Ch 4 Antepatum

37. A 38-week gestation client, Bishop score 1, is advised by her nurse midwife to take evening primrose daily. The office 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.

*37. 1. Evening primrose has been shown to cause skin rash in some women. 2. Evening primrose has not been shown to cause pedal edema. 3. Evening primrose has not been shown to cause blurred vision. 4. Evening primrose has not been shown to cause tinnitus.

1. 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. 1, 2, 3, and 4 are correct. 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. 5. Uterine growth is a probable sign of pregnancy.

10. 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.

10. 1. High levels of the hormone chorionic gonadotropin in the bloodstream and urine of the woman is a probable sign of pregnancy. 2. Oxytocin is the hormone of labor. It is not measured as a sign of pregnancy. 3. Prolactin is the hormone that stimulates lactogenesis immediately after delivery. It is not measured as a sign of pregnancy. 4. Luteinizing hormone is the hormone that stimulates ovulation. It is not measured as a sign of pregnancy.

100. 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."

100. 1. This is an inappropriate statement. The nurse should provide clients with accurate information when asked. 2. The sex is not established yet. 3. The sex is not established yet. 4. This statement is true. The sex is not visible yet.

101. 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.

101. 1. Fingernails would likely be quite long. 2. Eyelashes would be present. 3. Because this baby is post-term, lanugo would likely not be present. 4. Milia would be present.

102. 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.

102. 1. 15 weeks is too early for quickening. At 15 weeks, the fetus would not have lanugo. 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. 3. The eyes are unfused by 29 weeks' gestation so the gestation is shorter than that. 4. The eyes are unfused by 29 weeks' gestation so the gestation is shorter than that.

103. 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."

103. 1. This response is incorrect. The circulatory systems are never connected. 2. This response is incorrect. The blood never mixes. 3. This response is incorrect. The systems are never connected. 4. The blood supplies are completely separate.

104. Please place an "X" on the drawing of the cross section of a placenta at the site of gas exchange. Fetal portion of placenta (chorion) Maternal portion of placenta

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

105. 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.

105. 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. 2. This statement is incorrect. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births, not of women of childbearing age. 3. This statement is incorrect. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births, not 100,000 pregnancies. 4. This statement is incorrect. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births. Fetal portion of placenta (chorion) Maternal portion of placenta

106. 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."

106. 1. Rotavirus is administered to infants at 2, 4, and 6 months of age. It protects infants from a serious diarrheal illness. 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. 3. The human papillomavirus vaccine is not administered during pregnancy. The CDC recommends its administration to boys and girls beginning at 11 years of age. 4. The varicella vaccine is never administered during pregnancy. The CDC recommends its administration at the beginning of the second year of a child's life.

107. 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.

107. 2 and 3 are correct. 1. Women should be counseled to consume well done meat throughout their pregnancies. They should avoid eating rare meat. 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. 4. Women should be counseled to consume 8 to 12 oz of seafood each week. 5. Women should be counseled to consume no alcohol throughout their pregnancies.

11. 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?"

11. 1. This is an inappropriate statement to make. 2. The nurse should query the young woman about what she felt. 3. Even though this statement is correct, it is inappropriate to dismiss the young woman so abruptly. 4. This is an inappropriate statement to make.

12. 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."

12. 1. It is inappropriate to assume that the client and her family are happy about the pregnancy. 2. It is inappropriate to assume that the baby's father is still in the young woman's life. 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. 4. This information is important, but it is not the best statement to make initially.

. 13. 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.

13. 2 and 4 are correct. 1. Backaches usually do not develop until the second trimester of pregnancy. 2. The woman will likely complain of urinary frequency. 3. Dyspnea is associated with the third trimester of pregnancy. 4. Most women complain of fatigue during the fi rst trimester. 5. Diarrhea is not a complaint normally heard from prenatal clients.

14. 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.

14. 1. The client is likely 12 weeks pregnant. At 12 weeks, the fundal height is at the top of the symphysis. 2. The fundus is at the level of the umbilicus at 20 weeks' gestation. 3. The fundus is between the umbilicus and the xiphoid process at 28 weeks' gestation. 4. The fundus is at the level of the xiphoid process at 36 weeks' gestation.

15. 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.

15. 1. It is common for women to be ambivalent about their pregnancy during the fi rst trimester. 2. The nurse should be concerned if he or she were to see an 8-week pregnant client who exhibited signs of depression. 3. The nurse should be concerned if he or she were to see an 8-week pregnant client who exhibited signs of anxiety. 4. It is unusual for women at 8 weeks' gestation to exhibit signs of ecstasy.

