3230 EXAM #1 NCLEX QUESTIONS

Milk production actually requires higher levels of _________, which can be obtained from a healthy diet.

-Zinc

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? Select all that apply. 1. Pap smear. 2. Mammogram. 3. Glucose challenge test. 4. Biophysical profile. 5. Complete blood count.

1 and 5 are correct.

Body joints become more relaxed with pregnancy because of relaxin, a hormone produce by the placenta. a) False b) True

True

The nurse is caring for a gravid patient in labor who is 7 cm dilated and experiencing slow labor progress. Which factors can contribute to labor dystocia? Select all that apply. 1. Maternal exhaustion or fear 2. History of precipitous birth 3. Hypertonic uterine dysfunction (tachysystole) 4. Occiput anterior presentation 5. Analgesia early in labor

1, 3, 5

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result? 3.3 mEq/L 8.4 mEq/L 6.1 mEq/L 10.8 mEq/L

6.1 mEq/L

A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." The nurse's best response is a. "There is nothing to worry about." b. "The doctor is taking good care of you and your baby." c. "Tell me about your concerns." d. "Your baby is doing fine."

ANS: C Encouraging the client to discuss her feelings is the best approach. Women during their third trimester need reassurance that such fears are not unusual in pregnancy. An open-ended request to share information will encourage the patient to explain concerns further. The other statements belittle the patient's concerns and provide false hope.

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.

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. In addition, quickening occurs by week 20.

A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2012. Using Nagele's rule, the nurse calculates the client's estimated date of delivery as: 1. May 30, 2013. 2. June 20, 2013. 3. June 27, 2013. 4. July 3, 2013.

3. The estimated date of delivery is June 27, 2013.

A primigravid client is 39 weeks pregnant. Which of the following symptoms would the nurse expect the client to exhibit? 1. Nausea 2. Dysuria 3. Urinary frequency 4. Intermittent diarrhea

3. Urinary frequency Urinary frequency recurs at the end of the third trimester. As the uterus enlarges, it again compresses the bladder, causing urinary frequency

The nurse has determined that based on the client's physical examination she is at high risk for developing varicose veins. Which suggestions might the nurse teach the client to help reduce her risk? Select all that apply. -Elevate the feet and legs. -Walk daily. -Use thigh-high support hose. -Sit in a hot tub at least three times a week. -Use knee-high support hose.

-Elevate the feet and legs. -Walk daily. -Use thigh-high support hose.

What is Quickening?

-Fetal movements felt by the mother

A client states, "I think I might be pregnant. My period is late and I've been feeling really nauseous." Which would be the best response by the nurse? 1. "That's great! I am so happy for you." 2. "These are presumptive signs of pregnancy. You could be pregnant." 3. "These are positive signs of pregnancy. You are absolutely pregnant." 4. "You should schedule an appointment to make sure you do not have an ectopic pregnancy."

2

The nurse is caring for a patient following a precipitous delivery. Which complication would the nurse watch for? 1. Retained placenta 2. Postpartum hemorrhage 3. Hemorrhoids 4. Uterine rupture

2

To avoid supine hypotensive syndrome while measuring fundal height, where would a nurse position a pillow under a client? 1. Head 2. Hip 3. Feet 4. Knees

2

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion? A) Wide large eyes B) Thin upper lip C) Protruding jaw D) Elongated nose

B) Thin upper lip

A patient is experiencing braxton hicks contractions, which instruction is appropriate for the patient? A. avoid any lifting B. change position or walk C. perform kegel exercises D. avoid constrictive clothing

B. change position or walk

Which of the following changes related to the vital signs is expected in pregnant women? a) Pulse decreases. b) Blood pressure decreases. c) Lung space increases. d) Temperature decreases.

Blood pressure decreases.

