NRS 131.0 - Unit 8A - Prenatal Nursing
In describing the fetal ability to survive after birth, the perinatal nurse explains to the student nurse that surfactant, which assists in the process of lung maturation, is present at which gestation age? 1) 21 weeks 2) 22 weeks 3) 23 weeks 4) 24 weeks
Answer 4) 24 weeks Rationale: By 24 weeks, the lungs begin to secrete surfactant, a substance the decreases surface tension in the alveoli and is necessary for survival following birth.
The perinatal nurse describes for the prenatal class attendees that _______ is most common during the first and third trimesters of pregnancy. It is often related to physical discomforts, insomnia, and fetal activity.
Answer: fatigue Rationale: Fatigue and tiredness are common symptoms associated with pregnancy. As the pregnancy progresses from one trimester to the next, the woman's level of fatigue changes along the need for rest. Through education, the health-care provider can empower the expectant mother throughout the pregnancy to better manage her rest demands and cope with fatigue, which is more prevalent in the first and third trimesters.
The perceived sensation of ________ is a common concern voiced by pregnant patients to the clinic nurse. This symptom is most often caused by an increased awareness of the need to breathe and is related to physical changes in pregnancy.
Answer: dyspnea Rationale: Many women verbalize an increased awareness of the need to breathe and may perceive this sensation as dyspnea (difficulty breathing).
A pregnant client comes to the community-based clinic for the first prenatal visit at 10 weeks of gestation. The client had some spotting a week ago and was seen in the emergency department (ED), where an ultrasound confirmed the pregnancy. The client asks if the sex of the baby was noted during the ED visit. Which response by the nurse is the most appropriate? 1) "The external genitalia of your baby will not be visible until 12 to 14 weeks of gestation, so it is not possible to tell you the sex of your baby at this time." 2) "The external genitalia of your baby will not be visible until 15 to 18 weeks of gestation, so it is not possible to tell you the sex of your baby now." 3) "The ultrasound technician did not record the sex of your baby at the time of the test." 4) "The test results do not tell us the sex of your baby, but if you have a later ultrasound we will be able to tell you this information."
Answer: 1) "The external genitalia of your baby will not be visible until 12 to 14 weeks of gestation, so it is not possible to tell you the sex of your baby at this time." Rationale: The external genitalia of the fetus differentiate and are distinguishable by the 12th week of pregnancy.
The nurse provided specific nutrition teaching to a pregnant adolescent because of which factors affecting nutritional intake for the population? Select all that apply. 1) A lack of knowledge regarding the required foods 2) Inadequate finances 3) The practice of pica 4) The presence of eating disorders 5) Vegan diets
Answer: 1) A lack of knowledge regarding the required foods 2) Inadequate finances 3) The practice of pica 4) The presence of eating disorders Rationale: Eating disorders pose potentially harmful effects for the woman and the developing fetus, as nutrients are either not consumed or are quickly eliminated from the body. Pica, the consumption of nonnutritive substances or food, is a common eating disorder that can affect pregnancy. Lack of knowledge regarding nutritional values of food and inadequate finances to purchase healthy foods also contribute to an inadequate nutritional intake. Vegan diets are culturally based and not specific to the adolescent pregnant population.
A community health nurse is working to reduce the rate of adolescent pregnancy. Which action by the nurse is supported by Healthy People 2020? 1) Advocating for responsible sexual behavior 2) Banning condoms from schools 3) Promoting abstinence until the age of 18 years 4) Discouraging parents from discussing sex with their children
Answer: 1) Advocating for responsible sexual behavior Rationale: One goal of the Healthy People 2020 national health initiative directly addresses the number of pregnancies that occur in the adolescent population. The community health nurse can address this goal by advocating for responsible sexual behavior. Banning condoms, promoting abstinence until 18 years of age, and discouraging parents from discussing sex with their children will not help to meet this goal.
The nurse is providing care to a pregnant client who is at 12 weeks of gestation. Which psychosocial changes does the nurse anticipate for this client? Select all that apply. 1) Ambivalence 2) Active day dreaming 3) Introversion 4) Nesting behaviors 5) Sexual changes
Answer: 1) Ambivalence 3) Introversion 5) Sexual changes Rationale: Psychosocial changes that occur during the first trimester of pregnancy include ambivalence, introversion, and sexual changes. Active day dreaming and nesting behaviors are psychosocial changes that occur during the second trimester of pregnancy.
