The Prenatal Period

13. A pregnant woman who is at the end of 20 weeks of gestation is at a prenatal visit. Which of the following changes in weight from pre-pregnancy would require the nurse to take additional action? a. 6 pound increase b. 11 pound increase c. 14 pound increase d. 20 pound increase

ANS: A If at the end of 20 weeks of gestation the woman has not gained at least 10 pounds, she risks delivering an ill infant suffering from intrauterine growth restriction.

17. Which of the following mothers would be most likely to bond appropriately with their infant? a. A mother who feels unloved will bond appropriately because now the baby will love her. b. A mother who feels great about herself will show love toward the infant and bond appropriately. c. A mother who feels empty by the birth of her child will bond appropriately once she holds the baby. d. A mother who feels ugly will bond appropriately with her child because her child will bring self-esteem.

ANS: B After birth, the woman gradually sees the infant more and more as a separate individual, dependent on her care. The mother starts to bond with her baby based on her self-perception. If she feels good about herself, she will show love toward the infant. When she feels ugly or unlovable, she may make uncomplimentary remarks about the infants appearance.

11. Which of the following statements about race and culture in the United States is correct? a. The United States ranks 22nd in the world for infant mortality rate. b. Ethnic minority populations have higher rates of low-birth-weight infants. c. Black infants are more likely to have cleft palates than Native American infants. d. Whites have more fraternal twin pregnancies than non-Whites.

ANS: B Currently, the United States is 49th in the world ranking for infant mortality rate (IMR). This rate, which reflects the number of infants who die before the end of their first year of life is the leading indicator of a nations health, reflects the higher IMRs and low-birth-weight outcomes of Blacks, American Indians, and other ethnic minority populations in the United States. In the United States, non-Whites (mainly Blacks) have more fraternal twin pregnancies than Whites. More Native American, Latino, or Asian descent babies have cleft palates than do Black babies.

19. A nurse is caring for a client who is 30 weeks pregnant at a prenatal visit. Which of the following statements made by the client would be of concern to the nurse and warrant further explanation and close follow-up? a. I have been feeling more tired lately. b. My husband complains every time I ask him to do something for me. c. Sometimes, the smell of food makes me nauseous. d. I need to get up two times a night to go to the bathroom.

ANS: B Fatigue, nausea, and increased urinary frequency are all normal discomforts associated with pregnancy. These discomforts warrant anticipatory guidance from the nurse. A husband who resents the attention that his pregnant wife is receiving and the additional demands she may make on his time may lead him to abuse his wife. Therefore the nurse must obtain additional information and provide close follow-up when a woman states that her husband complains every time she asks him to do something because she may be at risk for abuse.

6. The client who is taking prescribed _____ would require preconception management to minimize the potential for drug-related birth defects. a. antiemetics b. antiepileptics c. iron d. non-narcotic analgesics

ANS: B Oral antiepileptic medications require preconception management to minimize potential birth defects and minimize health problems.

26. A woman who just found out she is pregnant starts crying. She tells the nurse that over the last 3 days she was not feeling herself, so she took some Tylenol. She states if she knew she was pregnant, she never would have taken the medication. Which of the following actions should be taken by the nurse? a. Tell the client that there is a high probability that her baby will have a birth defect b. Tell the client not to worry because research indicates that in recommended doses Tylenol is safe. c. Tell the client not to worry because she did not know she was pregnant, but in the future, she should use herbal products instead of over-the-counter medication. d. Tell the client that there is a high probability of a stillbirth.

ANS: B Research on aspirin and Tylenol indicates that both medications are safe in recommended doses. Little is known about the effects of herbal products and their interaction with other medications. As a result, the nurse may need to encourage a client to reconsider the use of herbs when evidence exists that the herbs may harm the fetus or the mother. Providing the mother with appropriate information will help to decrease the mothers anxiety level.

25. A woman is Rh negative and the father of her baby is Rh negative. The woman states that her friend told her that she would need a shot to keep her baby alive. Which of the following statements would be the best response by the nurse? a. Yes, you will need an injection of RhoGAM at 28 weeks gestation and within 72 hours after birth. b. Because the father of the baby is also Rh negative, your baby will not inherit Rh positive blood cells and you will not need the injection. c. Yes, you will need the injection because this is your first pregnancy. You will not need it with subsequent pregnancies. d. No, you will not need the injection because you are White. Rh incompatibility affects only Black women.

