Prep-U Ch. 5: Fetal Development, Ch. 6: Maternal Adaptation during Pregnancy & Ch. 7: Prenatal Care

The nurse is collecting a urine specimen from a pregnant client during a prenatal visit. For what will the nurse test this client's urine? Select all that apply. A. protein B. glucose C. bacteria D. drug levels E. white blood cells

A, B, C, E * Urine is tested for proteinuria, glycosuria, nitrites, and pyuria. All of these can be done by means of test strips. The nurse will not test the client's urine for drug levels as part of a routine prenatal visit.

A pregnant woman needs to increase the amount of milk she drinks daily. Early in pregnancy, which statement would probably be most effective as a health teaching measure? A. "Milk will strengthen your fingernails as well as be good for the baby." B. "The fetus needs milk to build strong bones and teeth." C. "Milk is a rich source of calcium that is important for fetal growth." D. "Your future baby will benefit from a high milk intake."

A. "Milk will strengthen your fingernails as well as be good for the baby." * Early in pregnancy, before the pregnancy seems real, women often respond best to health teaching that meets their needs rather than those of the coming infant.

A client is about 16 weeks' pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to this client's concern? A. "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." B. "You need to go to the emergency room right away." C. "You need to come to the office to be examined." D. "You have nothing to be concerned about. I am sure you are not feeling contractions at this point in your pregnancy."

A. "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." * Braxton Hicks contractions are the painless, intermittent, "practice" contractions of pregnancy.

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately: A. 85 beats per minute. B. 90 beats per minute. C. 95 beats per minute. D. 100 beats per minute.

A. 85 beats per minute. * During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.

A pregnant client is concerned she may develop preeclampsia, so she has stopped adding any salt to her food and is now questioning the nurse about avoiding prepared foods. The nurse should point out some salt is very beneficial and can help prevent which negative outcome for her baby? A. Congenital hypothyroidism B. Low birth weight C. Neural tube defects D. Night blindness

A. Congenital hypothyroidism * Iodized sodium is needed by the body for normal thyroid function. Women with severe iodine deficiencies deliver infants with congenital hypothyroidism. Low birth weight is related to smoking and alcohol. Neural tube defects are caused by low folic acid levels. When vitamin A levels are too low, night blindness may occur.

Which would be a normal finding by the nurse during a physical exam of a woman in her third trimester? A. Dyspnea B. Kyphosis C. Ptyalism D. Increased hematocrit

A. Dyspnea * In the third trimester, a women experiences dyspnea from the uterus pushing up into the diaphragm. A pregnant woman will experience lordosis, not kyphosis. Ptyalism is excessive saliva production and is often seen in the first trimester of pregnancy. The hematocrit of a pregnant woman will decrease in the third trimester, not increase.

A pregnant client at 18 weeks' gestation has arrived for her routine prenatal visit. Which assessment findings should the nurse prepare to document at this time? Select all that apply. A. Fundal height of approximately 18 cm B. Quickening C. Insomnia D. Braxton Hicks contractions E. Leg cramps

A. Fundal height of approximately 18 cm & B. Quickening * Between 18 and 30 weeks' gestation, fundal height in centimeters is approximately the same as the number of weeks' gestation. In this case, the client is 18 weeks pregnant, so fundal height should measure approximately 18 cm. Quickening, which is typically described as light fluttering and is usually felt between 16 and 22 weeks' gestation, is caused by fetal movement. Insomnia, Braxton Hicks contractions, and leg cramps are common during the third trimester.

During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse documents this finding as: A. Hegar sign. B. Goodell sign. C. Chadwick sign. D. Ortolani sign.

A. Hegar sign. * Hegar sign refers to the softening of the lower uterine segment or isthmus. Bluish coloration of the cervix is termed Chadwick sign. Goodell sign refers to the softening of the cervix. Ortolani sign is a maneuver done to identify developmental dysplasia of the hip in infants.

