Maternity & Women's Health Care- Chapter 12: Conception and Fetal Development

A nurse is teaching a prenatal class. The nurse teaches that during weeks 25 to 28, which fetal development occurs? a. Eyes reopen. b. Vernix caseosa covers the skin. c. Lanugo may develop. d. Brown fat is deposited.

ANS: A During this time frame the eyes reopen, and the fetus becomes plumper with smoother skin. The other changes occur during weeks 17 to 20.

Oogenesis, the process of egg formation, begins during fetal life in the female. Which statement related to ovum formation is correct? a. Two million primary oocytes will mature. b. At birth, all ova are contained in the female's ovaries. c. The oocytes complete their division during fetal life. d. Monthly, at least two oocytes mature.

ANS: B All of the cells that may undergo meiosis in a woman's lifetime are contained in the ovaries at birth. Only 400 to 500 ova will mature during the approximately 35 years of a woman's reproductive life. The primary oocytes begin their first meiotic division during fetal life but remain suspended until puberty. Every month, one primary oocyte matures and completes meiotic division yielding two unequal cells.

The hormone responsible for a positive pregnancy test is: A. Estrogen B. Progesterone C. Human Chorionic Gonadotropin D. Follicle Stimulating Hormone

Answer: C. Human chorionic gonadotropin (HCG) is the hormone secreted by the chorionic villi which is the precursor of the placenta. In the early stage of pregnancy, while the placenta is not yet fully developed, the major hormone that sustains the pregnancy is HCG.

During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify fetal abnormalities. Between 18 and 40 weeks gestation, which procedure is used to detect fetal anomalies? A. Amniocentesis B. Chorionic villi sampling C. Fetoscopy D. Ultrasound

Answer: D. Ultrasound is used between 18 and 40 weeks' gestation to identify normal fetal growth and detect fetal anomalies and other problems.

Pap smears and pelvic exams are recommended every __ year(s) in women over age ____. A. 1, 21 B. 3, 18 C. 1, 25 D. 3, 21

ans: D Rationale: Women who are 21 to 29 should have a Pap test every 3 years.

The common normal site of nidation/implantation in the uterus is: A. Upper uterine portion B. Mid-uterine area C. Lower uterine segment D. Lower cervical segment

A. Upper uterine portion The embryo's normal nidation site is the upper portion of the uterus. If the implantation is in the lower segment, this is an abnormal condition called placenta previa.

What does the student learn about recent trends in multiple births? a. The rate of twin births has declined. b. The rate of higher order pregnancies has increased. c. Higher order pregnancies are now very rare. d. Twinning is the most common form of multiple pregnancy.

ANS: D Twinning is the most common form of multiple pregnancy, and the rate has been increasing, not declining. Higher order births increased for a time but have now decreased, although they are not rare.

In which of the following conditions can the causative agent pass through the placenta and affect the fetus in utero? A. Gonorrhea B. Rubella C. Candidiasis D. Moniliasis

Answer: B. Rubella is caused by a virus and viruses have low molecular weight thus can pass through the placental barrier. Relatively few pathogens are capable of placental and fetal infections in humans and even for these, maternal infection does not guarantee placental or fetal infection.

What is the approximate time that the blastocyst spends traveling to the uterus for implantation? A. 2 days B. 7 days C. 10 days D. 14 weeks

Answer: B. 7 days The blastocyst takes approximately 1 week to travel to the uterus for implantation. Implantation is a process in which a developing embryo, moving as a blastocyst through a uterus, makes contact with the uterine wall and remains attached to it until birth.

The developing cells are called a fetus from the: A. Time the fetal heart is heard B. Eighth week to the time of birth. C. Implantation of the fertilized ovum. D. End of the send week to the onset of labor.

Answer: B. Eighth week to the time of birth. In the first 7-14 days, the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.

Which of the following refers to the single cell that reproduces itself after conception? A. Chromosome B. Blastocyst C. Zygote D. Trophoblast

Answer: C. The zygote is the single cell that reproduces itself after conception. It is the union of the sperm cell and the egg cell. Also known as a fertilized ovum, the zygote begins as a single cell but divides rapidly in the days following fertilization. After this two-week period of cell division, the zygote eventually becomes an embryo. If this goes well, the embryo becomes a fetus.

When teaching a client about contraception. Which of the following would the nurse include as the most effective method for preventing sexually transmitted infections? A. Spermicides B. Diaphragm C. Condoms D. Vasectomy

Answer: C. Condoms Condoms, when used correctly and consistently, are the most effective contraceptive method or barrier against bacterial and viral sexually transmitted infections.

A client at eight months' gestation is diagnosed with oligohydramnios. She asks the nurse if this can harm the fetus. What is the nurse's best response? A. "Well, the reduced fluid around the fetus can allow for umbilical cord compression." B. "Yes, it means the fetus swallowed too much fluid." C. "No, this commonly occurs toward the end of pregnancy." D. "No, this is a sign that the lungs are maturing."

ans A

Which response would indicate that a client clearly understands the risks of an amniocentesis? A. "I might go into labor early." B. "It could produce a congenital defect in my baby." C. "Actually, there are no real risks to this procedure." D. "The test could stunt my baby's growth."

ans A. Rationale: Amniocentesis has the potential for causing preterm labor, along with other complications, such as infection or bleeding.

The fetus is wrinkled, is covered with vernix, opens and closes eyelids, and has physiologically immature lungs that would sufficiently provide gas exchange. What gestational age is this fetus? A. 23 weeks B. 25 weeks C. 30 weeks D. 34 weeks

ans B

The umbilical ______ carry deoxygenated blood from the fetus to the mother. A. veins B. arteries C. pathways

ans. b Rationale: The umbilical arteries carry deoxygenated fetal blood toward the placenta for replenishment, and the umbilical vein carries newly oxygenated and nutrient-rich blood back to the fetus.

