OB Success: Antepartum

A woman states that she frequently awakens with "painful leg cramps" during the night. Which of the following assessments should the nurse make? 1. Dietary evaluation. 2. Goodell's sign. 3. Hegar's sign. 4. Posture evaluation.

1. A dietary evaluation is indicated since painful leg cramps can be caused by consuming too little calcium or too much phosphorus. 2. Goodell's sign is a physiological finding—a softened cervix. 3. Hegar's sign is a physiological finding—a softened uterine isthmus. 4. It is not necessary to evaluate the woman's posture. TEST-TAKING TIP: Leg cramps can occur as a result of low calcium and/or high phosphorus since they are often related to a poor calcium/phosphorus ratio. A dietary assessment should be done to determine whether or not the client is consuming enough calcium, primarily found in dairy products, or large quantities of phosphorus, found in carbonated beverages and processed sandwich meats.

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

2, 3, 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 only performed when needed. TEST-TAKING TIP: The test taker must read the question carefully. Although urine glucose assessments are done at each visit, blood glucoses are assessed only intermittently during the pregnancy. Similarly, although ultrasound assessments may be ordered intermittently during a pregnancy, they are certainly not done at every prenatal visit. As a matter of fact, there is no absolute mandate that a sonogram must be done at all during a pregnancy.

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

2. 2 eggs = 1 meat serving. 1. 4 tbsp of peanut butter = 2 meat servings. 3. 1 cup of cooked lima beans = 2 meat servings. 4. 2 ounces of nuts = 2 meat servings. TEST-TAKING TIP: The test taker should refer to the US Dietary Association information at http://www.health.gov/ dietaryguidelines for up-to-date dietary recommendations. As more research information is forthcoming, dietary recommendations change.

A pregnant woman must have a glucose challenge test (GCT). Which of the following should be included in the preprocedure teaching? 1. Fast for 12 hours before the test. 2. Bring a urine specimen to the laboratory on the day of the test. 3. Be prepared to have 4 blood specimens taken on the day of the test. 4. The test should take one hour to complete.

4. The test does take about 1 hour to complete. 1. The GCT is a nonfasting test. 2. It is unnecessary to take a urine sample to the lab on the day of testing. 3. Only one blood specimen is taken on the day of the test. TEST-TAKING TIP: The GCT is done at approximately 24 weeks' gestation to assess the client's ability to metabolize glucose. It is a 1-hour, nonfasting screening test. One hour after a client consumes 50 grams of a concentrated glucose solution, a serum glucose level is done. If the value is 130 mg/dL or higher, the client is referred for a 3-hour glucose tolerance test to determine whether or not she has gestational diabetes.

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

An "X" will be placed between the neonatal and maternal vessels where gas exchange occurs. TEST-TAKING TIP: It is important that the test taker have a complete understanding of the anatomy and the physiology of the placenta. Since this is the sole organ that maintains the health and well-being of the fetus, the nurse must be able to differentiate between the maternal portion and the fetal portion as well as the function of the structures.

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

X on the line fourth from the bottom on the fundal scale

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

1, 2, 3, and 5 are correct. 1. The genitalia are formed by the end of the first trimester. 2. The heart is formed by the end of the first trimester. 3. The fingers are formed by the end of the first trimester. 4. The alveoli will not be formed until well into the second trimester. 5. The kidneys are formed by the end of the first trimester. TEST-TAKING TIP: The test taker should be familiar with the basic developmental changes that occur during the three trimesters. In addition, the test taker should be able to develop a basic timeline of developmental milestones that occur during the pregnancy. By the conclusion of the first trimester, all major organs are completely formed. The maturation of the organ systems must, however, still occur.

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

1. Bologna should not be consumed during pregnancy unless it is thoroughly cooked. 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 fiber, although if loaded with butter and salt, is not the most healthy fiber choice. TEST-TAKING TIP: Because pregnant women are slightly immunocompromised, they are especially susceptible to certain diseases. Deli meats, unless heated to steaming hot, can cause listeriosis. Pregnant women should avoid these foods. Other foods that contain Listeria monocytogenes that should be avoided are unpasteurized milk, soft cheese, and undercooked meats. See http://www.cfsan.fda.gov/~pregnant/ ataglanc.html and http://www.health. gov/dietaryguidelines/dga2005/ document/html/chapter10.htm

A father experiencing couvade syndrome is likely to exhibit which of the following symptoms/behaviors? 1. Heartburn. 2. Promiscuity. 3. Hypertension. 4. Indifference.

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. It is inappropriate for a prospective father to be indifferent toward the pregnancy. TEST-TAKING TIP: Heartburn is a subjective complaint that fathers often experience during their partners' pregnancies. Fathers who are experiencing couvade symptoms are exhibiting a strong affiliation between themselves and their partners. It is inappropriate for prospective fathers to engage in illicit relationships and/or indifference toward their partners' pregnancies. They should be fully engaged in the process. Hypertension, an objective sign, should be investigated further. The father may have developed a pathologic condition.

The midwife has just palpated the fundal height at the location noted on the picture below. (7 line fundal scale, arrow pointing at line 2nd from the bottom) It is likely that the client is how many weeks pregnant? 1. 12. 2. 20. 3. 28. 4. 36.

1. The client is likely 12 weeks pregnant. At 12 weeks, the fundal height is at the top of the symphysis. 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. TEST-TAKING TIP: The fundal height is assessed at every prenatal visit. It is an easy, noninvasive means of assessing fetal growth. The nurse should know that the top of the fundus is at the level of the symphysis at the end of the first trimester.

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

2. Lanugo does cover the fetal body at approximately 20 weeks' gestation. 1. The fetal heart begins to beat during the first trimester, not when quickening is detected at 16 to 20 weeks. 3. The kidneys secrete urine by about week 12, before quickening is detected. Amniotic fluid is composed predominantly of fetal urine. 4. Fingernails begin to form at about week 10 but do not completely cover the tips of the fingers until mid third trimester. TEST-TAKING TIP: Although the test taker need not memorize all fetal developmental changes, it is important to have an understanding of major periods of development. For example, organogenesis occurs during the first trimester with all of the major organs functioning at a primitive level by week 12.

The nurse working in an outpatient obstetric office assesses four primigravid clients. Which of the client findings would the nurse highlight for the physician? 1. 17 weeks' gestation; denies feeling fetal movement. 2. 24 weeks' gestation; fundal height at the umbilicus. 3. 27 weeks' gestation; complains of excess salivation. 4. 34 weeks' gestation; complains of hemorrhoidal pain.

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. 1. It is common for primigravid women not to feel fetal movement until 19 to 20 weeks' gestation. 3. Excessive salivation, called ptyalism, is an expected finding in pregnancy. 4. Hemorrhoids are commonly seen in pregnant women. TEST-TAKING TIP: It is important for the test taker to know the timing of key pregnancy changes. The mother should feel fetal movement by 20 weeks' gestation. Primigravidas often feel fetal movement later than multigravidas. Specific fundal height measurements are also expected at key times in the pregnancy.

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

2. This fetus is about 22 weeks' gestation. Nails start to develop in the first trimester, and lanugo starts to develop at about 20 weeks, but eyes remain fused until about 29 weeks. 1. 15 weeks is too early for quickening. At 15 weeks, the fetus would not have lanugo. 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. TEST-TAKING TIP: The test taker should not panic when reading a question like the one in the scenario. This is an application question that requires the test taker to take things apart and put them back together again. Each of the signs is unique and relates to a specific period in fetal development. After an analysis, the only response that is plausible is response "2."

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

2. This is an accurate statement. 1. Unless a woman is high risk for preterm labor, there is no reason to refrain from making love during pregnancy. Therefore, this is an inappropriate statement. 3. Unless a woman is high risk for preterm labor, this is an inappropriate statement. 4. This is an inappropriate statement. TEST-TAKING TIP: There is no contraindication to intercourse or to orgasm during pregnancy, unless it has been determined that a client is high risk for preterm labor. Until late in pregnancy, there are very few oxytocin receptor sites on the uterine body. The woman will, therefore, not go into labor as a result of an orgasm during sexual relations.