During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition? A. Supine hypotension syndrome B. Preeclampsia C. Frequent urination D. Heartburn

A. Supine hypotension syndrome * The left side-lying position prevents the heavy uterus from resting on and compressing her vena cava, a condition known as supine hypotensive syndrome. Compression of the vena cava can cause maternal hypotension and poor gas exchange between the placenta and fetus. Preeclampsia is a condition characterized by elevated blood pressure and proteinuria. Once diagnosed, the treatment includes resting in a left-lateral position, but a side-lying position does not prevent preeclampsia. Urinary frequency in the third trimester is due to the enlarged uterus pressing on the bladder and is not influenced by position. Remaining in an upright position for 1 to 2 hours after meals helps to decrease heartburn.

A nursing student studying reproduction identifies which of the following statements to be correct? A. Twenty-two of the 23 pairs of chromosomes are autosomes and the remaining pair is the sex chromosomes. B. All 23 pairs of chromosomes are autosomes. C. Not all chromosomes are composed of genes. D. The nucleus of each soma cell contains 23 chromosomes.

A. Twenty-two of the 23 pairs of chromosomes are autosomes and the remaining pair is the sex chromosomes. * The nucleus of each soma cell contains 46 chromosomes, arranged in 23 pairs. Each parent donates one chromosome of every pair. Each chromosome is composed of genes, which are segments of DNA that control hereditary traits. Twenty-two of the 23 pairs of chromosomes are autosomes, and the remaining pair, the sex chromosomes, determines an individual gender.

The nurse has just informed a client that her pregnancy test is positive and she will need further assessment to determine the complete status of the situation. Which initial emotional response does the nurse expect the client to exhibit? A. ambivalence B. introversion C. acceptance D. emotional lability

A. ambivalence * Initially, the pregnant woman commonly experiences ambivalence, with conflicting feelings at the same time. Introversion heightens during the first and third trimesters when the woman's focus is on behaviors that will ensure a safe and healthy pregnancy outcome. Acceptance usually occurs during the second trimester. Emotional lability (mood swings) is characteristic throughout a woman's pregnancy.

A client makes an appointment at the prenatal clinic because the client thinks the client might be pregnant. Which assessment would the nurse identify as a presumptive sign of pregnancy? A. amenorrhea B. vagina violet in color C. cervical softening D. positive pregnancy test

A. amenorrhea * Amenorrhea is a presumptive sign of pregnancy. Chadwick sign (vagina changing in color from pink to purple), Goodell sign (softening of the cervix) and a positive pregnancy test are probable signs.

During pregnancy, the cardinal rule concerning medications and herbal remedies is that all drugs cross the placenta and have a potential impact on the fetus. What is one disease where treatment must continue during pregnancy? A. asthma B. gout C. cholelithiasis D. gastritis

A. asthma * Treatment (including medications) for certain diseases and conditions must continue during pregnancy. Examples include epilepsy, asthma, diabetes, and depression.

A woman has just learned that she is pregnant and would like to know how soon she can find out via ultrasound the sex of her fetus. The nurse should respond with which of the following? A. at about 4 months B. at about 2 months C. at about 6 months D. Fetal gender can only be determined by analysis of maternal serum.

A. at about 4 months * Although fetal gender is usually determined by an ultrasound screen at about 4 months, it can be determined as early as 7 weeks by analysis of maternal serum.

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to: A. encourage her to identify someone that she can talk to and share the pregnancy experience. B. tell her to move home so her family will be nearby to help her. C. remind her that she is still early in the pregnancy and she will feel better about it as the pregnancy progresses. D. offer to meet with the client on a regular basis to provide her someone to talk to about her concerns.

A. encourage her to identify someone that she can talk to and share the pregnancy experience. * A pregnant woman without social support needs to identify someone with whom she can share the experience of pregnancy because social support is a crucial part of adapting to parenthood. Telling her to move home and telling her that she will feel better as the pregnancy progresses do not address the issue of isolation. Also, moving home may not be a possibility for this woman. The nurse should maintain a professional relationship and not commit to a long-term relationship with a client.

An expectant mother is on heparin for previous blood clots and voicing concerns about how her medications will affect her baby. The nurse would inform the mother that: A. heparin does not cross the placenta and is safe for her to take. B. any medication that an expectant mother takes can cause sequelae for the infant. C. she should discontinue the heparin and change to another anticoagulant. D. it is recommended to stop taking the heparin while she is pregnant.