16. 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."

16. 1. This comment is inappropriate. First of all, everything may not turn out all right. In addition, the comment ignores the client's concerns. 2. This is a possible plan, but fi rst the nurse should acknowledge the client's feelings. 3. This is the best comment. It acknowledges the concerns that the client is having. 4. This comment is inappropriate. First of all, it assumes that the father of the baby is in the picture and, second, it ignores the client's concerns.

17. 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.

17. 1. Hearing a fetal heart rate is a positive sign of pregnancy. 2. A positive pregnancy test is a probable sign of pregnancy. 3. A positive Chadwick sign is a probable sign of pregnancy. 4. Montgomery gland enlargement is a presumptive sign of pregnancy.

18. 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."

18. 1. Cerebral palsy is not a genetic disease. 2. Hypertensive conditions can be genetically based, but a family history of hypertension does not warrant referral to a genetic counselor. 3. Asthma can be genetically based, but a family history of asthma does not warrant referral to a genetic counselor. 4. Cystic fi brosis is an autosomal recessive genetic disease, so the client with a family history of cystic fi brosis should be referred to a genetic counselor.

19. The nurse has taken a health history on four primigravid 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.

19. 1. The client with phenylketonuria (PKU) must receive counseling from a registered dietitian. 2. The client with Graves disease does not require strict nutrition counseling. 3. The client with Cushing syndrome does not require strict diet counseling. 4. The client with myasthenia gravis does not require strict diet counseling. TEST-TAKING TIP: PKU is a genetic disease that is characterized by the absence of the enzyme needed to metabolize phenylalanine, an essential amino acid. When clients with PKU consume phenylalanine, a metabolite that affects cognitive centers in the brain is created in the body. If a pregnant woman who has PKU were to eat foods high in phenylalanine, her baby would become severely developmentally disabled .

2. 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. 2 and 5 are correct. 1. Glucose levels should be within normal limits. 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. 3. Hematocrit levels are usually slightly lower. 4. Bilirubin levels should be within normal limits. 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.

35. 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.

2. An increase in the respiratory rate is expected. 3. An increase in the heart rate is expected. 4. A slight increase in temperature is expected.

20. 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.

20. 1, 2, and 4 are correct. 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. 3. This blood pressure is normal. 4. The hematocrit is below normal. 5. This hemoglobin is normal. 116 MATERNAL AND NEWBORN SUCCESS TEST-TAKING TIP: Women who enter their pregnancies underweight, that is with a BMI less than 18.5 kg/m 2 , are encouraged to gain slightly more—28 to 40 lb— during their pregnancies than are women of normal weight who are encouraged to gain between 25 and 35 lb (see www .acog.org/Resources-And-Publications/ Committee-Opinions/Committee-on -Obstetric-Practice/Weight-Gain-During -Pregnancy). A rubella titer of 1:8 or less indicates that the woman is nonimmune to rubella. If exposed, she is, therefore, at risk of developing the disease. Because a woman is at high risk of becoming anemic during her pregnancy, it is important to identify any woman who enters her pregnancy with a below normal hematocrit.

21. 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.

21. 1. The cervix should be long and thick. 2. The practitioner would expect to palpate an enlarged ovary. 3. The cervical mucus should be thin. 4. The vaginal wall should be bluish in color. TEST-TAKING TIP: The cervix is long and thick to retain the pregnancy in the uterine cavity. The cervical mucus is thin and the vaginal wall is bluish in color as a result of elevated estrogen levels. The ovary is enlarged because the corpus luteum is still functioning.

22. 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.

22. 1 and 5 are correct. 1. Women must fast for a minimum of 8 hours and a maximum of 16 hours prior to the test. 2. No urine test is performed. 3. The client will be given 75 grams of glucose in a liquid form upon arrival at the laboratory. 4. The OGTT is a fasting test. Women should neither eat nor drink prior to arriving at the laboratory. 5. Smoking on the morning of the test can alter the results. TEST-TAKING TIP: The 75-gram OGTT is currently recommended as the screening test for gestational diabetes. Human placental lactogen (hPL) is an insulin antagonist. At approximately 24 weeks' gestation, hPL levels can adversely alter a pregnant woman's glucose metabolism. To determine whether a woman has developed gestational diabetes, the OGTT is performed (see www.diabetes .org/newsroom/press-releases/2010/ revised-standards-of-care-2011.html).

23. The nurse working in an outpatient obstetric offi ce assesses four primigravid 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.

