Antepartum

Which of the following exercises should be taught to a pregnant woman who complains of backaches? 1. Kegeling. 2. Pelvic tilting. 3. Leg lifting. 4. Crunching.

2. The pelvic tilt is an exercise that can reduce backache pain.

Which fi nding would the nurse view as normal when evaluating the laboratory reports of a 34-week gestation client? 1. Mild anemia. 2. Thrombocytopenia. 3. Polycythemia. 4. Hyperbilirubinemia.

1. Anemia is an expected fi nding

The nurse is reading an article that states that the maternal mortality rate in the United States in the year 2014 was 14. Which of the following statements would be an accurate interpretation of the statement? 1. In the year 2014, there were 14 maternal deaths in the United States per 100,000 live births. 2. In the year 2014, there were 14 maternal deaths in the United States per 100,000 women of childbearing age. 3. In the year 2014, there were 14 maternal deaths in the United States per 100,000 pregnancies. 4. In the year 2014, there were 14 maternal deaths in the United States per 100,000 women in the country.

1. This statement is correct. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births.

The nurse is caring for a prenatal client who states she is prone to developing anemia. Which of the following foods should the nurse advise the gravida is the best source of iron? 1. Raisins. 2. Hamburger. 3. Broccoli. 4. Molasses.

2. Hamburger contains the most iron.

It is discovered that a pregnant woman practices pica. Which of the following complications is most often associated with this behavior? 1. Hypothyroidism. 2. Iron-defi ciency anemia. 3. Hypercalcemia. 4. Overexposure to zinc.

2. Iron-defi ciency anemia is often seen in clients who engage in pica.

Which of the following developmental features would the nurse expect to be absent in a 41-week gestation fetus? 1. Fingernails. 2. Eyelashes. 3. Lanugo. 4. Milia.

3. Because this baby is post-term, lanugo would likely not be present

A 20-week gestation client is being seen in the prenatal clinic. Place an "X" on the place on the abdomen where the nurse would expect the fundal height to be felt.

The "X" should be placed at the level of the umbilicus.

Please place an "X" on the drawing of the cross section of a placenta at the site of gas exchange.

An "X" will be placed between the neonatal and maternal vessels where gas exchange occurs.

Which of the following fi ndings in an 8-week gestation client, G2 P1001, should the nurse highlight for the nurse midwife? Select all that apply. 1. Body mass index of 17 kg/m 2 . 2. Rubella titer of 1:8. 3. Blood pressure of 100/60 mm Hg. 4. Hematocrit of 30%. 5. Hemoglobin of 13.2 g/dL.

1, 2, 4 1. The BMI of 17 is of concern. This client is entering her pregnancy underweight. 2. The rubella titer results should be reported to the nurse midwife. 4. The hematocrit is below normal.

A woman is planning to become pregnant. Which of the following actions should she be counseled to take before she stops using birth control? Select all that apply. 1. Take a daily multivitamin. 2. See a medical doctor. 3. Drink beer instead of vodka. 4. Stop all over-the-counter medications. 5. Stop smoking cigarettes.

1, 2, 5 1. Before attempting to become pregnant, it is very important that women begin taking daily multivitamin tablets. 2. Women who wish to become pregnant should fi rst see a medical doctor for a complete checkup. 5. Women who wish to become pregnant should be counseled to stop smoking

When analyzing the need for health teaching of a prenatal multigravida, the nurse should ask which of the following questions? 1. "What are the ages of your children?" 2. "What is your marital status?" 3. "Do you ever drink alcohol?" 4. "Do you have any allergies?"

1, 3 1. This is an important question, but it is not associated with health teaching. 3. This question is important to ask to determine a prenatal client's health teaching needs.

A woman whose prenatal weight was 105 lb weighs 109 lb at her 12-week visit. Which of the following comments by the nurse is appropriate at this time? 1. "We expect you to gain about 1 lb per week, so your weight is a little low at this time." 2. "Most women gain no weight during the fi rst trimester, so I would suggest you eat fewer desserts for the next few weeks." 3. "You entered the pregnancy well underweight, so we should check your diet to make sure you are getting the nutrients you need." 4. "Your weight gain is exactly what we would expect it to be at this time."

1, 4 1. Weight gain of 0.8 to 1 lb per week is expected during the second and third trimesters only. 4. The weight gain is normal for the fi rst trimester.

The nurse has taken a health history on four primigravida clients at their fi rst prenatal visits. It is high priority that which of the clients receives nutrition counseling? 1. The woman diagnosed with phenylketonuria. 2. The woman who has Graves disease. 3. The woman with Cushing syndrome. 4. The woman diagnosed with myasthenia gravis.

1. The client with phenylketonuria (PKU) must receive counseling from a registered dietitian.

A nurse is providing health education to a group of women who are planning to become pregnant. Which of the following actions should the nurse advise the women to take throughout their pregnancies? Select all that apply. 1. The women should avoid consuming well done meat. 2. The women should avoid traveling to locations where the zika virus is endemic. 3. The women should engage in a daily exercise program. 4. The women should consume one serving of seafood each day. 5. The women should drink beer and wine instead of spirits like whiskey and vodka.

2, 3 2. This statement is true. Throughout their pregnancies, women should avoid traveling to locations where the zika virus is endemic. 3. This statement is true. Women should engage in a daily exercise program throughout their pregnancies.

A woman asks the nurse about the function of amniotic fl uid. Which of the following statements by the woman indicates that the teaching was successful? Select all that apply. 1. The fl uid provides fetal nutrition. 2. The fl uid cushions the fetus from injury. 3. The fl uid enables the fetus to grow. 4. The fl uid provides the fetus with a stable thermal environment. 5. The fl uid enables the fetus to practice swallowing.