A. heparin does not cross the placenta and is safe for her to take. * Heparin is a medication that does not cross the placenta and therefore is safe to use during pregnancy. Not all medications cause fetal sequelae. It is not recommended to abruptly discontinue any medication without consulting the mother's health care provider. Heparin is the safest anticoagulant for a pregnant woman to take.

The nursing instructor is presenting the basic physiologic changes in the woman that can occur during a pregnancy. The instructor determines the session is successful when the students correctly choose which change in the respiratory function during pregnancy as normal? A. increased tidal volume B. increased expiratory volume C. decreased respiratory rate D. decreased oxygen consumption

A. increased tidal volume * A pregnant client breathes more deeply, which increases the tidal volume of gas moved in and out of the respiratory tract with each breath. The expiratory volume, residual volume, and respiratory rate decrease as the pregnancy progresses. The increased oxygen consumption in the pregnant client is 15% to 20% greater than in the nonpregnant state.

The husband of a pregnant woman in her first trimester tells the nurse that his wife is increasingly preoccupied with herself and her fetus as more signs of the pregnancy present themselves. What should the nurse point out to the husband is probably occurring in this situation? A. introversion B. ambivalence C. acceptance D. emotional lability

A. introversion * Introversion, or focusing on oneself, is common during early pregnancy, especially as more signs of the pregnancy become apparent. The woman may withdraw and become increasingly preoccupied with herself and her fetus. This is a normal psychological adaptation to upcoming motherhood. Ambivalence is an initial response that involves having conflicting feelings at the same time and is a universal feeling in pregnant women. It is considered normal when preparing for a lifestyle change and new role. In the stage of acceptance, the woman feels tangible signs that someone separate from herself is present. This response is common during the second trimester. Emotional lability involves experiencing mood swings (e.g., feeling great joy at one moment and then within a short time feeling shock and disbelief).

The nurse is assessing a client's risk for sexually transmitted infections. Which statement by the client would be cause for concern? A. "I am not sure if I want to keep the baby. It is a hard decision." B. "I am unsure who the father of the baby is. I will be raising it alone." C. "I needed Rho(D) immune globulin after my last pregnancy. Will I need it again?" D. "I only want my family to see the baby after it is born."

B. "I am unsure who the father of the baby is. I will be raising it alone." * While many individuals have complex social issues, if a client states that she is unsure of the father of the baby, it is understood that she has had recent, multiple sex partners. Sex with multiple partners places the client and fetus at risk for a sexually transmitted infection. Not wanting to keep the baby, needing Rho(D) immune globulin, and having social issues does not place the client at risk for sexually transmitted infections.

The nurse is concerned that a pregnant client is not adjusting emotionally to being pregnant. Which statement indicates that the client may need additional counseling? A. "I cannot wait to lose all of this excess weight." B. "I need to get right back to work after delivery." C. "My mother has been so helpful during this time." D. "My dad has already purchased toys for the baby!"

B. "I need to get right back to work after delivery." * The statement that the client needs to get back to work after delivery could indicate that she feels the pregnancy is robbing her of financial stability or ruin chances of a promotion. Desiring to lose weight after pregnancy does not indicate that the client is not adjusting emotionally to being pregnant. The statements about parental support do not indicate that the client is not adjusting emotionally to being pregnant.

The nurse is caring for a client at 8 weeks' gestation who states, "I did not plan for this right now and I am not happy or excited about this pregnancy. I am not sure what to do." Which response by the nurse is best? A. "You will become excited and happy when you feel the baby move." B. "Many women feel this way during the first trimester." C. "We can refer you to a clinic for potential termination if you desire." D. "Do not worry. Once you hold this baby, everything will be fine."

