NUR374 Exam 3- Labor, maternal fetal nutrition, prenatal genetic testing

A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? 1.Three contractions occurring within a 10-minute period 2.A fetal heart rate of 90 beats per minute 3.Adequate resting tone of the uterus palpated between contractions 4.Increased urinary output

2. A normal fetal heart rate is 120-160 BPM. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue to pitocin. The goal of labor augmentation is to achieve three good-quality contractions in a 10-minute period.

A nurse is beginning to care for a client in labor. The physician has prescribed an IV infusion of Pitocin. The nurse ensures that which of the following is implemented before initiating the infusion? 1.Placing the client on complete bed rest 2.Continuous electronic fetal monitoring 3.An IV infusion of antibiotics 4.Placing a code cart at the client's bedside

2. Continuous electronic fetal monitoring should be implemented during an IV infusion of Pitocin.

In addition to breathing with contractions, which of the following actions can help a woman in labor to work with the pain of the first stage of labor? 1. Lying in the lithotomy position. 2. Performing effleurage. 3. Practicing Kegel exercises. 4. Pushing with each contraction.

2. Effleurage is a light massage that can soothe the mother during labor.

A client in labor, G2 P1001, was admitted 1 hour ago at 2 cm dilated and 50% effaced. She was talkative and excited at that time. During the past 10 minutes she has become serious, closing her eyes and breathing rapidly with each contraction. Which of the following is an accurate nursing assessment of the situation? 1. The client had poor childbirth education prior to labor. 2. The client is exhibiting an expected behavior for labor. 3. The client is becoming hypoxic and hypercapnic. 4. The client needs her alpha-fetoprotein levels checked.

2. The woman is showing expected signs of the active phase of labor.

A client is in the second stage of labor. She falls asleep immediately after a contraction. Which of the following actions should the nurse perform as a result? 1. Awaken the woman and remind her to push. 2. Cover the woman's perineum with a sheet. 3. Assess the woman's blood pressure and pulse. 4. Administer oxygen to the woman via face mask.

2. The woman's privacy should be maintained while she is resting.

A client, who is 7 cm dilated and 100% effaced, is breathing at a rate of 30 breaths per minute during contractions. Immediately after a contraction, she complains of tingling in her fingers with some lightheadedness. Which of the following actions should the nurse take at this time? 1. Assess the blood pressure. 2. Have the woman breathe into a bag. 3. Turn the woman onto her side. 4. Check the fetal heart rate.

2. This client is showing signs of hyperventilation. The symptoms will likely subside if she rebreathes her exhalations.

A client arrives at birthing center in active labor. Her membranes are still intact, and the health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcome of the amniotomy? 1. less pressure on her cervix 2. decreased number of contractions 3. increased efficiency of contractions 4. the need for increased maternal blood pressure monitoring

3. Increased efficiency of contractions

A nurse is caring for a client who is receiving Oxytocin/Pitocin to induce labor. The nurse discontinues the infusion if which of the following is noted on assessment of the client? 1. Fatigue 2. Drowsiness 3. Uterine Hyperstimulation 4. Early decelerations of the fetal heart rate

3. Uterine hyperstimulation

Upon examination, a nurse notes that a woman is 10 cm dilated, 100% effaced, and 3 station. Which of the following actions should the nurse perform during the next contraction? 1. Encourage the woman to push. 2. Provide firm fundal pressure. 3. Move the client into a squat. 4. Assess for signs of rectal pressure.

4. Assessing for rectal pressure is appropriate at this time. (Although the test taker may see in practice that women are encouraged to begin to push as soon as they become fully dilated, it is best practice to wait until the woman exhibits signs of rectal pressure. Pushing a baby that is not yet engaged may result in an overly fatigued woman or, more significantly, a prolapsed cord.)

One hour ago, a multipara was examined with the following results: 8 cm, 50% effaced, and 1 station. She is now pushing with contractions and the fetal head is seen at the vaginal introitus. The nurse concludes that the client is now 1. 9 cm dilated, 70% effaced, and 2 station. 2. 9 cm dilated, 80% effaced, and 3 station. 3. 10 cm dilated, 90% effaced, and 4 station. 4. 10 cm dilated, 100% effaced, and 5 station.

