invasion. Intact membranes act as a barrier against organisms that may cause an intrauterine infection. Fetal tachycardia may occur during sex, but there is no evidence that it is harmful for the fetus. Leukorrhea is common because of increased production of mucus containing exfoliated vaginal epithelial cells; intercourse is not contraindicated by leukorrhea. Intercourse is not contraindicated if the membranes are intact; modification of sexual positions may be needed because of the enlarged abdomen.

A nurse in the prenatal clinic is caring for a client with heart disease who is in her second trimester. What hemodynamic change of pregnancy may affect the client at this time? 1 Decreased red blood cell count 2 Gradually increasing size of the uterus 3 Heart rate acceleration in the last half of pregnancy 4 Increase in cardiac output during the third trimester

3 The heart rate increases by about 10 beats/min in the last half of pregnancy; this increase, plus the increase in total blood volume, can strain a damaged heart beyond the point at which it can efficiently compensate. The number of red blood cells does not decrease during pregnancy. The increased size of the uterus is related to the growth of the fetus, not to any hemodynamic change. Cardiac output begins to decrease by the 34th week of gestation.

A client who is pregnant for the first time attends the prenatal clinic. She tells the nurse, "I'm worried about gaining too much weight, because I've heard that it's bad for me." How should the nurse respond? 1 "Yes, too much weight gain causes complications during pregnancy." 2 "You'll have to follow a low-calorie diet if you gain more than 15 lb." 3 "We're more concerned that you won't gain enough weight to ensure adequate growth of your baby." 4 "A 25-lb weight gain is recommended, but the pattern of weight gain is more important than the total amount

4 A sudden sharp increase in weight may indicate fluid retention related to preeclampsia. Weight gain is necessary to ensure adequate nutrition for the fetus. The term "too much" is vague; complications are rare when weight gain is more than 25 to 30 lb in an uncomplicated pregnancy. There is no specific number of pounds that the client should gain, but a low-calorie diet is contraindicated. Telling the client that the staff is more concerned that she won't gain enough weight to ensure adequate growth of her baby closes off communication and it does not allow the client to ask more questions about weight gain.

A 14-year-old emancipated minor at 22 weeks' gestation comes in for her second prenatal examination. As she enters the examination room with her mother, she tells the nurse that she does not want her mother present for the examination. What should the nurse say? 1 "Your mother needs to be present for the examination." 2 "What's the problem with your mother being present?" 3 "I'm sure that your mother wants to be with you for support." 4 Tell the mother, "I'm sorry, but I need to ask you to stay in the waiting area.

4 In many states a minor who is self supporting and living away from home, providing military service, married, pregnant, or a parent is considered a emancipated minor. The emancipated minor assumes most responsibilities before the age of 18 years. An emancipated minor is entitled to confidentiality in dealings with health care providers.

A client visits the prenatal clinic for the first time. The client tells the nurse that her last menstrual period began June 10. The nurse uses Nägele's rule to calculate the EDB. What is the EDB? 1 April 7 2 March 7 3 April 10 4 March 17

4 The EDB is March 17. Using Nägele's rule, subtract 3 months and add 1 year and 7 days to the first day of the last menstrual period. April 7, March 7, and April 10 all represent inaccurate applications of Nägele's rule.

A client at 9 weeks' gestation asks the nurse in the prenatal clinic whether she may have chorionic villi sampling (CVS) performed during this visit. What should the nurse keep in mind as the optimal time for CVS while formulating a response? 1 At 8 weeks but no later than 10 weeks 2 At 10 weeks but no later than 12 weeks 3 At 12 weeks but no later than 14 weeks 4 At 14 weeks but no later than 16 weeks

2 At 8 weeks but no later than 12 weeks is the ideal time for CVS; this gives the client time to consider other options if a problem is discovered. CVS is no longer performed before 10 weeks because it has been associated with digit reduction. At 12 weeks but no later than 14 weeks is too late for CVS. At 14 weeks but no later than 16 weeks is when genetic amniocentesis is performed.