ANS: B Rh incompatibility sometimes affects fetal development. The problem usually occurs when the mother has Rh-negative blood cells and the fetus has Rh-positive blood cells, inherited from the father who also has Rh-positive blood cells. All women should be assessed for blood type, Rh factor, and antibody development at their first prenatal visits and again at 24 to 28 weeks, unless the father is Rh-negative. Rh incompatibility may be prevented by administering RhoGAM at 28 weeks and within 72 hours after birth. In this case, because the father is Rh negative, RhoGAM is not necessary.

20. A woman who is 30 weeks pregnant tells the nurse that she and her husband are having sexual difficulties. Which of the following actions should the nurse take? a. Tell the woman she should not be sexually active at this point in her pregnancy because it may harm the fetus. b. Ask her to elaborate on the difficulties. c. Tell her that they should modify their positions during intercourse and that will take care of the problem. d. Tell her men like the way pregnant women look.

ANS: B Some women worry about intercourse during pregnancy, fearing that it will cause miscarriage, infection, early delivery, or harm to the baby. Sexual dissatisfaction of the couple may result from restrictions in sexual positions, pain on penetration, increased vaginal discharge, breast tenderness, or the other physical discomforts of pregnancy such as fatigue or heartburn. The couples feeling about the womans changing body may alter their sexual relationship. The nurses first step in primary prevention intervention is to support the couples needs and relate, in a sensitive fashion, accurate information that facilitates couples intimacy during pregnancy. Asking her to elaborate on the difficulties allows the nurse to understand the root of the problem and develop an appropriate intervention. It also opens the lines of communication, so the nurse can discuss common difficulties experienced by couples and help her and her husband adjust to the challenges and discomforts of pregnancy. Giving the woman advice on position changes or body image may not be effective if it is not the cause of the difficulties.

22. A pregnant woman is having a TORCH screening done at todays prenatal visit. She states she is anxious to get the results back because she recently had unprotected sex with someone she just met and is afraid she might have HIV. Which of the following statements would be the best response by the nurse? a. You will know your HIV status in about 1 week when the results come back. b. You will require additional testing for HIV as it is not tested for with the TORCH screen. c. You will need to be tested for HIV after you deliver because pregnancy can produce false HIV results. d. You need to be exposed for at least 6 months before being tested for HIV in order for the results to be accurate.

ANS: B The TORCH screening helps detect toxoplasmosis, hepatitis B, rubella, cytomegalovirus, and herpes simplex. HIV is not detected with the TORCH screen. Therefore she should tell the woman that she will require additional testing for HIV.

18. During the first prenatal visit, the pregnant woman informs the nurse that she cannot wait to start wearing maternity clothes. This finding is based on an assessment of which functional health pattern? a. Cognitive-perceptual pattern b. Self-perceptionself-concept pattern c. Health-perceptionhealth-management pattern d. Values-beliefs pattern

ANS: B To develop a maternal identity, the woman must first accept the pregnant body image. The pregnant womans personality, maturity level, and psychological development influence her readiness to assume the role of mother. Being excited about wearing maternity clothes is an indication that she has accepted the pregnant body image. Such an assessment is a component of the self-perceptionself-concept pattern.

23. A nurse makes a home visit to monitor the blood pressure of a pregnant woman who is single. Which finding would be of most concern to the nurse? a. The bedroom is located on the second floor. b. She has a pet cat. c. There is an area rug in the living room. d. She has a 1-year-old child.

ANS: B Toxoplasmosis is caused by a protozoan that infects people through undercooked meat, handling of cat feces, and exposure to infected soil. Sixty percent of maternal infections acquired during the third trimester result in fetal infection, which can lead to rash, enlarged lymph nodes and liver, inflammation of the heart, pneumonia, jaundice, and severe central nervous system damage after birth or years later. Thus, pregnant women should avoid handling cats or cleaning cat litter boxes to avoid exposure to toxoplasmosis.