A nurse midwife has advised a 39-week gestation gravid to take evening primrose oil 2500 mg daily as a complementary therapy. This suggestion was made because evening primrose has been shown to perform which of the following actions? 1. Relieve back strain. 2. Improve development of colostrum. 3. Ripen the cervix. 4. Reduce the incidence of hemorrhoids.

3. Evening primrose converts to a prostaglandin substance in the body. Prostaglandins are responsible for readying the cervix for dilation. 1. Evening primrose does not affect back strain. 2. Evening primrose does not affect lactation. 4. Evening primrose does not affect the development of hemorrhoids. TEST-TAKING TIP: Nurse midwives often recommend complementary therapies during pregnancy as well as during labor and delivery. Nurse midwives usually believe in promoting natural means for maintaining a healthy pregnancy and for stimulating labor. Evening primrose is one of those interventions.

The glucose challenge screening test is performed at or after 24 weeks' gestation to assess for the maternal physiological response to which of the following pregnancy hormones? 1. Estrogen. 2. Progesterone. 3. Human placental lactogen. 4. Human chorionic gonadotropin.

3. Human placental lactogen (hPL) is an insulin antagonist. 1. Estrogen levels are not related to glucose metabolism. 2. Progesterone levels are not related to glucose metabolism. 4. Human chorionic gonadotropin (hCG) levels are not related to glucose metabolism. TEST-TAKING TIP: hPL is produced by the placenta. As the placenta grows, the hormone levels rise. At approximately 24 weeks' gestation, the levels are high enough to impact glucose metabolism. If performed earlier, the GCT test may result in a false-negative result.

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

3. This is an accurate statement. Hormonal changes in pregnancy make the nasal passages prone to bleeds. 1. Unless nosebleeds are excessive, it is rare for them to lead to severe anemia. 2. Clients with nosebleeds rarely have temperature elevations. 4. Nosebleeds are an expected complication of pregnancy. TEST-TAKING TIP: Estrogen, one of the important hormones of pregnancy, promotes vasocongestion of the mucous membranes of the body. Increased vascular perfusion of the mucous membranes of the gynecological system is essential for the developing fetus to survive. The vasocongestion occurs in all of the mucous membranes of the body, however, leading to many complaints including nosebleeds and gingival bleeding.

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

4. Leg cramping is often a complaint of clients in the second trimester. 1. Nausea is commonly seen in the first trimester but should have resolved by the time the second trimester begins. 2. Dyspnea is commonly seen in the third trimester, not the second trimester. 3. Urinary frequency is commonly seen in the first trimester and late in the third trimester, but it is not related to the second trimester. TEST-TAKING TIP: Although clients in the second trimester do experience some physical discomfort, such as leg cramps and backaches, most women feel well. They no longer are fatigued, nauseous, and so on as in the first trimester, but the baby is not so large as to cause significant complaints like dyspnea or the recurrence of urinary frequency.

The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that she might experience in the coming weeks. Which of the following comments by the client indicates that further teaching is needed? 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 back pain." 4. "During the third trimester I may experience persistent headache."

4. Persistent headache should not be seen in pregnant women. 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. Back pain is a common complaint of pregnant women. TEST-TAKING TIP: This question is asking the test taker to determine which complaint is not expected during the third trimester. The nurse, therefore, must know which symptoms are normal during the third trimester in order to know which symptoms are not normal during that period. Persistent headache can indicate that the woman has developed a complication of pregnancy.

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 fish 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 fish, but sushi is too salty to eat during pregnancy." 3. "Sushi is raw. Raw fish is especially high in mercury." 4. "It is recommended that fish be cooked to destroy harmful bacteria."

4. This is correct. It is recommended that during pregnancy the client eat only well-cooked fish. 1. Fish is very healthy, but the recommendation is that the fish 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 fish contain methylmercury, but there are some fish with such high levels that they should not be eaten at all: swordfish, tilefish, king mackerel, and shark. The mercury level does not change when a fish is eaten cooked versus raw. TEST-TAKING TIP: Fish is an excellent source of omega-3 oil and protein. During pregnancy fish should be eaten well-cooked to avoid ingestion of pathogens. The pregnant woman should limit her intake to 12 oz per week or less to reduce the potential of her consuming toxic levels of methylmercury. See http://www.cfsan.fda.gov/~pregnant/ safemea.html

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 any to be seen." 3. "The technician says that the baby has a penis. It looks like you are having a boy." 4. "I am sorry. It will not be possible to see which sex the baby is for another month or so."

4. This statement is true. The sex is not visible yet. 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. TEST-TAKING TIP: The genitourinary system is the last organ system to fully develop. Before 12 weeks, both female and male genitalia are present. The sex is determined genetically, but it is as yet impossible to determine the sex visually. If the embryo secretes testosterone, the male sex organs mature and the female organs recede. If the embryo does not secrete testosterone, the male sex organs recede and the female organs mature. At 8 weeks, it is not possible to determine the sex of the fetus.

A vegan is being counseled regarding vitamin intake. It is essential that this woman supplement which of the following B vitamins? 1. B1 (thiamine). 2. B2 (niacin). 3. B6 (pyridoxine). 4. B12 (cobalamin).

4. Vitamin B12 (cobalamin) should be supplemented. 1. Vitamin B12 (cobalamin) should be supplemented. 2. Vitamin B12 (cobalamin) should be supplemented. 3. Vitamin B12 (cobalamin) should be supplemented. TEST-TAKING TIP: Vitamin B12 (cobalamin) is found almost exclusively in animal products—meat, dairy, eggs. Since vegans do not consume animal products, and the vitamin is not in most nonanimal sources, it is strongly recommended that vegans supplement that vitamin. Those who take in too little of the vitamin are susceptible to anemia and nervous system disorders. In addition, the vitamin is especially important during pregnancy since it is essential for DNA synthesis.

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

1, 2, 3, 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. TEST-TAKING TIP: There are three classifications of signs of pregnancy: presumptive, probable, and positive. Signs that are totally subjective, or presumptive, include amenorrhea, breast tenderness, quickening, and frequent urination. Signs that are objective, but not totally absolute, are termed probable and include alterations in uterine shape and size and softening of the cervix. Signs that are absolute, or positive, include hearing the fetal heartbeat, detecting fetal movement, and ultrasound images of the fetal outline.

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

1, 2, 3, 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. Polyuria is not highlighted as a danger sign of pregnancy. TEST-TAKING TIP: The danger signs of pregnancy are signs or symptoms that can occur in an otherwise healthy pregnancy that are likely due to serious pregnancy complications. For example, double vision, epigastric pain, and blurred vision are symptoms of the hypertensive illnesses of pregnancy, and persistent vomiting is a symptom of hyperemesis gravidarum.

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

1, 2, 3, and 5 are correct. 1. Leg cramps are normal, although the client's diet should be assessed. 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. TEST-TAKING TIP: There are a number of physical complaints that are "normal" during pregnancy. There are interventions, however, that can be taught to help to alleviate some of the discomforts. The test taker should be familiar with patient education information that should be conveyed regarding the physical complaints of pregnancy. For example, clients who complain of hemorrhoids should be encouraged to eat high-fiber foods and drink fluids in order to produce softer stools. The softer stools should decrease the irritation of the hemorrhoids.

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. Drink 2 glasses of water with each meal. 4. Eat 3 large meals plus a bedtime snack.

1. Greasy foods should be avoided. 2. Saltine crackers should be eaten before rising. Drinking orange juice is not recommended. 3. It is recommended that liquids and solids be eaten separately. 4. It is recommended that mothers eat small frequent meals throughout the day. TEST-TAKING TIP: Although many women experience nausea and vomiting or morning sickness upon rising, many women complain of nausea and/or vomiting at other times of the day. One theory that has been offered to explain this problem is that the body is ridding itself of teratogens that could potentially harm the fetus.