B. "Many women feel this way during the first trimester." * The best response is to let the client know this is a common feeling among all pregnant women. Most women experience ambivalence during the first trimester whether the pregnancy was planned or not. Acceptance of the pregnancy commonly occurs during the second trimester when quickening, or feeling the baby move, occurs. However, it is not appropriate for the nurse to assume the client will become excited as each pregnancy is unique and a time of dramatic alterations. Stating not to worry and everything will be fine is nontherapeutic communication and does not focus on the client's concern. The nurse would discuss the client's feelings and concerns before making a referral.

A gravid woman who is in her first trimester reports experiencing constipation. Which statement by the client indicates the need for further instruction? A. "Increasing my water intake will aid in reducing my constipation." B. "Taking gentle enemas no more frequently than once a week is acceptable." C. "Adding more vegetables to my diet will be helpful." D. "Exercise such as walking daily helps increase my bowel movements."

B. "Taking gentle enemas no more frequently than once a week is acceptable." * Constipation is a common source of concern for many women in pregnancy. It results from the slowing of intestinal peristalsis and also as a side effect of iron administration. Steps such as increasing fluid intake, increasing dietary fiber, and exercising are beneficial in reducing constipation. Weekly enemas during the pregnancy are not advisable. Enemas can be habit forming and do not correct the causes of the constipation being experienced.

A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate? A. "Now that you have reached the second trimester you are at a reduced risk for causing complications to your fetus." B. "There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." C. "As long as you do not increase the amount of alcohol you are drinking there is little risk." D. "The best thing for you to do is to reduce the amount of alcohol you are drinking."

B. "There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." * Alcohol ingestion during the pregnancy is considered unsafe at all points in the pregnancy. Alcohol can impact the fetus during each of trimester of pregnancy. There are no exact amounts of alcohol that can be ingested safely. Alcohol impacts each pregnancy and fetus differently. The best course of action is to share the dangers with the woman.

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week? A. 2/3 lb (0.30 kg) B. 1 lb (0.45 kg) C. 1.5 lb (0.68 kg) D. 2 lb (0.90 kg)

B. 1 lb (0.45 kg) * The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (0.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (0.45 kg) per week. Overweight women should gain about 2/3 lb (0.30 kg) per week.

The nurse is counseling a client with a BMI of 23 about weight gain during pregnancy. The nurse teaches the client that during the second and third trimester of pregnancy, dietary intake should be increase by how many calories per day above what she was eating prior to the pregnancy? A. 100 B. 300 C. 500 D. 1000

B. 300 * A BMI of 23 is considered a healthy weight. For clients at a healthy weight, 300 additional calories are needed to support fetal growth in the second and third trimester of the pregnancy. If the client had been underweight, more calories would have been recommended; if the client had been obese, less calories would have been recommended.

Why is the first prenatal visit usually the longest prenatal visit? A. Laboratory tests are performed. B. Baseline data is collected. C. A pelvic exam with Papanicolaou test is performed. D. Extensive client teaching is done.

B. Baseline data is collected. * The first prenatal visit is usually the longest because the baseline data to which all subsequent assessments are compared are obtained at this visit.

After the nurse describes fetal circulation to a pregnant woman, the woman asks why her fetus has a different circulation pattern than hers. When responding to the client, the nurse integrates understanding of what information? A. Fetal blood is thicker than that of adults and needs different pathways. B. Fetal circulation carries highly oxygenated blood to vital areas first. C. Fetal blood has a higher oxygen saturation and circulates more slowly. D. Fetal heart rates are rapid and circulation time is double that of adults.

B. Fetal circulation carries highly oxygenated blood to vital areas first. * Fetal circulation carries highly oxygenated blood to vital areas first while shunting it away from less vital ones. Fetal blood is not thicker than that of adults. Large volumes of oxygenated blood are not needed because the placenta essentially takes over the functions of the lung and liver during fetal life. Although fetal heart rates normally range from 120 to 160 beats per minute, circulation time is not doubled.

A student nurse is preparing for a presentation that will illustrate the various physiologic changes in the woman's body during pregnancy. Which cardiovascular changes up through the 26th week should the student point out? A. Decreased pulse rate and increased blood pressure B. Increased pulse rate and decreased blood pressure C. Increased pulse rate and blood pressure D. No change in pulse rate or blood pressure

B. Increased pulse rate and decreased blood pressure * Pulse rate frequently increases during pregnancy, although the amount varies from a slight increase to 10 to 15 beats per minute. Blood pressure generally decreases slightly during pregnancy, reaching its lowest point during the second trimester.