The clinic nurse reviews warning signs that a pregnant woman, a G3 TPAL 2002, in her second trimester. For which of the following is the pregnant woman taught to seek medical assistance? Select all that apply. 1) Any vaginal bleeding 2) Feels greater than 10 fetal movements in 20 minutes 3) Has a fever greater than 100.5°F (38.1°C) 4) Has heartburn 5) Experiences quickening
Answer: 1) Any vaginal bleeding 3) Has a fever greater than 100.5°F (38.1°C) Rationale: The following are danger signs that need to be reported during pregnancy: reduction in fetal movements; signs of preterm labor such as low, dull backache, pelvic pressure feelings, uterine contractions, or menstrual cramps; vaginal fluid loss or vaginal bleeding; maternal fever over 100.5°F (38.1°C); persistent headache associated with blurred vision or flashing lights in front minutes is an expected finding. Heartburn and quickening can be a normal occurrence during pregnancy and do not require seeking medical attention.
Which actions by clinic nurse advocate for the rights of pregnant women? Select all that apply. 1) Assisting each woman/family to develop a birth plan with personal wishes clearly stated 2) Documenting care provided at each visit 3) Describing each woman's teaching in the prenatal records 4) Obtaining prenatal information that can be purchased in different languages 5) Allowing a pregnant adolescent client to make health-care decisions
Answer: 1) Assisting each woman/family to develop a birth plan with personal wishes clearly stated 2) Documenting care provided at each visit 3) Describing each woman's teaching in the prenatal records 5) Allowing a pregnant adolescent client to make health-care decisions Rationale: Promoting maternal physical, psychological, and spiritual health and facilitating maternal empowerment are important keys in promoting and enhancing fetal well-being and a positive pregnancy outcome. During the prenatal visits, educational needs can be identified and addressed, concerns can be discussed, reassurance can be provided, and problems or potential problems can be discovered.
The perinatal nurse teaches pregnant women who use sunscreen about the need for vitamin D. Which foods that are rich in this vitamin should be included in the diet during pregnancy? Select all that apply. 1) Cereal 2) Egg whites 3) Milk 4) Salmon 5) Tuna
Answer: 1) Cereal 3) Milk 4) Salmon Rationale: Vitamin D is important in the absorption and metabolism of calcium. Milk and ready-to-eat cereals constitute the major food sources of vitamin D, which is also produced in the skin by the action of sunlight. Other sources of vitamin D include cereals, egg yolks, liver, and seafood.
A young adult pregnant client at 30 weeks of gestation has been prescribed a daily iron supplement. On which potential side effects of this supplement will the nurse educate the client prior to use? Select all that apply. 1) Constipation 2) Diarrhea 3) Nausea 4) Red, bloody stools 5) Black, tarry stools
Answer: 1) Constipation 3) Nausea 5) Black, tarry stools Rationale: Gastrointestinal side effects of supplemental iron include constipation, black and tarry stools, nausea, and abdominal cramping.
The perinatal nurse is describing initial lactation for the prenatal class attendees. When teaching about the "let-down" reflex, which hormone will the nurse include in the session? 1) Oxytocin 2) Prolactin 3) Relaxin 4) Estrogen
Answer: 1) Oxytocin Rationale: Oxytocin primarily causes uterine contractions, but high levels of progesterone prevent contractions until close to term. Oxytocin also stimulates milk ejection from the breasts, or the "let-down" reflex.
The clinic nurse uses effective communication when providing care to pregnant womenand their families. Which are elements of effective communication? Select all that apply. 1) Eye contact 2) Humor 3) Close-ended questions 4) Honesty 5) Empathy
Answer: 1) Eye contact 2) Humor 4) Honesty 5) Empathy Rationale: Effective communication is essential to promote family cohesiveness. Communication includes both verbal and nonverbal language such as body posture, gestures, facial expressions, tone of voice, and empathy. Within the family, communication needs to be open and truthful and received in a nonjudgmental and accepting manner, ultimately affirming and supporting one another. The use of close-ended questions is not an element of effective communication but a barrier to communication.
During preconception counseling, the clinic nurse explains that daily folic acid supplementation is important for which reasons? Select all that apply. 1) Fetal neural tube development 2) DNA production 3) Normal brain function 4) White blood cell production 5) Platelet production
Answer: 1) Fetal neural tube development 2) DNA production 3) Normal brain function 5) Platelet production Rationale: Folic acid is essential in the production of DNA and RNA and helps to maintain normal brain function and red blood cells, and to stabilize mental and emotional health. Folic acid deficiency is primarily responsible for the development of neural tube defects, including spina bifida, cleft lip and palate, and anencephaly.
The clinic nurse asks the pregnant woman about her awareness of quickening or fetal movement at 18 weeks of gestation. The nurse educates the woman that this sensation is a result of which items? Select all that apply. 1) Flatus 2) Abdominal muscle contractions 3) A urinary tract infection 4) Peristalsis 5) A sexually transmitted infection
Answer: 1) Flatus 2) Abdominal muscle contractions 4) Peristalsis Rationale: The perception of fetal movement (quickening) occurs during the second trimester. The sensation of fetal movement may also result from flatus, peristalsis, and abdominal muscle contractions. This sensation does not result from a urinary tract infection or a sexually transmitted infection.