4. The cervix is fully dilated and fully effaced and the baby is low enough to be seen through the vaginal introitus.

The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as: A. Ladin's sign B. Hegar's sign C. Goodell's sign D. Chadwick's sign

D. Chadwick's sign

A 39 year old female is currently 18 weeks pregnant. She has two sets of twin daughters that were born at 38 and 39 weeks gestation and an 11 year-old son who was born at 32 weeks gestation. She has no history of miscarriage or abortion. What is her GTPAL?* A. G=4, T=2, P=2, A=1, L=5 B. G=4, T=1, P=1, A=0, L=4 C. G=4, T=1, P=2, A=1, L=4 D. G=4, T=2, P=1, A=0, L=5

D. G=4, T=2, P=1, A=0, L=5

1. Stage 1 of labor includes which phases in the correct order? A. Transition, Latent, Active B. Active, Latent, Transition C. Active, Transition, Latent D. Latent, Active, Transition

D. Latent, Active, Transition

An expected cardiopulmonary adaptation experienced by most pregnant women is: A. Tachycardia B. Dyspnea at rest C. Progression of dependent edema D. Shortness of breath on exertion

D. Shortness of breath on exertion This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm.

True or False: Stage 2 of labor begins with the delivery of the baby and ends with the delivery of the placenta.

False

True or False: Stage 4 of labor starts with the full delivery of the baby and ends with the full delivery of the placenta.

False, that is stage 3

A 30 year old female is 25 weeks pregnant with twins. She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. What is her GTPAL?* A.G=7, T=4, P=0, A=1, L=5 B. G=7, T=4, P=1, A=1, L=5 C. G=6, T=4, P=0, A=1, L=5 D. G=6, T=2, P=2, A=1, L=5

G=7, T=4, P=1, A=1, L=5

The nurse enters a laboring client's room. The client is complaining of intense back pain with each contraction. The nurse concludes that the fetus is likely in which of the following positions? 1. Mentum anterior. 2. Sacrum posterior. 3. Occiput posterior. 4. Scapula anterior.

3. When a fetus is in the occiput posterior position, mothers frequently complain of severe back pain.

A nurse has just performed a vaginal examination on a client in labor. The nurse palpates the baby's buttocks as facing the mother's right side. Where should the nurse place the external fetal monitor electrode? 1. Left upper quadrant (LUQ). 2. Left lower quadrant (LLQ). 3. Right upper quadrant (RUQ). 4. Right lower quadrant (RLQ).

3. Since the baby's back is facing the mother's right side and the sacrum is presenting, the fetal monitor should be placed in her RUQ.

The nurse is caring for a client in labor. Which assessment finding indicates to the nurse that the client is beginning the second stage of labor? 1. The contractions are regular. 2. The membranes have ruptured 3. The cervix is completely dilated 4. The client starts to expel clear vaginal fluid

3. The cervix is completely dilated

When during the latent phase of labor should the nurse assess the fetal heart pattern of a low-risk woman, G1 P0000? Select all that apply. 1. After vaginal exams. 2. Before administration of analgesics. 3. Periodically at the end of a contraction. 4. Every ten minutes. 5. Before ambulating.

1, 2, 3, and 5 are correct. 1. The nurse should assess the fetal heart after all vaginal exams. 2. The nurse should assess the fetal heart before giving the mother any analgesics. 3. The fetal heart should be assessed periodically at the end of a contraction. 5. The nurse should assess the fetal heart before the woman ambulates.

A client enters the labor and delivery suite stating that she thinks she is in labor. Which of the following information about the woman should the nurse note from the woman's prenatal record before proceeding with the physical assessment? Select all that apply. 1. Weight gain. 2. Ethnicity and religion. 3. Age. 4. Type of insurance. 5. Gravidity and parity.