23. 2 and 4 are correct. 1. It is common for primigravid women not to feel fetal movement until 19 to 20 weeks' gestation. 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. 3. Excessive salivation, called ptyalism, is an expected fi nding in pregnancy. 4. The woman may be going into preterm labor. 5. Hemorrhoids are commonly seen in pregnant women.

24. 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.

24. 1. A positive pregnancy test will not necessarily promote fathers' interests in their partners' pregnancies. 2. Most fathers are very involved with their partners' pregnancies well before childbirth education classes begin. 3. Hearing the fetal heartbeat often increases fathers' interests in their partners' pregnancies. 4. Meeting the healthcare practitioner is unlikely to promote fathers' interests in their partners' pregnancies.

25. 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.

25. 1. Ballottement is not related to the mucous plug. 2. This is the defi nition of ballottement. 3. Palpating fetal parts is not related to ballottement. 4. Fetal position is not related to ballottement.

27. 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.

27. 1. Estrogen levels are not related to glucose metabolism. 2. Progesterone levels are unrelated to glucose metabolism. 3. Human placental lactogen is an insulin antagonist. 4. Human chorionic gonadotropin levels are unrelated to glucose metabolisms.

28. 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."

28. 1. The majority of the organ systems are developed before the end of the fi rst trimester. This client is in her second trimester. 2. There are a number of over-the-counter medications that should be taken with care during pregnancy. 3. The physician will prescribe a medication that is safe to take during pregnancy. 4. There are oral medications that can be taken during pregnancy. Also, many medications administered rectally do enter the blood stream.

3. 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?"

3. 1. This is an important question, but it is not associated with health teaching. 2. 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. 4. This is an important question, but it is not associated with health teaching.

30. 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.

30. 1. 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. 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. 3. 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. 4. 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.

31. 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.

31. 1. Although breast cancer is hormonally driven, it is rare to see its development during pregnancy. 2. Nodular breast tissue is normal in pregnancy. 3. The woman is not exhibiting psychotic behavior. 4. Anxiety attacks are not common during pregnancy.

32. 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.

32. 1. An evaluation of the client's exercise schedule should be performed. 2. Goodell sign is a physiological fi nding—a softened cervix. 3. Hegar sign is a physiological fi nding—a softened uterine isthmus. 4. Leg cramps are likely related to the woman's level of exercise.

33. 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.

33. 1. The Kegel exercises are done to promote the muscle tone of the perineal muscles. 2. The pelvic tilt is an exercise that can reduce backache pain. 3. Leg lifts will not help to reduce backache pain. 4. Crunches will not help to reduce backache pain.

34. 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.

34. 1. Although some women do have diffi culty breastfeeding, many women with inverted nipples are able to breastfeed with little to no problem. 2. The client should be referred to a lactation consultant. 3. There is no need to telephone the labor unit. However, it would be appropriate to document the fi nding on the client's prenatal record. 4. It is not recommended that exercises be done to evert the nipples.

36. 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.

36. 1. Evening primrose does not affect back strain. 2. Evening primrose does not affect lactation. 3. Evening primrose converts to a prostaglandin substance in the body. Prostaglandins are responsible for readying the cervix for dilation. 4. Evening primrose does not affect the development of hemorrhoids.

38. 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.

38. 1. It is unlikely that the client has a galactocele. 2. The woman should not pump her breasts during pregnancy. 3. Colostrum is normally seen at this time and naturally can be a number of colors, including whitish, yellowish, reddish, and brownish. 4. It is normal for colostrum to be expressed late in pregnancy.

39. 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.

39. 1. It is unlikely that the woman is hypertensive. 2. The fundal height is the likely cause of the woman's dyspnea. 3. It is unlikely that the woman has hydramnios. 4. It is unlikely that the woman has congestive heart failure.

4. 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."

4. 1 and 4 are correct. 1. Weight gain of 0.8 to 1 lb per week is expected during the second and third trimesters only. 2. A weight gain of 3 to 5 lb is expected during the entire fi rst trimester. 3. Since the client's height is not stated, there is no way to know whether or not the client is underweight. 4. The weight gain is normal for the fi rst trimester.

40. 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."

40. 1, 2, and 3 are correct. 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. 4. Persistent headache should not be seen in pregnant women. 5. Pregnant women should not complain of blurred vision.

41. 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."

41. 1. This response ignores and dismisses the client's concerns as unimportant. 2. This is a true statement. Labor contractions often begin in the back. 3. Although active labor is usually more uncomfortable than the normal aches and pains of pregnancy, that is not necessarily true of prodromal labor or the latent phase of labor. 4. The nurse is making an assumption here. This may not be the client's concern at all.

42. 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.