The nurse is caring for a first-time mother at her first prenatal visit. The client confides, "I'm not sure about all this." Which research-based knowledge guides a nurse regarding the emotional factors of pregnancy? 1 A rejected pregnancy will result in a rejected infant. 2 Ambivalence and anxiety about mothering are common. 3 A mother's love usually develops in the first week after birth. 4 An effective mother does not experience ambivalence and anxiety about mothering

2 Because mothering is not an inborn instinct in human beings, almost all mothers, including multiparas, report some ambivalence and anxiety about their mothering ability. Frequently maternal feelings are bolstered by the sight of the infant. The time it takes to develop these feelings is specific to each individual. With some mothers it may take a much longer time. Ambivalent feelings are universal in response to a neonate.

During the first trimester, a client tells a nurse at the prenatal clinic that she frequently feels nauseated. What should the nurse teach her about easing the nausea? 1 Eat small frequent meals. 2 Take an antacid between meals. 3 Drink cinnamon tincture before rising. 4 Take dimenhydrinate (Dramamine) at bedtime.

1 An increased level of the hormone human chorionic gonadotropin (hCG) may cause nausea and vomiting during the first trimester, so the stomach should be neither too full nor too empty. Small, more frequent meals usually relieve the nausea. Taking an antacid will not help the nausea and vomiting associated with the first trimester of pregnancy, and antacids should not be taken without a prescription; one may be prescribed during the second trimester when pyrosis and acid indigestion occur, because progesterone slows gastrointestinal tract motility. Tincture of cinnamon is not a treatment for nausea. Over-the-counter medications are contraindicated during pregnancy, especially during the first trimester, the period of organogenesis. The health care provider should be consulted before any medications are taken during pregnancy.

A pregnant client tells the nurse in the prenatal clinic that although she and her husband do not have the disease, she has a 1-year-old daughter with sickle cell anemia. She asks the nurse, "Will this baby also have sickle cell anemia?" How should the nurse respond? 1 "The chance that another child will have sickle cell anemia is 25%." 2 "Only one child in a family is affected, so the others probably will be all right." 3 "The most likely conclusion is that your children will have sickle cell anemia." 4 "If your partner has the sickle cell gene, 50% of your children will have sickle cell anemia."

1 According to the Mendelian laws of inheritance, the sickle cell gene is recessive. If neither parent has the disease, both of them have the sickle cell trait; there is therefore a 25% chance that a child will have sickle cell anemia, a 50% chance that a child will have the sickle cell trait, and a 25% chance that a child will be unaffected. Saying that only one child in a family is affected and that the others probably will be all right is too vague. Stating that the children will have sickle cell anemia is not an accurate answer. The client should be told the probability of a child's inheriting the disease, but 50% is too high.

A nurse is teaching a prenatal class about the changes that occur during the second trimester of pregnancy. What cardiovascular changes should the nurse include? Select all that apply. 1 Cardiac output increases. 2 Blood pressure decreases. 3 The heart is displaced upward. 4 The blood plasma volume peaks. 5 The hematocrit level is lowered

1, 2, 3 Cardiac output increases during the second trimester because of an increasing plasma volume. The blood pressure decreases because of the enlarged intravascular compartment and hormonal effects on peripheral resistance. As the fetus grows and the enlarging uterus outgrows the pelvic cavity, it displaces the heart upward and to the left. The blood volume starts to increase earlier but does not peak until the third trimester. The reduction in hematocrit occurs in the first trimester; the erythrocyte increase may not be in direct proportion to the blood volume, lowering hematocrit and hemoglobin levels, which remain lower throughout pregnancy.