The perinatal nurse is discussing fatigue with a pregnant woman in her third trimester. Which are causes of fatigue that the nurse will include in the discussion? Select all that apply. 1) Frequent voiding at night 2) Increased weight bearing related to pregnancy 3) Physiologic anemia 4) Emotional stress related to the initial adjustment to pregnancy 5) Depression associated with pregnancy
Answer: 1) Frequent voiding at night 2) Increased weight bearing related to pregnancy 3) Physiologic anemia Rationale: The pregnant woman's level of fatigue increases as the fetus continues to grow and develop. The maternal weight-bearing load associated with the fetus is compounded by a corresponding increase in extracellular fluid and blood volume, maternal reserves, placental mass, and amniotic fluid. Increased bladder pressure from the gravid uterus causes increased voiding, especially at night, when the woman is trying to sleep. Inadequate iron intake can lead to anemia, causing fatigue. Emotional stress and depression are causes for fatigue in the second trimester of pregnancy, not the third trimester of pregnancy.
The clinic nurse is aware that excessive weight gain in pregnancy is associated with an increased risk for which disorder? 1) Gestational diabetes 2) Anemia 3) Placental previa 4) Intrauterine growth restriction
Answer: 1) Gestational diabetes Rationale: Women who gain too much weight during pregnancy are at an increased risk for gestational diabetes. This complication places the infant at risk for macrosomia, congenital anomalies, birth trauma, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, cardiomyopathy, hyperbilirubinemia, and polycythemia.
The nurse is providing education to a couple who wishes to use the Lamaze approach to birth. Which item is appropriate for the nurse to teach this couple based on their wishes? 1) Giving birth free from routine medical interventions 2) Requiring support to become a good parent 3) Parenting as a learned art 4) Having a unique, irreplaceable role in your child's life
Answer: 1) Giving birth free from routine medical interventions Rationale: The Lamaze approach to birth states that women have a right to give birth free from routine medical interventions. The other choices are appropriate when teaching the Lamaze approach to parenting, not birth.
The nurse working in reproductive health is preparing a lecture about the Human Genome Project. When discussing the goal of this project, which will the nurse include in the presentation? 1) Identify exact human DNA sequences and genes. 2) Identify human DNA and RNA sequences. 3) Measure exact human DNA sequences for chromosomal diseases. 4) Measure exact human DNA sequence maps for disease prevention.
Answer: 1) Identify exact human DNA sequences and genes. Rationale: The Human Genome Project began in 1990 with an overarching goal to identify the exact DNA (deoxyribonucleic acid -- intracellular complex protein that carries genetic information) sequences (3 billion chemical base pairs) and 20,000 to 25,000 genes (segments of DNA that contain information needed to make protein) found in humans. This international project was coordinated by the U.S. Department of Energy and the National Institutes of Health and ended in 2003. The information obtained from the Human Genome Project has enabled scientists to read the complete genetic blueprint of a human being.
The clinic nurse describes the process of fetal immunity to the student nurse. The clinic nurse evaluates that the student understanding this process when the student states that the passive immunity given to the fetus by the mother is primarily made up of which component? 1) IgG 2) IgA 3) IgM 4) IgD
Answer: 1) IgG Rationale: Three major types of immunoglobulins -- IgG, IgA, and IgM-- are primarily involved in immunity. Circulating levels of maternal IgG are decreased during pregnancy because of transfer across the placenta. As the only immunoglobulin transported across the placenta, IgG is active against bacterial toxins.
A couple who has been unable to conceive after a year was referred to an internal medicine specialist. Which is the best explanation for the reason for this referral? 1) Optimize the health status of each person. 2) Facilitate testing for diabetes and hypertension. 3) Serve as a requirement before referral to an obstetrician/gynecologist. 4) Facilitate testing for autoimmune and liver diseases.
Answer: 1) Optimize the health status of each person. Rationale: Infertility is a widespread problem and treatment may include referrals to internal medicine, endocrinology, obstetrics, urology, and psychiatry. Infertility is usually first identified by the gynecologist/obstetrician. A referral to internal medicine may be recommend to optimize the health status of both partners.
The perinatal nurse knows that which factors may influence a pregnant woman's willingness to seek prenatal care? Select all that apply. 1) Perception of the benefits of care 2) Insurance coverage 3) Previous relationships with health-care providers 4) Number of other pregnant women seen by the clinic 5) Cultural expectations.
Answer: 1) Perception of the benefits of care 2) Insurance coverage 3) Previous relationships with health-care providers 5) Cultural expectations Rationale: A number of issues affect a woman's willingness to use health-care services. These include personal beliefs about pregnancy, cultural expectations, previous relationships with health-care providers, and perceived benefits of prenatal care, together with the more practical issues of access to care, medical insurance, and financial support.