2, 3, 4, 5 2. Amniotic fl uid does cushion the fetus from injury. 3. Amniotic fl uid enables the fetus's limbs and body to move freely so that the baby can grow unencumbered. 4. The amniotic fl uid is maintained at the mother's body temperature, providing the fetus with a neutral thermal environment. 5. The fetus does swallow the amniotic fl uid while in utero.

A woman delivers a fetal demise that has lanugo covering the entire body, nails that are present on the fi ngers and toes, but eyes that are still fused. Prior to the death, the mother stated that she had felt quickening. Based on this information, the nurse knows that the baby is about how many weeks' gestation? 1. 15 weeks. 2. 22 weeks. 3. 29 weeks. 4. 36 weeks.

2. This fetus is about 22 weeks' gestation. Nails start to develop in the fi rst trimester, and lanugo starts to develop at about 20 weeks, but eyes remain fused until about 29 weeks. In addition, quickening occurs by week 20.

A gravid client is counseled by her primary healthcare provider to have a vaccination during her third trimester of pregnancy. The client questions the healthcare provider's recommendation. Which of the following statements would be appropriate for the nurse to give the client? 1. "When received during pregnancy, the rotavirus vaccine helps to prevent dehydration in newborns." 2. "If you receive the tetanus, diphtheria, and acellular pertussis vaccine, your baby will be protected against whooping cough." 3. "When received during pregnancy, the human papillomavirus vaccine helps to prevent newborns from acquiring the sexually transmitted infection." 4. "If you receive the varicella vaccine, your baby will be protected from the chickenpox virus."

2. This statement is correct. The Centers for Disease Control and Prevention (CDC) recommends the administration of the Tdap vaccine to all pregnant women during the third trimester to provide their neonates with passive immunity to whooping cough.

A client asks the nurse, "Could you explain how the baby's blood and my blood separate at delivery?" Which of the following responses is appropriate for the nurse to make? 1. "When the placenta is born, the circulatory systems separate." 2. "When the doctor clamps the cord, the blood stops mixing." 3. "The separation happens after the baby takes the fi rst breath. The baby's oxygen no longer has to come from you." 4. "The blood actually never mixes. Your blood supply and the baby's blood supply are completely separate."

4. The blood supplies are completely separate

The nurse plans to provide anticipatory guidance to a 10-week gravid client who is being seen in the prenatal clinic. Which of the following information should be a priority for the nurse to provide? 1. Pain management during labor. 2. Methods to relieve backaches. 3. Breastfeeding positions. 4. Characteristics of the newborn.

1, 2 1. It is too early in the pregnancy to provide anticipatory guidance about pain management during labor. 2. It is appropriate for the nurse to provide anticipatory guidance regarding methods to relieve back pain.

A client enters the prenatal clinic. She states that she missed her period yesterday and used a home pregnancy test this morning. She states that the results were negative, but "I still think I am pregnant." Which of the following statements would be appropriate for the nurse to make at this time? 1. "Your period is probably just irregular." 2. "We could do a blood test to check." 3. "Home pregnancy test results are very accurate." 4. "You should repeat the test in one week."

1, 2 1. This response is inappropriate. It does not acknowledge the client's concerns. 2. This response is correct. Serum pregnancy tests are more sensitive than urine tests.

The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that are within normal limits during the latter half of the pregnancy. Which of the following comments by the client indicates that teaching was successful? Select all that apply. 1. "During the third trimester I may experience frequent urination." 2. "During the third trimester I may experience heartburn." 3. "During the third trimester I may experience nagging backaches." 4. "During the third trimester I may experience persistent headache." 5. "During the third trimester I may experience blurred vision."

1, 2, 3 1. Frequency is seen once lightening, or the descent of the fetus into the pelvis, has occurred. 2. Heartburn is a common complaint of pregnant women. 3. Backaches are common complaints of pregnant women.

An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following fi ndings would the nurse determine are presumptive signs of pregnancy? Select all that apply. 1. Amenorrhea. 2. Breast tenderness. 3. Quickening. 4. Frequent urination. 5. Uterine growth.

1, 2, 3, 4 1. Amenorrhea is a presumptive sign of pregnancy. 2. Breast tenderness is a presumptive sign of pregnancy. 3. Quickening is a presumptive sign of pregnancy. 4. Frequent urination is a presumptive sign of pregnancy.

A nurse is advising a pregnant woman about the danger signs of pregnancy. The nurse should teach the mother that she should notify the physician immediately if she experiences which of the following signs/symptoms? Select all that apply. 1. Convulsions. 2. Double vision. 3. Epigastric pain. 4. Persistent vomiting. 5. Polyuria.

1, 2, 3, 4 1. Convulsions are a danger sign of pregnancy. 2. Double vision is a danger sign of pregnancy. 3. Epigastric pain is a danger sign of pregnancy. 4. Persistent vomiting is a danger sign of pregnancy.

A nurse is working in the prenatal clinic. Which of the following fi ndings seen in third-trimester pregnant women would the nurse consider to be within normal limits? Select all that apply. 1. Leg cramps. 2. Varicose veins. 3. Hemorrhoids. 4. Fainting spells. 5. Lordosis.

1, 2, 3, 5 1. Although annoying, leg cramps are not pathological. 2. Varicose veins are normal, although client teaching may be needed. 3. Hemorrhoids are normal, although client teaching may be needed. 5. Lordosis, or change in the curvature of the spine, is normal, although patient teaching may be needed.

A woman has just completed her fi rst trimester. Which of the following fetal structures can the nurse tell the woman are well formed at this time? Select all that apply. 1. Genitals. 2. Heart. 3. Fingers. 4. Alveoli. 5. Kidneys.