Which of the following is a means of metabolic and nutrient exchange between the embryonic and maternal circulation? A. amniotic fluid B. the placenta C. the umbilical cord D. uterus

ans: b Rationale: The placenta is the means of metabolic and nutrient exchange between the embryonic and maternal circulations.

What maintains the pregnancy until the placenta has matured enough (at about 11 weeks)? A. the ovaries B. the uterus C. the corpus luteum D. the pre-placenta

ans: c

During which of the following would the focus of classes be mainly on physiologic changes, fetal development, sexuality, during pregnancy, and nutrition? A. Prepregnant period B. First trimester C. Second trimester D. Third trimester

Answer: B. First trimester First-trimester classes commonly focus on such issues as early physiologic changes, fetal development, sexuality during pregnancy, and nutrition. Some early classes may include pregnant couples.

The placenta allows the exchange of oxygen, nutrients, and waste products between the mother and fetus by a. contact between maternal blood and fetal capillaries within the chorionic villi. b. interaction of maternal and fetal pH levels within the endometrial vessels. c. a mixture of maternal and fetal blood within the intervillous spaces. d. passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries.

ANS: A Fetal capillaries within the chorionic villi are bathed with oxygen- and nutrient-rich maternal blood within the intervillous spaces. The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. Maternal and fetal blood do not normally mix. Maternal carbon dioxide does not enter into the fetal circulation.

Which information regarding amniotic fluid is important for the nurse to understand? a.Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus. b.Volume of the amniotic fluid remains approximately the same throughout the term of a healthy pregnancy. c.The study of fetal cells in amniotic fluid yields little information. d.A volume of more than 2 L of amniotic fluid is associated with fetal renal abnormalities.

ANS: A Rationale: Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, cushions the fetus, and helps maintain a constant body temperature. The volume of amniotic fluid constantly changes. The study of amniotic fluid yields information regarding the sex of the fetus and the number of chromosomes. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

What kind of fetal anomalies are most often associated with oligohydramnios? a.Renal b.Cardiac c.Gastrointestinal d.Neurologic

ANS: A Rationale: An amniotic fluid volume of less than 300 ml (oligohydramnios) is often associated with fetal renal anomalies. The amniotic fluid volume has no bearing on the fetal cardiovascular system. Gastrointestinal anomalies are associated with hydramnios or an amniotic fluid volume greater than 2 L. The amniotic fluid volume has no bearing on the fetal neurologic system.

A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where the baby makes the meconium. What is the correct response by the nurse? a.Fetal intestines b.Fetal kidneys c.Amniotic fluid d.Placenta

ANS: A Rationale: As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. Meconium is not produced by the fetal kidneys nor should it be present in the amniotic fluid, which may be an indication of fetal compromise. The placenta does not produce meconium.

A woman asks the nurse, "What protects my baby's umbilical cord from being squashed while the baby's inside of me?" What is the nurse's best response? a."Your baby's umbilical cord is surrounded by connective tissue called Wharton's jelly, which prevents compression of the blood vessels." b."Your baby's umbilical cord floats around in blood and amniotic fluid." c."You don't need to be worrying about things like that." d."The umbilical cord is a group of blood vessels that are very well protected by the placenta."

ANS: A Rationale: Explaining the structure and function of the umbilical cord is the most appropriate response. Connective tissue called Wharton's jelly surrounds the umbilical cord, prevents compression of the blood vessels, and ensures continued nourishment of the embryo or fetus. The umbilical cord does not float around in blood or fluid. Telling the client not to worry negates her need for information and discounts her feelings. The placenta does not protect the umbilical cord.

An expectant couple attending childbirth classes have questions regarding multiple births since twins "run in the family." What information regarding multiple births is important for the nurse to share? a.Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. b.Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. c.Identical twins are more common in Caucasian families. d.Fraternal twins are the same gender, usually male.

ANS: A Rationale: If the parents-to-be are older and have taken fertility drugs, then they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; that is, they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference, and fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender, and identical twins are the same gender.

The nurse caring for a pregnant client is evaluating his or her health teaching regarding fetal circulation. Which statement from the client reassures the nurse that his or her teaching has been effective? a."Optimal fetal circulation is achieved when I am in the side-lying position." b."Optimal fetal circulation is achieved when I am on my back with a pillow under my knees." c."Optimal fetal circulation is achieved when the head of the bed is elevated." d."Optimal fetal circulation is achieved when I am on my abdomen."

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

A new mother asks the nurse about the "white substance" covering her infant. How should the nurse explain the purpose of vernix caseosa? a.Vernix caseosa protects the fetal skin from the amniotic fluid. b.Vernix caseosa promotes the normal development of the peripheral nervous system. c.Vernix caseosa allows the transport of oxygen and nutrients across the amnion. d.Vernix caseosa regulates fetal temperature

ANS: A Rationale: Prolonged exposure to the amniotic fluid during the fetal period could result in the breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system was dependent on nutritional intake of the mother. The amnion was the inner membrane that surrounded the fetus and was not involved in the oxygen and nutrient exchange. The amniotic fluid helped maintain fetal temperature.

The various systems and organs of the fetus develop at different stages. Which statement is most accurate? a.Cardiovascular system is the first organ system to function in the developing human. b.Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks of gestation. c.Body changes from straight to C-shape occurs at 8 weeks of gestation. d.Gastrointestinal system is mature at 32 weeks of gestation.

ANS: A Rationale: The heart is developmentally complete by the end of the embryonic stage. Hematopoiesis begins in the liver during the sixth week. The body becomes C-shaped at 21 weeks of gestation. The gastrointestinal system is complete at 36 weeks of gestation.

FHR can be auscultated with a fetoscope as early as which of the following? A. 5 weeks gestation B. 10 weeks gestation C. 15 weeks gestation D. 20 weeks gestation

Answer: D. 20 weeks gestation The FHR can be auscultated with a fetoscope at about 20 week's gestation. FHR usually is auscultated at the midline suprapubic region with a Doppler ultrasound transducer at 10 to 12 week's gestation. FHR, cannot be heard any earlier than 10 weeks' gestation.