2. A nurse is assessing a woman for positive signs of pregnancy. Which of the following assessment findings would the nurse discover? (select all that apply) a. Positive test for HCG in the maternal urine b. Detection of fetal heart tones c. Enlargement of the uterus d. Palpation of fetal body parts

ANS: B, D Positive signs of pregnancy include: detection of fetal heart tones by auscultation, ultrasonography, or a Doppler; palpation of fetal body parts using Leopold maneuvers; fetal movements visible and detected by examiner; and radiological or ultrasonographic demonstration of fetal parts. Enlargement of the uterus and positive test for HCG in the maternal urine are both probable signs of pregnancy.

12. During the second prenatal visit, the pregnant woman informs the nurse that she has stopped smoking. This finding is based on an assessment of which functional health pattern? a. Cognitive-perceptual pattern b. Self-perceptionself-concept pattern c. Health-perceptionhealth-management pattern d. Values-beliefs pattern

ANS: C A womans acceptance of her pregnancy influences her health management practices. A woman who denies or has negative feelings about her pregnancy may fail to eat properly, get enough rest and exercise, and so on. A woman who has stopped smoking because she is pregnant indicates that she accepts her pregnancy and the health practices that must be instituted to promote a healthy pregnancy, delivery, and baby. Such an assessment is a part of the health perceptionhealth management pattern.

15. A nurse is assessing the nutritional-metabolic patterns of a pregnant woman. Which of the following findings would be of concern to the nurse? a. The woman drinks about 1 gallon of water a day. b. The woman works out at the gym daily. c. The woman does not like vegetables. d. The woman usually eats three meals a day in addition to two snacks a day.

ANS: C Because of pressure from the enlarging uterus, slowed peristalsis, and supplemental iron and calcium intake, the woman is at risk for constipation that can then lead to hemorrhoids. Therefore, the woman should eat foods high in fiber, including vegetables and fruits. A woman who does not like or eat vegetables is at risk for constipation and hemorrhoids.

16. A woman who is 23 weeks pregnant is concerned because her baby is moving less than it was a few weeks ago. Which of the following statements would be the most appropriate response by the nurse? a. Your infant is in distress. We should call an ambulance. b. You need to be more active; take a dance class once a week. c. At this point in your pregnancy, the baby moves less frequently because of lack of space in the uterus. d. You probably counted incorrectly.

ANS: C Education and guidance are important nursing functions. It is true that by the end of the second trimester fetal movement occurs less frequently because of lack of space in the uterus. The nurse should provide the woman with this information, so she knows what to anticipate.

27. A nurse is discussing the harmful effects that chemical agents can have on an unborn child with a woman who is pregnant. Which of the following statements made by the woman indicates a need for further teaching? a. It is safe to eat up to 12 ounces of cooked fish weekly. b. I should avoid using caffeine during pregnancy. c. Consumption of one drink per day will not cause any harm to my unborn baby. d. Use of nicotine during pregnancy may cause my child to be born prematurely.

ANS: C Numerous studies have shown that no safe level of alcohol use exists during pregnancy; therefore alcohol should be avoided during this time and when attempting conception.

5. During a routine clinic visit, a pregnant woman expresses concern about reflux she is experiencing. Which statement should be made by the nurse when addressing the womans concern? a. Frequent heartburn may be a sign of fetal distress and an ultrasound should be performed immediately. b. Frequent heartburn is caused by high levels of hormones during pregnancy. c. Frequent heartburn is a result of gastrointestinal system changes that occur during pregnancy. d. Frequent heartburn during pregnancy requires immediate consultation with a gastroenterologist.

ANS: C The gastrointestinal system undergoes dramatic changes during pregnancy, which include frequent heartburn secondary to upward displacement of the stomach and a relaxed gastroesophageal sphincter. Therefore the appropriate response for this woman would be to provide her with information regarding normal changes during pregnancy. In this case the frequent heartburn is a result of gastrointestinal system changes that occur during pregnancy.

8. A nurse is caring for a woman who is in labor. The nurse anticipates that the labor will progress through which of the following sequences? a. Dilation stage, pressure stage, placental stage, recovery stage b. Dilation stage, pushing stage, pain stage, recovery stage c. Dilation stage, pushing stage, placental stage, recovery stage d. Dilation stage, pushing stage, placental stage, refractory stage

ANS: C The sequence for the four stages of labor is dilation stage, pushing stage, placental stage, and recovery stage.