1, 2, 3, 5 1. Although not yet clearly visible on ultrasound, the genitalia are formed by the end of the fi rst trimester. 2. The heart is formed by the end of the fi rst trimester. 3. The fi ngers are formed by the end of the fi rst trimester. 5. The kidneys are formed by the end of the fi rst trimester.

Which of the following vital sign changes should the nurse highlight for a pregnant woman's obstetrician? 1. Prepregnancy blood pressure (BP) 100/60 and third trimester BP 140/90. 2. Prepregnancy respiratory rate (RR) 16 rpm and third trimester RR 22 rpm. 3. Prepregnancy heart rate (HR) 76 bpm and third trimester HR 88 bpm. 4. Prepregnancy temperature (T) 98.6 º F/37 º C and third trimester T 99.2 º F/37.3 º C.

1. The blood pressure should not elevate during pregnancy. This change should be reported to the healthcare practitioner.

A gravida's fundal height is noted to be at the xiphoid process. The nurse is aware that which of the following fetal changes is likely to be occurring at the same time in the pregnancy? 1. Surfactant is formed in the fetal lungs. 2. Eyes begin to open and close. 3. Respiratory movements begin. 4. Spinal column is completely formed.

1. Surfactant is usually forming in the fetal lungs by the 36th week.

A client asks the nurse what was meant when the physician told her she had a positive Chadwick sign. Which of the following information about the fi nding would be appropriate for the nurse to convey at this time? 1. "It is a purplish stretch mark on your abdomen." 2. "It means that you are having heart palpitations." 3. "It is a bluish coloration of your cervix and vagina." 4. "It means the doctor heard abnormal sounds when you breathed in."

1, 3 1. Purplish stretch marks are called abdominal striae. 3. A positive Chadwick sign means that the client's cervix and vagina are a bluish color. It is a probable sign of pregnancy.

A father experiencing couvade syndrome is likely to exhibit which of the following symptoms/behaviors? Select all that apply. 1. Heartburn. 2. Promiscuity. 3. Hypertension. 4. Bloating. 5. Abdominal pain.

1, 4, 5 1. Heartburn is a common symptom. 4. Some fathers complain of abdominal bloating. 5. Some fathers complain of abdominal pain

A gravida, G1 P0000, is having her fi rst prenatal physical examination. Which of the following assessments should the nurse inform the client that she will have that day? Select all that apply. 1. Pap smear. 2. Mammogram. 3. Glucose tolerance test. 4. Biophysical profi le. 5. Complete blood count.

1, 5 1. The client will have a Pap smear done 5. A complete blood count will be performed

A pregnant client's primary healthcare provider has ordered a 75-gram oral glucose tolerance test (OGTT) to screen the client for gestational diabetes. The nurse is providing preprocedure counseling to the client. Which of the following must the client do? Select all that apply. 1. Fast for 8 to 16 hours prior to the test. 2. Bring a fi rst void urine specimen to the laboratory for testing. 3. Consume a solid sugar cube immediately upon awakening. 4. Drink 16 ounces of water 1 hour prior to the test. 5. Smoke no cigarettes the day of the test

1, 5 1. Women must fast for a minimum of 8 hours and a max 5. Smoking on the morning of the test can alter the results.

The midwife has just palpated the fundal height at the location noted on the picture below. It is likely that the client is how many weeks pregnant? 1. 12. 2. 20. 3. 28. 4. 36.

1. The client is likely 12 weeks pregnant. At 12 weeks, the fundal height is at the top of the symphysis.

A woman states that she frequently awakens with "painful leg cramps" during the night. Which of the following assessments should the nurse make? 1. Woman's exercise schedule. 2. Her Goodell sign. 3. Her Hegar sign. 4. Woman's dietary intake.

1. An evaluation of the client's exercise schedule should be performed.

During a preconception counseling session, the nurse encourages a couple to prepare a birth plan. Which of the following is the most important goal for this action? 1. Promote communication between the couple and healthcare professionals. 2. Enable the couple to learn about the types of pain medicine used in labor. 3. Provide the couple with a list of items that they should take to the hospital for the labor and delivery. 4. Give the high-risk couple a sense of control over the likelihood of having a surgical delivery.

1. Birth plans help to facilitate communication between couples and their healthcare providers.

A nurse is discussing diet with a pregnant woman. Which of the following foods should the nurse advise the client to avoid consuming during her pregnancy? 1. Bologna. 2. Cantaloupe. 3. Asparagus. 4. Popcorn.

1. Bologna should not be consumed during pregnancy unless it is thoroughly cooked.

During a prenatal visit, a gravid client is complaining of ptyalism. Which of the following nursing interventions is appropriate? 1. Encourage the woman to brush her teeth carefully. 2. Advise the woman to have her blood pressure checked regularly. 3. Encourage the woman to wear supportive hosiery. 4. Advise the woman to avoid eating rare meat.

1. Clients who experience ptyalism have an excess of saliva. They should be advised to be vigilant in the care of their teeth and gums. Ptyalism is often accompanied by gingivitis and nausea and vomiting.

A 38-week gestation client, Bishop score 1, is advised by her nurse midwife to take evening primrose daily. The offi ce nurse advises the client to report which of the following side effects that has been attributed to the oil? 1. Skin rash. 2. Pedal edema. 3. Blurred vision. 4. Tinnitus.

1. Evening primrose has been shown to cause skin rash in some women.

A mother is experiencing nausea and vomiting every afternoon. The ingestion of which of the following spices has been shown to be a safe complementary therapy for this complaint? 1. Ginger. 2. Sage. 3. Cloves. 4. Nutmeg.

1. Ginger has been shown to be a safe antiemetic agent for pregnant women

Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following? 1. Avoid eating greasy foods. 2. Drink orange juice before rising. 3. Consume 1 teaspoon of nutmeg each morning. 4. Eat 3 large meals plus a bedtime snack.