Which development related to the integumentary system is correct? a.Very fine hairs called lanugo appear at 12 weeks of gestation. b.Eyelashes, eyebrows, and scalp hair appear at 28 weeks of gestation. c.Fingernails and toenails develop at 28 weeks of gestation. d.By 32 weeks, scalp hair becomes apparent.

ANS: A Rationale: Very fine hairs, called lanugo appear first at 12 weeks of gestational age on the fetus' eyebrows and upper lip. By 20 weeks of gestation, lanugo covers the entire body. By 20 weeks of gestation the eyelashes, eyebrows, and scalp hair also begin to grow. By 28 weeks of gestation, the scalp hair is longer than these fine hairs, which is thin and may disappear by term. Fingernails and toenails develop from thickened epidermis, beginning during the 10th week. Fingernails reach the fingertips at 32 weeks of gestation, and the toenails reach the toe tips at 36 weeks of gestation.

Which part of the mature sperm contains the male chromosomes? a. The head of the sperm b. The middle portion of the sperm c. X-bearing sperm d. The tail of the sperm

ANS: A The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. The middle portion of the sperm supplies energy for the tail's whip-like action. If an X-bearing sperm fertilizes the ovum, the baby will be female. The tail of the sperm helps propel the sperm toward the ovum.

One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered within normal limits? a. Two arteries and one vein b. Two arteries and two veins c. Two veins and one artery d. One artery and one vein

ANS: A The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. Any option other than two arteries and one vein is considered abnormal and requires further assessment. Blood pumped by the embryo's heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus

The student learns about shunts that support fetal circulation. Which of the following are included in this support system? (Select all that apply.) a. Ductus venosus b. Foramen ovale c. Ductus arteriosus d. Foramen magnum e. Ductus deferens

ANS: A, B, C The ductus venosus, foramen ovale, and ductus arteriosus are part of fetal circulation. The foramen magnum is located at the base of the skull. The ductus (or vas) deferens is part of the male reproductive system.

The nursing faculty explains that the fetus can survive in a low-oxygen environment due to which of the following? (Select all that apply.) a. Fetal hemoglobin carries more oxygen than an adult's. b. The fetus has higher average hemoglobin and hematocrit. c. Hemoglobin carries more oxygen at low partial pressures of carbon dioxide. d. Fetal blood is more acidic than the maternal blood. e. The fetus does not need gas exchange while in utero.

ANS: A, B, C The fetus can survive in low oxygen environments due to its hemoglobin being able to carry more oxygen that the mom, having a higher level of hemoglobin and hematocrit, and the fact that hemoglobin can carry more oxygen at low partial pressures of carbon dioxide. Fetal blood is alkaline. The fetus does need gas exchange in utero.

The nurse assesses pregnant women for exposure to human teratogens, including which of the following? (Select all that apply.) a. Infections b. Radiation c. Maternal conditions d. Drugs e. Chemicals

ANS: A, B, C, D, E Exposure to radiation and a number of infections may result in profound congenital deformities. These include varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and PKU may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities. Coffee is not considered a teratogen.

Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, he or she should be knowledgeable regarding known human teratogens. Which substances might be considered a teratogen? (Select all that apply.) a.Cytomegalovirus (CMV) b.Ionizing radiation c.Hypothermia d.Carbamazepine e.Lead

ANS: A, B, D, E Rationale: Exposure to radiation and a number of infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria (PKU) may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medications (e.g., carbamazepine) and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, may also result in structural and functional abnormalities.

The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determine fetal lung maturity. Which ratio reflects fetal maturity of the lungs? a.1.4:1 b.1.8:1 c.2:1 d.1:1

ANS: C Rationale: The L/S ratio indicates a 2:1 ratio of lecithin to sphingomyelin, which is an indicator of fetal lung maturity and occurs at approximately the middle of the third trimester. L/S ratios of 1.4:1, 1.8:1, and 1:1 each indicate immaturity of the fetal lungs.

Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (select all that apply) a. Human chorionic gonadotropin (hCG) b. Insulin c. Estrogen d. Progesterone e. Testosterone

ANS: A, C, D Feedback:Correct hCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman's uterus and breasts; cause growth of the ductal system in the breasts; and, as term approaches, play a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT , hCA, and a number of growth factors. Incorrect Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures.

Relating to the fetal circulatory system, which special characteristics allow the fetus to obtain sufficient oxygen from the maternal blood? (Select all that apply.) a.Fetal hemoglobin (Hb) carries 20% to 30% more oxygen than maternal Hb. b.Fetal Hb carries 40% to 50% more oxygen than maternal Hb. c.Hb concentration is 50% higher than that of the mother. d.Fetal heart rate is 110 to 160 beats per minute. e.Fetal heart rate is 160 to 200 beats per minute.

ANS: A, C, D Rationale: The following three special characteristics enable the fetus to obtain sufficient oxygen from maternal blood: (1) the fetal Hb carries 20% to 30% more oxygen; (2) the concentration is 50% higher than that of the mother; and (3) the fetal heart rate is 110 to 160 beats per minute, a cardiac output that is higher than that of an adult.

A patient is sent from the physician's office for assessment of oligohydramnios. The nurse is aware that this condition can result in a. excessive fetal urine secretion. b. newborn respiratory distress. c. central nervous system abnormality. d. gastrointestinal blockage.

ANS: B Because an abnormally small amount of amniotic fluid restricts normal lung development, the infant may have inadequate respiratory function after birth, when the placenta no longer performs respiratory function. Oligohydramnios may be caused by a decrease in urine secretion. Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality. Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid.

A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" What is the best answer? a."A baby's sex is determined as soon as conception occurs." b."The baby has developed enough to enable us to determine the sex by examining the genitals through an ultrasound scan." c."Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different." d."It might be possible to determine your baby's sex, but the external organs look very similar right now."

ANS: B Rationale: Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.