42. 1. Anemia is an expected finding. 2. The client should not be thrombocytopenic. Although some women do develop idiopathic thrombocytopenia of pregnancy, this is a complication of pregnancy. 3. The nurse would not expect to see polycythemia. 4. The nurse would not expect to see hyperbilirubinemia.

43. 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.

43. 1. Although the orthopneic position is a safe position for the client to be placed in, a prenatal examination cannot be performed in this position. 2. Although the lateral-recumbent position is a safe position for the client to be placed in, a prenatal examination cannot be performed in this position. In addition, the pregnant abdomen may not enable the client fully to attain this position. 3. Although the Sims position is a safe position for the client to be placed in, a prenatal examination cannot be performed in this position, and the pregnant abdomen may not enable the client fully to attain this position. 4. The client should be placed in a semi- Fowler position.

44. 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.

44. 2, 3, and 4 are correct. 1. Urine glucose is performed at each visit, not the blood glucose. 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. 5. Ultrasounds are performed only when needed.

45. 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.

45. 1, 2, 3, and 5 are correct. 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. 4. Fainting spells are not normal, although the client may feel faint when rising quickly from a lying position. 5. Lordosis, or change in the curvature of the spine, is normal, although patient teaching may be needed.

46. 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.

46. 1. The nurse would expect to note hypotension rather than hypertension. 2. Dizziness is an expected fi nding. 3. The nurse would expect to see dyspnea, not rales. 4. The nurse would not expect to see any skin changes.

47. 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?"

47. 1. This is an appropriate question to ask the client. 2. It is inappropriate to ask the Muslim client about the name for the baby. 3. This is an appropriate question to ask the client. 4. This is an appropriate question to ask the client.

48. 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.

48. 1. The oral glucose tolerance test (OGTT) is performed at approximately 24 weeks' gestation. 2. Amniotic fl uid volume assessment is part of the biophysical profi le (BPP). The BPP is performed when the healthcare practitioner is concerned about the health and well-being of the fetus. 3. Vaginal and rectal cultures are done at approximately 36 weeks' gestation. 4. Karyotype analysis or chromosomal analysis, if performed, is done early in pregnancy.

49. 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?"

49. 1. Unless nosebleeds are excessive, it is rare for them to lead to severe anemia. 2. Clients with nosebleeds rarely have temperature elevations. 3. This is an accurate statement. Hormonal changes in pregnancy make the nasal passages prone to bleeds. 4. Nosebleeds are an expected complication of pregnancy.

5. 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.

5. 1. Greasy foods should be avoided. 2. Saltine crackers should be eaten before rising. Drinking orange juice has not been recommended. 3. Although consuming ginger may help to alleviate the nausea and vomiting of pregnancy, neither cinnamon nor nutmeg has been shown to alleviate the symptoms. 4. It is recommended that mothers eat small frequent meals throughout the day.

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.

5. 1. Greasy foods should be avoided. 2. Saltine crackers should be eaten before rising. Drinking orange juice has not been recommended. 3. Although consuming ginger may help to alleviate the nausea and vomiting of pregnancy, neither cinnamon nor nutmeg has been shown to alleviate the symptoms. 4. It is recommended that mothers eat small frequent meals throughout the day.

50. 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."

50. 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. 2. Some men do gain weight during pregnancy. This is viewed as a sympathetic response to the woman's weight gain. 3. Men often become much more concerned about the fi nances of the household during a woman's pregnancy. 4. The father is exhibiting a strong attachment to the unborn baby.

51. 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.

51. 1. The nurse would expect the hematocrit to drop. 2. The nurse would expect to see an elevated white blood cell count. 3. The nurse would not expect to see an abnormal potassium level. 4. The nurse would not expect to see an abnormal sodium level.

52. 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.

52. 1. 35-week gestation clients should not complain of nausea and vomiting. 2. 35-week gestation clients should not be ambivalent about their pregnancies. 3. At 35 weeks, the fundus should be 15 cm above the umbilicus. 4. The use of three pillows for sleep comfort is often seen in clients who are 35 weeks' gestation.

53. 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."

53. 1. Unless a woman is at high risk for preterm labor, there is no reason to refrain from making love during pregnancy. Therefore, this is an inappropriate statement. 2. This is an accurate statement. 3. Unless a woman is at high risk for preterm labor, this is an inappropriate statement. 4. This is an inappropriate statement.

54. 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.

54. 1. Although the tour of the facility is important, this should not be the couple's first step. 2. It is best that a couple fi rst develop a birth plan. 3. Although appointments should be made, this should not be the couple's first step. 4. Although the couple may wish to research the healthcare practitioner's malpractice history, this should not be the couple's first step.