A nurse teaches the warning signs that should be reported throughout pregnancy. Which statement by the client indicates an understanding of the prenatal instructions? 1 "I'll call the clinic if I have abdominal pain." 2 "Mild, irregular contractions mean that my labor is starting." 3 "I need to call the clinic if my ankles start to swell at night." 4 "A whitish vaginal discharge means that I'm getting an infection

1 Abdominal pain should be reported immediately because it may indicate abruptio placentae or the epigastric discomfort of severe preeclampsia. Mild, irregular contractions are preparatory (Braxton Hicks) contractions, which are common and are believed to help prepare the uterus for labor. Swelling of the ankles at night is physiologic edema of pregnancy, caused by pressure of the gravid uterus that impedes venous return; it disappears with elevation of the legs. Leukorrhea occurs during pregnancy as a result of increases in the estrogen and progesterone levels, which cause the vaginal discharge to become more alkaline.

A client at 32 weeks' gestation is admitted to the prenatal unit in preterm labor. An infusion of magnesium sulfate is started. What physiologic response indicates to the nurse that the magnesium sulfate is having a therapeutic effect? 1 Dilation of the cervix by 1 cm every hour 2 Tightening and pain in the perineal area 3 A decrease in blood pressure to 120/80 mm Hg 4 A decrease in frequency and duration of contractions

4 The purpose of administering magnesium sulfate is to stop preterm labor. It is a tocolytic agent that relaxes uterine smooth muscle. Labor is progressing if dilation of the cervix continues. Perineal discomfort is usually felt as the fetus moves down the birth canal and labor is progressing. A decrease in blood pressure to 120/80 mm Hg is not a therapeutic effect of magnesium sulfate for a woman in preterm labor.

A client at 32 weeks' gestation visits the prenatal clinic because she is having uterine contractions. She is to be treated at home with restricted activity and long periods of bedrest. What instructions should the teaching plan include when the client is advised to remain in bed? 1 Raise the foot of the bed on blocks. 2 Sit with several large pillows supporting the back. 3 Assume a side position, with the head raised on a small pillow. 4 Assume the knee-chest position several times a day for a few minutes

3 Bedrest keeps the pressure of the fetus off the cervix, minimizing cervical dilation; the side-lying position enhances uterine perfusion. Raising the foot of the bed on blocks will impede respiration and is not advised. Sitting will increase pressure on the cervix. Assuming the knee-chest position several times a day for a few minutes may help relieve the pressure of the fetus on the cervix, but it will not enhance uterine perfusion and is not recommended.

A pregnant client arrives at the prenatal clinic, and the nurse obtains her obstetrical history. The client has two children at home, one born at 38 weeks' gestation and the second born at 34 weeks' gestation. She has also had one miscarriage, at 18 weeks, and an elective abortion. Using the GTPAL system, what is the client's obstetrical record? 1 G5 T1 P1 A2 L2 2 G4 T2 P2 A1 L4 3 G2 T3 P3 A2 L1 4 G3 T2 P1 A3 L3

1 G (gravida) stands for the total number of pregnancies a client has had. Gravida 5 indicates that this is the client's fifth pregnancy. T (term) stands for the number of neonates born at the expected date of birth. The neonate born at 38 weeks' gestation was born at term. P (preterm) stands for the number of neonates born before the expected date of birth. The neonate born at 34 weeks' gestation was born preterm. A (abortion or miscarriage) stands for the birth of a fetus before 20 weeks' gestation. Both the miscarriage and elective abortion are considered abortions. L (living) stands for the number of living children at the time of assessment. The client has two living children.

A nurse is teaching participants in a prenatal class about breastfeeding versus formula feeding. A client asks, "What is the primary advantage of breastfeeding?" What is best reply by the nurse? 1 "Breastfed infants have fewer infections." 2 "Breastfeeding inhibits ovulation in the mother." 3 "Breastfed infants adhere more easily to a feeding schedule." 4 "Breastfeeding provides more protein than cow's milk formula does."