Which statement regarding the structure and function of the placenta is correct? a.Produces nutrients for fetal nutrition b.Secretes both estrogen and progesterone c.Forms a protective, impenetrable barrier to microorganisms such as bacteria and viruses d.Excretes prolactin and insulin

ANS: B Rationale: As one of its early functions, the placenta acts as an endocrine gland, producing four hormones necessary to maintain the pregnancy and to support the embryo or fetus: human chorionic gonadotropin (hCG), human placental lactogen (hPL), estrogen, and progesterone. The placenta does not produce nutrients. It functions as a means of metabolic exchange between the maternal and fetal blood supplies. Many bacteria and viruses can cross the placental membrane.

Which statement concerning neurologic and sensory development in the fetus is correct? a.Brain waves have been recorded on an electroencephalogram as early as the end of the first trimester (12 weeks of gestation). b.Fetuses respond to sound by 24 weeks of gestation and can be soothed by the sound of the mother's voice. c.Eyes are first receptive to light at 34 to 36 weeks of gestation. d.At term, the fetal brain is at least one third the size of an adult brain.

ANS: B Rationale: Hearing develops early and is fully developed at birth. Brain waves have been recorded at week 8. Eyes are receptive to light at 28 weeks of gestation. The fetal brain is approximately one fourth the size of an adult brain.

The pancreas forms in the foregut during the 5th to 8th week of gestation. A client with poorly controlled gestational diabetes asks the nurse what the effects of her condition will be on the fetus. What is the best response by the nurse? Poorly controlled maternal gestational diabetes will: a.produce fetal hypoglycemia. b.result in a macrocosmic fetus. c.result in a microcosmic fetus. d.enhance lung maturation.

ANS: B Rationale: Insulin is produced by week 20 of gestation. In the fetus of a mother with uncontrolled diabetes, maternal hypoglycemia produces fetal hypoglycemia and macrocosmia results. Hyperinsulinemia blocks lung maturation, placing the neonate at risk for respiratory distress.

A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. What is the nurse's best answer? a."You should have felt the baby move by now." b."Within the next month, you should start to feel fluttering sensations." c."The baby is moving; however, you can't feel it yet." d."Some babies are quiet, and you don't feel them move."

ANS: B Rationale: Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating, "you should have felt the baby move by now" is incorrect and may be an alarming statement to the client. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, then further assessment is necessary.

A newly married couple plans to use the natural family planning method of contraception. Understanding how long an ovum can live after ovulation is important to them. The nurse knows that his or her teaching was effective when the couple responds that an ovum is considered fertile for which period of time? a.6 to 8 hours b.24 hours c.2 to 3 days d.1 week

ANS: B Rationale: Most ova remain fertile for approximately 24 hours after ovulation, much longer than 6 to 8 hours. However, ova do not remain fertile for 2 to 3 days or are viable for 1 week. If unfertilized by a sperm after 24 hours, the ovum degenerates and is reabsorbed.

The maternity nurse is cognizant of what important structure and function of the placenta? a.As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b.As one of its early functions, the placenta acts as an endocrine gland. c.The placenta is able to keep out most potentially toxic substances, such as cigarette smoke, to which the mother is exposed. d.Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B Rationale: The placenta produces four hormones necessary to maintain the pregnancy: hCG, hPL, estrogen, and progesterone. The placenta widens until 20 weeks of gestation and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.

A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a."That must have been a coincidence; babies can't respond like that." b."The fetus is demonstrating the aural reflex." c."Babies respond to sound starting at approximately 24 weeks of gestation." d."Let me know if it happens again; we need to report that to your midwife."

ANS: C Rationale: Babies respond to external sound starting at approximately 24 weeks of gestation. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The last statement is inappropriate and may cause undue psychologic alarm to the client.

During a centering pregnancy group meeting, the nurse teaches patients that the fetal period is best described as one of a. Development of basic organ systems b. Resistance of organs to damage from external agents c. Maturation of organ systems d. Development of placental oxygen-carbon dioxide exchange

ANS: C Feedback A Basic organ systems are developed during the embryonic period. B The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant the organs will be. The greatest risk is when the organs are developing. C During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. D The placental system is complete by week 12, but that is not the best description of the fetal period.

The purpose of the ovum's zona pellucida is to a. make a pathway for more than one sperm to reach the ovum. b. allow the 46 chromosomes from each gamete to merge. c. prevent multiple sperm from fertilizing the ovum. d. stimulate the ovum to begin mitotic cell division.

ANS: C Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. Each gamete (sperm and ovum) has only 23 chromosomes. There will be 46 chromosomes when they merge. Mitotic cell division begins when the nuclei of the sperm and ovum unite.

Which statement regarding the development of the respiratory system is a high priority for the nurse to understand? a.The respiratory system does not begin developing until after the embryonic stage. b.The infant's lungs are considered mature when the L/S ratio is 1:1, at approximately 32 weeks of gestation. c.Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. d.Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks of gestation.

ANS: C Rationale: A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and thus accelerates lung maturity. The development of the respiratory system begins during the embryonic phase and continues into childhood. The infant's lungs are considered mature when the L/S ratio is 2:1, at approximately 35 weeks of gestation. Lung movements have been visualized on ultrasound scans at 11 weeks of gestation.

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

ANS: C Rationale: The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. "We don't really know when such defects occur" is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development—in the third to fifth weeks; therefore, the statement, "They usually occur in the first 2 weeks of development" is inaccurate.

A client arrives for her initial prenatal examination. This is her first child. She asks the nurse, "How does my baby get air inside my uterus?" What is the correct response by the nurse? a."The baby's lungs work in utero to exchange oxygen and carbon dioxide." b."The baby absorbs oxygen from your blood system." c."The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream." d."The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen."

ANS: C Rationale: The placenta delivers oxygen-rich blood through the umbilical vein, not the artery, to the fetus and excretes carbon dioxide into the maternal bloodstream. The fetal lungs do not function as respiratory gas exchange in utero. The baby does not simply absorb oxygen from a woman's blood system; rather, blood and gas transport occur through the placenta.