The nurse is providing care to a pregnant client who is diagnosed with gonorrhea and chlamydia at her first prenatal visit. Based on this diagnosis, the client is at risk for developing which of the following during the pregnancy? Select all that apply. 1) Preterm labor 2) Preterm premature rupture of the membranes 3) Gestational hypertension 4) Gestational diabetes 5) Iron-deficiency anemia
Answer: 1) Preterm labor 2) Preterm premature rupture of the membranes Rationale: Gonorrhea and chlamydia are cervical infections that can ascend through the cervix and increase the risk of premature rupture of membranes and preterm labor.
The clinic nurse documents dental health teaching provided during pregnancy. Which topics are appropriate for the nurse to include in this teaching session? Select all that apply. 1) Regular dental examinations 2) Daily nutritional intake to include five to six servings of calcium-rich foods 3) Chewing gum containing Xylitol after meals 4) Flossing once a day 5) Brushing twice a day
Answer: 1) Regular dental examinations 3) Chewing gum containing Xylitol after meals 5) Brushing twice a day Rationale: Pregnant women need to receive regular dental examinations and treatment as determined by a dental practitioner. Promoting twice-daily brushing and flossing, recommending the use of fluoride toothpaste, encouraging a healthy diet, and encouraging chewing gum containing Xylitol after meals are appropriate patient teaching strategies to promote dental health.
In reviewing a woman's history during preconception counseling, it would be important to discuss potential teratogenic medications such as anticonvulsants and which other classification of medication? 1) Retinoids 2) Antiemetics 3) Antibiotics 4) Antihistamines
Answer: 1) Retinoids Rationale: A small number of medications and other substances are known, or are strongly suspected to be human teratogens. These include fat-soluable vitamins, alcohol, tobacco, caffeine, cocaine, opiates, anticonvulstants, warfarin, certain cardiovascular agents (e.g., LIpitor, Mevacor, Pravachol), retinoids, certain hormones (e.g., Depo-Provera, Android, Androlone-D, Pitressin), antineoplastics, certain anti-infective agents (e.g., Penetrex, Novoquinine, Virazole), thalidomide, and methyl mercury.
The clinic nurse counsels the newly diagnosed pregnant woman about the need for blood typing. Which will be included in the blood screening test for this pregnant woman? Select all that apply. 1) Rhesus typing 2) Blood group typing 3) Assessment of hematological antibodies 4) Assessment for the presence of fetal antibodies 5) Hematocrit
Answer: 1) Rhesus typing 2) Blood group typing 3) Assessment of hematological antibodies Rationale: Blood is drawn for the identification of the woman's blood type, Rh status, and the presence of irregular antibodies. The blood type and Rh are important in determining if the woman is at risk for developing isoimmunization during her pregnancy. A hematocrit will be drawn in the second trimester, not the first trimester.
The clinic nurse is providing care to a pregnant client who is at 15 weeks gestation. The nurse explains to the client that she is eligible to have a triple-screen test at this visit. Which is the best description of the test? 1) Screening 2) Diagnostic 3) Confirming 4) Mandatory
Answer: 1) Screening Rationale: Down syndrome screening may be initiated in the first or second trimester of pregnancy. in the first trimester, three "markers" are evaluated (the triple screen or triple test): pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin, and nuchal translucency (NT).
The clinic nurse screens all pregnant women regarding their exposure to environmental hazards. Which hazards can negatively impact a pregnancy and should be avoided? Select all that apply. 1) Secondhand smoke 2) Pesticides 3) Radiation 4) Carbon 5) Dilantin
Answer: 1) Secondhand smoke 2) Pesticides 3) Radiation Rationale: Common environmental hazards include exposure to cigarette smoke (either directly or passively) , alcohol consumption, recreational drugs, poor or inadequate diet, viruses, and occupational hazards, such as radiation and pesticides. It is estimated that approximately 10% of fetal malformations are related to exposure to environmental hazards. Carbon and Dilantin are not considered environmental hazards. Dilantin, however, may not be a safe medication to take during pregnancy.
When discussing the frequency of the menstrual cycle with a prepubescent girl, which topics does the nurse include in the session that can affect this cycle? Select all that apply. 1) Stress 2) Excessive exercise 3) Illness 4) Climate 5) Nutritional status
Answer: 1) Stress 2) Excessive exercise 3) Illness 5) Nutritional status Rationale: Factors such as stress, nutritional status, excessive exercise, fatigue, and illness can alter an individual's menstrual cycle intervals and length. Climate is not a factor that affects an individual's menstrual cycle intervals and length.