1 Maternal antibodies are transferred from the mother in breast milk, providing protection for a longer time than do antibodies transferred to the fetus by way of the placenta. The neonate is protected by these antibodies; the fetus's own antibody system is immature at birth. Lactating mothers rarely ovulate for the first 9 postpartum weeks; however, they may ovulate at any time after that period; although this may be considered an advantage, it is not a primary advantage. Because of the higher carbohydrate content of breast milk, which is digested rapidly, breastfed infants wake more frequently than formula-fed infants. Their feeding demands take more time to regulate than the formula-fed infant's. Breast milk has 1.1 g protein/100 mL; cow's milk has 3.5 g/100 mL. Whole cow's milk is unsuitable for infants.

A client on her first prenatal clinic visit is at 6 weeks' gestation. She asks how long she may continue to work and when she should plan to quit. How should the nurse respond? 1 "What activities does your job entail?" 2 "How do you feel about continuing to work?" 3 "Most women work throughout their pregnancies." 4 "Usually women quit work at the start of their third trimester."

1 More information is needed before the nurse can give a professional response. Although it is important to ascertain the client's feelings about continuing to work, at this time she is seeking information. Although it is true that most women work throughout their pregnancies, more information is needed before the nurse can respond. It is misinformation to state that usually women quit work at the start of the third trimester.

While teaching a prenatal class about infant feeding, the nurse is asked about the relationship between breast size and ease of breastfeeding. How should the nurse respond? 1 "Breast size is not related to milk production." 2 "Motivated women tend to breastfeed successfully." 3 "You seem to have some concerns about breastfeeding." 4 "Glandular tissue in the breasts determines the amount of milk you'll produce."

1 The question should be answered directly in the class. However, the mother's statement indicates some concerns about breastfeeding that should be explored privately later. Stating that motivated women tend to breastfeed successfully constitutes false reassurance; successful breastfeeding requires mastery, and some women have difficulty. Although noting that the client seems to have concerns about breastfeeding indicates that the nurse perceives the client's concerns, this response is inappropriate in a class setting; the nurse should elicit more information privately later. The infant's suckling and emptying of the breasts determine the amount of milk produced.

During her sixth month of pregnancy, a woman visits the prenatal clinic for the first time. As part of the initial assessment a complete blood count and urinalysis are performed. Which laboratory finding should alert the nurse to the need for further assessment? 1 Hemoglobin of 10 g/dL 2 Urine specific gravity of 1.020 3 Glucose level of 1+ in the urine 4 White blood cell count of 9,000/mm3

1 This hemoglobin reading suggests a true anemia. The lowest hemoglobin resulting from physiologic anemia of pregnancy is 12 g/dL; this anemia occurs because the plasma volume increases to a greater extent than the red blood cells during pregnancy. A white blood cell count of 9,000/mm3 is within the expected range of 5,000 to 10,000/mm3; it may increase to 15,000/mm3 during the second half of pregnancy. A urine specific gravity of 1.020 is within the expected range of 1.010 to 1.030. A 1+ urine glucose level is not unusual during pregnancy because of the lowered renal threshold for glucose during pregnancy; if it increases to 2+, further investigation for diabetes should be undertaken.

During a prenatal examination a nurse draws blood from an Rh-negative client. The nurse explains that an indirect Coombs test will be performed to predict whether the fetus is at risk for: 1 Acute hemolytic anemia 2 Respiratory distress syndrome 3 Protein metabolism deficiency 4 Physiologic hyperbilirubinemia

1 When an Rh-negative woman carries an Rh-positive fetus, there is a risk for the formation of maternal antibodies against Rh-positive blood; antibodies cross the placenta and destroy the fetal red blood cells. Determination of the lecithin/sphingomyelin ratio or the phosphatidylglycerol test, not the Rh factor, may provide information about the risk for respiratory distress syndrome (RDS). Testing for the Rh factor will not provide information about protein metabolism deficiency. Physiologic bilirubinemia is a common occurrence in newborns; it is not associated with the Rh factor.