A client's last menstrual period was April 11. Using the Naegele rule, her estimated date of delivery (EDD) would be: A. January 4. B. January 18. C. January 25. D. February 24.

B. January 18. * To use the Naegele rule, subtract 3 months and then add 7 days to the first day of the client's LMP (April 11): April minus 3 months is January, plus 7 days is 18. Thus, her estimated date of delivery (EDD) would be January 18 of the next year.

The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns? A. Her body is changing and she may be angry about it. B. Pregnant women often experience mood swings and self-centeredness but this is normal. C. Moodiness and irritability are not usual responses to pregnancy. D. What you are describing may be normal but we need to talk to her more in depth.

B. Pregnant women often experience mood swings and self-centeredness but this is normal. * During the first trimester of pregnancy, the woman often has mood swings, bouts of irritability and is hypersensitive. The partner needs to know that these are all normal behaviors for a pregnant woman.

During which stage of fetal development is exposure to teratogens most damaging? A. pre-embryonic stage B. embryonic stage C. fetal stage D. mitosis stage

B. embryonic stage * The most sensitive period of fetal development related to teratogens is during the embryonic period when the different body systems are developing. During the pre-embryonic stage, the fetal stage, and the mitosis stage, the risk of teratogenic exposure is not as influential on the fetus.

A woman is confused after finding out the ultrasound results predict a different due date for the birth of her baby. Which factor should the nurse point out is most likely the reason for the miscalculation of the fetal age? A. an error in math when calculating B. mistaking implantation bleeding for last menstrual period (LMP) C. amount of weight gain of mother in early weeks of pregnancy D. not seeking prenatal care in the beginning

B. mistaking implantation bleeding for last menstrual period (LMP) * The most common cause is implantation bleeding, which can occur as the blastocyst implants itself into the endometrium. This bleeding can be mistaken for a scanty menstrual period and can lead to miscalculation of fetal age by 2 weeks. The other choices might also contribute, especially the math miscalculation, but are not the primary reason.

What medication should the nurse advise a woman to discontinue prior to becoming pregnant because it will damage the developing dental and osseous tissue in the fetus? A. chemotherapy agents B. tetracycline C. acetaminophen D. ibuprofen

B. tetracycline * Tetracycline may damage the developing dental and osseous tissue in the fetus.

A woman comes in for her annual gynecological examination and informs the nurse that she is going to try and become pregnant. She asks the nurse when the best time in the month is to become pregnant. What is the best response by the nurse? A. "The day after your menstrual cycle ends." B. "5 days after your menstrual cycle is to begin." C. "3 days before until 2 days after ovulation." D. "2 weeks before and 2 weeks after ovulation."

C. "3 days before until 2 days after ovulation." * Sperm are able to fertilize the ovum for up to 72 hours after ejaculation, and the ovum remains fertile for a maximum of 48 hours after ovulation. Thus, the window of opportunity for conception is 3 days before until 2 days after ovulation.

The nurse is completing the initial assessment at the prenatal visit of a pregnant client. Which question should the nurse prioritize when completing the review of systems? A. "Have you ever had a heart attack?" B. "Do you have a peptic ulcer?" C. "Have you had any urinary tract infections?" D. "Have you had any neurologic diseases?"

C. "Have you had any urinary tract infections?" * It is important to ensure the woman does not have any current infections as they can all contribute to adverse effects in the pregnancy. Any conditions the woman has had in the past may recur or be exacerbated during pregnancy. It is also possible for the woman to currently have a low-grade infection and not be aware of it. A urine culture may be required to ensure the woman does not currently have an infection. UTIs can contribute to premature labor.