Which of the following findings in an 8-week gestation client, G2 P1001, should the nurse highlight for the nurse midwife? 1. Body mass index of 17. 2. Blood pressure of 100/60. 3. Hematocrit of 36%. 4. Hemoglobin of 13.2.

1. The BMI of 17 is of concern. This client is entering her pregnancy underweight. 2. This blood pressure is normal. 3. This hematocrit is normal. 4. This hemoglobin is normal. TEST-TAKING TIP: Women who enter their pregnancies underweight are encouraged to gain slightly more—35 to 45 lb—during their pregnancies than are women of normal weight who are encouraged to gain 25 to 35 lb.

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) 98.6ºF and third trimester T 99.2ºF.

1. The blood pressure should not elevate during pregnancy. This change should be reported to the health care practitioner. 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. TEST-TAKING TIP: The basal metabolic rate of the woman increases during pregnancy. As a result the nurse would expect to observe a respiratory rate of 20 to 24 rpm. High levels of progesterone in the body result in a decrease in the contractility of the smooth musculature throughout the body. This results in an increase in the pulse rate. In addition, progesterone is thermogenic, resulting in a slight rise in the woman's core body temperature.

A gravida, G1 P0000, is having her first prenatal physical examination. Which of the following assessments should the nurse inform the client that she will have that day? 1. Pap smear. 2. Mammogram. 3. Glucose challenge test. 4. Biophysical profile.

1. The client will have a Pap smear done. 2. A mammogram will not be performed. 3. A glucose challenge test will likely be performed at the end of the second trimester. 4. A biophysical profile may be done, but not until the third trimester. TEST-TAKING TIP: At the first prenatal visit, pregnant clients will undergo complete obstetrical and medical physical assessments. The assessments are performed to provide the health care practitioner with baseline data regarding the health and well-being of the woman as well as to inform the health care practitioner of any medical problems that the mother has that might impact the pregnancy. A breast exam will be performed by the practitioner to assess for abnormalities, but since mammograms are potentially harm-producing x-rays, they are only ordered in emergent cases.

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. VCR tape. 3. CD case. 4. Video camera.

1. This is an accurate statement. A serving of meat is approximately equal to a deck of cards. 2. The VCR tape is too large. 3. The CD case is too large. 4. The video camera is too large. TEST-TAKING TIP: The dietary recommendation of the meat group for pregnant clients is: 3 servings of meat per day. Each serving is defined as 2 to 3 oz of meat, fish, or poultry. The average American diet well exceeds the recommended meat intake since most Americans consider a serving of meat to be larger than a deck of cards.

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

1. This statement is true. Organogenesis begins prior to the missed menstrual period. 2. Insurance companies do not require a woman be preapproved to become pregnant. 3. This statement is untrue. Only women with specific 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. TEST-TAKING TIP: The test taker may be unfamiliar with the term organogenesis. To answer the question correctly, however, it is essential that the test taker be able to decipher the definition. It is important that the nurse break the word down into its parts in order to deduce the meaning. Organo means "organ" and genesis means "origin." The definition of the term, therefore, is origin, or development, of the organ systems.

A nurse is discussing the serving sizes in the grain food group with a new prenatal client. Which of the following foods equals 1 serving size 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 cup dry cereal.

2, 4, and 5 are correct. 1. 1 bagel = 2 servings. 2. 1 slice bread = 1 serving. 3. 1 cup cooked pasta = 2 servings. 4. 1 tortilla = 1 serving. 5. 1 cup dry cereal = 1 serving. TEST-TAKING TIP: The test taker should note that pregnant women are recommended to consume 7 to 11 servings of grain. However, 1 sandwich equals 2 servings since each piece of bread equals 1 serving. Also, it is important to counsel women to eat whole grain foods rather than processed grains. More nutrients as well as more fiber are obtained from whole grain foods.

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

2. Many Chinese women do believe in the "hot and cold" theory of life. 1. Chinese do consume protein, especially rice and seafood. 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. TEST-TAKING TIP: Whenever a question specifies that a client belongs to a specific cultural or ethnic group, the test taker should attend carefully to that information. It is very likely that the question is asking the test taker to discern cultural/ethnic differences in order to discern the test taker's cultural competence. Pregnancy is believed by many Chinese to be a "hot period." In order to maintain the equilibrium of the body, therefore, pregnant women consume "cold" foods and drinks.

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

2. Nodular breast tissue is normal in pregnancy. 1. Although breast cancer is hormonally driven, it is rare to see its development during pregnancy. 3. The woman is not exhibiting psychotic behavior. 4. Anxiety attacks are not common during pregnancy. TEST-TAKING TIP: The high levels of estrogen seen in pregnancy result in a number of changes. The hypertrophy and hyperplasia of the breast tissue, in preparation for neonatal lactation, are two of the changes.

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

2. The pelvic tilt is an exercise that can reduce backache pain. 1. The Kegel exercises are done to promote the muscle tone of the perineal muscles. 3. Leg lifts will not help to reduce backache pain. 4. Crunches will not help to reduce backache pain. TEST-TAKING TIP: Pelvic tilt exercises help to reduce backache pain. The client is taught to get into an optimal position— on the hands and knees is often best. She is then taught to force her back out while tucking her head and buttocks under and holding that position for a few seconds, followed by holding the alternate position for a few seconds—arching her back while lifting her head and her buttocks toward the ceiling. These positions should be alternated repeatedly for about 5 minutes. The exercises are very relaxing while also improving the muscle tone of the lower back.

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

2. The practitioner would expect to palpate an enlarged ovary. 1. The cervix should be long and thick. 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 in order 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.

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

2. This is a true statement. 1. This response ignores and dismisses the client's concerns as unimportant. 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. TEST-TAKING TIP: Labor contractions often begin in a woman's back, feeling much like a backache. The difference is that labor contractions are intermittent and rhythmic. The client should be advised to attend to any pains that come and go and time them. She may be beginning the labor process.

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.

2. This is a true statement. Dizygotic twins result from two mature ova that are fertilized. 1. This is true of monozygotic twins. 3. This is true of monozygotic twins. 4. This is true of monozygotic twins. TEST-TAKING TIP: The best way for the test taker to differentiate between monozygotic twinning and dizygotic twinning is to remember the meaning of the prefixes to the two words. "Mono" means 1. Monozygotic twins, therefore, originate from one fertilized ovum. The babies have the same DNA; therefore, they are the same sex. They share a placenta and chorion. "Di" means 2. Dizygotic twins arise from 2 separately fertilized eggs. Their genetic relationship is the same as if they were siblings born from different pregnancies.

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 B2 (niacin). 4. Vitamin B12 (cobalamin).

2. Vitamin D supplementation can be harmful during pregnancy. 1. Supplementation of vitamin C has not been shown to 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. TEST-TAKING TIP: The water-soluble vitamins, if consumed in large quantities, have not been shown to be harmful during pregnancy. The body eliminates the excess quantities through the urine and stool. However, the fat-soluble vitamins—vitamins A, D, E, and K—can build up in the body. Vitamins A and D have been shown to be teratogenic to the fetus in megadoses.

A client asks the nurse what was meant when the physician told her she had a positive Chadwick's sign. Which of the following information about the finding 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."

3. A positive Chadwick's sign means that the client's cervix and vagina are a bluish color. It is a probable sign of pregnancy. 1. Purplish stretch marks are called abdominal striae. 2. Chadwick's sign is not related to the heart muscle. 4. Chadwick's sign is not related to the respiratory system. TEST-TAKING TIP: Chadwick's sign is a probable sign of pregnancy. The bluish coloration is due to the increase in vascularization of the area in response to the high levels of circulating estrogen in the pregnant woman's system.