An overweight woman with a BMI of 32 asks how much weight she should gain during her pregnancy, which response by the nurse is the most appropriate? A. 25 - 35 pounds B. 28 - 40 pounds C. 15 - 25 pounds D. no weight change

C. 15 - 25 pounds

What prenatal lab is not needed for routine prenatal care? A. CBC (Hgb, Hct) B. Glucose check C. HIV D. Blood culture

D. Blood culture

A nurse explains to a pregnant woman the importance of consuming adequate iodine in her diet. Which of the following conditions can a deficiency in iodine lead to? a) Diminished bone density b) Hypercholesterolemia c) Goiter d) Anemia

Goiter

How would the obstetric history be recorded for a pregnant woman if she has previously delivered two infants at term and had one abortion at 12 weeks' gestation? a) Gravida 3, para 3 b) Gravida 4, para 2 c) Gravida 4, para 3 d) Gravida 3, para 2

Gravida 4, para 2

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy? a) Premature ventricular contractions b) Split S1S2 c) S4 (atrial gallop) d) Soft systolic murmur

Soft systolic murmur

Which of the following is a presumptive sign or symptom of pregnancy? a. Restlessness b. Elevated mood c. Urinary frequency d. Low backache

Urinary frequency

The nurse is caring for a multigravid who experienced a placental abruption 4 hours ago. For which potential situation will the nurse prioritize assessment? Uterine atony Blood incompatibilities Hypertensive crisis Maternal blood loss

Uterine atony

12. A woman in her second trimester is found to have a TORCH infection. Which of the following is included in this category? a. Gonorrhea b. Toxoplasmosis c. Human immunodeficiency virus d. Group B streptococcal virus

b

Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? oxytocin promethazine ondansetron methotrexate

methotrexate

Which factor would contribute to a high-risk pregnancy? blood type O positive history of allergy to honey bee pollen first pregnancy at age 33 type 1 diabetes

type 1 diabetes A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia. The age of 33 without other risk factors does not increase risk, nor does type O-positive blood or environmental allergens.

17. A nurse is caring for a patient who has just been found on ultrasound to have triplets. Which of the following risks should the nurse expect to be increased in this patient? (Select all that apply.) a. Preterm labor and delivery b. Vaginal delivery c. Preeclampsia d. Low birth weight neonate e. Perinatal fetal mortality

a,c,d,e

A pregnant client with a history of asthma since childhood presents for a prenatal visit. What statement by the client would the nurse prioritize? "I sometimes get a bit wheezy." "I sometimes get a feeling of euphoria." "Certain substances make me sneeze." "I have trouble getting comfortable in bed."

"I sometimes get a bit wheezy." Wheezing is a classic symptom of asthma. This statement should alert the nurse to the possibility that the woman's asthma is not being well-controlled and needs further evaluation and possible intervention. The other statements do not relate to the typical presentation of this disease in pregnancy.

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

"What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

Presumptive signs are possible signs of pregnancy that appear in the first trimester, often only noted subjectively by the mother and include...

-breast changes, amenorrhea, morning sickness

A gravid patient presents to labor and delivery for labor induction due to preeclampsia. The nurse notes the Bishop score of 5 in her medical record. Which intervention would the nurse anticipate? 1. Cervical ripening agents 2. Amniotomy 3. Oxytocin infusion 4. Cesarean delivery

1

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.

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.

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.

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.

The first time you see a woman during pregnancy, her fundal height is palpable at the level of her umbilicus. This measurement is typical of what gestational age? a) 6 weeks b) 24 weeks c) 12 weeks d) 20 weeks

20 weeks

Misoprostol has been ordered for a pregnant patient at 41 weeks' gestation. Which statement made by the patient indicates to the nurse that teaching about the use of misoprostol has been effective? 1. "Misoprostol enhances uteroplacental perfusion in an aging placenta." 2. "Misoprostol increases amniotic fluid volume." 3. "Misoprostol ripens the cervix in preparation for labor induction." 4. "Misoprostol stimulates the amniotic membranes to rupture."

3

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 is an insulin antagonist

The blood volume in pregnant women increases by what percent? a) 40-50 percent b) 30-40 percent c) 20-30 percent d) 10-20 percent

40-50 percent

b) Eat dry crackers or toast before rising Pg. 297 The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.