When teaching families at a prenatal class the functions of the maternal bony pelvis, which items will the nurse include in the session? Select all that apply. 1) Supports the growing uterus 2) Protects the pelvic contents 3) Forms a relatively fixed axis for birth 4) Encircles the lower abdominal contents 5) Secretes hormones to maintain pregnancy
Answer: 1) Supports the growing uterus 2) Protects the pelvic contents 3) Forms a relatively fixed axis for birth Rationale: The pelvis forms a bony ring that transmits body weight to the lower extremities. In women, the bony pelvis is structured to adapt to the demands of childbearing. The pelvis functions to support and protect the pelvic contents and to form a relatively fixed axis for the birth passage. The bony pelvis does not encircle the abdominal contents, nor does it secrete hormones to maintain pregnancy.
The clinic nurse is describing the process of genetic testing for a couple who requests assessment for Tay Sach disease. The best method of testing for Tay Sach disease is ______.
Answer: chorionic villus sampling
When educating a pregnant client about foods that should not be consumed during pregnancy, which foods high in methyl mercury should the pregnant client avoid? Select all that apply. 1) Swordfish 2) Salmon 3) Orange roughy 4) Lobster 5) Ahi tuna
Answer: 1) Swordfish 3) Orange roughy 5) Ahi tuna Rationale: Methyl mercury is a known neurotoxin that is especially harmful to the fetus, infant, and child. Human exposure to mercury primarily occurs through the consumption of fish (e.g., swordfish, shark, king mackerel, orange roughy, ahi tuna, and tilefish) contaminated through atmospheric mercury releases. Salmon and lobster are safe to consume during pregnancy.
The clinic nurse uses the GTPAL system to describe a woman's obstetrical history. When documenting the "P" in this system, which is correct? 1) The number of preterm deliveries 2) The number of total pregnancies 3) The parity of the woman 4) The number of missed pregnancies or abortions
Answer: 1) The number of preterm deliveries Rationale: The GTPAL system records the number of pregnancies and their outcomes. G = gravida; T = number of term pregnancies; P = number o preterm deliveries; A = number of abortions, spontaneous and induced; and L = number of living children.
The perinatal nurse explains to the novice nurse that a pregnant woman's intake of freshwater fish should be limited to ______ ounces per week.
Answer: 12 Rationale: Raw shellfish and fish high in mercury, including shark, swordfish, tilefish, and king mackerel, should be avoided. Fresh or frozen tuna, red snapper, and orange roughy contain moderate amounts of mercury, and women who are pregnant or planning to become pregnant should limit their intake of these products to 12 ounces per week.
The perinatal nurse provides information about fetal growth and development to parents in a prenatal class. When does the fetus begin to produce urine? 1) 6 to 8 weeks 2) 9 to 12 weeks 3) 12 to 16 weeks 4) 15 to 18 weeks
Answer: 2) 9 to 12 weeks Rationale: Urine production commences between 9 and 12 weeks of gestation. During late gestation, fetal urine and fetal lung secretions are the primary contributors to the total amniotic fluid volume.
The clinic nurse teaches a young adult client about foods to avoid when taking iron supplements. Which foods will the nurse teach the client to avoid while takin iron supplements? Select all that apply. 1) Orange juice 2) Eggs 3) Tea 4) Milk 5) Cranberry juice
Answer: 2) Eggs 3) Tea 4) Milk Rationale: Women should be taught to avoid consuming bran, tea, coffee, milk, oxylates (found in Swiss chard and spinach), and egg yolk at the same time as they take the iron supplement. Also, iron is best absorbed when taken between meals with a beverage other than tea, coffee, or milk.
When conducting education during a perception visit, which client response regarding where fertilization occurs indicates correct understanding of the information presented by the nurse? 1) Ovaries 2) Fallopian tubes 3) Uterus 4) Cervix
Answer: 2) Fallopian tubes Rationale: Fertilization usually occurs in the outer one-third of the fallopian tube, which provides a safe, nourishing environment for the ovum and sperm.
The perinatal nurse educator is preparing an educational session regarding the female reproductive system. Which type of bony pelvis is the best suited for childbirth? 1) Android 2) Gynecoid 3) Anthropoid 4) Platypelloid
Answer: 2) Gynecoid Rationale: There are four basic bony pelvis types: gynecoid, android, anthropoid, and platypelloid. Each type has a distinct shape, and each shape has distinct implications for childbirth. The gynecoid pelvis type is the typical, traditional female pelvis (present in 50% of women) that is best suited for childbirth.
The clinic nurse explains to a pregnant client, who is now at 30 weeks of gestation, the need to move her feet when having to stand for any prolonged length of time. This strategy is important to avoid which complication from occurring? 1) Decreased mean arterial pressure 2) Orthostatic hypotension 3) Vena caval syndrome 4) Increased mean arterial pressure
Answer: 2) Orthostatic hypotension Rationale: Orthostatic hypotension is a condition that occurs frequently during pregnancy and results from stagnation of blood in the lower extremities. If the woman stands for too long or arises too quickly, gravity causes blood to flow to the lower extremities, decreasing blood flow to the brain.