55. 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.

55. 1. Birth plans help to facilitate communication between couples and their healthcare providers. 2. The type of pain medication the woman wishes to have during her labor and birth should be included in the birth plan, but the plan is not the location where the couple will learn about the medications. 3. The list of items that should be taken to the hospital for labor and delivery is separate from the birth plan, although the plan may include how the items will be used. The items are often placed in what is called a "goody" bag. 4. The birth plan should give any couple, whether their baby is being delivered vaginally or surgically, a sense of control over the labor and delivery process.

56. 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.

56. 1. The presence of the father at delivery should be nonnegotiable. 2. Whether or not a client would prefer to have an episiotomy should be discussed, but this may need to be a negotiable issue. 3. Whether or not a client would prefer to have an epidural should be discussed, but this may need to be a negotiable issue. 4. Whether or not a father will be allowed to take pictures during the delivery should be discussed, but this may need to be a negotiable issue.

57. 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.

57. 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. 2. Ptyalism is not related to a change in blood pressure. 3. Ptyalism is not related to changes in the lower extremities. 4. Ptyalism is not related to the meat intake.

58. A gravid woman who recently emigrated from mainland China is being seen at her first 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. Influenza. 2. Mumps. 3. Rubella. 4. Varicella.

58. 1. The woman should receive the infl uenza injection. The nasal spray, however, should not be administered to a pregnant woman. 2. The mumps vaccine should not be administered to the pregnant client. 3. The rubella vaccine should not be administered to the pregnant client. 4. The varicella vaccine should not be administered to the pregnant client.

59. 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.

59. 1. The woman should stay out of rooms that are being renovated. 2. The water should be tested for the presence of lead. If there is lead in the water, it is recommended that the water from the hot water tap not be consumed. 3. Unless mold has been found, there is no reason the client should refrain from entering the basement. 4. As long as she is feeling well, there is no reason the client should refrain from walking up the stairs.

6. 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."

6. 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. 3. This statement is correct, but because the woman's period is only 1 day late, the test may not be sensitive enough to detect the pregnancy. 4. The client could repeat the test, but since the more accurate serum test is available, it would be better for the nurse to recommend that action. At-home tests are reliable only if used correctly.

60. 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.

60. 1. An allergy to strawberries is not the likely reason. 2. Strawberries have not been shown to cause birth defects. 3. The woman believes in old wives' tales. 4. A previous poor pregnancy outcome is not the likely reason.

61. 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.

61. 1, 2, and 5 are correct. 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. 3. Women who wish to become pregnant should refrain from drinking any alcohol. 4. Women who wish to become pregnant should ask an obstetrician/gynecologist which over-the-counter medications should be avoided. Some—for example, acetaminophen—are safe to take, while others are not. 5. Women who wish to become pregnant should be counseled to stop smoking.

62. 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.

62. 1. Unless a woman is at high risk for preterm labor, has been diagnosed with placenta previa, or has preterm rupture of the membranes, sexual intercourse is not contraindicated. 2. Breast fondling should be discouraged only if the client is at high risk for preterm labor. 3. With increasing size of the uterine body, the couple may need counseling regarding alternate options for sexual intimacy. 4. There is no contraindication for vaginal lubricant use in pregnancy. As a matter of fact, with the increased discharge experienced by many mothers, lubricants are often not needed.

63. 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.

63. 1. Linea nigra—the darkened area on the skin from the symphysis to the umbilicus—is a normal skin change seen in pregnancy. 2. Melasma—the "mask" of pregnancy—is a normal skin change seen in pregnancy. 3. Petechiae are pinpoint red or purple spots on the skin. They are seen in hemorrhagic conditions. 4. Spider nevi—benign radiating blood vessels— are normal skin changes seen in pregnancy.

64. 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.

64. 1. The estimated date of delivery is June 27, 2016. 2. The estimated date of delivery is June 27, 2016. 3. The estimated date of delivery is June 27, 2016. 4. The estimated date of delivery is June 27, 2016.

65. 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.

65. 1, 4, and 5 are correct. 1. Heartburn is a common symptom. 2. It is inappropriate for a prospective father to engage in promiscuity. 3. Hypertension in a prospective father should be investigated. 4. Some fathers complain of abdominal bloating. 5. Some fathers complain of abdominal pain.

66. 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.

66. 1, 2, 3, and 4 are correct. 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. 5. Although polyuria may be a sign of diabetes or another illness, it is not highlighted as a danger sign of pregnancy.

67. 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.