A woman with epilepsy was on phenytoin when she became pregnant. She is very worried that her baby will have a birth defect. Which reply by the nurse is most therapeutic? A. "All substances and medications increase the risk of birth defects when you are pregnant. It is very important for you to discontinue any medications or over-the-counter medications immediately. This is the best way you can protect your baby." B. "Please don't worry. Phenytoin is a very safe medication and unlikely to cause a birth defect." C. "Yes, phenytoin increases the risk of certain defects in the fetus; however, overall the risk is low that your baby will be affected. Your doctor weighs the risk of untreated epilepsy on the fetus with the risk of the medication when making decisions about your treatment plan." D. "Yes, there is a very high risk that your fetus will have major birth defects. Your doctor will most likely switch you to a safer medication. Are you on any other medications?"

C. "Yes, phenytoin increases the risk of certain defects in the fetus; however, overall the risk is low that your baby will be affected. Your doctor weighs the risk of untreated epilepsy on the fetus with the risk of the medication when making decisions about your treatment plan." * Phenytoin is therapeutic for preventing seizures in the mother but can cause cleft palate and other abnormalities in the fetus. In such a circumstance, the practitioner weighs the risk to the mother against the risk to the developing fetus before prescribing a potential teratogen.

A woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her? A. Use a diluted urine specimen. B. Wait until after two missed menstrual periods. C. Arrange for prenatal care if the test is positive. D. Refrain from eating for 4 hours before testing.

C. Arrange for prenatal care if the test is positive. * Home pregnancy testing can be accurate as soon as a period is missed; it should not take the place of prenatal care.

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? A. The heart rate increase may indicate that the client is experiencing cardiac overload. B. The blood pressure should be higher since the cardiac volume is increased. C. Both findings are normal at this point of the pregnancy. D. Combined, both of these findings are very concerning and warrant further investigation.

C. Both findings are normal at this point of the pregnancy. * A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.

The nurse is performing an assessment of a woman who has come to a health care facility for a diagnosis of pregnancy. The women is positive for breast changes, nausea, and amenorrhea. On physical exam, it is noted that the client has softening of the cervix. How should the nurse document this in her notes? A. ballottement B. Chadwick sign C. Goodell sign D. Hegar sign

C. Goodell sign * The description of a Goodell sign is softening of the cervix. Ballottement is when tapping the lower uterine segment on a bimanual exam elicits the fetus to rise against the abdominal wall. Chadwick sign is when the vagina changes color from pink to violet. Hegar sign is softening of the lower uterine segment.

What effect does progesterone have on normal gallbladder function? A. It has no effect on the gallbladder. B. The gallbladder will hypertrophy. C. Progesterone interferes with gallbladder contraction, leading to stasis of bile. D. Bile will be produced at a more rapid rate due to the progesterone.

C. Progesterone interferes with gallbladder contraction, leading to stasis of bile. * Progesterone interferes with normal gallbladder contractions, which leads to stasis of bile. This stasis results in cholestasis, either seen in the gallbladder or the liver.

The nurse is helping a pregnant client adapt psychologically. What outcome best demonstrates that the client has successfully adapted to the second trimester? A. The client states that she is fully prepared for parenthood. B. The client accepts the pregnancy. C. The client accepts the reality and uniqueness of the baby. D. The client finishes making a detailed plan for labor and birth.

C. The client accepts the reality and uniqueness of the baby. * Gradually, as the pregnancy progresses, the client comes to have a sense of the child as his or her own separate entity. This acceptance may be enhanced when she first hears the fetal heartbeat, when she feels the baby move inside her, or when she sees the fetal image during a sonogram. Accepting the pregnancy occurs in the first trimester. Full preparation for parenthood is unlikely at this time, and detailed labor and birth plans are more common in the third trimester.

Which body system is most affected throughout the embryonic and fetal period by teratogens? A. gastrointestinal system B. genitourinary system C. central nervous system D. musculoskeletal system

C. central nervous system * Whether the teratogen is ingested, injected, occurs through an infectious agent, or is environmental, the CNS and brain are the body systems most seriously affected during this period.

By the time a woman is 36 weeks' gestation, where would the nurse expect to find the uterus? A. at the umbilicus B. halfway between the umbilicus and bottom edge of the ribcage C. near the bottom of the sternum D. under the edge of the ribcage

C. near the bottom of the sternum * By 20 weeks' gestation, the uterus is at about the umbilicus; by 36 weeks, it nears the bottom of the sternum.