1, 2, 5 are correct 1. Before proceeding with a physical assessment, the nurse should check the client's weight gain reported in her prenatal record. 2. The client's ethnicity and religion should be noted before physical assessment. This allows the nurse to proceed in a culturally sensitive manner. 3. The client's age should also be noted before the physical assessment is begun. 5. The client's gravidity and parity—how many times she has been pregnant and how many times she has given birth—should also be noted before a physical assessment is begun.

A nurse is caring for a laboring woman who is in transition. Which of the following signs/symptoms would indicate that the woman is progressing into the second stage of labor? Select all that apply. 1. Bulging perineum. 2. Increased bloody show. 3. Spontaneous rupture of the membranes. 4. Uncontrollable urge to push. 5. Inability to breathe through contractions.

1, 2, and 4 are correct. As the fetal head descends through a fully dilated cervix, the perineum begins to bulge, the bloody show increases, and the laboring woman usually feels a strong urge to push. 1. A bulging perineum indicates progression to the second stage of labor. 2. The bloody show increases as a woman enters the second stage of labor 4. With a fully dilated cervix and bulging perineum, laboring women usually feel a strong urge to push.

A woman has just arrived at the labor and delivery suite. In order to report the client's status to her primary health care practitioner, which of the following assessments should the nurse perform? Select all that apply. 1. Fetal heart rate. 2. Contraction pattern. 3. Contraction stress test. 4. Vital signs. 5. Biophysical profile.

1,2,4 1. The nurse should assess the fetal heart before reporting the client's status to the health care provider. 2. The nurse should assess the contraction pattern before reporting the client's status. 4. The nurse should assess the woman's vital signs before reporting her status.

A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate a need to contact the physician? 1.Fetal heart rate of 180 beats per minute 2.White blood cell count of 12,000 3.Maternal pulse rate of 85 beats per minute 4.Hemoglobin of 11.0 g/dL

1. A normal fetal heart rate is 120-160 beats per minute. A count of 180 beats per minute could indicate fetal distress and would warrant physician notification. By full term, a normal maternal hemoglobin range is 11-13 g/dL as a result of the hemodilution caused by an increase in plasma volume during pregnancy.

A nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate? 1.Document the findings and tell the mother that the monitor indicates fetal well-being 2.Take the mothers vital signs and tell the mother that bed rest is required to conserve oxygen. 3.Notify the physician or nurse mid-wife of the findings. 4.Reposition the mother and check the monitor for changes in the fetal tracing

1. Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve.

On examination, it is noted that a full-term primipara in active labor is right occipitoanterior (ROA), 7 cm dilated, and 3 station. Which of the following should the nurse report to the physician? 1. Descent is progressing well. 2. Fetal head is not yet engaged. 3. Vaginal delivery is imminent. 4. External rotation is complete

1. Descent is progressing well. The presenting part is 3 centimeters below the ischial spines

The nurse is monitoring a client in active stage of labor. The client has been experiencing contractions that are short, irregular, and weak. The nurse documents that the client is experiencing which type of labor dystocia? 1. Hypotonic 2. Precipitous 3. Hypertonic 4. Preterm labor

1. Hypotonic

A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus is at -1 station. The nurse determines that the fetal presenting part is: 1.1 cm above the ischial spine 2.1 fingerbreadth below the symphysis pubis 3.1 inch below the coccyx 4.1 inch below the iliac crest

1. Station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, is measured in centimeters, and is noted as a negative number above the line and a positive number below the line. At -1 station, the fetal presenting part is 1 cm above the ischial spines.

While evaluating the fetal heart monitor tracing on a client in labor, the nurse notes that there are fetal heart decelerations present. Which of the following assessments must the nurse make at this time? 1. The relationship between the decelerations and the labor contractions. 2. The maternal blood pressure. 3. The gestational age of the fetus. 4. The placement of the fetal heart electrode in relation to the fetal position.