1. Greasy foods should be avoided.

The nurse notes each of the following fi ndings in a 10-week gestation client. Which of the fi ndings would enable the nurse to tell the client that she is positively pregnant? 1. Fetal heart rate via Doppler. 2. Positive pregnancy test. 3. Positive Chadwick sign. 4. Montgomery gland enlargements.

1. Hearing a fetal heart rate is a positive sign of pregnancy.

A client enters the prenatal clinic. She states that she believes she is pregnant. Which of the following hormone elevations will indicate a high probability that the client is pregnant? 1. Chorionic gonadotropin. 2. Oxytocin. 3. Prolactin. 4. Luteinizing hormone

1. High levels of the hormone chorionic gonadotropin in the bloodstream and urine of the woman is a probable sign of pregnancy.

When assessing the psychological adjustment of an 8-week gravida, which of the following would the nurse expect to see signs of? 1. Ambivalence. 2. Depression. 3. Anxiety. 4. Ecstasy.

1. It is common for women to be ambivalent about their pregnancy during the fi rst trimester.

The nurse is assisting a couple to develop decisions for their birth plan. Which of the following decisions should be considered nonnegotiable by the parents? 1. Whether or not the father will be present during labor. 2. Whether or not the woman will have an episiotomy. 3. Whether or not the woman will be able to have an epidural. 4. Whether or not the father will be able to take pictures of the delivery

1. The presence of the father at delivery should be nonnegotiable.

The nurse asks a woman about how the woman's husband is dealing with the pregnancy. The nurse concludes that counseling is needed when the woman makes which of the following statements? 1. "My husband is ready for the pregnancy to end so that we can have sex again." 2. "My husband has gained quite a bit of weight during this pregnancy." 3. "My husband seems more worried about our fi nances now than before the pregnancy." 4. "My husband plays his favorite music for my belly so the baby will learn to like it."

1. The woman implies that she and her husband are not having sex. There is no need to refrain from sexual intercourse during a normal pregnancy—so the woman and her husband need further counseling.

A gravid woman who recently emigrated from mainland China is being seen at her fi rst prenatal visit. She was never vaccinated in her home country. An injection to prevent which of the following communicable diseases should be administered to the woman during her pregnancy? 1. Infl uenza. 2. Mumps. 3. Rubella. 4. Varicella.

1. The woman should receive the infl uenza injection. The nasal spray, however, should not be administered to a pregnant woman.

A gravid woman and her husband inform the nurse that they have just moved into a three-story home that was built in the 1930s. Which of the following is critical for the nurse to advise the woman to protect the unborn child? 1. Stay out of any rooms that are being renovated. 2. Drink water only from the hot water tap. 3. Refrain from entering the basement. 4. Climb the stairs only once per day.

1. The woman should stay out of rooms that are being renovated.

The nurse is teaching a couple about fetal development. Which statement by the nurse is correct about the morula stage of development? 1. "The fertilized egg has yet to implant into the uterus." 2. "The lung fi elds are fi nally completely formed." 3. "The sex of the fetus can be clearly identifi ed." 4. "The eyelids are unfused and begin to open and close."

1. This is a true statement. In the morula stage, about 2 to 4 days after fertilization, the fertilized egg has not yet implanted in the uterus.

A nurse who is providing nutrition counseling to a new gravid client advises the woman that a serving of meat is approximately equal in size to which of the following items? 1. Deck of cards. 2. Paperback book. 3. Clenched fi st. 4. Large tomato.

1. This is an accurate statement. A serving of meat—typically a 2 to 3 oz serving—is approximately equal to a deck of cards.

Why is it essential that women of childbearing age be counseled to plan their pregnancies? 1. Much of the organogenesis occurs before the missed menstrual period. 2. Insurance companies must preapprove many prenatal care expenditures. 3. It is recommended that women be pregnant no more than 3 times during their lifetime. 4. The cardiovascular system is stressed when pregnancies are less than 2 years apart.

1. This statement is true. Organogenesis begins prior to the missed menstrual period.

The nurse is caring for a pregnant client who is a vegan. Which of the following foods should the nurse suggest the client consume as substitutes for restricted foods? 1. Tofu, legumes, broccoli. 2. Corn, yams, green beans. 3. Potatoes, parsnips, turnips. 4. Cheese, yogurt, fi sh.

1. Tofu, legumes, and broccoli are excellent substitutes for the restricted foods.

A pregnant client is lactose intolerant. Which of the following foods could this woman consume to meet her calcium needs? 1. Turnip greens. 2. Green beans. 3. Cantaloupe. 4. Nectarines.

1. Turnip greens are calcium rich.

A third-trimester client is being seen for routine prenatal care. Which of the following assessments will the nurse perform during the visit? Select all that apply. 1. Blood glucose. 2. Blood pressure. 3. Fetal heart rate. 4. Urine protein. 5. Pelvic ultrasound.

2, 3, 4 2. The blood pressure is assessed at each prenatal visit. 3. The fetal heart rate is assessed at each prenatal visit. Depending on the equipment available, it will be assessed mechanically via Doppler or manually via fetoscope. The fetal heart is audible via Doppler many weeks before it is audible via fetoscope. 4. Urine protein is performed at each prenatal visit.

The nurse working in an outpatient obstetric offi ce assesses four primigravida clients. Which of the client fi ndings should the nurse highlight for the physician? Select all that apply. 1. 17 weeks' gestation; denies feeling fetal movement. 2. 24 weeks' gestation; fundal height at the umbilicus. 3. 27 weeks' gestation; salivates excessively. 4. 34 weeks' gestation; experiences uterine cramping. 5. 37 weeks' gestation; complains of hemorrhoidal pain.