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

3. Because this baby is postterm, lanugo would likely not be present. 1. Fingernails would likely be quite long. 2. Eye lashes would be present. 4. Milia would be present. TEST-TAKING TIP: Lanugo is a fine hair that covers the body of the fetus. It begins to disappear at about 38 weeks and very likely has completely vanished by 41 weeks' gestation.

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. Vanilla yogurt. 2. Parmesan cheese. 3. Gorgonzola cheese. 4. Chocolate milk.

3. The intake of gorgonzola cheese should be discouraged during pregnancy. 1. Yogurt is an excellent dairy source. Its intake should be encouraged. 2. Parmesan cheese is an excellent dairy source. Its intake should be encouraged. 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. TEST-TAKING TIP: Gorgonzola cheese is a soft cheese. Soft cheeses harbor Listeria monocytogenes, the organism that causes listeriosis. Pregnant women are at high risk of developing this infection because they are slightly immunosuppressed. The adult disease can assume many forms, including meningitis, pneumonia, and sepsis. Pregnant women who develop the disease often deliver stillborn babies or babies who are at risk of dying postdelivery from fulminant disease.

A client is in the 10th week of her pregnancy. Which of the following symptoms would the nurse expect the client to exhibit? 1. Backache. 2. Dyspnea. 3. Fatigue. 4. Diarrhea.

3. Most women complain of fatigue during the first trimester. 1. Backaches usually do not develop until the second trimester of pregnancy. 2. Dyspnea is associated with the third trimester of pregnancy. 4. Diarrhea is not a complaint normally heard from prenatal clients. TEST-TAKING TIP: During the first trimester, the body undergoes a number of important changes. The embryo is developing, the hormones of the body are increasing, and the maternal blood supply is increasing. To accomplish each of the tasks, the body uses energy. The mother is fatigued not only because the body is undergoing great change but also because the thyroid gland has not caught up with the increasing energy demands.

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. Bananas. 2. Rice. 3. Yogurt. 4. Celery.

4. Celery is an excellent food to reverse constipation. 1. Bananas are a constipating food. 2. Rice is a constipating food. 3. Many women state that yogurt is a constipating food. TEST-TAKING TIP: Most women complain of constipation during pregnancy. Progesterone, a muscle-relaxant, is responsible for a slowing of the digestive system. It is important, therefore, to recommend foods to pregnant clients that will help to alleviate the problem. Foods high in fiber, like celery, are excellent suggestions.

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

4. Cystic fibrosis is an autosomal recessive genetic disease so the client with a history of cystic fibrosis should be referred to a genetic counselor. 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. TEST-TAKING TIP: Virtually all diseases, chronic and acute, have some genetic component, but the ability for the genetic counselor to predict the impact of many diseases is very poor. Those illnesses with clear hereditary patterns, however, do warrant referral to genetic counselors. Cystic fibrosis has an autosomal recessive inheritance pattern.

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

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 TEST-TAKING TIP: By the end of the second trimester, the blood supply of the woman increases by approximately 50%. This increase is necessary in order for the client to be able to perfuse the placenta. There is a concurrent increase in red blood cell production, but the vast majority of women are unable to produce the red blood cells in sufficient numbers to keep pace with the increase in blood volume. As a result, clients develop what is commonly called "physiological anemia of pregnancy." A hematocrit of 32% is considered normal for a pregnant woman.

The nurse has taken a health history on four primigravid clients at their first 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's syndrome. 4. The woman diagnosed with myasthenia gravis.

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's 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 patients 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 develop severe mental retardation in utero.

The nurse is reading an article that states that the maternal mortality rate in the United States in the year 2000 was 17. Which of the following statements would be an accurate interpretation of the statement? 1. There were 17 maternal deaths in the United States in 2000 per 100,000 live births. 2. There were 17 maternal deaths in the United States in 2000 per 100,000 women of childbearing age. 3. There were 17 maternal deaths in the United States in 2000 per 100,000 pregnancies. 4. There were 17 maternal deaths in the United States in 2000 per 100,000 women in the country.

1. This statement is correct. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births. 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. TEST-TAKING TIP: One important indicator of the quality of health care in a country is its maternal mortality rate. The rate in the United States is very low as compared to many other countries in the world. For example, the maternal mortality rate in sub-Saharan Africa in 1995 was 1,100 deaths per 100,000 live births.

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, fish.

1. Tofu, legumes, and broccoli are excellent substitutes for the restricted foods. 2. Although corn, yams, and green beans are vegetables, 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. TEST-TAKING TIP: Vegans are vegetarians who eat absolutely no animal products. Since animal products are most clients' sources of protein and iron, it is necessary for vegans to be very careful to meet their increased needs by eating excellent sources of these nutrients. It is recommended that vegans meet with a registered dietitian early in their pregnancies to discuss diet choices.

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

2. Dizziness is an expected finding. 1. The nurse would expect to note hypotension rather than hypertension. 3. The nurse would expect to see dyspnea, not rales. 4. The nurse would not expect to see any skin changes. TEST-TAKING TIP: Because the weight of the gravid uterus compresses the great vessels, the nurse would expect the client to complain of dizziness when lying supine. The blood supply to the head and other parts of the body is diminished when the great vessels are compressed.

The nurse is assessing the laboratory report of a 40-week gestation client. Which of the following values would the nurse expect to find elevated above prepregnancy levels? 1. Glucose. 2. Fibrinogen. 3. Hematocrit. 4. Bilirubin.

2. Fibrinogen levels will be elevated slightly in a 40-week pregnant woman because coagulation factors like fibrinogen increase to help prevent excessive blood loss during delivery. 1. Glucose levels should be within normal limits. 3. Hematocrit levels are usually slightly lower. 4. Bilirubin levels should be within normal limits. TEST-TAKING TIP: During the latter part of the third trimester, coagulation factors increase in preparation for delivery. It is the body's means of protecting itself against a large loss of blood at delivery.

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

2. Hamburger contains the most iron. 1. Raisins contain some iron but they are not the best source of 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. TEST-TAKING TIP: Iron is present in most animal sources—seafood, meats, eggs— although it is not present in milk. There also is iron in vegetable sources, although not in the same concentration as in animal products. If the nurse is caring for a pregnant vegetarian, the nurse must counsel the client regarding good nonanimal sources of all nutrients.

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/mm3 to 15,000 cells/mm3. 3. Rise in potassium from 3.9 mEq/ L to 5.2 mEq/ L. 4. Rise in sodium from 137 mEq/ L to 150 mEq/ L.

2. The nurse would expect to see an elevated white blood cell count. 1. The nurse would expect the hematocrit to drop. 3. The nurse would not expect to see an abnormal potassium level. 4. The nurse would not expect to see an abnormal sodium level. TEST-TAKING TIP: At the end of the third trimester and through to the early postpartum period, a normal leukocytosis, or rise in white blood cell count, is seen. This is a natural physiological change that protects the woman's body from the invasion of pathogens during the birth process. The nurse should rely on a temperature elevation to determine whether or not the woman has an infection.

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 11⁄2 oz hard cheese. 3. 1⁄2 cup cottage cheese, 8 oz whole milk, 1 cup of buttermilk, and 1⁄2 oz hard cheese. 4. 1⁄2 cup frozen yogurt, 8 oz skim milk, 4 oz cream cheese, and 11⁄2 cup of cottage cheese.

2. This client consumed 32⁄3 servings: 1 cup yogurt = 1 serving, 8 oz chocolate milk = 1 serving; 1 cup cottage cheese = 2⁄3 serving; and 11⁄2 oz hard cheese = 1 serving. 1. This client consumed 25⁄6 servings: 4 oz whole milk = 1⁄2 serving; 2 oz hard cheese = 11⁄3 servings; 1 cup pudding made with milk = 1 serving; the 2 oz of cream cheese = 0 dairy servings since cream cheese is a food in the fat group, not in the dairy group. 3. This client consumed 22⁄3 servings: 1⁄2 cup cottage cheese = 1⁄3 serving; 8 oz whole milk = 1 serving; 1 cup buttermilk = 1 serving; and 1⁄2 oz hard cheese = 1⁄3 serving. 4. This client consumed 21⁄2 servings: 1⁄2 cup frozen yogurt = 1⁄2 serving, 8 oz skim milk = 1 serving; 4 oz cream cheese = 0 serving; and 11⁄2 cup cottage cheese = 1 serving. TEST-TAKING TIP: It is essential that the test taker know which foods are placed in which food groups and the equivalent quantity of food that meets one serving size. For example, 1 cup of any type of milk—whole, skim, butter, or even chocolate—is equal to one dairy serving while 11⁄2 oz of hard cheese is equal to one serving.