1. The relationship between the decelerations and the contractions will determine the type of deceleration pattern.

While caring for a client in the transition phase of labor, the nurse notes that the fetal monitor tracing shows average short-term and long-term variability with a baseline of 142 beats per minute (bpm). What should the nurse do? 1. Provide caring labor support. 2. Administer oxygen via face mask. 3. Change the client's position. 4. Speed up the client's intravenous.

1. The tracing is showing a normal fetal heart tracing. No intervention is needed.

The nurse auscultates a fetal heart rate of 152 on a client in early labor. Which of the following actions by the nurse is appropriate? 1. Inform the mother that the rate is normal. 2. Reassess in 5 minutes to verify the results. 3. Immediately report the rate to the health care practitioner. 4. Place the client on her left side and apply oxygen by face mask.

1. This is the correct response. A fetal heart rate of 152 is normal.

An ultrasound is preformed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that abruption placentae is present. On the basis of these findings, the nurse should prepare the client for which anticipated prescription? 1.Delivery of the fetus. 2. Strict monitoring of intake and output 3.Complete bed rest for the remainder of the pregnancy 4. The need for weekly monitoring of coagulation studies until the time of delivery

1.Delivery of the fetus.

The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the health care provider's prescriptions and should question which prescription? 1.Prepare the client for an ultrasound. 2.Obtain equipment for a manual pelvic examination. 3.Prepare to draw a hemoglobin and hematocrit blood sample 4. Obtain equipment for external electronic fetal heart rate monitoring

2. Obtain equipment for a manual pelvic examination.

The nurse is assessing a client who states, "I think I'm in labor." Which of the following findings would positively confirm the client's belief? 1. She is contracting q 5 min 60 sec. 2. Her cervix has dilated from 2 to 4 cm. 3. Her membranes have ruptured. 4. The fetal head is engaged.

2. Once the cervix begins to dilate, a client is in true labor

The nurse is assessing the fetal station during a vaginal examination. Which of the following structures should the nurse palpate? 1. Sacral promontory. 2. Ischial spines. 3. Cervix. 4. Symphysis pubis.

2. Station is assessed by palpating the ischial spines.

During a vaginal examination, the nurse palpates fetal buttocks that are facing the left posterior and are 1 cm above the ischial spines. Which of the following is consistent with this assessment? 1. LOA 1 station. 2. LSP 1 station. 3. LMP 1 station. 4. LSA 1 station.

2. The LSP position is the correct answer. The fetal buttocks (S or sacrum) are facing toward the mother's left posterior (LP) and buttocks at 1 station are 1 cm above the ischial spines.

A low-risk 38-week-gestation woman calls the labor unit and says, "I have to come to the hospital right now. I just saw pink streaks on the toilet tissue when I went to the bathroom. I'm bleeding." Which of the following responses should the nurse make first? 1. "Does it burn when you void?" 2. "You sound frightened." 3. "That is just the mucus plug." 4. "How much blood is there?"

2. The nurse is using reflection to acknowledge the client's concerns Pregnant women are very protective of themselves and of the babies they are carrying. Anytime a change that might portend a problem occurs, a pregnant woman is likely to become concerned and frightened. Certainly, seeing any kind of blood loss from the vagina can be scary. The nurse must acknowledge that fear before asking other questions or making other comments.

A gravid client, G3 P2002, was examined 5 minutes ago. Her cervix was 8 cm dilated and 90% effaced. She now states that she needs to move her bowels. Which of the following actions should the nurse perform first? 1. Offer the client the bedpan. 2. Evaluate the progress of labor. 3. Notify the physician. 4. Encourage the patient to push.