9. A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant? a) Avoid eating spicy food b) Eat dry crackers or toast before rising c) Drink plenty of fluids at bedtime d) Avoid foods such as cheese

What is a presumptive sign of labor? A. Fatigue B. Braxton Hicks C. Chadwicks sign D. Fetal heart sound

A. Fatigue

22. What routine nursing assessment is contraindicated in the patient admitted with suspected placenta previa? a. Monitoring FHR and maternal vital signs b. Observing vaginal bleeding or leakage of amniotic fluid c. Determining frequency, duration, and intensity of contractions d. Determining cervical dilation and effacement

ANS: D Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage and is therefore contraindicated. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. Monitoring for bleeding and rupture of membranes is not contraindicated in this woman. Monitoring contractions is not contraindicated in this woman. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 530 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

A nurse suspects that a pregnant client may be experiencing a placental abruption based on assessment of which finding? Select all that apply. dark red vaginal bleeding insidious onset rigid uterus absence of pain absent fetal heart tones

Absent fetal heart tones Dark red vaginal bleeding Rigid uterus

A client in the third trimester of pregnancy has to travel a long distance by car. The client is anxious about the effect the travel may have on her pregnancy. Which of the following instructions should the nurse provide to promote easy and safe travel for the client? a) Use a lap belt that crosses over the uterus. b) Activate the air bag in the car. c) Apply a padded shoulder strap properly. d) Always wear a three-point seat belt.

Always wear a three-point seat belt.

A feeling expressed by most women upon learning they are pregnant is: a. Acceptance b. Depression c. Jealousy d. Ambivalence

Ambivalence

The nurse should administer Rhogam (Rh immune globulin) to the pregnant woman who is Rho(D)-, after which of the following tests? a) CST (Contraction Stress Test) b) Biophysical Profile c) Amniocentesis d) NST (Non Stress Test)

Amniocentesis

A woman in her first trimester is having trouble maintaining adequate nutrition because of nausea and vomiting. She also complains that her heartburn gets worse after eating so she avoids food even when she feels hungry. To help with her nutritional deficit, she is taking a multivitamin supplement. Which substance do you caution her to avoid within 1 hour of ingesting her multivitamin supplement? a) Acetaminophen b) Fatty or fried foods c) Coffee or other caffeinated beverages d) An antacid

An antacid

A woman in the second trimester of pregnancy reports that she is "tired all the time." She appears pale and her hematocrit, though within the normal range, is low. Which recommendation would be most helpful for this woman? a) A calcium supplement b) More seafood and organ meats in her diet c) More meat in her diet d) An iron supplement

An iron supplement

When measuring the diagonal conjugate of a woman's pelvis, the distance between which of the following anatomic landmarks would be used? a) Anterior surface of the sacral prominence and the anterior surface of the symphysis pubis b) Medial surface of the ischial tuberosities c) Posterior surface of sacrum and the axis of the ischial tuberosities d) Interior surface of the sacral prominence and the posterior surface of the symphysis pubis

Anterior surface of the sacral prominence and the anterior surface of the symphysis pubis

A friend tells you that she is going to use a home pregnancy test to determine whether she is pregnant. Which of the following precautions would you give her? a) Use a diluted urine specimen. b) Arrange for prenatal care if the test is positive. c) Refrain from eating for 4 hours before testing. d) Wait until after two missed menstrual periods.

Arrange for prenatal care if the test is positive.

At 37 weeks of gestation, the patient is in a severe automobile crash where her abdomen was hit by the steering wheel and her seat belt. What priority action would the emergency room nurse expect to perform upon the patient's arrival at the hospital? 1 Stay with the patient, assure a patent airway is present, and keep the patient as calm as possible. 2 Move the patient's skirt to determine if any vaginal bleeding is present, find out who to call, and monitor the level of consciousness. 3 Assess the patient's vital signs, determine location and severity of pain, and establish continual fetal heart rate monitoring. 4 Obtain arterial blood gases, obtain a hemoglobin and hematocrit,and oxygen saturation rate.

Assess the patient's vital signs, determine location and severity of pain, and establish continual fetal heart rate monitoring.