2, 4 2. The fundal height at 24 weeks should be 4 cm above the umbilicus. The fundal height at the level of the umbilicus is expected at 20 weeks' gestation. 4. The woman may be going into preterm labor.

A client is in the 10th week of her pregnancy. Which of the following symptoms would the nurse expect the client to exhibit? Select all that apply. 1. Backache. 2. Urinary frequency. 3. Dyspnea on exertion. 4. Fatigue. 5. Diarrhea.

2, 4 2. The woman will likely complain of urinary frequency. 4. Most women complain of fatigue during the fi rst trimester

A nurse is discussing the serving sizes in the grain food group with a new prenatal client. Which of the following foods equals 1 oz. serving from the grain group? Select all that apply. 1. 1 bagel. 2. 1 slice of bread. 3. 1 cup cooked pasta. 4. 1 tortilla. 5. 1 ounce dry cereal.

2, 4, 5 2. 1 slice bread = one 1 oz serving 4. 1 tortilla = one 1 oz serving. 5. 1 ounce dry cereal = one 1 oz serving.

The nurse is assessing the laboratory report of a 40-week gestation client. Which of the following values would the nurse expect to fi nd elevated above prepregnancy levels? Select all that apply. 1. Glucose. 2. Fibrinogen. 3. Hematocrit. 4. Bilirubin. 5. White blood cells.

2, 5 2. Fibrinogen levels will be elevated slightly in a 40-week pregnant woman because coagulation factors like fi brinogen increase to help prevent excessive blood loss during delivery. 5. A 40-week pregnant woman's white blood cell count will be elevated above normal as a means of protecting her body from infection.

Which of the following choices can the nurse teach a prenatal client is equivalent to a 1 oz. non meat serving of protein? 1. 2 tbsp peanut butter. 2. 1 egg. 3. 1 cup cooked lima beans. 4. 3 ounces mixed nuts.

2. 1 egg = a 1 oz non-meat serving of protein .

A 36-week gestation gravid lies fl at on her back. Which of the following maternal signs/symptoms would the nurse expect to observe? 1. Hypertension. 2. Dizziness. 3. Rales. 4. Chloasma

2. Dizziness is an expected fi nding

A couple is preparing to interview obstetric primary care providers to determine who they will go to for care during their pregnancy and delivery. To make the best choice, which of the following actions should the couple perform fi rst? 1. Take a tour of hospital delivery areas. 2. Develop a preliminary birth plan. 3. Make appointments with three or four obstetric care providers. 4. Search the Internet for the malpractice histories of the providers

2. It is best that a couple fi rst develop a birth plan.

The nurse is interviewing a 38-week gestation Muslim woman. Which of the following questions would be inappropriate for the nurse to ask? 1. "Do you plan to breastfeed your baby?" 2. "What do you plan to name the baby?" 3. "Which pediatrician do you plan to use?" 4. "How do you feel about having an episiotomy?"

2. It is inappropriate to ask the Muslim client about the name for the baby.

A mother has just experienced quickening. Which of the following developmental changes would the nurse expect to occur at the same time in the woman's pregnancy? 1. Fetal heart begins to beat. 2. Lanugo covers the fetal body. 3. Kidneys secrete urine. 4. Fingernails begin to form.

2. Lanugo does cover the fetal body at approximately 20 weeks' gestation

A Chinese immigrant is being seen in the prenatal clinic. When providing nutrition counseling, which of the following factors should the nurse keep in mind? 1. Many Chinese eat very little protein. 2. Many Chinese believe pregnant women should eat cold foods. 3. Many Chinese are prone to anemia. 4. Many Chinese believe strawberries can cause birth defects

2. Many Chinese women do believe in the "hot and cold" theory of life.

An 18-week gestation client telephones the obstetrician's offi ce stating, "I'm really scared. I think I have breast cancer. My breasts are fi lled with tumors." The nurse should base the response on which of the following? 1. Breast cancer is often triggered by pregnancy. 2. Nodular breast tissue is normal during pregnancy. 3. The woman is exhibiting signs of a psychotic break. 4. Anxiety attacks are especially common in the second trimester.

2. Nodular breast tissue is normal in pregnancy.

A woman tells the nurse that she would like suggestions for alternate vitamin C sources because she isn't very fond of citrus fruits. Which of the following suggestions is appropriate? 1. Barley and brown rice. 2. Strawberries and potatoes. 3. Buckwheat and lentils. 4. Wheat fl our and fi gs.

2. Strawberries and potatoes are excellent sources of vitamin C, as are zucchini, blueberries, kiwi, green beans, green peas, and the like.

A woman in her third trimester advises the nurse that she wishes to breastfeed her baby, "but I don't think my nipples are right." Upon examination, the nurse notes that the client has inverted nipples. Which of the following actions should the nurse take at this time? 1. Advise the client that it is unlikely that she will be able to breastfeed. 2. Refer the client to a lactation consultant for advice. 3. Call the labor room and notify them that a client with inverted nipples will be admitted. 4. Teach the woman exercises to evert her nipples.

2. The client should be referred to a lactation consultant.

A 36-week gestation gravid client is complaining of dyspnea when lying fl at. Which of the following is the likely clinical reason for this complaint? 1. Maternal hypertension. 2. Fundal height. 3. Hydramnios. 4. Congestive heart failure.

2. The fundal height is the likely cause of the woman's dyspnea.

A 16-year-old, G1 P0000, is being seen at her 10-week gestation visit. She tells the nurse that she felt the baby move that morning. Which of the following responses by the nurse is appropriate? 1. "That is very exciting. The baby must be very healthy." 2. "Would you please describe what you felt for me?" 3. "That is impossible. The baby is not big enough yet." 4. "Would you please let me see if I can feel the baby?"