At a routine prenatal visit, the nurse explains the development of the fetus to her client. At approximately ____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. The client is how many weeks of gestation at today's visit? a.20 b.24 c.28 d.30

ANS: C Rationale: These milestones in human development occur at 28 weeks of gestation. These milestones have not occurred by 20 or 24 weeks of gestation but have been reached before 30 weeks of gestation.

Between 6 and 10 days after conception, the trophoblast secretes enzymes that enable it to burrow into the endometrium until the entire blastocyst is covered. This is termed implantation. Tiny projections then develop out of the trophoblast and extend into the endometrium. These projections are referred to as a. Decidua basalis b. Decidua capsularis c. Decidua vera d. Chorionic villi

ANS: D Feedback:These villi are vascular processes that obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood.

Which structure is responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream? a.Decidua basalis b.Blastocyst c.Germ layer d.Chorionic villi

ANS: D Rationale: Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula; implantation occurs at this stage. The germ layer is a layer of the blastocyst.

A woman who is 8 months pregnant asks the nurse, "Does my baby have any antibodies to fight infection?" What is the most appropriate response by the nurse? a."Your baby has all the immunoglobulins necessary: immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA)." b."Your baby won't receive any antibodies until he is born and you breastfeed him." c."Your baby does not have any antibodies to fight infection." d."Your baby has IgG and IgM."

ANS: D Rationale: During the third trimester, IgG is the only immunoglobulin that crosses the placenta; it provides passive acquired immunity to specific bacterial toxins. However, the fetus produces IgM by the end of the first trimester. IgA immunoglobulins are not produced by the baby. Therefore, by the third trimester, the fetus has both IgG and IgM. Breastfeeding supplies the newborn infant with IgA.

What is the most basic information that a nurse should be able to share with a client who asks about the process of conception? a.Ova are considered fertile 48 to 72 hours after ovulation. b.Sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours. c.Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d.Implantation in the endometrium occurs 6 to 10 days after conception.

ANS: D Rationale: Implantation occurs 6 to 10 days after conception and is complete after 10 days. Ova are considered fertile for approximately 24 hours after ovulation. Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.

Some of the embryo's intestines remain within the umbilical cord during the embryonic period. What is the rationale for this development of the gastrointestinal system? a.Umbilical cord is much larger at this time than it will be at the end of pregnancy. b.Intestines begin their development within the umbilical cord. c.Nutrient content of the blood is higher in this location. d.Abdomen is too small to contain all the organs while they are developing.

ANS: D Rationale: The abdominal contents grow more rapidly than the abdominal cavity; therefore, part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas.

While teaching an early pregnancy class, the nurse explains that the morula is a a. fertilized ovum before mitosis begins. b. flattened disk-shaped layer of cells within a fluid-filled sphere. c. double layer of cells that becomes the placenta. d. solid ball composed of the first cells formed after fertilization.

ANS: D The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization. The fertilized ovum is called the zygote. This is the embryonic disk. It will develop into the baby. The placenta is formed from two layers of cells: the trophoblast, which is the other portion of the fertilized ovum, and the decidua, which is the portion of the uterus where implantation occurs.

After implantation, tiny projections develop out of the trophoblast and extend into the endometrium. These projections are referred to as a. decidua basalis. b. decidua capsularis. c. decidua vera. d. chorionic villi.

ANS: D These villi are vascular processes that obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood. The deciduas basalis is the portion of the endometrium where the chorionic villi tap into the maternal blood vessels. The deciduas capsularis is the portion of the endometrium that covers the blastocyst. The portion of the endometrium that lines the rest of the uterus is called decidua vera.

A nurse is performing an assessment of a primipara who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing? A. Consistent increase in fundal height B. Fetal heart rate of 180 BPM C. Braxton Hicks contractions D. Quickening

Answer: B. Fetal heart rate of 180 BPM. The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected.

When explaining twin conception, the nurse points out that dizygotic twins develop from a. a single fertilized ovum and are always of the same sex. b. a single fertilized ovum and may be the same sex or different sexes. c. two fertilized ova and are the same sex. d. two fertilized ova and may be the same sex or different sexes.

ANS: D Dizygotic twins are two different zygotes, each conceived from a single ovum and a single sperm. They may be both male, both female, or one male and one female. A single fertilized ovum that produces twins is called monozygotic. Monozygotic twins are always the same sex. Dizygotic twins are from two fertilized ova and may or may not be the same sex.

The nurse auscultates the FHR and determines a rate of 112 bpm. Which action is appropriate? A. Inform the maternal client that the rate is normal. B. Reassess the FHR in 5 minutes because the rate is low. C. Report the FHR to the doctor immediately. D. Turn the maternal client on her side and administer oxygen.

Ans A

The nurse is working with a young childbearing family who has one child with a congenital heart disease. The parents are trying to determine the risks of a second child being born with congenital heart disease. Which information is important in assisting the parens in this decision? A. Genetics B. Genomics C Evidence-based practice D. Safety

Ans B Genomics describes the study of all the genes in an individual and the interactions of these genes with one another and with that individual's environment. Genomic information allows health care providers to determine how genomic changes contribute to patient conditions and influence treatment decisions.

A woman asks her doctor what she can do before she begins trying to get pregnant to help her baby, since she is prone to anemia. The provider correctly advises her to: A. Get pregnant, then begin on extra iron. B. Add more carbohydrates to her diet. C. Begin taking folic acid supplements daily. D. Have a hemoglobin baseline done now so her progress can be followed.

Ans c

After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so that you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy? a."Protein will help my baby grow." b."Eating protein will prevent me from becoming anemic." c."Eating protein will make my baby have strong teeth after he is born." d."Eating protein will prevent me from being diabetic."

Ans: A* Rationale: Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? a.Fat-soluble vitamins A and D b.Water-soluble vitamins C and B6 c.Iron and folate d.Calcium and zinc

Ans: C* Rationale: Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Zinc is sometimes supplemented; most women get enough calcium.