2. The nurse should first assess the progress of labor to see if the client has moved into the second stage of labor.

The nurse is reviewing the record of a client in the labor room and notes that the health care provider had documented the fetal presenting part is at the -1 station. This documented finding indicates that the fetal presenting part is located at which area? 1. 1 inch below the coccyx 2. 1 inch below the iliac crest 3. 1 cm above the ischial spine 4. 1 fingerbreadth below the symphysis pubis

3. 1cm above the ischial spine

The childbirth education nurse is evaluating the learning of four women, 38 to 40 weeks' gestation, regarding when they should go to the hospital. The nurse determines that the client who makes which of the following statements needs additional teaching? 1. The client who says, "If I feel a pain in my back and lower abdomen every 5 minutes." 2. The client who says, "When I feel a gush of clear fluid from my vagina." 3. The client who says, "When I go to the bathroom and see the mucus plug on the toilet tissue." 4. The client who says, "If I ever notice a greenish discharge from my vagina." 1

3. Expelling the mucus plug is not sufficient reason to go to the hospital to be assessed

An obstetrician is performing an amniotomy on a gravid woman in transition. Which of the following assessments must the nurse make immediately following the procedure? 1. Maternal blood pressure. 2. Maternal pulse. 3. Fetal heart rate. 4. Fetal fibronectin level.

3. It is essential to assess the fetal heart rate immediately after an amniotomy.

A client is complaining of severe back labor. Which of the following nursing interventions would be most effective? 1. Assist mother with childbirth breathing. 2. Encourage mother to have an epidural. 3. Provide direct sacral pressure. 4. Use a hydrotherapy tub.

3. When direct sacral pressure is applied, the nurse is providing a counteraction to the pressure being exerted by the fetal head.

A nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 BPM. Which of the following nursing actions is most appropriate? 1.Encourage the client's coach to continue to encourage breathing exercises 2.Encourage the client to continue pushing with each contraction 3.Continue monitoring the fetal heart rate 4.Notify the physician or nurse mid-wife

4. A normal fetal heart rate is 120-160 beats per minute. Fetal bradycardia between contractions may indicate the need for immediate medical management, and the physician or nurse mid-wife needs to be notified.

A woman who states that she "thinks" she is in labor enters the labor suite. Which of the following assessments will provide the nurse with the most valuable information regarding the client's labor status? 1. Leopold's maneuvers. 2. Fundal contractility. 3. Fetal heart assessment. 4. Vaginal examination.

4. A vaginal examination will provide the nurse with the best information about the status of labor.

36. A woman, 40 weeks' gestation, calls the labor unit to see whether or not she should go to hospital to be evaluated. Which of the following statements by the woman indicates that she is probably in labor and should proceed to the hospital? 1. "The contractions are 5 to 20 minutes apart." 2. "I saw a pink discharge on the toilet tissue when I went to the bathroom." 3. "I have had cramping for the past 3 or 4 hours." 4. "The contractions are about a minute long and I am unable to talk through them."

4. This client is exhibiting clear signs of true labor. Not only are the contractions lasting a full minute but she is stating that they are so uncomfortable that she is unable to speak through them. She should be seen.

In stage 1 of labor, during the latent phase, the cervix dilates? A. 1-3 cm B. 7-10 cm C. 4-7 cm D. 8-10 cm

A. 1-3cm

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

A. Acute hemolytic When an Rh negative mother carries an Rh positive fetus there is a risk for maternal antibodies against Rh positive blood; antibodies cross the placenta and destroy the fetal RBC's.

What does GTPAL stand for? A. G - gravida, T - term births, P - preterm births, A - abortions, L - living children B. G - gravida, T - total pregnancies, P - premature infants, A - abortions, L - living children C. G - gravida, T - total pregnancies, P - pelvic infections, A - accidental pregnancies, L - living children D. G - gravida, T - term births, P - premature infants, A - abortions, L - living children

A. G - gravida, T - term births, P - preterm births, A - abortions, L - living children

A 20 year old female is currently 8 weeks pregnant. She had a miscarriage at 12 weeks gestation two years ago. She has no living children. What is her GTPAL?* A. G=2, T=0, P=0, A=1, L=0 B. G=3, T=1, P=1, A=0, L=3 C. G=2, T=2, P=0, A=1, L=2 D. G=1, T=1, P=1, A=0, L=1

A. G=2, T=0, P=0, A=1, L=0

A 29 year old female is currently 9 weeks pregnant. She has no living children. Two years ago she had 2 miscarriages at 10 and 12 weeks gestation. What is her GTPAL?* A. G=3, T=0, P=0, A=2, L=0 B. G=3, T=1, P=2, A=0, L=0 C. G=3, T=1, P=2, A=0, L=4 D. G=3, T=0, P=1, A=2, L=2