2. The nurse should query the young woman about what she felt.

The blood of a pregnant client was initially assessed at 10 weeks' gestation and reassessed at 38 weeks' gestation. Which of the following results would the nurse expect to see? 1. Rise in hematocrit from 34% to 38%. 2. Rise in white blood cells from 5,000 cells/mm 3 to 15,000 cells/mm 3 . 3. Rise in potassium from 3.9 mEq/L to 5.2 mEq/L. 4. Rise in sodium from 137 mEq/L to 150 mEq/L.

2. The nurse would expect to see an elevated white blood cell count.

A woman, 6 weeks pregnant, is having a vaginal examination. Which of the following would the practitioner expect to fi nd? 1. Thin cervical muscle. 2. An enlarged ovary. 3. Thick cervical mucus. 4. Pale pink vaginal wall.

2. The practitioner would expect to palpate an enlarged ovary.

A client who was seen in the prenatal clinic at 20 weeks' gestation weighed 128 lb at that time. Approximately how many pounds would the nurse expect the client to weigh at her next visit at 24 weeks' gestation? 1. 129 to 130 lb. 2. 131 to 132 lb. 3. 133 to 134 lb. 4. 135 to 136 lb.

2. The woman would be expected to weigh 131 to 132 lb. At this stage of pregnancy, the woman is expected to gain about 0.8 to 1 lb a week.

The nurse is evaluating the 24-hour dairy intake of four gravid clients. Which of the following clients consumed the highest number of dairy servings during 1 day? The client who consumed: 1. 4 oz whole milk, 2 oz hard cheese, 1 cup of pudding made with milk and 2 oz cream cheese. 2. 1 cup yogurt, 8 oz chocolate milk, 1 cup cottage cheese, and 1. oz hard cheese. 3. 1 cup cottage cheese, 8 oz whole milk, 1 cup buttermilk, and . oz hard cheese. 4. . cup frozen yogurt, 8 oz skim milk, 4 oz cream cheese, and 1. cup cottage cheese.

2. This client consumed 3ó servings: 1 cup yogurt = 1 serving, 8 oz chocolate milk = 1 serving; 1 cup cottage cheese = ó serving; and 1ó oz hard cheese = 1 serving.

A woman is carrying dizygotic twins. She asks the nurse about the babies. Which of the following explanations is accurate? 1. During a period of rapid growth, the fertilized egg divided completely. 2. When the woman ovulated, she expelled two mature ova. 3. The babies share one placenta and a common chorion. 4. The babies will defi nitely be the same sex and have the same blood type.

2. This is a true statement. Dizygotic twins result from two mature ova that are fertilized independently.

A client in her third trimester is concerned that she will not know the difference between labor contractions and normal aches and pains of pregnancy. How should the nurse respond? 1. "Don't worry. You'll know the difference when the contractions start." 2. "The contractions may feel just like a backache, but they will come and go." 3. "Contractions are a lot worse than your pregnancy aches and pains." 4. "I understand. You don't want to come to the hospital before you are in labor."

2. This is a true statement. Labor contractions often begin in the back.

A woman, 26 weeks' gestation, calls the triage nurse stating, "I'm really scared. I tried not to but I had an orgasm when we were making love. I just know that I will go into preterm labor now." Which of the following responses by the nurse is appropriate? 1. "Lie down and drink a quart of water. If you feel any back pressure at all call me back right away." 2. "Although oxytocin was responsible for your orgasm, it is very unlikely that it will stimulate preterm labor." 3. "I will inform the doctor for you. What I want you to do is to come to the hospital right now to be checked." 4. "The best thing for you to do right now is to take a warm shower and then do a fetal kick count assessment."

2. This is an accurate statement.

A woman confi des in the nurse that she practices pica. Which of the following alternatives could the nurse suggest to the woman? 1. Replace laundry starch with salt. 2. Replace ice with frozen fruit juice. 3. Replace soap with cream cheese. 4. Replace soil with uncooked pie crust.

2. This is an excellent suggestion. Fruit juice, although high in sugar, does contain vitamins.

The nurse midwife tells a client that the baby is growing and that ballottement was evident during the vaginal examination. How should the nurse explain what the nurse midwife means by ballottement? 1. The nurse midwife saw that the mucous plug was intact. 2. The nurse midwife felt the baby rebound after being pushed. 3. The nurse midwife palpated the fetal parts through the uterine wall. 4. The nurse midwife assessed that the baby is head down.

2. This is the defi nition of ballottement.

A woman who is seen in the prenatal clinic is found to be 8 weeks pregnant. She confi des to the nurse that she is afraid her baby may be "permanently damaged because I had at least fi ve beers the night I had sex." Which of the following responses by the nurse would be appropriate? 1. "I would let the doctor know that if I were you." 2. "It is unlikely that the baby was affected." 3. "Abortions during the fi rst trimester are very safe." 4. "An ultrasound will tell you if the baby was affected."

2. This statement is true

A client states that she is a strong believer in vitamin supplements to maintain her health. The nurse advises the woman that it is recommended to refrain from consuming excess quantities of which of the following vitamins during pregnancy? 1. Vitamin C. 2. Vitamin D. 3. Vitamin B 2 (niacin). 4. Vitamin B 12 (cobalamin).

2. Vitamin D supplementation can be harmful during pregnancy.

Below are four important landmarks of fetal development. Please place them in chronological order: 1. Four-chambered heart is formed. 2. Vernix caseosa is present. 3. Blastocyst development is complete. 4. Testes have descended into the scrotal sac.