The nurse is educating an adult client about the process of menopause. The client states that she is experiencing irregular menstrual cycles with variable amounts of blood flow. Which phase of menopause will the nurse document in the medical record based on this data? 1) Climacteric phase 2) Perimenopausal phase 3) Menopause phase 4) Postmenopausal phase
Answer: 2) Perimenopausal phase Rationale: Based on the information provided by the client, the nurse documents that the client is experiencing the perimenopausal phase. During this phase, anovulatory menstrual cycles are irregular and variable in the amount of blood flow. The nurse would need to gather more data to document the other phases of menopause.
The clinic nurse encourages a woman to bring her partner to a preconception visit. Which is the most important benefit of this approach? 1) Facilitating support of this pregnancy 2) Providing an opportunity to discuss extended family health histories 3) Implementing blood testing of both parents 4) Providing an opportunity to review the menstrual/fertility history
Answer: 2) Providing an opportunity to discuss extended family health histories Rationale: A review of the family history is an important component of the preconception visit. Through the information gained, the woman's and her partner's extended families can be assessed for potential illness or diseases that tend to run in families. For this reason, it is desirable for the patient's partner to be present at the preconception visit so that he or she can accurately provide information about his or her family.
When describing fetal growth and development, the perinatal nurse correctly identifies which gestation week as when the fetal heart begins to beat? 1) Second week 2) Third week 3) Fourth week 4) Sixth week
Answer: 2) Third week Rationale: A primordial heart tube joins with blood vessels in the embryo, connecting the body stalk, chorion, and yolk sac to form a primitive cardiovascular system. The heart begins to beat and blood begins to circulate by the end of the third week.
When describing fetal circulation to the student nurse, the clinic nurse explains that most of the fetus's blood bypasses the lungs by shunting through the ______.
Answer: ductus arteriosus Rationale: Most of the fetus's blood bypasses the lungs by shunting through the ductus arteriosus, a vascular channel between the pulmonary artery and descending aorta. The remaining blood flows to the pulmonary circulation to support lung development.
A couple is receiving preconception counseling and asks about fetal development and the role of amniotic fluid. When educating the couple regarding the amniotic fluid, at which gestation week will the nurse state that amniotic fluid appears? 1) Week 2 2) Week 3 3) Week 5 4) Week 7
Answer: 2) Week 3 Rationale: Amniotic fluid first appears at about 3 weeks gestation. There are approximately 30 mL of amniotic fluid present at 10 weeks of gestation, and this amount increases to approximately 800 milliliters at 24 weeks of gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term.
The perinatal nurse discusses the need for calcium with a pregnant adolescent client at 18 weeks of gestation in her first pregnancy. Which is the requirement for calcium for this client during pregnancy? 1) 500 mg 2) 900 mg 3) 1,300 mg 4) 1,500 mg
Answer: 3) 1,300 mg Rationale: The RDA for calcium is 1,000 mg/day in pregnant and prepregnant women. Calcium requirements are increased in pregnant adolescents, who need an intake of 1,300 mg/day.
The perinatal nurse is talking with a pregnant client who is at 32 weeks of gestation. The client has had irregular contractions and is concerned about preterm labor. The client wants to breastfeed her baby, but is worried that she may not be able to do so if the baby is born prematurely. In responding to the pregnant client, the perinatal nurse explains that colostrum is present by which gestational week? 1) 10 2) 12 3) 16 4) 28
Answer: 3) 16 Rationale: During the second trimester, precolostrum, a clear, thin fluid, is found in the acini cells, the smallest parts of the milk glands. Precolostrum becomes colostrum, a creamy, whitish-yellow liquid that may leak from the nipples as early as the 16th week of gestation.
While conducting a preconception education visit, which response by the client indicates appropriate understanding of the number of mature ova released for potential fertilization? 1) 50 to 100 2) 100 to 200 3) 300 to 400 4) 500 to 800
Answer: 3) 300 to 400 Rationale: Throughout a woman's reproductive years, only 300 to 400 follicles will develop into mature ova and be released for potential fertilization by a sperm.
When teaching a female client about the hormones responsible for increasing libido, energy, and immunity, which hormone will the nurse include in the teaching session? 1) Estrogen 2) Progesterone 3) Testosterone 4) Relaxin
Answer: 3) Testosterone Rationale: In both genders, testosterone enhances the libido, increases energy, boosts immune function, and helps protect against osteoporosis.
The clinic nurse focusses on the breast examination as well as circulatory assessment of the legs and abdomen in the pregnant patient who is older than ____ years of age due to an increased likelihood of preexisting medical conditions such as diabetes and hypertension among this population.
Answer: 35 Rationale: The clinic nurse focuses on the breast examination as well as a circulatory assessment of the legs and abdomen in the pregnant patient who is older than 35 years of age due to an increased likelihood of preexisting medical conditions such as diabetes and hypertension among this population.