During a routine visit to the prenatal clinic a client listens to the fetal heartbeat for the first time. The client, commenting on how rapid it is, appears frightened and asks whether this is normal. The nurse should explain: 1 "The heart rate is usually rapid, and this one is in the expected range." 2 "The heart rate is usually rapid and twice the mother's pulse rate." 3 "The heart rate is rapid, but I'd be more concerned if it were slow." 4 "The heart rate is rapid, but it accommodates the fetus's nutritional needs."

1 With spontaneous or stimulated activity, the fetal heart rate (FHR) is usually between 110 and 160 beats/min. This is to be expected, and the client should be made aware of this. The normal heart rate for a fetus is not twice the mother's heart rate. Stating that the FHR is rapid implies that this one is too rapid; this misinformation may cause more concerns. The FHR is rapid to accommodate the metabolic, not nutritional, needs of the fetus.

A 26-year-old G1 P0 is seen in the clinic for her routine prenatal visit at 29 weeks' gestation. On examination the nurse notes that she has gained 8 lb since her last visit, 2 weeks ago; that her blood pressure is 150/90 mm Hg, and that she has 1+ proteinuria on urine dipstick. What is the likely diagnosis for this client? 1 Mild preeclampsia 2 Severe preeclampsia 3 Chronic hypertension 4 Gestational hypertension

1 Preeclampsia is hypertension that develops after 20 weeks' gestation in a previously normotensive woman. With mild preeclampsia the systolic blood pressure is below 160 mm Hg and diastolic BP is below 110 mm Hg. Proteinuria is present, but there is no evidence of organ dysfunction. Severe preeclampsia is a systolic blood pressure of greater than 160 mm Hg or diastolic blood pressure of at least 110 mm Hg and proteinuria of 5 g or more per 24-hour specimen. Chronic hypertension is hypertension that is present before the pregnancy or diagnosed before 20 weeks' gestation. Gestational hypertension is the onset of hypertension during pregnancy without other signs or symptoms of preeclampsia and without preexisting hypertension.

A client with mild preeclampsia is admitted to the high-risk prenatal unit because her blood pressure is progressively increasing. The nurse reviews the practitioner's prescriptions. What prescriptions does the nurse expect? Select all that apply. 1 Daily weight 2 Side-lying bed rest 3 2-gram-sodium diet 4 Deep tendon reflexes 5 Glucose tolerance test

1, 2, 4 Rapid weight gain is a sign of increasing edema. One liter of fluid is equal to 2.2 lb. Maintaining bedrest promotes fluid shift from the interstitial spaces to the intravascular space, which enhances blood flow to the kidneys and uterus; the side-lying position promotes placental perfusion. A 2 g/day sodium diet will deplete the circulating blood volume, limiting blood flow to the placenta. A moderate sodium intake (≤6 g) is permitted as long as the client is alert and has no nausea or indication of an impending seizure. Deep tendon reflexes should be monitored. Reflexes of +2 are indicative of mild preeclampsia; +4 indicates severe preeclampsia. There is no data indicating that a glucose tolerance test is needed.

During a prenatal visit a client who is at 36 weeks' gestation states that she is having uncomfortable irregular contractions. How should the nurse respond? 1 "Lie down until they stop." 2 "Walk around until they subside." 3 "Time the contractions for 30 minutes." 4 "Take 2 extra-strength aspirin if the discomfort persists.

2 Ambulation relieves the discomfort of preparatory (Braxton Hicks) contractions. These contractions will increase when the client is resting. Preparatory contractions are not indicative of true labor and need not be timed. Aspirin may be harmful to the fetus because it can hemolyze red blood cells.