3, 1, 2, 4

A nurse midwife has advised a 40-week gestation gravid to take evening primrose oil 2,500 mg daily as a complementary therapy. This suggestion was made because evening primrose has been shown to perform which of the following actions? 1. Relieve back strain. 2. Improve development of colostrum. 3. Ripen the cervix. 4. Reduce the incidence of hemorrhoids

3. Evening primrose converts to a prostaglandin substance in the body. Prostaglandins are responsible for readying the cervix for dilation.

The following four changes occur during pregnancy. Which of them usually increases the father's interest and involvement in the pregnancy? 1. Learning the results of the pregnancy test. 2. Attending childbirth education classes. 3. Hearing the fetal heartbeat. 4. Meeting the obstetrician or midwife

3. Hearing the fetal heartbeat often increases fathers' interests in their partners' pregnancies.

A 75-gram oral glucose tolerance test (OGTT) is ordered at or after 24 weeks' gestation for a pregnant client to assess her physiological response to which of the following pregnancy hormones? 1. Estrogen. 2. Progesterone. 3. Human placental lactogen. 4. Human chorionic gonadotropin

3. Human placental lactogen is an insulin antagonist.

A 20-year-old client states that the at-home pregnancy test that she took this morning was positive. Which of the following comments by the nurse is appropriate at this time? 1. "Congratulations, you and your family must be so happy." 2. "Have you told the baby's father yet?" 3. "How do you feel about the results?" 4. "Please tell me when your last menstrual period was."

3. It is important for the nurse to ask the young woman how she feels about being pregnant. She may decide not to continue with the pregnancy.

When assessing the fruit intake of a pregnant client, the nurse notes that the client usually eats one piece of fruit per day and drinks a 12 oz glass of fruit juice per day. Which of the following is the most important communication for the nurse to make? 1. "You are effectively meeting your daily fruit requirements." 2. "Fruit juices are excellent sources of folic acid." 3. "It would be even better if you were to consume more whole fruits and less fruit juice." 4. "Your fruit intake far exceeds the recommended daily fruit intake."

3. It is recommended that pregnant clients eat whole fruits rather than consume large quantities of fruit juice. This is the most important statement for the nurse to make.

Which of the following skin changes should the nurse highlight for a pregnant woman's healthcare practitioner? 1. Linea nigra. 2. Melasma. 3. Petechiae. 4. Spider nevi.

3. Petechiae are pinpoint red or purple spots on the skin. They are seen in hemorrhagic conditions.

A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2015. Using Nagele rule, the nurse calculates the client's estimated date of delivery as: 1. May 30, 2016. 2. June 20, 2016. 3. June 27, 2016. 4. July 3, 2016.

3. The estimated date of delivery is June 27, 2016.

A nurse is providing diet counseling to a new prenatal client. Which of the following dairy products should the client be advised to avoid eating during the pregnancy? 1. Frozen yogurt. 2. Parmesan cheese. 3. Gorgonzola cheese. 4. Chocolate milk.

3. The intake of gorgonzola cheese should be discouraged during pregnancy.

A client is 15 weeks pregnant. She calls the obstetric offi ce to request a medication for a headache. The nurse answers the telephone. Which of the following is the nurse's best response? 1. "Because the organ systems in the baby are developing right now, you may take no medication." 2. "You can take any of the over-the-counter medications because they are all safe in pregnancy." 3. "The physician will prescribe a medication for you that has been shown not to cause any fetal injuries." 4. "The physician will prescribe a rectal suppository because the medicine will not enter your blood stream."

3. The physician will prescribe a medication that is safe to take during pregnancy

An ultrasound of a fetus's heart shows that normal fetal circulation is occurring. Which of the following statements should the nurse interpret as correct in relation to the fetal circulation? 1. The foramen ovale is a hole between the ventricles. 2. The umbilical vein contains oxygen-poor blood. 3. The right atrium contains both oxygen-rich and oxygen-poor blood. 4. The ductus venosus lies between the aorta and pulmonary artery.

3. The right atrium does contain both oxygen-rich and oxygen-poor blood.

After nutrition counseling, a woman, G3 P1101, proclaims that she certainly can't eat any strawberries during her pregnancy. Which of the following is the likely reason for this statement? 1. The woman is allergic to strawberries. 2. Strawberries have been shown to cause birth defects. 3. The woman believes in old wives' tales. 4. The premature baby died because the woman ate strawberries.

3. The woman believes in old wives' tales.

A woman provides the nurse with the following obstetrical history: Delivered a son, now 7 years old, at 28 weeks' gestation; delivered a daughter, now 5 years old, at 39 weeks' gestation; had a miscarriage 3 years ago; and had a fi rst-trimester abortion 2 years ago. She is currently pregnant. Which of the following portrays an accurate picture of this woman's gravidity and parity? 1. G4 P2121. 2. G4 P1212. 3. G5 P1122. 4. G5 P2211.

3. This accurately refl ects this woman's gravidity and parity—G5 P1122.

A 34-week gestation woman calls the obstetric offi ce stating, "Since last night I have had three nosebleeds." Which of the following responses by the nurse is appropriate? 1. "You should see the doctor to make sure you are not becoming severely anemic." 2. "Do you have a temperature?" 3. "One of the hormones of pregnancy makes the nasal passages prone to bleeds." 4. "Do you use any inhaled drugs?"

3. This is an accurate statement. Hormonal changes in pregnancy make the nasal passages prone to bleeds.

A client makes the following statement after fi nding out that her pregnancy test is positive, "This is not a good time. I am in college and the baby will be due during fi nal exams!" Which of the following responses by the nurse would be most appropriate at this time? 1. "I'm absolutely positive that everything will turn out all right." 2. "I suggest that you e-mail your professors to set up an alternate plan." 3. "It sounds like you're feeling a little overwhelmed right now." 4. "You and the baby's father will fi nd a way to get through the pregnancy."