The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which schedule is recommended for prenatal care? A. once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth B. once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth C. once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth D. once every 4 weeks for the first 36 weeks, then weekly until the birth

C. once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth * The best health for mother and baby results when the mother has her first visit before the end of the first trimester (before the end of week 13) and then has regular visits until after she has delivered the baby. The usual timing for visits is about once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

A pregnant client tells the nurse that she is not happy to learn about the pregnancy. At which point in the pregnancy does the nurse realize that the client will change her mind about the pregnancy? A. around the third month B. after the seventh month C. when quickening occurs D. after lightening happens

C. when quickening occurs * Quickening or feeling the baby move inside the body is a dramatic event and causes the pregnant woman's feelings about the pregnancy to change. Quickening occurs during the second trimester of the pregnancy, which is after the third but before the seventh month. Lightening occurs near the end of the pregnancy.

The nurse is caring for several pregnant clients in the office setting. Which client's statement would be of most concern to the nurse? A. "A few weeks before I knew I was pregnant, I took acetaminophen for a headache." B. "I smoked cigarettes daily until a few years ago, and I was able to quit." C. "I take heparin every day since I have a history of blood clots." D. "I forgot to tell you at my first prenatal appointment that I take phenytoin for seizures."

D. "I forgot to tell you at my first prenatal appointment that I take phenytoin for seizures." * Phenytoin is a teratogen and the provider would consider an alternate seizure medication if indicated. Ideally, the client would have alerted the health care provider as early as possible. Acetaminophen is not considered a teratogen when taken as directed and heparin does not cross the placental barrier and is considered safe during pregnancy. Smoking during pregnancy can cause intrauterine growth restriction, but this client stopped smoking before the pregnancy.

The nurse assesses a 20-week gestational client at a routine prenatal visit. What will the nurse predict the fundal height to be on this client experiencing an uneventful pregnancy? A. 24 cm B. 12 cm C. 16 cm D. 20 cm

D. 20 cm * Between weeks 18 and 32 the fundal height in centimeters should match the gestational age of the pregnancy. At 20 weeks' the fundal height should be at the umbilicus. A fundal height smaller than expected can indicate that the original dates were miscalculated, oligohydramnios, or that the fetus is smaller than expected. If the fundal height is larger than expected this can indicate multiple gestation, the original dates were miscalculated, polyhydramnios, or a molar pregnancy.

A couple comes to the clinic for preconception counseling and care. As part of the visit, the nurse teaches the couple about fertilization and initial development, stating that the zygote formed by the union of the ovum and sperm consists of how many chromosomes? A. 22 B. 23 C. 44 D. 46

D. 46 * With fertilization, the ovum, containing 23 chromosomes, and the sperm, containing 23 chromosomes, join, forming a zygote with a diploid number or 46 chromosomes.

The client is 32 weeks' pregnant and has been referred for a biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? A. The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. B. The BPP is a blood test to detect placental problems. C. The BPP is a screening for neural tube defects. D. The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.

D. The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. * A biophysical profile uses a combination of factors to determine fetal well-being based upon five fetal biophysical variables. An NST is done to measure FHR acceleration. Then an ultrasound is done to measure breathing, body movements, tone, and amniotic fluid volume. Each variable receives a score from 0 to 2 for a maximum score of 10. A score of 6 or less indicates altered fetal well-being and indicates a need for further assessment. A needle is not involved with the BPP. The BPP does not detect placental problems, and the BPP is not a screening for neural tube defects.

The placenta is the site where antibodies in the mother's blood pass into the fetal circulation. These antibodies give passive immunity to the fetus for several common childhood diseases. There are some infections for which the mother does not provide antibodies to the fetus. What infection is the fetus not protected from? A. diphtheria B. smallpox C. rubeola D. rubella

D. rubella * The fetus does not receive immunity to rubella, cytomegalovirus (CMV), varicella, or measles. If the woman encounters these pathogens during her pregnancy, fetal infection may ensue.