A. G=3, T=0, P=0, A=2, L=0

A pregnant woman's last menstrual period began on April 8, 2005, and ended on April 13. Using Naegele's rule her estimated date of birth would be: A. January 15, 2006 B. January 20, 2006 C. July 1, 2006 D. November 5, 2005

A. January 15th 200

A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action? Discuss A. Place the client in Trendelenburg's position B. Call the delivery room to notify the staff that the client will be transported immediately C. Gently push the cord into the vagina D. Find the closest telephone and stat page the physician

A. Place the client in Trendelenburg's position

A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell's sign. The nurse determines this sign indicates: A. softening of the cervix B. soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus. C. The presence of hCG in the urine D. The presence of fetal movement

A. Softening of the cervix In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell's sign.

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? (Select all that apply.) A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 to 11.5 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. E. Normal weight women should gain 11.5 to 16 kg.

A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 to 11.5 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. E. Normal weight women should gain 11.5 to 16 kg. Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. Normal weight women should gain 11.5 to 16kg.

A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all that apply: A. Uterine enlargement B. Fetal heart rate detected by nonelectric device C. Outline of the fetus via radiography or ultrasound D. Chadwick's sign E. Braxton Hicks contractions F. Ballottemen

A. Uterine enlargement D. Chadwick's sign E. Braxton Hicks contractions F. Ballottement The probable signs of pregnancy include: >Uterine Enlargement >Hegar's sign or softening and thinning of the uterine segment that occurs at week 6. >Goodell's sign or softening of the cervix that occurs at the beginning of the 2nd month >Chadwick's sign or bluish coloration of the mucous membranes of the cervix, vagina and vulva. Occurs at week 6. >Ballottement or rebounding of the fetus against the examiner's fingers of palpation >Braxton-Hicks contractionsPositive pregnancy test measuring for hCG. >Positive signs of pregnancy include: >Fetal Heart Rate detected by electronic device (doppler) at 10-12 weeks >Fetal Heart rate detected by nonelectronic device (fetoscope) at 20 weeks AOG >Active fetal movement palpable by the examiners >Outline of the fetus via radiography or ultrasound

A 26 year old female is currently 26 weeks pregnant. She had a miscarriage at 10 weeks gestation five years ago. She has a three year old who was born at 39 weeks. What is her GTPAL? A. G=3, T=1, P=0, A=1, L=1 B. G=3, T=1, P=1, A=0, L=3 C. G=3, T=2, P=0, A=2, L=2 D. G=2, T=1, P=0, A=1, L=1

A: G=3, T=1, P=0, A=1, L=1

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: A. A pound a week throughout pregnancy. B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. C. A pound a week during the first two trimesters, then 2 lbs per week during the third trimester. D. A total of 25 to 35 lbs.

B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. A pound a week is not the correct guideline during pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/wk during the second and third trimesters. These are not accurate guidelines for weight gain during pregnancy. The total is correct, but the pattern needs to be explained.

The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is: A. A decrease in WBC's B. An increase in hematocrit C. An increase in blood volume D. A decrease in sedimentation rate

B. An increase in blood volume The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.

Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include: A. A decrease of 200 calories a day B. An increase of 300 calories a day C. An increase of 500 calories a day D. A maintenance of her present caloric intake per day

B. An increase of 300 calories a day This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy.

The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine position can: A. Unduly prolong labor B. Cause decreased placental perfusion C. Lead to transient episodes of hypotension D. Interfere with free movement of the coccyx

B. Cause decreased placental perfusion This is because impedance of venous return by the gravid uterus, which causes hypotension and decreased systemic perfusion.

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. Drink warm fluids with each of her meals. B. Eat a high-protein snack before going to bed. C. Keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. Schedule three meals and one midafternoon snack a day

B. Eat a high-protein snack before going to bed. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

A pregnant woman experiencing nausea and vomiting should: A. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. B. Eat small, frequent meals (every 2 to 3 hours). C. Increase her intake of high-fat foods to keep the stomach full and coated. D. Limit fluid intake throughout the day.