A client at 38 weeks' gestation is admitted to the high-risk prenatal unit with a diagnosis of severe preeclampsia. The nurse obtains the vital signs, performs a health history and physical assessment, and reviews the client's laboratory results. What is the priority nursing intervention? 1 Monitoring intake and output 2 Providing a dark private room 3 Measuring the extent of edema 4 Preparing for an immediate cesarean birth

2 Increasing cerebral edema may predispose the client to seizures; therefore, stimuli of any kind should be minimized. Although intake and output should be monitored to identify oliguria, this will not limit the occurrence of a seizure. Although edema should be measured, it will not limit the occurrence of a seizure. A cesarean birth may not be needed. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats such as the hospital record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and nurse/client interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking.

A woman arrives at the prenatal clinic stating that her pregnancy test is positive. She asks the nurse for information about an abortion. After verifying that the woman is at 8 weeks' gestation, the nurse counsels her that having an abortion is controversial and that many women have long-lasting feelings of guilt after an abortion. What is the nurse's legal responsibility? 1 To share her own thoughts on abortion with the client 2 To provide the client with correct, unbiased information 3 To ask why the client wants information about abortion 4 To notify the health care provider because this is beyond the scope of nursing practice

2 Nurses who counsel clients about abortion should know what services are available and the various methods that are used to induce abortion. Nurses who cannot control their negative feelings regarding abortion should not counsel women who are thinking of undergoing the procedure. Nursing practice necessitates knowledge of research results; statements must be based on fact, not personal feelings or beliefs. The nurse should give the client only the information requested, not state personal feelings. The nurse is responsible for giving information about abortion and need not defer to the health care provider.

Why is it important for a nurse in the prenatal clinic to provide nutritional counseling to all newly pregnant women? 1 Most weight gain is caused by fluid retention. 2 Different cultural groups favor different essential nutrients. 3 Dietary allowances should not increase throughout pregnancy. 4 Pregnant women must adhere to a specific pregnancy dietary regimen

2 The nurse should become informed about the cultural eating patterns of clients so that foods containing the essential nutrients that are part of these dietary patterns may be included in the diet. Fluid retention is only one component of weight gain; growth of the fetus, placenta, breasts, and uterus also contributes to weight gain. The need for calories and nutrients increases during pregnancy. Pregnancy diets are not specific; they are composed of the essential nutrients.

During a prenatal interview at 20 weeks' gestation, the nurse determines that the client has a history of pica. What is the most appropriate nursing action? 1 Seeking a psychologic referral for the client 2 Ensuring that the client's diet is nutritionally adequate 3 Informing the client of the danger this poses to her fetus 4 Obtaining a prescription for a multivitamin supplement for the client

2 The primary concern when a pregnant woman practices pica is that other intake will be nutritionally inadequate to meet both fetal and maternal needs. Pica does not necessarily indicate a psychologic/emotional disturbance; more often it is related to the client's culture. If a substance is not toxic to the mother, generally it is not fetotoxic, either. Obtaining a prescription for a multivitamin supplement for the client is not necessary if other nutritional intake is adequate.

On her first prenatal visit a client says to the nurse, "I guess I'll be having an internal examination today." What is the nurse's best response? 1 "Yes, an internal exam is done at the mother's first visit." 2 "Are you worried about having an internal examination?" 3 "Have you ever had an internal examination done before?" 4 "Yes, a slightly uncomfortable internal exam must be done."

3 Before health teaching is instituted, the nurse should ascertain the client's past experiences; they will influence the teaching plan. Stating that an internal exam is performed on the mother's first visit does not give the client a chance to discuss her feelings about the examination. Implying that the client is fearful of having an internal examination presupposes that the client is fearful and does not address the client's question. Stating that a slightly uncomfortable internal exam must be performed does not give the client a chance to discuss her feelings about the examination; the nurse is assuming that the client's concerns are related to discomfort.