67. 1. This does not refl3ect an accurate picture. 2. This does not reflect an accurate picture. 3. This accurately reflects this woman's gravidity and parity—G5 P1122. 4. This does not reflect an accurate picture.

68. 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."

68. 1. Although this is an accurate statement, it is inappropriate at this time. 2. Although this is an accurate statement, it is inappropriate at this time. 3. It is never appropriate to make this statement. 4. This is an appropriate comment to make at this time.

69. 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.

69. 1. Tofu, legumes, and broccoli are excellent substitutes for the restricted foods. 2. Although corn, yams, and green beans are foods consistent with a vegan diet, they are not high either in protein or in iron. 3. Although potatoes, parsnips, and turnips are vegetables, they are not high either in protein or in iron. 4. These are examples of a vegan's restricted foods.

7. 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.

7. 1 and 5 are correct. 1. The client will have a Pap smear done. 2. A mammogram will not be performed. 3. A glucose assessment will likely be performed at the end of the second trimester. 4. A biophysical profi le may be done but not until the third trimester. 5. A complete blood count will be performed.

70. 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."

70. 1. Although this is an accurate statement, this is not the most important communication for the nurse to make. 2. Fruit juices are good sources of folic acid, but this is not the most important communication for the nurse to make. 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. 4. Although this is an accurate statement, this is not the most important communication for the nurse to make.

71. 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).

71. 1. Supplementation of vitamin C has not been shown to be harmful during pregnancy. 2. Vitamin D supplementation can be harmful during pregnancy. 3. Supplementation of the B vitamins has not been shown to be harmful during pregnancy. 4. Supplementation of the B vitamins has not been shown to be harmful during pregnancy.

From Chapter 2 72. A man has inherited the gene for familial adenomatous polyposis (FAP), an autosomal dominant disease. He and his wife wish to have a baby. Which of the following would provide the couple with the highest probability of conceiving a healthy child? 1. Amniocentesis. 2. Chorionic villus sampling. 3. Preimplantation genetic diagnosis. 4. Gamete intrafallopian transfer.

72. 1. Amniocentesis will provide the couple with information regarding the genetics of a fetus in utero . 2. CVS will provide the couple with information regarding the genetics of a fetus in utero. 3. Preimplantation genetic diagnosis will provide the couple with the highest probability of conceiving a healthy child. 4. GIFT is a type of infertility procedure.

72. 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).

72. 1. Vitamin B 12 (cobalamin) should be supplemented. 2. Vitamin B 12 (cobalamin) should be supplemented. 3. Vitamin B 12 (cobalamin) should be supplemented. 4. Vitamin B 12 (cobalamin) should be supplemented.

73. 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.

73. 1. Pasta is a low-fiber food. 2. Rice is a low-fiber food. 3. Dairy products are low-fi ber foods. 4. Celery is an excellent food to reverse constipation. It is a high-fi ber food.

74. 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.

74. 1. Turnip greens are calcium rich. 2. Green beans are not high in calcium. 3. Cantaloupes are not high in calcium. 4. Nectarines are not high in calcium.

73. A woman asks the obstetrician's nurse about cord blood banking. Which of the following responses by the nurse would be best? 1. "I think it would be best to ask the doctor to tell you about that." 2. "The cord blood is frozen in case your baby develops a serious illness in the future." 3. "The doctors could transfuse anyone who gets into a bad accident with the blood." 4. "Cord blood banking is very expensive and the blood is rarely ever used."

74. A 3-month-old baby has been diagnosed with cystic fi brosis (CF). The mother says, "How could this happen? I had an amniocentesis during my pregnancy and everything was supposed to be normal!" What must the nurse understand about this situation? 1. Cystic fi brosis cannot be diagnosed by amniocentesis. 2. The baby may have an uncommon genetic variant of the disease. 3. It is possible that the laboratory technician made an error. 4. Instead of obtaining fetal cells, the doctor probably harvested maternal cells.

75. 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 first. 4. Large tomato.

75. 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. 2. A paperback book is too large. 3. A clenched fi st is too large. 4. A large tomato is too large.

76. 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.

76. 1. This client consumed 25/6 servings: 4 oz whole milk = . serving; 2 oz hard cheese = 11/3 servings; 1 cup pudding made with milk = 1 serving; 2 oz of cream cheese = 0 dairy serving since cream cheese is a food in the fat group, not in the dairy group. 2. This client consumed 3½ servings: 1 cup yogurt = 1 serving, 8 oz chocolate milk = 1 serving; 1 cup cottage cheese = ½ serving; and 1½ oz hard cheese = 1 serving. 3. This client consumed 25⁄6 servings: 1 cup cottage cheese = . serving; 8 oz whole milk = 1 serving; 1 cup buttermilk = 1 serving; and . oz hard cheese = 1/3 serving. 4. This client consumed 2. servings: . cup frozen yogurt = . serving, 8 oz skim milk = 1 serving; 4 oz cream cheese = 0 serving; and 1. cup cottage cheese = . serving.