The nurse is counseling a couple who has sought information about conceiving. The couple asks the nurse to explain when ovulation usually occurs. Which statement by the nurse is correct? A. Two weeks before menstruation. B. Immediately after menstruation. C. Immediately before menstruation. D. Three weeks before menstruation.

Answer A. Ovulation occurs 14 days before the first day of the menstrual period (A). Although ovulation can occur in the middle of the cycle or 2 weeks after menstruation, this is only true for a woman who has a perfect 28-day cycle. For many women, the length of the menstrual cycle varies.

The primary healthcare provider has ordered 300 mcg of immunoglobulin to be delivered intramuscularly to a pregnant patient. What would be the reason for administering this to the patient? The patient: A. Is Rh negative and unsensitized. B. as elevated amniotic fluid volume. C. Has group B streptococcal infection. D. Is human immunodeficiency virus (HIV) positive

Answer: A A patient who is Rh negative or Rh unsensitized should receive 300 mcg immunoglobulin to prevent complications in the fetus related to Rh incompatibility. Elevated amniotic fluid volume (or polyhydramnios), streptococcal infection, and HIV infection cannot be treated with immunoglobulin. Severe polyhydramnios is treated by aspirating a small amount of amniotic fluid (amniocentesis). If a patient tests positive for group B streptococcal infection, antibiotic therapy is initiated. If the pregnant patient is HIV positive, antiretroviral drugs are administered to prevent transmission of infection from the mother to the child.

Which of the following are the functions of amniotic fluid? Select all that apply. A. Cushions the fetus from abdominal trauma B. Serves as the fluid for the fetus C. Maintains the internal temperature D. Facilitates fetal movement

Answer: A, B, C, & D All the four functions enumerated are true of amniotic fluid. Amniotic fluid surrounds the embryo and fetus during development and has a myriad of functions.

The hormone responsible for the maturation of the Graafian follicle is: A. Follicle-stimulating hormone B. Progesterone C. Estrogen D. Luteinizing hormone

Answer: A. The hormone that stimulates the maturation of the Graafian follicle is the *Follicle Stimulating Hormone* which is released by the anterior pituitary gland.

Which of the following would cause a false-positive result on a pregnancy test? A. The test was performed less than 10 days after an abortion. B. The test was performed too early or too late in the pregnancy. C. The urine sample was stored too long at room temperature. D. A spontaneous abortion or a missed abortion is impending.

Answer: A. A false-positive reaction can occur if the pregnancy test is performed less than 10 days after an abortion.

Nurse Berta is facilitating a monthly mothers' class at a small village. As a knowledgeable nurse, she must know that a mother who breastfeeds her child passes on which antibody through breast milk? A. IgA B. IgE C. IgG D. IgM

Answer: A. Antibodies, which are also called immunoglobulins, take five basic forms, indicated as IgG, IgA, IgM, IgD and IgE. All have been detected in human milk, but by far the most abundant type is IgA, particularly the form known as secretory IgA, which is found in great amounts throughout the gut and respiratory system of adults. The secretory IgA molecules passed to the suckling child are helpful in ways that go beyond their ability to bind to microorganisms and keep them away from the body's tissues.

When describing dizygotic twins to a couple, on which of the following would the nurse base the explanation? A. Two ova fertilized by separate sperm. B. Sharing of a common placenta. C. Each ova with the same genotype. D. Sharing of a common chorion.

Answer: A. Dizygotic (fraternal) twins involve two ova fertilized by separate sperm. Monozygotic (identical) twins involve a common placenta, same genotype, and common chorion.

A nursing instructor is conducting a lecture and is reviewing the functions of the female reproductive system. She asks the student nurse to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). The student nurse accurately responds by stating that: A. FSH and LH are released from the anterior pituitary gland. B. FSH and LH are secreted by the corpus luteum of the ovary C. FSH and LH are secreted by the adrenal glands D. FSH and LH stimulate the formation of milk during pregnancy.

Answer: A. FSH and LH, when stimulated by the gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, the growth of the Graafian follicle, and production of progesterone.

During a prenatal examination, the nurse draws blood from a young Rh-negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for: A. Acute hemolytic disease B. Respiratory distress syndrome C. Protein metabolic deficiency D. Physiologic hyperbilirubinemia

Answer: A. Acute hemolytic disease. When an Rh-negative mother carries an Rh-positive fetus there is a risk for maternal antibodies against Rh-positive blood; antibodies cross the placenta and destroy the fetal RBCs.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? A. Doppler blood flow analysis B. Contraction stress test (CST) C. Amniocentesis D. Daily fetal movement counts

Answer: A. Doppler blood flow analysis Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancy due to intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor.

A patient asks a nurse, "My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?" A. Green vegetables and liver B. Yellow vegetables and red meat C. Carrots D. Milk

Answer: A. Green vegetables and liver Green vegetables and liver are a great source of folic acid.

Which of the following statements is TRUE of conception? A. Within 2-4 hours after intercourse, conception is possible in a fertile woman. B. Generally, fertilization is possible 4 days after ovulation. C. Conception is possible during menstruation in a long menstrual cycle. D. To avoid conception, intercourse must be avoided 5 days before and 3 days after menstruation.

Answer: A. Within 2-4 hours after intercourse conception is possible in a fertile woman. The sperms when deposited near the cervical os will be able to reach the fallopian tubes within 4 hours. If the woman has just ovulated (within 24hours after the rupture of the Graafian follicle), fertilization is possible.

Smoking is contraindicated in pregnancy because: A. Nicotine causes vasodilation of the mother's blood vessels. B. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus. C. The smoke will make the fetus, and the mother feels dizzy. D. Nicotine will cause vasoconstriction of the fetal blood vessels.