The nurse in the prenatal clinic is providing nutritional counseling for a pregnant woman with a cardiac problem. What should the nurse advise the client to do? 1 Limit the intake of fat. 2 Increase sodium in the diet. 3 Eat a moderate amount of protein. 4 Control the number of calories consumed

4 Controlling caloric intake is recommended to keep weight gain to no more than 25 lb so the increased cardiac workload that occurs during pregnancy may be controlled as much as possible. Fats are not specifically limited; however, they should be eaten in moderation to control the total number of calories consumed. Increased sodium and moderate protein are not advised for clients with cardiac problems.

A 23-year-old primigravida is at her first prenatal appointment today. Ultrasound indicates that she is at 9 weeks' gestation. She asks when she can first expect to feel her baby move. The best response by the nurse is: 1 "You should be able to feel the baby move any day now." 2 "You should feel your first light movement of the baby around 24 weeks." 3 "Most women can first detect movement of their babies by 12 to 14 weeks." 4 "Many women are able to first feel light movement between 18 and 20 weeks."

4 Fetal movement can be felt after 18 weeks and usually by 20 weeks in a primigravida. Fetal movement is normally not felt before 18 weeks' gestation, when the uterus has risen into the abdomen. Fetal movement should continue to be felt at 24 weeks' gestation but normally is felt 4 to 6 weeks before this time.

A client visiting the prenatal clinic for the first time asks a nurse about the probability of having twins because her husband is one of a pair of fraternal twins. What is the appropriate response by the nurse? 1 "A sonogram will tell us if there's a twin pregnancy." 2 "There's a 25 percent probability of you having twins." 3 "The husband's history of being a twin increases the chance of having twins." 4 "There's no greater probability of you having twins than in the general population."

4 Fraternal twins may occur as a result of a hereditary trait, but it is related to the release of two eggs during one ovulation; the fact that the father is a fraternal twin would not influence the female's ovaries to release two eggs during one ovulation. Although this response is true, it does not answer the client's question. If there is no maternal family history of twin pregnancies, this client's pregnancy with twins would be a chance occurrence equal to the probability found in the general population.

On her first visit to the prenatal clinic a woman is to have a pelvic examination. What information should the nurse include when discussing the examination? 1 She should direct her questions to the health care provider. 2 She should relax during the examination to prevent discomfort. 3 A douche will be necessary before the examination for the biopsy. 4 A rectal examination may be performed after the pelvic examination.

4 On her first visit to the prenatal clinic a woman is to have a pelvic examination. What information should the nurse include when discussing the examination?

A client in labor at 39 weeks' gestation is told by the health care provider that she will need a cesarean birth. The nurse reviews the client's prenatal history. What preexisting condition is the most likely reason for the cesarean birth? 1 Gonorrhea 2 Chlamydia 3 Chronic hepatitis 4 Active genital herpes

4 Once the membranes have ruptured, the active herpes infection ascends and can infect the fetus; because herpes does not cross the placenta, a cesarean birth prevents transfer of the virus to the fetus. Gonorrhea, Chlamydia, and chronic hepatitis are not indications for a cesarean birth; treatment is pharmacological.

An adolescent at 10 weeks' gestation visits the prenatal clinic for the first time. The nutrition interview indicates that her dietary intake consists mainly of soft drinks, candy, French fries, and potato chips. Why does the nurse consider this diet inadequate? 1 The caloric content will result in too great a weight gain. 2 The ingredients in soft drinks and candy can be teratogenic in early pregnancy. 3 The salt in this diet will contribute to the development of gestational hypertension. 4 The nutritional composition of the diet places her at risk for a low-birthweight infant.

4 The diet does not reflect a healthy balance of foods and nutrients, especially protein; adequate nutrition is necessary for the birth of a healthy full-term infant whose weight is appropriate for gestational age. The caloric content of these foods is not high if small amounts are consumed; in addition, this client's weight gain may not be reflective of an adequate weight gain in the developing fetus. No data are available to support the assertion that the ingredients of candy and soft drinks are teratogenic. Unrestricted salt intake does not contribute to the development of gestational hypertension.