30. At 1 minute of age, an infant has a heart rate of 95, a strong cry, some flexion of extremities, a cry reflex, and is completely pink. Which of the following is a correct assessment of the infants Apgar score? a. 4 b. 6 c. 8 d. 10

ANS: C There are five signs that are scored using the Apgar scoring system. A heart rate under 100 receives a score of 1, a strong cry receives a score of 2, some flexion of extremities receives a score of 1, a cry for the reflex irritability sign receives a score of 2, and an infant whose color is completely pink receives a score of 2: 1 + 2 + 1 + 2 + 2 = 8.

28. During a prenatal visit, pregnant parents ask the nurse what they can do to prepare their 4-year-old child for the birth of the new baby. Which of the following actions would be most appropriate for the nurse to suggest? a. Discourage any negative comments the child makes about the baby or the pregnancy. b. Do not make any plans regarding the baby in front of the 4-year-old child. c. Provide him with very detailed information about the pregnancy and the birth. d. Ask the 4-year-old boy to help decorate the new babys room.

ANS: D Children in the family also experience role changes during and after the pregnancy. Having a child participate in decisions about the baby helps to prepare the child for the arrival of the neonate. Helping the parents decorate the new babys room allows the child to participate in the arrival of the new baby.

21. During a prenatal visit, a pregnant woman informs the nurse that she and her husband have chosen godparents for the baby. This finding is based on an assessment of which functional health pattern? a. Cognitive-perceptual pattern b. Self-perceptionself-concept pattern c. Health-perceptionhealth-management pattern d. Values-beliefs pattern

ANS: D For women with strong spiritual needs related to their cultural backgrounds, spiritual interventions will help them integrate various dimensions of their lives, develop the ability to parent successfully, and find meaning in the changes and goals of pregnancy. Identifying godparents will help the woman find meaning in the changes and goals of pregnancy. Such religious beliefs assessments are components of the values-beliefs pattern.

14. During a prenatal visit, a nurse discovers that a Black woman has been occasionally craving and eating clay. Which of the following actions should be taken by the nurse? a. Tell the client that many pregnant women crave such nonfood substances, and it is not a problem. b. Ignore the comment because pica is acceptable in some rural Black cultures. c. Encourage the client to eat it with plenty of water because of the risk of constipation. d. Stress the importance of an appropriate diet and avoiding pica in a culturally sensitive way.

ANS: D Pica may negatively influence the quality of a womans nutrition during pregnancy. The practice of pica is acceptable in some rural Black cultures. However, it can lead to lead poisoning, fecal impaction, parasitic infections, prematurity, perinatal mortality, low birth weight infants, and anemia in infants. When the nurse identifies instances of pica, she should suggest a culturally sensitive diet that will better meet the needs of the woman and her fetus. The nurse must remain nonjudgmental but stress the importance of an appropriate diet and the dangers of pica.

Which of the following changes is experienced by the urinary system during pregnancy? a. Increased urinary output secondary to total body water increase b. Decreased bladder capacity c. Decreased glomerular filtration rate (GFR) resulting from estrogen and progesterone surge d. Increased renal excretion of acidic drugs

NS: A The urinary system undergoes dramatic changes during gestation. The changes include a 50% increase in GFR, an increase in the diameter of the ureters, and increase in urinary output related to total body water increase and an increase in bladder capacity.

1. Which properties must the sperm possess for conception to occur? (select all that apply) a. High motility b. Uniform size c. Ability to secrete enzymes that dissolve the membrane surrounding the egg d. Life span of at least 3 hours

ANS: A, B, C The sperm must be of uniform size, be normally formed, possess high motility, and have an ability to secrete enzymes that dissolve the membrane surrounding the egg.

31. A woman usually eats an 1800-calorie diet. She is now in the second trimester of her pregnancy. Which of the following best describes the caloric nutritional needs for this woman during the second and third trimester? a. 1800 calories b. 2100 calories c. 2400 calories d. 2700 calories

ANS: B During pregnancy, a womans caloric needs increase by 300 calories. Someone who usually eats an 1800-calorie diet should increase her caloric intake to 2100 calories (1800 + 300 = 2100).

A pregnant woman reports to the nurse that the first day of her last menstrual period was January 22. Using Ngeles rule, which of the following dates would be the most accurate estimated date of delivery?