The perinatal nurse is providing preconception education to a couple. By which week in pregnancy does the female fetus fallopian tubes, the uterus, and the vagina? 1) 8 weeks 2) 10 weeks 3) 12 weeks 4) 16 weeks
Answer: 4) 16 weeks Rationale: In the fetus, by 16 weeks, the paramesonephric ducts evolve into the fallopian tubes, uterus, and vagina.
The perinatal nurse educator explains to the student nurse that fetal hemoglobin is very different from adult hemoglobin. The difference between the types of hemoglobin is extremely important, as fetal hemoglobin maintains which item during pregnancy? 1) Carbon dioxide level at a safe level 2) Acid-base balance of the fetal circulation 3) A decreased fetal perfusion rate 4) Patency of the ductus arteriosus
Answer: 4) Patency of the ductus arteriosus Rationale: Fetal hemoglobin has a lower oxygen content than that of the adult. The low PO2 level is important in maintaining fetal circulation, as it keeps the ductus arteriosus open and the pulmonary vascular bed constricted. Fetal hemoglobin enables the fetus to adapt to the lowered PO2. This unique type of hemoglobin has a high affinity for oxygen at low tensions, which improves saturation and facilitates oxygen transport to the fetal tissues. The increased perfusion rate (as compared to the adult) also helps to compensate for the lower oxygen saturations and increased oxygen-hemoglobin affinity.
The perinatal nurse explains to the pregnant client that gender is determined at conception but it takes about _____ weeks of development before the reproductive system becomes differentiated as male or female.
Answer: 8 Rationale: In humans, the course of gender maturation is quite lengthy, extending from embryonic development to full maturation in later adolescence. Although the gender of an individual is determined at the moment of conception, it takes about 8 weeks of development before the reproductive system becomes differentiated as male or female. Prior to 8 weeks of gestation, the embryo displays no distinguishing sexual characteristics.
The clinic nurse uses the CARE priniciple throughout the prenatal period with the understanding that this acronym refers to communicating, ________, respecting, and enabling.
Answer: Advocating Rationale: Throughout the childbearing experience, the nurse's primary role is to "CARE" for the patient. The "CARE" principle centers on communicating, advocating, respecting, and enabling/empowering the individual.
During prenatal class, the perinatal nurse correctly explains that neonates receive the beneficial immunoglobulin ______ from the maternal breast milk.
Answer: IgA Rationale: IgA is passed to the neonate in breast milk.
__________, the transient loss of consciousness, often occurs during pregnancy.
Answer: Syncope Rationale: Syncope is the transient loss of consciousness that can occur during pregnancy.
Tiny, slightly raised, bluish end-arterioles that appear on the neck, face, arms, and thorax during pregnancy are referred to as _______.
Answer: angiomas Rationale: The tiny, slightly raised, bluish end-arterioles that appear on the neck, face, arms, and thorax during pregnancy are referred to as angiomas.
Dark, blotchy pigment occurring around the eyes, hairline, brow, and nose during pregnancy is documented in the medical record as _______.
Answer: cholasma Rationale: Cholasma is the medical term used to describe the dark, blotchy pigment that occurs around the eyes, hairline, brow, and nose during pregnancy.
The clinic nurse talks with a pregnant client, who is at 32 weeks gestation, about the pain and numbness that the client is feeling in her hands. The nurse explains that these symptoms are most likely associated with carpal tunnel syndrome, a condition caused by the collection of ________ in the wrist that puts pressure on the median nerve.
Answer: fluid Rationale: Edema from vascular permeability can lead to a collection of fluid in the wrist that puts pressure on the median nerve lying beneath the carpal ligament. This alteration leads to carpal tunnel syndrome, a condition that usually develops during the third trimester. It is manifested by pain and paresthesia (a burning, tingling, or numb sensation) in the hand that radiates to the elbow.
The clinic nurse describes the importance of ________ supplements to a couple during preconception counseling. The woman understands that she would take this supplement 3 months prior to conception and at least 1 month following.
Answer: folic acid Rationale: Folic acid supplementation has been found to decrease the incidence of neural tube defects (NTDs) (Evans, Llurba, Landsberfer, O'Brien, & Harrison, 2004). Currently, the U.S. Public Health Service recommends that all women of childbearing age who are capable of becoming pregnant consume 0.4 mg of folic acid daily to reduce the incidence of neural tube defects.
The clinic nurse tests the urine of each pregnant client during each prenatal visit. The finding of _____ may be a normal finding due to increased glucose excretion during pregnancy, but warrants further investigation.
Answer: glucosuria Rationale: The finding of glucosuria may be normal due to an increased glucose excretion during pregnancy. However, a finding of glucosuria in a pregnant woman warrants further investigation.