Answer: B. Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child that was delivered at 37 weeks and tells the nurse that she doesn't have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as: A. G = 3, T = 2, P = 0, A = 0, L =1 B. G = 2, T = 0, P = 1, A = 0, L =1 C. G = 1, T = 1. P = 1, A = 0, L = 1 D. G = 2, T = 0, P = 0, A = 0, L = 1

Answer: B. G = 2, T = 0, P = 1, A = 0, L =1. Pregnancy outcomes can be described with the acronym GTPAL. "G" is Gravidity, the number of pregnancies. "T" is term births, the number of born at term (38 to 41 weeks). "P" is preterm births, the number born before 38 weeks gestation. "A" is abortions or miscarriages, included in "G" if before 20 weeks gestation, included in parity if past 20 weeks AOE. "L" is live births, the number of births of living children.

When assessing the adequacy of sperm for conception to occur, which of the following is the most useful criterion? A. Sperm count B. Sperm motility C. Sperm maturity D. Semen volume

Answer: B. Sperm motility Although all of the factors listed are important, sperm motility is the most significant criterion when assessing male infertility. To reach and fertilize an egg, sperm must move — wriggling and swimming through a woman's cervix, uterus, and fallopian tubes. This is known as motility. Males are most likely to be fertile if at least 40% of their sperm are moving.

The nurse in-charge is reviewing a patient's prenatal history. Which finding indicates a genetic risk factor? A. The patient is 25 years old. B. The patient has a child with cystic fibrosis. C. The patient was exposed to rubella at 36 weeks' gestation. D. The patient has a history of preterm labor at 32 weeks' gestation.

Answer: B. The patient has a child with cystic fibrosis Cystic fibrosis is a recessive trait; each offspring has a one in four chance of having the trait or the disorder. etic defects.

During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines that the fetal heart rate is normal if which of the following is noted? A. 80 BPM B. 100 BPM C. 150 BPM D. 180 BPM

Answer: C The fetal heart rate depends on gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress.

An adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by: A. Return preovulatory basal body temperature. B. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle. C. 3 full days of elevated basal body temperature and clear, thin cervical mucus. D. Breast tenderness and mittelschmerz.

Answer: C. 3 full days of elevated basal body temperature and clear, thin cervical mucus. Ovulation (the period when pregnancy can occur) is accompanied by a basal body temperature increase of 0.7 degrees F to 0.8 degrees F and clear, thin cervical mucus.

Which of the following is TRUE in Rh incompatibility? A. The condition can occur if the mother is Rh(+) and the fetus is Rh(-). B. Every pregnancy of an Rh(-) mother will result in erythroblastosis fetalis. C. On the first pregnancy of the Rh(-) mother, the fetus will not be affected. D. RhoGam is given only during the first pregnancy to prevent incompatibility.

Answer: C. On the first pregnancy, the mother still has no contact with Rh(+) blood thus it has not antibodies against Rh(+). After the first pregnancy, even if terminated into an abortion, there is already the possibility of mixing of maternal and fetal blood so this can trigger the maternal blood to produce antibodies against Rh(+) blood. The fetus takes its blood type usually from the father. The most common cause of Rh incompatibility is exposure from an Rh-negative mother by Rh-positive fetal blood during pregnancy or delivery. As a consequence, blood from the fetal circulation may leak into the maternal circulation, and, after a significant exposure, sensitization occurs leading to maternal antibody production against the foreign Rh antigen. In women who are prone to Rh incompatibility, the second pregnancy with an Rh-positive fetus often produces a mildly anemic infant, whereas succeeding pregnancies produce more seriously affected infants who ultimately may die in utero from massive antibody-induced hemolytic anemia. The exact mechanism by which passive administration of Rh IgG prevents Rh immunization is unknown. The most likely hypothesis is that the Rh immune globulin coats the surface of fetal RBCs containing Rh antigens. These exogenous antibody-antigen complexes cross the placenta before they can stimulate the maternal endogenous immune system B cells to produce IgG antibodies.

A 26-year old multigravida is 14 weeks pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, "What does the alpha-fetoprotein test indicate?" The nurse bases a response on the knowledge that this test can detect: A. Kidney defects B. Cardiac defects C. Neural tube defects D. Urinary tract defects

Answer: C. Neural tube defects. The alpha-fetoprotein test detects neural tube defects and Down syndrome. Alpha-fetoprotein (AFP) is a plasma protein produced by the embryonic yolk sac and the fetal liver. AFP levels in serum, amniotic fluid, and urine functions as a screening test for congenital disabilities, chromosomal abnormalities, as well as some other adult occurring tumors and pathologies.

Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy? A. Large for gestational age (LGA) fetus B. Hemorrhage C. Small for gestational age (SGA) baby D. Erythroblastosis fetalis

Answer: C. Small for gestational age (SGA) baby Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus.

A couple who wants to conceive but has been unsuccessful during the last 2 years has undergone many diagnostic procedures. When discussing the situation with the nurse, one partner states, "We know several friends in our age group, and all of them have their own child already, Why can't we have one?". Which of the following would be the most appropriate nursing diagnosis for this couple? A. Fear related to the unknown. B. Pain related to numerous procedures. C. Ineffective family coping related to infertility. D. Self-esteem disturbance related to infertility.

Answer: D. Self-esteem disturbance related to infertility. Based on the partner's statement, the couple is verbalizing feelings of inadequacy and negative feelings about themselves and their capabilities. Thus, the nursing diagnosis of self-esteem disturbance is most appropriate.

A pregnant woman is advised to alter her diet during pregnancy by increasing her protein and Vitamin C to meet the needs of the growing fetus. Which diet best meets the client's needs? A. Scrambled egg, hash browned potatoes, half-glass of buttermilk, small nectarine B. 3oz. Chicken, ½ cup corn, lettuce salad, small banana C. 1 C. macaroni, ¾ cup peas, whole glass milk, medium pear D. Beef, ½ cup Lima beans, glass of skim milk, ¾ cup strawberries

Answer: D. Beef, ½ C. Lima beans, a glass of skim milk, ¾ cup strawberries Increasing vitamin C intake helps the pregnant woman in the absorption of iron while protein aids in building the baby's bones, muscles, and other tissues during the second and third trimester. Beef and beans are an excellent source of protein as is skim milk. Strawberries are a good source of Vitamin C.