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. "My recommendation would be to repeat the test in one week."

2. This response is correct. Serum pregnancy tests are more sensitive than urine tests are. 1. This response is inappropriate. It does not acknowledge the client's concerns. 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. TEST-TAKING TIP: Because quantitative pregnancy tests measure the exact quantity of human chorionic gonadotropin in the bloodstream, they are more accurate than urine tests that simply measure whether or not the hormone is present in the urine. Similar to the urine tests on the market, qualitative serum tests detect whether or not the hormone is present, but they are still considered to be more accurate than urine tests are.

A client is 15 weeks pregnant. She calls the obstetric office 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, it is risky to take medicine." 2. "You can take any of the over-the-counter medications because they are all safe in pregnancy." 3. "The physician will prescribe a category "X" medication for you." 4. "You can take acetaminophen because it is a category "B" medicine."

4. Category "B" medications have been shown to be safe to take throughout pregnancy. 1. The majority of the organ systems are developed before the end of the first 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. Category "X" medications have been shown to be teratogenic. TEST-TAKING TIP: It is important for pregnant women to contact their health care practitioners to find out which medications are safe to take during pregnancy and which medications must be avoided. All medications are assigned a pregnancy category from "A"—research has shown they are safe to be consumed throughout pregnancy—to "X"—a teratogenic agent. Category "B" medications are considered safe because of anecdotal evidence, although controlled research has not been conducted to confirm that evidence. Teratogens are agents that have definitely been shown to cause fetal damage.

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.

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 first trimester. 2. Vernix caseosa is present during the latter half of pregnancy. 4. The testes descend in the scrotal sac about mid third trimester. TEST-TAKING TIP: Before putting these items into chronological order, the test taker should carefully analyze each choice. The blastocyst is developed by about day 6 after fertilization. The egg has yet even to implant into the uterine body at this point. The fetal heart develops during the early part of the first trimester, but after implantation. Vernix is present during the entire latter half of the pregnancy in order to protect the skin of the fetus. It appears, therefore, at about week 20. And, finally, the testes do not descend into the scrotal sac until mid third trimester. Indeed, male preterm babies are often birthed before the testes descend.

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

1, 2, and 5 are correct. 1. It is very important that women, before attempting to become pregnant, begin taking daily multivitamin tablets. 2. Women who wish to become pregnant should first see a medical doctor for a complete check-up 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. TEST-TAKING TIP: Because the embryo is very sensitive during the first trimester of pregnancy, women should be advised to be vigilant about their health even before becoming pregnant. For example, folic acid, a vitamin in multivitamin tablets, helps to prevent neural tube defects. Women of childbearing age often fail to go for complete physical examinations. It is important to discover the presence of any medical illnesses before the pregnancy begins, however, so women should be counseled to have a complete physical before stopping birth control methods.

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 health care professionals. 2. Enable the couple to learn about the types of medicine used in labor. 3. Provide the couple with a list of items that they should put in a bag for labor. 4. Give the high-risk couple a sense of control over having to have a cesarean.

1. Birth plans help to facilitate communication between couples and their health care providers. 2. The types of medications 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 "goodie" bag. 4. The birth plan should give the couple a sense of control about the entire labor and delivery process. TEST-TAKING TIP: The earlier a birth plan is developed, the better. A pregnant woman and her partner must feel comfortable with the communication methods, physical care, and health care philosophies of their obstetrical health care provider. The birth plan is a means for everyone to clearly understand each step of the birthing process. When the client enters the hospital for delivery, the birth plan should be presented to the nursing staff in order to facilitate the communication during that transition.

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

1. Clients who experience ptyalism have an excess of saliva. They should be advised to be vigilant in the care for 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. TEST-TAKING TIP: Ptyalism is related to the increase in vascular congestion of the mucous membranes from increased estrogen production. Women with increased salivation often also experience gingivitis, which is also related to estrogen production. In addition, ptyalism is seen in women with nausea and vomiting. Because of the caustic affects of gastric juices on the enamel of the teeth, the inflammation seen in the gums and the increased salivation, it is essential that the pregnant woman take special care of her teeth during pregnancy, including regular visits to the dentist or the dental hygienist.

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.

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. TEST-TAKING TIP: Even though evening primrose is a "natural" substance, it can cause side effects in some clients. The most common side effect seen from the oil is a skin rash. Headaches and nausea have also been seen.

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

1. Ginger has been shown to be a safe antiemetic agent for pregnant women. 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. TEST-TAKING TIP: Morning sickness and daytime nausea and vomiting are common complaints of pregnant women during the first trimester. Ginger, consumed as ginger tea, ginger ale, or the like, has been shown to be a safe and an effective antinausea agent for many pregnant women.

The nurse notes each of the following findings in a 12-week gestation client. Which of the findings 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's sign. 4. Montgomery gland enlargements.

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's sign is a probable sign of pregnancy. 4. Montgomery gland enlargement is a presumptive sign of pregnancy. TEST-TAKING TIP: Positive signs of pregnancy are signs that irrefutably show that a fetus is in utero. An ultrasound of a fetus is one positive sign and the fetal heartbeat is another positive sign.

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

1. High levels of the hormone chorionic gonadotropin in the bloodstream and urine of the woman is a probable sign of pregnancy. 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. TEST-TAKING TIP: Human chorionic gonadotropin is produced by the fertilized egg. Its presence in the bloodstream signals the body to keep the corpus luteum alive. Until the placenta takes over the function of producing progesterone and estrogen, the corpus luteum produces the hormones that are essential to the maintenance of the pregnancy.

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

1. It is common for women to be ambivalent about their pregnancy during the first 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. TEST-TAKING TIP: Even women who stop taking birth control pills in order to become pregnant are often startled and ambivalent when they actually get pregnant. This is not pathological. The women usually slowly accept the pregnancy and, by 20 weeks' gestation, are happy and enthusiastic about the prospect of becoming a mother.

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. The spinal column is completely formed.

1. Surfactant is usually formed 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 first trimester. TEST-TAKING TIP: The test taker should realize that this question is asking two things. First, the test taker needs to know what stage of pregnancy the woman is in when the fundal height is at the xiphoid process. Once the test taker realizes that this fundal height signifies 36 weeks' gestation, he or she must determine what other change or process is likely to be occurring at 36 weeks. The spinal column is completely formed by the end of the first trimester, fetal respiratory movements begin at about 24 weeks, and the eyes open and close at about 28 weeks. Surfactant, which is essential for mature lung function, forms in the fetal lungs at about 36 weeks. It is important for the nurse to realize that babies who are born preterm are high risk for a number of reasons, including lack of surfactant, lack of iron stores to sustain them during the early months of life, and lack of brown adipose tissue needed for thermoregulation.

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

1. The presence of the father at delivery should be nonnegotiable. 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. TEST-TAKING TIP: Even though the birth plan should include issues like the use or nonuse of episiotomies, emergent issues during the delivery may lead to a sudden change in plans. For example, if a cesarean is needed for malpresentation, the issue of episiotomy is moot and the client will definitely need anesthesia. However, there are some issues that should be nonnegotiable. If the father wishes to be in the delivery room no matter the type of delivery or whether or not an emergent situation is occurring, that should be stated in the plan and accepted by the health care provider.