B. Eat small, frequent meals (every 2 to 3 hours). A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated. This is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

A 21-year old client, 6 weeks' pregnant is diagnosed with hyperemesis gravidarum. This excessive vomiting during pregnancy will often result in which of the following conditions? A. Bowel perforation B. Electrolyte imbalance C. Miscarriage D. Pregnancy induced hypertension (PIH)

B. Electrolyte imbalance Excessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid, electrolyte, and acid-base imbalances.

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

B. Fetal heart rate of 180 BPM

A 30 year old female is 20 weeks pregnant with twins. She has a 6 year-old who was born at 40 weeks gestation. She has no history of miscarriage or abortion. What is her GTPAL?* A. G=1, T=0, P=1, A=3, L=0 B. G=2, T=1, P=0, A=0, L=1 C. G=2, T=1, P=2, A=0, L=1 D. G=1, T=1, P=0, A=0, L=1

B. G=2, T=1, P=0, A=0, L=1

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. Spina bifida. B. Intrauterine growth restriction. C. Diabetes mellitus. D. Down syndrome.

B. Intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.

Gravida refers to which of the following descriptions? A. A serious pregnancy B. Number of times a female has been pregnant C. Number of children a female has delivered D. Number of term pregnancies a female has had

B. Number of times a female has been pregnant Gravida refers to the number of times a female has been pregnant, regardless of pregnancy outcome or the number of neonates delivered.

At a prenatal visit at 36 weeks' gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to: A.Lie down until they stop B. Walk around until they subside C. Time contraction for 30 minutes D. Take 10 grains of aspirin for the discomfort

B. Walk around until they subside

The nurse is caring for a client who delivered a healthy newborn via vaginal delivery. An episiotomy was performed, and the woman has developed a wound infection at the episiotomy site. The nurse reinforces instructions to the mother regarding care related to the infection. Which statement by the mother indicates the need for further teaching? A. "Bright red bleeding is abnormal and should be reported. B. "Sexual activity may be resumed in about 3 weeks when the episiotomy has healed and the lochia has stopped." C. "I need to isolate my infant for 48 hours after starting the antibiotics." D. "I should be applying ice packs to the perineum for the first 12 to 24 hours"

C. "I need to isolate my infant for 48 hours after starting the antibiotics." All of the other options are episiotomy care

A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term? A. "It is the irregular, painless contractions that occur throughout pregnancy." B. "It is the soft blowing sound that can be heard when the uterus is auscultated." C. "It is the fetal movement that is felt by the mother." D. "It is the thinning of the lower uterine segment."

C. "It is the fetal movement that is felt by the mother." Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar's sign.

Beth is 39 weeks pregnant with her third baby. She has been pregnant 3 times. Her first pregnancy resulted in a baby girl born at 39 weeks gestation. Her second pregnancy resulted in a baby boy born at 38 weeks gestation. What is her GTPAL? A. G 4 T 3 P 1 A 0 L 3 B. G 3 T 3 P 3 A 3 L 3 C. G3 T 2 P 0 A 0 L 2 D. G 4 T 2 P 0 L 2

C. C. G3 T 2 P 0 A 0 L 2

A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is: A. G4 T3 P2 A1 L4 B. G5 T2 P2 A1 L4 C. G5 T2 P1 A1 L4 D. G4 T3 P1 A1 L4

C. G5 T2 P1 A1 L4 5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.

A 35 year old female is currently pregnant with twins. She has 10 year old triplets who were born at 32 weeks gestation, and a 16 year old who was born at 41 week gestation. Twelve years ago she had a miscarriage at 19 weeks gestation. What is her GTPAL?* A. G=4, T=1, P=2, A=1, L=1 B. G=3, T=1, P=1, A=0, L=4 C. G=4, T=1, P=1, A=1, L=4 D. G=4, T=1, P=1, A=1, L=1