ANS: C An accurate estimated date of delivery is determined by using Ngeles rule. This is done by adding 7 days to the date of the first day of her last normal menstrual period and subtracting 3 months: 22 + 7 = 29. Subtracting 3 months from January is October. Thus, the estimated date would be October 29.

During which week would pregnancy begin to pose health concerns for the fetus? a. 36 weeks b. 38 weeks c. 40 weeks d. 42 weeks

ANS: D When pregnancy continues beyond 42 weeks, or 2 weeks beyond the calculated due date, placental function decreases even more, posing concerns about the well-being of the fetus.

. Which of the following best describes an abnormality in structure or function that occurs during fetal development? a. Congenital defect b. Genetic defect c. Embryonic defect d. Chromosomal defect

ANS: A During fetal development, an abnormality in structure or function is known as a congenital defect.

24. A client who is 36 weeks of gestation is at her prenatal visit. The nurse tells the client that she will be screened for group B Streptococcus during todays visit. Which of the following statements would be made by the nurse when providing client education about this screening test? a. Screening for group B Streptococcus is necessary as this infection can cause complications with pregnancy and to the unborn infant. b. This screening will help us to determine if your unborn infant will be susceptible to respiratory distress when he or she is born. c. Screening for group B Streptococcus will help us identify if you have been exposed to this or any other infections during your pregnancy. d. This screening is necessary to determine if there is any Rh blood group incompatibility between you and your unborn child.

ANS: A Screening at 36 to 37 weeks of pregnancy for group B Streptococcus infection has been recommended because this infection causes preterm rupture of the amniotic membranes, premature labor, fetal respiratory distress syndrome, fetal septicemia, and meningitis.

9. A nurse is caring for a woman who is in labor and the fetus descends to the lower birth canal. The woman is in which of the following stages of labor? a. First b. Second c. Third d. Fourth

ANS: B During the second stage of labor, the fetus descends through the lower birth canal toward the womans perineum.

7. A nurse is caring for a pregnant woman who has a pre-pregnancy body mass index (BMI) of 27. Which of the following instructions should the nurse provide the woman regarding weight gain during pregnancy? a. You should gain 11 to 20 pounds during your pregnancy. b. You should gain 15 to 25 pounds during your pregnancy. c. You should gain 25 to 35 pounds during your pregnancy. d. You should gain 28 to 40 pounds during your pregnancy.

ANS: B In 2009, the IOM released new weight gain guidelines that are based on revised BMI categories. Overweight women (BMI of 25 to 29.9) should gain 15 to 25 pounds. Healthy women at a normal weight for their height (BMI of 18.5 to 24.9) should gain 25 to 35 pounds. Underweight women (BMI less than 18.5) should gain 28 to 40 pounds. Obese women (BMI greater than 30) should limit their gain to 11 to 20 pounds.

10. A nurse is caring for a woman during the fourth stage of labor. Which of the following best describes an action the nurse would take during this stage? a. Providing constant reinforcement and education about the labor process and assisting the woman with pushing b. Explaining unusual interventions such as the use of a fetal heart monitor c. Assisting with labor discomfort by modeling breathing d. Teaching the new mother positioning of the infant to assist with breast-feeding

ANS: D Active nursing support during the third and fourth stages of labor includes observing for excessive vaginal bleeding after the placenta is expelled, assisting the woman with breast-feeding, monitoring vital signs, implementing uterine massage as indicated, and providing emotional support. Thus, the best response is the nurse teaching the new mother the football hold to assist with breast-feeding.

29. A Mexican American woman comes to the office for a visit. She is found to be 30 weeks pregnant. Which of the following conclusions can the nurse draw from this finding? a. The woman does not value prenatal care. b. Client education may require a different approach because of dissimilar cultural beliefs. c. This culture does not believe in traditional medicine. d. Signs of pregnancy were not recognized by the woman.

NS: B Cultural groups have unique ideas and beliefs related to pregnancy, childbirth, and childbearing that must be understood by the nurse to render individualized care to each pregnant woman. Mexican Americans may consider prenatal care not needed because pregnancy is a normal life event. In addition, education influences their prenatal care access. Therefore finding out that she is 30 weeks pregnant may be an indication that this woman may require a different approach to education because of dissimilar cultural beliefs.