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

77. 1. 2 tbsp of peanut butter = a 2 oz non-meat serving of protein. 2. 1 egg = a 1 oz non-meat serving of protein . 3. 1 cup of cooked lima beans = four 1 oz nonmeat servings of protein. 4. 3 ounces of nuts = six 1 oz nonmeat servings of protein

78. 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.

78. 2, 4, and 5 are correct. 1. 1 bagel = two or more 1 oz servings (depending on the size of the bagel). 2. 1 slice bread = one 1 oz serving. 3. 1 cup cooked pasta = two 1 oz servings. 4. 1 tortilla = one 1 oz serving. 5. 1 ounce dry cereal = one 1 oz serving.

79. 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.

79. 1. Although herbals are natural substances, there are many herbals that are unsafe for consumption during pregnancy. 2. Both licorice and cat's claw should be avoided during pregnancy. There is evidence that licorice may increase the incidence of preterm labor, and cat's claw has been used to prevent and to abort pregnancies. 3. There is not enough evidence to determine whether or not many herbals are safe in pregnancy. 4. Every woman should advise her healthcare practitioner of what she is consuming, including food, medicines, herbals, and all other substances.

8. 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

8. 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. 3. It is too early in the pregnancy to provide anticipatory guidance about breastfeeding positions. 4. It is too early in the pregnancy to provide anticipatory guidance about characteristics of the newborn.

80. 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.

80. 1. Chinese women typically do consume protein, especially rice and seafood. 2. Many Chinese women do believe in the "hot and cold" theory of life. 3. Chinese women are no more prone to anemia than other groups of women. 4. The belief that strawberries cause birth defects is not particularly associated with the Chinese population.

81. A nurse has identified 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.

81. 1. Potatoes and grapes are not high in folic acid. 2. Cranberries and squash are not high in folic acid. 3. Apples and corn are not high in folic acid. 4. Oranges and spinach are excellent folic acid sources.

82. 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.

82. 1. Bologna should not be consumed during pregnancy unless it is thoroughly cooked. 2. Cantaloupe is an excellent source of vitamins A and C. 3. Asparagus is an excellent source of vitamin K and folic acid. 4. Popcorn is an excellent source of fi ber, although if loaded with butter and salt is not the most healthy fi ber choice.

83. 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."

83. 1. Fish is very healthy, but the recommendation is that the fi sh be well cooked. 2. Although pregnant women should not overeat salty foods, sushi should be avoided because it is raw, not because of its salt content. 3. All fi sh contain methylmercury, but there are some fi sh with such high levels that they should not be eaten at all, for example, swordfi sh, tilefi sh, king mackerel, and shark. The mercury level does not change when a fi sh is eaten cooked versus raw. 4. This is correct. It is recommended that during pregnancy the client eat only well-cooked fi sh.

84. 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.

84. 1. Raisins contain some iron but they are not the best source of iron. 2. Hamburger contains the most iron. 3. Broccoli contains some iron but it is not the best source of iron. 4. Molasses contains some iron but it is not the best source of iron.

85. 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.

85. 1. Hypothyroidism is not related to pica. 2. Iron-defi ciency anemia is often seen in clients who engage in pica. 3. Hypercalcemia is not related to pica. 4. Overexposure to zinc is not related to pica.

86. 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.

86. 1. This is not an appropriate substitute. High levels of salt can lead to elevated blood pressure and fl uid retention. 2. This is an excellent suggestion. Fruit juice, although high in sugar, does contain vitamins. 3. This is not an appropriate substitute. Cream cheese has little to no nutritional benefi t. 4. This is not an appropriate substitute. Uncooked pie crust is high in fat and fl our. It provides little to no nutritional benefi t.

87. 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.

87. 1. Ginger has been shown to be a safe antiemetic agent for pregnant women. 2. Sage has not been shown to reduce nausea and vomiting in pregnant women. 3. Cloves have not been shown to reduce nausea and vomiting in pregnant women. 4. Nutmeg has not been shown to reduce nausea and vomiting in pregnant women.

88. 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 flour and figs.

88. 1. Barley and brown rice are not good vitamin C sources. 2. Strawberries and potatoes are excellent sources of vitamin C, as are zucchini, blueberries, kiwi, green beans, green peas, and the like. 3. Buckwheat and lentils are not good vitamin C sources. 4. Wheat fl our and fi gs are not good vitamin C sources.