3. This is the best comment. It acknowledges the concerns that the client is having.

A woman is 36 weeks' gestation. Which of the following tests will be done during her prenatal visit? 1. Oral glucose tolerance test. 2. Amniotic fl uid volume assessment. 3. Vaginal and rectal cultures. 4. Karyotype analysis.

3. Vaginal and rectal cultures are done at approximately 36 weeks' gestation.

The nurse discusses sexual intimacy with a pregnant couple. Which of the following should be included in the teaching plan? 1. Vaginal intercourse should cease by the beginning of the third trimester. 2. Breast fondling should be discouraged because of the potential for preterm labor. 3. The couple may fi nd it necessary to experiment with alternate positions. 4. Vaginal lubricant should be used sparingly throughout the pregnancy.

3. With increasing size of the uterine body, the couple may need counseling regarding alternate options for sexual intimacy

A client informs the nurse that she is "very constipated." Which of the following foods would be best for the nurse to recommend to the client? 1. Pasta. 2. Rice. 3. Yogurt. 4. Celery.

4. Celery is an excellent food to reverse constipation. It is a high-fi ber food.

The nurse takes the history of a client, G2 P1001, at her fi rst prenatal visit. Which of the following statements would indicate that the client should be referred to a genetic counselor? 1. "My fi rst child has cerebral palsy." 2. "My fi rst child has hypertension." 3. "My fi rst child has asthma." 4. "My fi rst child has cystic fi brosis."

4. Cystic fibrosis is an autosomal recessive genetic disease, so the client with a family history of cystic fi brosis should be referred to a genetic counselor.

A woman asks the nurse about consuming herbal supplements during pregnancy. Which of the following responses is appropriate? 1. Herbals are natural substances, so they are safely ingested during pregnancy. 2. It is safe to take licorice and cat's claw, but no other herbs are safe. 3. A federal commission has established the safety of herbals during pregnancy. 4. The woman should discuss everything she eats with a healthcare practitioner.

4. Every woman should advise her healthcare practitioner of what she is consuming, including food, medicines, herbals, and all other substances.

A 37-week gravid client states that she noticed a "white liquid" leaking from her breasts during a recent shower. Which of the following nursing responses is appropriate at this time? 1. Advise the woman that she may have a galactocele. 2. Encourage the woman to pump her breasts to stimulate an adequate milk supply. 3. Assess the liquid because a breast discharge is diagnostic of a mammary infection. 4. Reassure the mother that this is normal in the third trimester

4. It is normal for colostrum to be expressed late in pregnancy

A multigravid client is 22 weeks pregnant. Which of the following symptoms would the nurse expect the client to exhibit? 1. Nausea. 2. Dyspnea. 3. Urinary frequency. 4. Leg cramping.

4. Leg cramping is often a complaint of clients in the second trimester.

A nurse has identifi ed the following nursing diagnosis for a prenatal client: Altered nutrition: less than body requirements related to poor folic acid intake. Which of the following foods should the nurse suggest the client consume? 1. Potatoes and grapes. 2. Cranberries and squash. 3. Apples and corn. 4. Oranges and spinach.

4. Oranges and spinach are excellent folic acid sources.

The nurse asks a 31-week gestation client to lie on the examining table during a prenatal examination. In which of the following positions should the client be placed? 1. Orthopneic. 2. Lateral-recumbent. 3. Sims. 4. Semi-Fowler.

4. The client should be placed in a semi- Fowler position.

A client is 35 weeks' gestation. Which of the following fi ndings would the nurse expect to see? 1. Nausea and vomiting. 2. Maternal ambivalence. 3. Fundal height 10 cm above the umbilicus. 4. Use of three pillows for sleep comfort.

4. The use of three pillows for sleep comfort is often seen in clients who are 35 weeks' gestation.

The partner of a gravida accompanies her to her prenatal appointment. The nurse notes that the father of the baby has gained weight since she last saw him. Which of the following comments is most appropriate for the nurse to make to the father? 1. "I see that you are gaining weight right along with your partner." 2. "You and your partner will be able to go on a diet together after the baby is born." 3. "I can see that you are a bad infl uence on your partner's eating habits." 4. "I am so glad to see that you are taking so much interest in your partner's pregnancy."

4. This is an appropriate comment to make at this time.

A 12-week gestation client tells the nurse that she and her husband eat sushi at least once per week. She states, "I know that fi sh is good for me, so I make sure we eat it regularly." Which of the following responses by the nurse is appropriate? 1. "You are correct. Fish is very healthy for you." 2. "You can eat fi sh, but sushi is too salty to eat during pregnancy." 3. "Sushi is raw. Raw fi sh is especially high in mercury." 4. "It is recommended that fi sh be cooked to destroy harmful bacteria."

4. This is correct. It is recommended that during pregnancy the client eat only well-cooked fi sh.

A client is having an ultrasound assessment done at her prenatal appointment at 8 weeks' gestation. She asks the nurse, "Can you tell what sex my baby is yet?" Which of the following responses would be appropriate for the nurse to make at this time? 1. "The technician did tell me the sex, but I will have to let the doctor tell you what it is." 2. "The organs are completely formed and present, but the baby is too small for them to be seen." 3. "The technician says that the baby has a penis. It looks like you are having a boy." 4. "I am sorry. It will not be possible to see which sex the baby is for another month or so."

4. This statement is true. The sex is not visible yet.

A vegan is being counseled regarding vitamin intake. It is essential that this woman supplement her intake of which of the following B vitamins? 1. B 1 (thiamine). 2. B 2 (niacin). 3. B 6 (pyridoxine). 4. B 12 (cobalamin).

4. Vitamin B 12 (cobalamin) should be supplemented.