A woman asks the nurse about the function of amniotic fluid. Which of the following statements by the woman indicates that additional teaching is needed? 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 a stable thermal environment.

1. The umbilical cord, not the amniotic fluid, delivers nutrition to the developing fetus. 2. Amniotic fluid does cushion the fetus from injury. 3. Amniotic fluid enables the fetus' 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. TEST-TAKING TIP: The amniotic fluid is produced primarily by the fetus as fetal urine. In addition to the functions noted above, the baby practices "breathing" the amniotic fluid in and out of the lungs in preparation for breathing air in the extrauterine environment.

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 finances now than before the pregnancy." 4. "My husband plays his favorite music for my belly so the baby will learn to like it."

1. The woman implies that she and her husband are not having sex. There is no need to refrain from sexual intercourse during a normal pregnancy—so the woman and her husband need further counseling. 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 finances of the household during a woman's pregnancy. 4. The father is exhibiting a strong attachment to the unborn baby. TEST-TAKING TIP: Couvade is the term given to a father's physiological responses to his partner's pregnancy. Men have been seen to exhibit a number of physical complaints/changes that simulate their partner's physical complaints/changes—for example, indigestion, weight gain, urinary frequency, and backache.

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.

1. The woman should receive the influenza 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. TEST-TAKING TIP: It is very important for pregnant women to be protected from the flu by receiving the inactivated influenza injection. The fetus will not be injured from the shot and the woman will be protected from the many sequelae that can develop from the flu. However, the live nasal flu spray should not be administered to pregnant women. It is contraindicated to vaccinate pregnant women with many other vaccines, including the measles-mumps-rubella (MMR) and the varicella vaccines. See http://www.acog.org/from_home/ publications/misc/bco282.pdf

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 in order to protect the unborn child? 1. Stay out of any rooms that are being renovated. 2. Drink water only from the hot water tap. 3. Refrain from entering the basement. 4. Climb the stairs only once per day.

1. The woman should stay out of rooms that are being renovated. 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. There is no reason why the client should refrain from entering the basement. 4. As long as she is feeling well, there is no reason why the client should refrain from walking up the stairs. TEST-TAKING TIP: Antique houses often contain lead-based paint and water piping that has been soldered with leadbased solder. Lead, when consumed either through the respiratory tract or the GI tract, can cause permanent damage to the central nervous system of the unborn child. It is very important, therefore, that the woman not breathe in the air in rooms that have recently been sanded. The paint aerosolizes and the lead can be inhaled. In addition, lead leaches into hot water more readily than into cold so water from the cold tap should be consumed—but only after the water has run through the pipes for a minimum of 2 minutes.

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 eye lids are unfused and begin to open and close."

1. This is a true statement. In the morula stage, about 2 to 4 days after fertilization, the fertilized egg has not yet implanted in the uterus. 2. Lung development occurs much later than the morular stage. 3. The sex of the fetus is identified much later than the morular stage. 4. The fetal eyelids unfuse much later than the morular stage. TEST-TAKING TIP: The morula is the undifferentiated ball of cells that migrates down the fallopian tube toward the uterine body. The morular stage lasts from about the 2nd to the 4th day after fertilization.

A pregnant client is lactose intolerant. Which of the following alternative calciumrich foods could this woman consume? 1. Turnip greens. 2. Green beans. 3. Cantaloupe. 4. Nectarines.

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. TEST-TAKING TIP: There are a number of women who, for one reason or another, do not consume large quantities of dairy products. The nurse must be prepared to suggest alternate sources since dairy products are the best sources for calcium intake. Any of the dark green leafy vegetables, like kale, spinach, collards, and turnip greens, are excellent sources, as are small fish that are eaten with the bones, like sardines.

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 deficiency anemia. 3. Hypercalcemia. 4. Overexposure to zinc.

2. Iron deficiency anemia is often seen in clients who engage in pica. 1. Hypothyroidism is not related to pica. 3. Hypercalcemia is not related to pica. 4. Overexposure to zinc is not related to pica. TEST-TAKING TIP: Clients who engage in pica eat large quantities of nonfood items like ice, laundry starch, soap, and dirt. There are a number of problems related to pica, including teratogenesis related to eating foods harmful to the fetus. More commonly, the women fill up on items like ice instead of eating high-quality foods. This practice is often culturally related.

A 10-week gravid client is being seen in the prenatal clinic. For the nurse caring for this patient, providing anticipatory guidance for which of the following should be a priority? 1. Pain management during labor. 2. Methods to relieve backaches. 3. Breastfeeding positions. 4. Characteristics of the newborn.

2. It is appropriate for the nurse to provide anticipatory guidance regarding methods to relieve back pain. 1. It is too early in the pregnancy to provide anticipatory guidance about pain management during labor. 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. TEST-TAKING TIP: This 10-week gravid client will be entering the second trimester in a couple of weeks. As the uterine body grows, the client is likely to experience backaches. It is appropriate for the nurse to provide information about this possibility and ways to relieve them.

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

2. It is best that a couple first develop a birth plan. 1. Although the tour of the facility is important, this should not be the couple's first step. 3. Although appointments should be made, this should not be the couple's first step. 4. Although the couple may wish to research health care practitioner's malpractice history, this should not be the couple's first step. TEST-TAKING TIP: It is important for a couple's needs and wants to match their obstetrical care practitioner's philosophy of care. If, for example, the couple is interested in the possibility of having a water birth, it is important that the health care provider be willing to perform a water birth. If, however, the woman wants to be "completely pain free," the health care provider must be willing to order pain medications throughout the labor and delivery. A birth plan will list the couples' many wishes.

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

2. It is inappropriate to ask the Muslim client about the name for the baby. 1. This is an appropriate question to ask the client. 3. This is an appropriate question to ask the client. 4. This is an appropriate question to ask the client. TEST-TAKING TIP: Traditional Muslim couples will not tell anyone the baby's name until he or she has gone through the official naming ceremony, called "aqiqah." Babies are rarely named before a week of age. The parents need time to get to know their baby and decide on an appropriate name for him or her.

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.

2. Strawberries and potatoes are excellent sources of vitamin C, as are zucchini, blueberries, kiwi, green beans, green peas, and the like. 1. Barley and brown rice are not good vitamin C sources. 3. Buckwheat and lentils are not good vitamin C sources. 4. Wheat flour and figs are not good vitamin C sources. TEST-TAKING TIP: The test taker must be prepared to answer basic nutrition questions related to the health of the pregnant woman. Even though citrus fruits are commonly thought of as the primary sources of vitamin C, the test taker should realize that virtually all fruits and vegetables contain the vitamin, while grains do not.

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 in order to evert her nipples.

2. The client should be referred to a lactation consultant. 1. Although some women do have difficulty breastfeeding, many women with inverted nipples are able to breastfeed with little to no problem. 3. There is no need to telephone the labor unit. However. it would be appropriate to document the finding on the client's prenatal record. 4. It is not recommended that exercises be done to evert the nipples. TEST-TAKING TIP: Research on eversion exercises has shown that they are not effective plus breast manipulation can bring on contractions since oxytocin production is stimulated. Lactation consultants are breastfeeding specialists. A lactation consultant would probably recommend that the client wear breast shields in her bra. The shields are made of hard plastic and have a small hole through which the nipple everts.

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

2. The fundal height is the likely cause of the woman's dyspnea. 1. It is unlikely that the woman is hypertensive. 3. It is unlikely that the woman has hydramnios. 4. It is unlikely that the woman has congestive heart failure. TEST-TAKING TIP: As the uterus enlarges, the woman's organs are impacted. At 36 weeks, the fundus is at the level of the xiphoid process. The diaphragm is elevated and the lungs are displaced. When a client lies flat she has difficulty breathing. Most women use multiple pillows at night for sleep. Whenever caring for a pregnant woman, the nurse should elevate the head of the bed.