The cell division process that results in two identical cells, each with the same number of chromosomes as the original cell, is called: A. Meiosis. B. Mitosis. C. Oogenesis. D. Gametogenesis.

ans B Rationale: Mitosis is a fundamental process for life. During mitosis, a cell duplicates all of its contents, including its chromosomes, and splits to form two identical daughter cells.

Which of the following would be typical of a fetus at 20 weeks? Select the 2 that apply. A. The fetus has a body weight of 3 lbs. B. The fetus actively sucks and swallows amniotic fluid. C. The kidneys begin to produce urine. D. Lanugo covers the entire body.

ans B, D Rationale: A fetus at 20 weeks has a body weight of 435-465 g, can actively suck and swallow amniotic fluid, and has lanugo that covers the entire body.

A woman is seven months pregnant, and has come to the obstetrical clinic for a routine prenatal examination. During the assessment, the nurse hears a soft blowing sound above the mother's symphysis pubis. The rate of sound is synchronous with the mother's heartbeat. The nurse identifies this as: A. A normal sound called funic souffle. B. A normal sound called uterine souffle. C. An abnormal sound representing an aortic aneurysm. D. An abnormal sound representing a false knot in the cord.

ans B. Rationale: The normal sound called uterine souffle is timed precisely with the mother's pulse, and is heard over the mother's pubis during the last months of pregnancy.

In assisting with an abdominal ultrasound procedure for determination of fetal age, the nurse: A. Asks the woman to sign an operative consent form prior to the procedure. B. Has the woman empty her bladder before the test begins. C. Assists the woman into a supine position on the examining table. D. Instructs the woman to eat a fat-free meal 2 hours before the scheduled test time.

ans C Rationale: Clients are placed in a supine position on the table. Abdominal ultrasounds are not invasive procedures, and do not require a consent form. The recommendation is that the client have a full bladder to help elevate the uterus out of the pelvic cavity for better visualization. Dietary intake is not relevant to the ultrasound.

The primiparous client has completed her first prenatal clinic appointment. She is asking how often prenatal visits will be done if everything remains normal and she develops no complications. Which of the following statements best answers her question? "Prenatal visits are scheduled: A. "Every 2 weeks for the first 28 weeks, then every week." B. 'Every 4 weeks until 30 weeks, every 3 weeks until 36 weeks, then every week." C. 'Every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, then every week." D. "Every 4 weeks until 30 weeks, then every other week."

ans C. Rationale: Normal prenatal exams are scheduled every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and then every week until delivery. Clients at high risk and those experiencing complications will be seen more frequently.

A mother is pregnant with twins: one boy and one girl. Which type of twins could she be pregnant with? (select all that apply) A. dizygotic twins B. monozygotic twins C. Monochorionic-diamniotic twins D. Monochorionic-monoamniotic twins

ans. A Rationale: Fraternal Twins (Dizygotic twins) are as alike as siblings would be — in other words, they are not identical. Fraternal twins might be two boys, two girls, or a boy and a girl. Each baby develops in his or her own placenta

During an ultrasound, the ultrasound technician sees 2 embryos that each have their own amnion but share the same chorion. The ultrasound tech informs the expecting mother that she is pregnant with: A. fraternal twins B. dichorionic-diamniotic twins C. monochorionic-diamniotic twins D. monochorionic-monoamniotic twins

ans. c Rationale: Monochorionic-diamniotic twins are identical twins that share a placenta but each develops in their own separate amniotic sac. This is the most common type.

During an ultrasound, the ultrasound technician sees 2 embryos that share an amnion and a chorion. The ultrasound tech informs the expecting mother that she is pregnant with: A. fraternal twins B. dichorionic-diamniotic twins C. monochorionic-diamniotic twins D. monochorionic-monoamniotic twins

ans. d Rationale: Monochorionic-monoamniotic twins are identical twins that share both a placenta and an amniotic sac. This is the rarest and highest risk form of twin pregnancies.

Baby Bradley's umbilical cord only has 2 vessels instead of 3. The obstetrician informs his mother that he is at risk for malformations of the following systems: (select all that apply) A. cardiovascular B. gastrointestinal C. reproductive D. renal

ans: a, b ,d

These hazardous agents cause development of abnormal structures in the embryo (select all that apply) A. Acutane B. Aspirin C. Rubella D. The common cold F. Radiation

ans: a, c, f

Which of the following are functions of amniotic fluid? (select all that apply) A. Permit symmetrical external growth and development of the embryo B. provides the circulatory pathway from the placenta to the fetus C. Act as a cushion to protect the embryo against mechanical injury D. Help control the embryo's temperature E. Acts as a means of metabolic and nutrient exchange F. Provide fluid for analysis to determine fetal health and maturity

ans: a,c,d,f* Rationale: The fluid cushions the baby from outside pressures, acting as a shock absorbent barrier to protect against mechanical injury. Insulates the baby, keeping it warm and maintaining a regular temperature. The amniotic fluid contains antibodies. By breathing and swallowing the amniotic fluid, the baby practices using the muscles of these systems as they grow. As the baby floats inside the amniotic sac, it has the freedom to move about, giving muscles and bones the opportunity to develop properly. Amniotic fluid prevents the fetus from drying out and prevents parts of the body such as the fingers and toes from growing together; webbing can occur if amniotic fluid levels are low.

The upper uterus is the best place for the fertilized ovum to implant because it is here that the a. Placenta attaches most firmly b. Developing baby is best nourished c. Uterine endometrium is softer d. Maternal blood flow is lower

ans: b The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimal nourishment of the fetus. If the placenta attaches too deeply, it does not easily detach after birth. Softness is not a concern with implantation; attachment and nourishment are the major concerns. The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus.

How often should breast self examinations (BSE) be performed? A. once a week B. once a month C. once a year D. once every 2 years

ans: b Rationale: Breast self-examination should be done every month.