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? a) At the level of the umbilicus b) At the level of the symphysis pubis c) Three finger-breadths above the umbilicus d) At the level near the bottom of the sternum

At the level of the umbilicus

A woman is 20 weeks pregnant. The nurse would expect to palpate the fundus at which of the following locations? a) At the umbilicus b) Between the symphysis and umbilicus c) Symphysis pubis d) Just below the ensiform cartilage

At the umbilicus

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances? a) Maintain personal hygiene b) Avoid intake of coffee c) Eat a well-balanced diet d) Avoid medications

Avoid medications

All of the following are common discomforts of pregnancy except: A. Constipation B. Epigastric pain C. Hemorrhoids D. Urinary frequency

B. Epigastric pain (sign of pregnancy induced hypertension)

During a clinic visit, a pregnant client at 30 weeks' gestation tells the nurse, "I've had some mild cramps that are pretty irregular. What does this mean?" The cramps are probably: a. The beginning of labor in the very early stages b. An ominous finding indicating that the client is about to have a miscarriage c. Related to overhydration of the woman d. Braxton Hicks contractions, which occur throughout pregnancy

Braxton Hicks contractions, which occur throughout pregnancy

A gravida 3, para 2 women who is 20 weeks gestation comes to the clinic for a routine checkup. What is the appropriate caloric increase this woman needs to apply when starting her 3rd trimester? A) 300 B) 400 C) 100 D) 500

C) 100

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the nurse to suspect that the client is having an adverse effect associated with this drug? A) Gastrointestinal bleeding B) Blurred vision C) Tachycardia D) Sweating

C) Tachycardia

maternal PKU is a maternal genetic disease. When educating on a diet low in phenylalanine, the nurse said include all of the following foods accept: A. apples B. grapes C. Nuts D. Rice E. grapefruit juice

C. nuts

During the physical exam at the first prenatal visit a speculum exam is performed. What sign of pregnancy does the practitioner look for during the speculum exam? a) Hagar's sign b) Chadwick's sign c) Goodell's sign d) Nagel's sign

Chadwick's sign

A nurse is caring for a pregnant client who has been diagnosed with lordosis. The nurse offers preventive measures for which of the following consequences of lordosis when caring for this client? a) Edema in lower extremities b) Chloasma c) Chronic backache d) Diastasis

Chronic backache

A woman has come to the clinic for her first prenatal visit. Which of the following would be the most effective way to initiate data gathering for a health history? a) Wait until she is in the examining room and prepared for her physical examination. b) Conduct an interview in a private room to obtain her health history. c) Ask her some basic questions in the waiting room before taking her to the examining room. d) Ask her to complete a written questionnaire concerning her past and present status.

Conduct an interview in a private room to obtain her health history.

A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware of the client's risk of perinatal complications including which of the following? a) Post-term birth b) Congenital anomalies c) Maternal hypotension d) Fetal non-immune hydrops

Congenital anomalies

A woman is seeing the nurse for her first prenatal visit. She informs the nurse that she had a normal period starting on January 6 and spotted on February 4. The nurse correctly calculates her estimated date of delivery as ______________________.

Correct Responses October 13 Nägele's rule states to subtract 3 months and add 7 days to the first day of the last normal menstrual period. Robbie's last normal period was January 6.

A woman of Muslim culture tells the nurse she needs to find a physician to take care of her during her pregnancy. Being aware of the cultural beliefs of this woman, the nurse will recommend _______________.

Correct Responses an older female physician In many Muslim cultures, exposure of the genitals to men is considered demeaning. Nurses must remember that the reputations of women from these cultures depend on their demonstrated modesty. If possible, female health care providers should provide care.

A pregnant woman asks the nurse, I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby? Which response by the nurse would be most appropriate? A) The caffeine in coffee has been linked to birth defects. B) Caffeine has been shown to cause growth restriction in the fetus. C) Caffeine is a stimulant and needs to be avoided completely. D) If you keep your intake to less than 300 mg/day, you should be okay.

D) If you keep your intake to less than 300 mg/day, you should be okay.