C. G=4, T=1, P=1, A=1, L=4

A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele's rule, the nurse determines the estimated date of confinement as: A July 26, 2013 B June 12, 2014 C June 26, 2014 D July 12, 2014

C. June 26th 2014

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

C. Neural tube defects The alpha-fetoprotein test detects neural tube defects and Down syndrome.

Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy? A. Mastitis B. Metabolic alkalosis C. Physiologic anemia D. Respiratory acidosis

C. Physiologic anemia Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production.

A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse? A. Urinary output of 20 ml since the previous assessment B. Deep tendon reflexes of 2+ C. Respiratory rate of 10 BPM D. Fetal heart rate of 120 BPM

C. Respiratory rate of 10 bpm Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WDL for a resting fetus.

During stage 3 of labor, you note a gush of blood and that the uterus changes shape from an oval shape to globular shape. This indicates? A. Postpartum hemorrhage B. Imminent delivery of the baby C. Signs of placental separation D. Answers B and C

C. Signs of placental separation

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present? A. Absence of abdominal pain B. A soft abdomen C. Uterine tenderness/pain D. Painless. bright red vaginal bleeding

C. Uterine tenderness/pain

Your laboring patient has transitioned to stage 2 of labor. What changes in the perineum indicate the birth of the baby is imminent? A. Increase in meconium-stained fluid and retracting perineum B. Retracting perineum and anus with an increase of bloody show C. Rapid and intense contractions D. Bulging perineum and rectum with an increase in bloody show

D. Bulging perineum and rectum with an increase in bloody show

A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn. the nurse assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall and is ready for delivery? A. The umbilical cord shortens in length and changes in color B. A soft and boggy uterus C. Maternal complaints of severe uterine cramping D. Changes in the shape of the uterus

D. Changes in the shape of the uterus Signs of placental separation include lengthening of the umbilical cord. a sudden gush of dark blood from the introitus (vaginal). a firmly contracted uterus. and the uterus changing from a discoid (like a disk) to a globular (like a globe) shape. The client may experience vaginal fullness. but not severe uterine cramping.

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. Iron absorption is inhibited by a diet rich in vitamin C. C. Iron supplements are permissible for children in small doses. D. Constipation is common with iron supplements.

D. Constipation is common with iron supplements. These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem.

A 27 year old female is currently 16 weeks pregnant. She has 2 year-old twins that were born at 39 weeks gestation and a 5 year-old who was born at 40 weeks gestation. She had no history of miscarriage or abortion. What is her GTPAL?* A. G=3, T=1, P=0, A=1, L=3 B. G=3, T=1, P=1, A=0, L=3 C. G=3, T=2, P=0, A=1, L=1 D. G=3, T=2, P=0, A=0, L=3

D. G=3, T=2, P=0, A=0, L=3

A nurse midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement? A. Auscultating for fetal heart sounds B. Palpating the abdomen for fetal movement C. Assessing the cervix for thinning D. Initiating a gentle upward tap on the cervix

D. Initiating a gentle upward tap on the cervix Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger.

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? A. This weight gain indicates possible gestational hypertension. B. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). C. This weight gain cannot be evaluated until the woman has been observed for several more weeks. D. The woman's weight gain is appropriate for this stage of pregnancy.

D. The woman's weight gain is appropriate for this stage of pregnancy. Although this is an accurate statement, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. C. Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy. This is an accurate statement. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.

A pregnant woman at 32 weeks' gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to: A. Assess the woman's blood pressure and pulse B. Have the woman breathe into a paper bag C. Raise the woman's legs D. Turn the woman on her left side

D. Turn the woman on her left side During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side (specifically left side) will remove the compression and restore cardiac output and blood pressure. Then vital signs can be assessed. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation.

A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to: A. Avoid wearing a bra B. Wash the nipples and areola area daily with soap, and massage the breasts with lotion. C. Wear tight-fitting blouses or dresses to provide support D. Wash the breasts with warm water and keep them dry

D. Wash the breasts with warm water and keep them dry