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

2. The nurse should query the young woman about what she felt. 1. This is an inappropriate statement to make. 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. TEST-TAKING TIP: Quickening, or subjective fetal movement, occurs between 16 and 20 weeks' gestation. At 10 weeks' gestation it would be impossible for the young woman to feel fetal movement. The nurse, therefore, should elicit more information from the teen to determine what she had felt.

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

2. This is an excellent suggestion. Fruit juice, although high in sugar, does contain vitamins. 1. This is not an appropriate substitute. High levels of salt can lead to elevated blood pressure and fluid retention. 3. This is not an appropriate substitute. Cream cheese has little to no nutritional benefit. 4. This is not an appropriate substitute. Uncooked pie crust is high in fat and flour. It provides little to no nutritional benefit. TEST-TAKING TIP: Although the nurse might prefer that a client completely stop a behavior that the nurse deems unsafe or inappropriate, the client may disagree. The nurse, therefore, must attempt to provide a substitute for the client's behavior. Pica is a behavior that should be discouraged because of its potentially detrimental effects. If the client wishes to consume ice, an excellent alternative is ice pops, Italian ices, or iced fruit juice.

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 mucus plug was intact. 2. The nurse midwife felt the baby rebound after being pushed. 3. The nurse midwife palpated the fetal parts through the uterine wall. 4. The nurse midwife assessed that the baby is head down.

2. This is the definition of ballottement. 1. Ballottement is not related to the mucus plug. 3. Palpating fetal parts is not related to ballottement. 4. Fetal position is not related to ballottement. TEST-TAKING TIP: Although this question discusses nurse-patient interaction, it is simply a definition question. The test taker is being asked to identify the definition of the word ballottement.

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 5 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."

2. This statement is true. 1. The woman should be assured that it is unlikely that the fetus was affected. 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. TEST-TAKING TIP: The 2-week period between ovulation and implantation is often called "the all or nothing period." During that time, the fertilized egg/ embryo is floating freely in the woman's fallopian tubes toward the uterine body. The mother is not supplying the embryo with nutrients at this time. Rather, the embryo is self-sufficient. If an insult occurs—for example, a teratogen is ingested or an abdominal x-ray is taken— the embryo is either destroyed or completely spared. And, since the pregnancy of the woman in the scenario was maintained, the nurse can assure her that the embryo was spared insult.

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

3. Hearing the fetal heart beat often increases fathers' interests in their partners' pregnancies. 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. 4. Meeting the health care practitioner is unlikely to promote fathers' interests in their partners' pregnancies. TEST-TAKING TIP: Women who are in the first few weeks of pregnancy often experience a number of physical complaints—nausea and vomiting, fatigue, breast tenderness, and urinary frequency. Prospective fathers whose partners' experience these complaints are often not very interested in the pregnancies. When the baby becomes "real," with a positive heartbeat or fetal movement, the fathers often become very excited.

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

3. It is important for the nurse to ask the young woman how she feels about being pregnant. She may decide not to continue with the pregnancy. 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. 4. This information is important, but it is not the best statement to make initially. TEST-TAKING TIP: Some pregnant women are happy about their pregnancy, some are sad, and still others are frightened. At the initial interview, it is essential that the nurse not assume that the woman will respond in any particular way. The nurse must ask open-ended questions in order to elicit the woman's feelings about the pregnancy.

When assessing the fruit intake of a pregnant client, the nurse notes that the client usually eats 1 piece of fruit per day and drinks 7 to 8 servings of fruit juice per day. Which of the following is the most important communication for the nurse to make? 1. "You are effectively meeting your daily fruit requirements." 2. "Fruit juices are excellent sources of folic acid." 3. "It would be even better if you were to consume more whole fruits and less fruit juice." 4. "Your fruit intake far exceeds the recommended daily fruit intake."

3. It is recommended that pregnant clients eat whole fruits rather than consume large quantities of fruit juice. This is the most important statement for the nurse to make. 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. 4. Although this is an accurate statement, this is not the most important communication for the nurse to make. TEST-TAKING TIP: Approximately 6 oz of fruit juice equals 1 serving from the fruit group. Fruit juices, however, are usually much higher in sugar than are whole fruits. In addition, the client is not receiving the benefit of the fiber that is contained in the whole fruit. The nurse should compliment the client on her fruit intake but encourage her to consume whole fruits rather than large quantities of juice.

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

3. Petechiae are pinpoint red or purple spots on the skin. They are seen in hemorrhagic conditions. 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. 4. Spider nevi—benign radiating blood vessels—are normal skin changes seen in pregnancy. TEST-TAKING TIP: There are many skin changes that occur normally during pregnancy. Most of the changes—such as linea nigra, melasma, and hyperpigmentation of the areolae—are related to an increase in the melanin-producing bodies of the skin as a result of stimulation by the female hormones, estrogen and progesterone. The presence of petechiae is usually related to a pathological condition, such as thrombocytopenia.

A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2006. Using Nagele's rule, the nurse calculates the client's estimated date of delivery as: 1. May 30, 2007. 2. June 20, 2007. 3. June 27, 2007. 4. July 3, 2007.

3. The estimated date of delivery is June 27, 2007. 1. The estimated date of delivery is June 27, 2007. 2. The estimated date of delivery is June 27, 2007. 4. The estimated date of delivery is June 27, 2007. TEST-TAKING TIP: Nagele's rule is a simple method used to calculate a client's estimated date of confinement (EDC) or estimated date of delivery (EDD) from the last normal menstrual period (LMP). The nurse learns the date of the last menstrual period from the client. He or she then subtracts 3 months from the date, adds 7 days to the date, and adjusts the year, if needed. For the example given: Last normal menstrual period—September 20, 2006 = 9 - 20 - 2006 -3 +7 --------- 6 27 adjust the year 6 - 27 - 2007 = June 27, 2007

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

3. The right atrium does contain both oxygen-rich and oxygen-poor blood. 1. The foramen ovale is a hole between the atria. 2. The umbilical vein carries oxygen-rich blood. 4. The ductus venosus lies between the umbilical vein and the inferior vena cava, not between the aorta and the pulmonary artery. TEST-TAKING TIP: The test taker should have an understanding of fetal circulation. One principle to remember when studying the circulation of the fetus is that the blood bypasses the lungs since the baby is receiving oxygen-rich blood directly from the placenta via the umbilical vein. The location of the three ducts—ductus venosus, formen ovale, ductus arteriosus—therefore, enable the blood to bypass the lungs.

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

3. The woman believes in old wives' tales. 1. An allergy to strawberries is not the likely reason. 2. Strawberries have not been shown to cause birth defects. 4. A previous poor pregnancy outcome is not the likely reason. TEST-TAKING TIP: There are a number of old wives' tales that pregnant women believe in and live by. One of the common tales relates to the ingestion of strawberries: Women who eat strawberries have babies with strawberry marks on their bodies. Unless old-wives' tales have the potential to impact the health of the baby and/or mother, it is ill advised and unnecessary to argue with the mother about her beliefs.

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 first-trimester abortion 2 years ago. She is currently pregnant. Which of the following portrays an accurate picture of this woman's gravidity and parity? 1. G4 P2121. 2. G4 P1212. 3. G5 P1122. 4. G5 P2211.

3. This accurately reflects this woman's gravidity and parity—G5P1122. 1. This does not reflect an accurate picture. 2. This does not reflect an accurate picture. 4. This does not reflect an accurate picture. TEST-TAKING TIP: Gravidity refers to pregnancy and parity refers to delivery. Every time a woman is pregnant, it is counted as one gravida (G). The results of each pregnancy are then documented as a para (P) in the following order. The first number refers to full-term births or births ≥ 38 weeks' gestation; the second number refers to preterm births or births between 20 and 37 weeks' gestation; the third number refers to abortions, whether spontaneous or therapeutic; and the fourth number refers to the number of living children. The client has been pregnant 5 times (G5); she birthed 1 son, 1 daughter, had 1 miscarriage, had 1 first trimester abortion, and is currently pregnant. Her parity (P1122) accurately reflects her obstetrical history: 1 full-term delivery (daughter at 39 weeks), 1 preterm delivery (son at 28 weeks), 2 abortions (1 miscarriage, 1 first-trimester abortion), and, finally, currently has 2 living children.