89. 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.

89. 1. Frozen yogurt, although relatively high in calories, is an excellent dairy source. Its intake should be encouraged. 2. Parmesan cheese is an excellent dairy source. Its intake should be encouraged. 3. The intake of gorgonzola cheese should be discouraged during pregnancy. 4. Chocolate milk, although relatively high in calories, is an excellent dairy source. Its intake should be encouraged if the client refuses to drink unflavored milk.

9. 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."

9. 1. Purplish stretch marks are called abdominal striae. 2. Chadwick sign is not related to the heart muscle. 3. A positive Chadwick sign means that the client's cervix and vagina are a bluish color. It is a probable sign of pregnancy. 4. Chadwick sign is not related to the respiratory system.

90. 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 fluid provides fetal nutrition. 2. The fluid cushions the fetus from injury. 3. The fluid enables the fetus to grow. 4. The fluid provides the fetus with a stable thermal environment. 5. The fluid enables the fetus to practice swallowing.

90. 2, 3, 4, and 5 are correct. 1. The umbilical cord, not the amniotic fl uid, delivers nutrition to the developing fetus. 2. Amniotic fluid does cushion the fetus from injury. 3. Amniotic fluid enables the fetus's limbs and body to move freely so that the baby can grow unencumbered. 4. The amniotic fluid is maintained at the mother's body temperature, providing the fetus with a neutral thermal environment. 5. The fetus does swallow the amniotic fluid while in utero.

91. 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.

91. 1. This statement is true. Organogenesis begins prior to the missed menstrual period. 2. Insurance companies do not require that a woman be preapproved to become pregnant. 3. This statement is untrue. Only women with specifi c physical complications may be counseled to limit the numbers of pregnancies that they should carry. 4. This statement is untrue. The cardiovascular system is stressed during each and every pregnancy.

92. 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.

92. 1, 2, 3, and 5 are correct. 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. 4. The alveoli will not be formed until well into the second trimester. 5. The kidneys are formed by the end of the fi rst trimester.

93. 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.

93. 1. The foramen ovale is a hole between the atria. 2. The umbilical vein carries oxygen-rich blood. 3. The right atrium does contain both oxygen-rich and oxygen-poor blood. 4. The ductus venosus lies between the umbilical vein and the inferior vena cava, not between the aorta and the pulmonary artery.

94. 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 fields are finally completely formed." 3. "The sex of the fetus can be clearly identified." 4. "The eyelids are unfused and begin to open and close."

94. 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. 2. Lung development occurs much later than the morular stage. 3. The sex of the fetus is identifi ed much later than the morular stage. 4. The fetal eyelids unfuse much later than the morular stage.

95. 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 definitely be the same sex and have the same blood type.

95. 1. This is true of monozygotic twins. 2. This is a true statement. Dizygotic twins result from two mature ova that are fertilized independently. 3. This is true of monozygotic twins. 4. This is true of monozygotic twins.

96. 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.

96. 1. The fetal heart begins to beat during the fi rst trimester, not when quickening is detected at 16 to 20 weeks. 2. Lanugo does cover the fetal body at approximately 20 weeks' gestation. 3. The kidneys secrete urine by about week 12, before quickening is detected. Amniotic fl uid is composed predominantly of fetal urine. 4. Fingernails begin to form at about week 10 but do not completely cover the tips of the fi ngers until mid third trimester.

97. A woman who is seen in the prenatal clinic is found to be 8 weeks pregnant. She confides to the nurse that she is afraid her baby may be "permanently damaged because I had at least five 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 first trimester are very safe." 4. "An ultrasound will tell you if the baby was affected."

97. 1. The woman should be assured that it is unlikely that the fetus was affected. 2. This statement is true. 3. It is inappropriate for the nurse to suggest that the client seek an abortion. 4. The woman should be assured that it is unlikely that the fetus was affected.

98. 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.

98. 1. Surfactant is usually forming in the fetal lungs by the 36th week. 2. The eyes open and close at about 28 weeks. 3. Fetal respiratory movements begin at about 24 weeks. 4. The spinal column is completely formed well before the end of the fi rst trimester.

99. 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.

99. The correct order is 3, 1, 2, 4. 3. The blastocyst is developed about 6 days after fertilization and before implantation in the uterus has occurred. 1. The four-chambered heart is formed during the early part of the fi rst trimester. 2. Vernix caseosa is present during the latter half of pregnancy. 4. The testes descend in the scrotal sac about mid third trimester.