During the first prenatal visit of a woman who is at 23 weeks' gestation, the nurse discovers that she has a history of pica. What is the most appropriate nursing action? 1 Seeking a psychology referral 2 Explaining the danger this poses to the fetus 3 Obtaining a prescription for an iron supplement 4 Determining whether the diet is nutritionally adequate

4 The primary concern for a pregnant women who practices pica is that her diet is nutritionally inadequate. Nutritional guidance may be necessary, depending on the findings of this assessment. Pica does not indicate a psychologic/emotional disturbance; frequently it is influenced by the client's culture. If a substance is not toxic to the mother, it is generally not fetotoxic. Iron is routinely prescribed during pregnancy; this does not specifically address the practice of pica.

A client at 35 weeks' gestation who has had no prenatal care arrives in labor and delivery and is found to be 20 percent effaced and 2 cm dilated, with her membranes intact and contractions 3 minutes apart. The nurse notices some ruptured blisterlike vesicles in the genital area. What should the nurse's next action be? 1 Educating the client on what to expect during labor 2 Discussing pain management options available during labor 3 Discussing the possibility of using Pitocin to move labor along 4 Contacting the health care provider about the need for a cesarean birth

4 Transmission of genital herpes simplex virus (HSV-2) to the newborn can occur during vaginal delivery when active lesions are present. Blindness, brain damage, or death could result if early measures are not taken. The priority is informing the health care provider of the presence of active genital herpes lesions so preparations for a cesarean birth may be made. The nurse would not want to enhance contractions; instead the nurse will begin preparations for a cesarean birth as soon as possible.

A client at 36 weeks' gestation is schedule for a routine ultrasound prior to an amniocentesis. After teaching the client about the purpose for the ultrasound, which of the following client statements would indicate to the nurse in charge that the client needs further instruction? A. The ultrasound will help to locate the placenta B. The ultrasound identifies blood flow through the umbilical cord C. The test will determine where to insert the needle D. The ultrasound locates a pool of amniotic fluid

B. The ultrasound identifies blood flow through the umbilical cord Before amniocentesis, a routine ultrasound is valuable in locating the placenta, locating a pool of amniotic fluid, and showing the physician where to insert the needle. Color Doppler imaging ultrasonography identifies blood flow through the umbilical cord. A routine ultrasound does not accomplish this.

The nurse is developing a teaching plan for a patient who is 8 weeks pregnant. The nurse should tell the patient that she can expect to feel the fetus move at which time? A.Between 10 and 12 weeks' gestation B.Between 16 and 20 weeks' gestation C.Between 21 and 23 weeks' gestation D.Between 24 and 26 weeks' gestation

B.Between 16 and 20 weeks' gestation A pregnant woman usually can detect fetal movement (quickening) between 16 and 20 weeks' gestation. Before 16 weeks, the fetus is not developed enough for the woman to detect movement. After 20 weeks, the fetus continues to gain weight steadily, the lungs start to produce surfactant, the brain is grossly formed, and myelination of the spinal cord begins.

A nurse is being oriented to a prenatal clinic after graduation. The new nurse takes a course on several tests during pregnancy. Place the tests in the order in which they should be performed during pregnancy. 1. Fetal movement test 2. Sickle cell screening 3. Group B Streptococcus culture 4. Serum glucose for gestational diabetes 5. α-Fetoprotein (AFP) testing for neural tube defects

Correct1.Sickle cell screening Correct2.α-Fetoprotein (AFP) testing for neural tube defects Correct3.Serum glucose for gestational diabetes Correct4.Fetal movement test Correct5.Group B Streptococcus culture Sickle cell screening, particularly for black women, should be done on the initial visit. AFP testing for neural tube defects should be done between 14 and 16 weeks. Serum glucose testing for gestational diabetes should be done between 26 and 28 weeks. Fetal movement tests may be started at 28 weeks' gestation because the fetus' pattern of movement becomes stabilized at this time. Group B Streptococcus culture should be done between 36 and 38 weeks.