A client makes the following statement after finding out that her pregnancy test is positive, "This is not a good time. I am in college and the baby will be due during final 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 find a way to get through the pregnancy."

3. This is the best comment. It acknowledges the concerns that the client is having. 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 first the nurse should acknowledge the client's feelings. 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. TEST-TAKING TIP: Nurses have two roles when clients express concerns to them. First, the nurse must acknowledge the client's concerns so that the client feels accepted and understood. Second, the nurse must help the client to problem solve the situation. It is very important, however, that the acceptance precede the period of problem solving.

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. This question is important to ask in order to determine a prenatal client's health teaching needs. 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. 4. This is an important question, but it is not associated with health teaching. TEST-TAKING TIP: When answering questions, it is essential that the test taker attend to the specific question that is being asked. All of the possible responses are questions that should be asked of a pregnant multigravida, but only one is related to the client's needs for health teaching.

A woman is 36-weeks' gestation. Which of the following tests will be done during her prenatal visit? 1. Glucose challenge test. 2. Amniotic fluid volume assessment. 3. Vaginal and rectal cultures. 4. Karyotype analysis.

3. Vaginal and rectal cultures are done at approximately 36 weeks' gestation. 1. The glucose challenge test is performed at approximately 24 weeks' gestation. 2. Amniotic fluid volume assessment is part of the biophysical profile (BPP). The BPP is only performed when the health care practitioner is concerned about the health and well-being of the fetus. 4. Karyotype analysis or chromosomal analysis, if performed, is done early in pregnancy. TEST-TAKING TIP: Vaginal and rectal cultures are done to assess for the presence of group B streptococcal (GBS) bacteria in the woman's vagina and rectum. If the woman has GBS as part of her normal flora, she will be given IV antibiotics during labor to prevent vertical transmission to her baby at birth. GBS is often called, "the baby killer."

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 find it necessary to experiment with alternate positions. 4. Vaginal lubricant should be used sparingly throughout the pregnancy.

3. With increasing size of the uterine body, the couple may need counseling regarding alternate options for sexual intimacy. 1. Unless a woman is high risk for preterm labor, she has been diagnosed with placenta previa, or she has preterm rupture of the membranes, sexual intercourse is not contraindicated. 2. Breast fondling should only be discouraged if the client is high risk for preterm labor. 4. There is no contraindication for vaginal lubricant use in pregnancy. Although with the increased discharge experienced by many mothers, lubricants are often not needed. TEST-TAKING TIP: Pregnancy lasts 10 lunar months. It is essential that the nurse counsel clients on ways to maintain health and well-being in the many facets of their lives. Sexual intimacy is one of the important aspects of a married couple's life together. The couple can be counseled to use alternate positions, engage in mutual masturbation, or other means to satisfy their needs for sexual expression during the pregnancy period.

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 health care practitioner.

4. Every woman should advise her health care practitioner of what she is consuming, including food, medicines, herbals, and all other substances. 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. TEST-TAKING TIP: Herbals are not regulated by the Food and Drug Administration (FDA). There is some information on selected herbals at the National Institute of Health web site—http://nccam. nih.gov/health—but because research on pregnant women is particularly sensitive there is very little definitive information on the safety of many herbals in pregnancy. No matter what is consumed by the mother, however, the health care practitioner should be consulted.

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

4. It is normal for colostrum to be expressed late in pregnancy. 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. TEST-TAKING TIP: Even though colostrum is present in the breasts in the latter part of the third trimester, it is important for women not to pump their breasts. Oxytocin, the hormone that promotes the ejection of milk during lactation, is the hormone of labor. Pumping of the breasts, therefore, could stimulate the uterus to contract.

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.

4. Oranges and spinach are excellent folic acid sources. 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 TEST-TAKING TIP: The intake of folic acid is especially important during the first trimester of pregnancy to help to prevent structural defects, including spina bifida and gastroschisis. The best sources of folic acid are liver and green leafy vegetables. Oranges and orange juice are also good sources.

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 first breath. The baby's oxygen no longer has to come from you." 4. "The blood actually never mixes. Your blood supply and the baby's blood supply are completely separate."

4. The blood supplies are completely separate. 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. TEST-TAKING TIP: It is important to understand the relationship between the maternal vascular system and the fetal system. There is a maternal portion to the placenta and a fetal portion of the placenta. By the time the placenta is fully functioning, at about 12 weeks' gestation, fetal blood vessels have burrowed into the decidual lining and maternal vessels have burrowed into the chorionic layer. The vessels, therefore, lie next to each other. Gases and nutrients, then, move across the membranes of the vessels in order to provide the baby with needed substances and in order for the mother to dispose of waste products.

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's.

4. The client should be placed in a semi- Fowler's position. 1. Although the orthopneic position is a safe position for the client to be placed, 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, 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, a prenatal examination cannot be performed in this position, and the pregnant abdomen may not enable the client fully to attain this position. TEST-TAKING TIP: Because of the growth of the uterus, it is very difficult for women in the third trimester to breathe in the supine position. During the prenatal visit, the baby's heartbeat will be monitored and the fundal height will be assessed. Both of these procedures can safely be performed in the semi-Fowler's position.

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

4. The use of three pillows for sleep comfort is often seen in clients who are 35 weeks' gestation. 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. TEST-TAKING TIP: It is essential that the test taker differentiate between normal and abnormal findings at various points during the pregnancy—for example, nausea and vomiting are normal during the first trimester but not during the second or third trimesters. The fundal height measurement is also important to remember. From 20 weeks' gestation, when the fundal height is usually at the same height as the umbilicus, to 36 weeks' gestation, when the final height is at the xiphoid process, the height measures are approximately the same number of centimeters above the symphysis as the number of weeks of fetal gestation. For example, at 24 weeks' gestation, the height is usually 24 cm above the symphysis or 4 cm above the umbilicus, and at 35 weeks' gestation, the height is usually 35 cm above the symphysis, or 15 cm above the umbilicus.

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 1 lb per week, so your weight is a little low at this time." 2. "Most women gain no weight during the first 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. The weight gain is within normal for the first trimester. 1. Weight gain of 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 first trimester. 3. Since the client's height is not stated, there is no way to know whether or not the client is underweight. TEST-TAKING TIP: One of the assessments that aids health care practitioners in assessing the health and well-being of antenatal clients and their babies is weight gain. For women who enter the pregnancy with a normal weight for height, the expected weight gain is: 3 to 5 lb for the entire first trimester and approximately 1 lb per week from weeks 13 to 40.

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 lb. 2. 130 lb. 3. 131 lb. 4. 132 lb.

4. The woman would be expected to weigh about 132 lb. At this stage of pregnancy, the woman is expected to gain about 1 lb a week. 1. The woman would be expected to weigh about 132 lb. At this stage of pregnancy, the woman is expected to gain about 1 lb a week. 2. The woman would be expected to weigh about 132 lb. At this stage of pregnancy, the woman is expected to gain about 1 lb a week. 3. The woman would be expected to weigh about 132 lb. At this stage of pregnancy, the woman is expected to gain about 1 lb a week. TEST-TAKING TIP: The incremental weight gain of a client is an important means of assessing the growth and development of the fetus. The nurse would expect that, during the second and third trimesters, the woman should gain approximately 1 lb per week.

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 influence on your partner's eating habits." 4. "I am so glad to see that you are taking so much interest in your partner's pregnancy."

4. This is an appropriate comment to make at this time. 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. TEST-TAKING TIP: This father is exhibiting a sign of couvade; i.e., weight gain. This is a positive response since it shows that he is exhibiting a sympathetic response to his partner's pregnancy. In addition, this father is accompanying his partner to the prenatal visit, another positive sign.