The clinic nurse is encouraging a young adult pregnant client at 36 weeks of gestation to rest on her side as much as possible in order to avoid supine ______ syndrome, a condition that may occur if she lies on her back at this point in pregnancy.
Answer: hypotension Rationale: The pregnant woman may experience supine hypotension syndrome, or vena caval syndrome (faintness related to bradycardia), if she lies on her back. The pressure from the enlarged uterus exerted on the vena cava decreases the amount of venous return from the lower extremities and causes a marked decrease in blood pressure, with accompanying dizziness, diaphoresis, and pallor. Placing the woman on her left side can relieve the symptoms.
The light line from the umbilicus to the mons pubis that occurs during pregnancy is referred to as the _________ alba.
Answer: linea Rationale: The light line from the umbilicus to the mons pubis that occurs during pregnancy is called the linea alba.
While providing care, the perinatal nurse examines the vaginal/perineal area of a woman in labor. The nurse knows that the urinary _________ located below the clitoris is often seen in the shape of an inverted "V".
Answer: meatus Rationale: The urethral or urinary meatus (opening) is located in the midline of the vestibule, approximately 1 to 2.5 centimeters below the clitoris. The small opening is often shaped like an inverted "V". Anatomically, the clitoral shape is similar to that of the urinary meatus, and the structural similarity of the two organs sometimes results in misguided and painful catheterization attempts.
The perinatal nurse describes the process of inception for identical twins as _______, or coming from one fertilized oocyte.
Answer: monozygotic Rationale: Monozygotic (identical) twins develop from one fertilized oocyte (zygote) that divides into equal halves during an early cleavage phase (series of mitotic cell divisions) of development. Monozygotic twins are genetically identical, always the same gender, and similar in physical appearance.
The clinic nurse correctly uses the term "_______" to refer to a woman who is pregnant for the third time.
Answer: multigravida Rationale: Multigravida describes a woman who is pregnant for the third (or more) time.
The perinatal nurse recognizes that the discovery of _____ or more minor anomalies in the neonate signals the possibility of an additional major anomaly.
Answer: one Rationale: Single, minor anomalies occur in approximately 14% of newborns. The greater the number of anomalies present, the greater the risk of a major anomaly. Statistically, 90% of infants with three or more minor anomalies will also one or more major anomaly.
The perinatal nurse knows that the process of _______ involves the maturation of oocytes into human ova.
Answer: oogenesis Rationale: During fetal life, underdeveloped egg cells, oogonia, develop to become oocytes, (primitive eggs). There are 2 to 4 million oocytes present in the ovary at the time of birth. The process of oocyte development that results in maturation of human ova is called oogenesis.
The clinic nurse educates a pregnant client that ______ is produced by the anterior pituitary gland and stimulates maturation of the mammary glands during pregnancy and initiates milk production.
Answer: prolactin Rationale: Following birth and delivery of the placenta, there is an abrupt decrease in estrogen. The event triggers an increased secretion of prolactin (the hormone) that stimulates milk production) by the anterior pituitary gland.
Decreased hemoglobin caused by increased plasma volume with a proportionately lower increase in red blood cells that occurs during pregnancy is referred to as ______.
Answer: pseudoanemia Rationale: Pseduoanemia is the term used to describe the decreased hemoglobin caused by increased plasma volume with a proportionately.
The clinic nurse explains to a woman who will undergo a physical examination and a Pap smear that a speculum is used to facilitate examination of the vaginal canal and collection of cells from the ______ junction.
Answer: squamocolumnar Rationale: The vaginal portion of the cervix is composed of squamous (epithelial) cells. The canal portion of the cervix that leads into the uterine epithelium is composed of columnar cells. The juncture of these two cell types is called the squamocolumnar junction, from which cells are collected in a Pap smear.
The perinatal nurse is aware that it is important to model positive thinking during pregnancy, as this approach can be associated with decreased ____ and increased immunity.
Answer: stress Rationale: Positive thinking is under each individual's control but can be modeled. A positive attitude toward life is associated with released stress, improved coping abilities, improved immunity, and a greater sense of well-being.
During a prenatal class on pregnancy discomforts, the perinatal nurse describes "round ligament pain" as discomfort caused by _____ of the uterine ligaments and sudden maternal position changes.
Answer: stretching Rationale: The round ligaments expand both in diameter and in length during pregnancy, and this normal physiologic change may be associated with maternal discomfort termed round ligament pain. As the uterus expands, the round ligaments become stretched tight and sudden movements such as position changes, coughing, or stretching may result in sharp pains that can be quite concerning until the women understands the physiology of the discomfort.
The clinic nurse explains to the female client that the usual site for tubal ligation is the isthmus, which is anatomically located closest to the ______.
Answer: uterus Rationale: The third division of the fallopian tube, the isthmus, is nearest to the uterus and is typically the site for tubal ligation (permanent sterilization).