Which medication would the nurse question if ordered to control a pregnant woman's asthma? A) Budesonide B) Albuterol C) Salmeterol D) Oral prednisone

D) Oral prednisone

A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborns risk for the infection. Which of the following statements by the nurse would be most appropriate? A)Youll probably have a cesarean birth to prevent exposing your newborn. B)Antibodies cross the placenta and provide immunity to the newborn. C)Wait until after the infant is born and then something can be done. D)Antiretroviral medications are available to help reduce the risk of transmission.

D)Antiretroviral medications are available to help reduce the risk of transmission.

A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? Bright red, painless vaginal bleeding Painful uterine contractions and nausea Dark red, "clumpy" vaginal discharge Brisk deep tendon reflexes and shoulder pain

Dark red, "clumpy" vaginal discharge

The nurse is assessing a new client who is being admitted with gestational hypertension. Which nursing diagnosis should the nurse prioritize for this client? Decreased reflexes due to medication administration Imbalanced nutrition related to decreased sodium levels Deficient fluid volume related to vasospasm of arteries Risk for injury related to fetal distress

Deficient fluid volume related to vasospasm of arteries

A woman in early pregnancy is concerned because she is nauseated every morning. Which of the following would be the best measure to help relieve this? a) Take a teaspoon of baking soda before breakfast. b) Delay breakfast until midmorning. c) Take two aspirin on arising. d) Delay toothbrushing until noon.

Delay breakfast until midmorning.

A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant? Eat dry crackers or toast before rising. Avoid eating spicy food. Avoid foods such as cheese. Drink plenty of fluids at bedtime.

Eat dry crackers or toast before rising. The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.

The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions would the nurse most likely include? Select all that apply. administering antiemetic agents monitoring intake and output maintaining NPO status for the first day or two preparing the woman for insertion of a feeding tube obtaining baseline blood electrolyte levels

Everything but preparing for insertion of feeding tube

The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which of the following danger sign might occur at this point in her pregnancy? a) Excessive vomiting b) Swelling of extremities c) Dyspnea d) Lower abdominal pressure

Excessive vomiting

Which of the following findings is most worrisome in Melissa, a woman in her 26th week of pregnancy? a) Generalized hair loss b) Facial edema c) Nosebleeds d) A hyperpigmented rash over the maxillary region bilaterally

Facial edema

Which of the following is a positive sign of pregnancy? a) Positive pregnancy test b) Hegar's sign c) Uterine contractions d) Fetal movement felt by examiner

Fetal movement felt by examiner

A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion. How would the nurse document this information on the patient chart? a) G4 P3115 b) G5 P3114 c) G5 P3115 d) G5 P1135

G5 P3114

Pregnancy tests (both urine and blood) measure levels of which hormone to validate the existence of pregnancy? a) Human chorionic gonadotropin (hCG) b) Estrogen c) Progesterone d) Aldosterone

Human chorionic gonadotropin (hCG)

When obtaining a blood test for pregnancy, which hormone would the nurse expect the test to measure? a. Human chorionic gonadotropin (hCG) b. Human placental lactogen (hPL) c. Follicle-stimulating hormone (FSH) d.Luteinizing hormone (LH)

Human chorionic gonadotropin (hCG)

A pregnant woman you care for tells you she often has allergic responses to drugs. She is concerned that she will be allergic to her fetus or her body will reject the pregnancy. You would base your reply to her on which of the following statements? a) The kidneys release a hormone during pregnancy to prevent this from happening. b) The level of aldosterone during pregnancy reduces production of IgG antibodies. c) Immunologic activity is decreased during pregnancy. d) The decreased corticosteroid activity during pregnancy ensures this will not happen.

Immunologic activity is decreased during pregnancy.

If constipation is a problem for a woman during pregnancy, which of the following would be best to recommend? a) Eating more meat products b) Mineral oil c) Increased fiber intake d) Stopping prenatal vitamins temporarily

Increased fiber intake

When describing the pregnant woman's hypercoagulable state, which of the following would the nurse identify as being least likely related? a) Increased clotting factors b) Increased number of red blood cells c) Increased plasma fibrinogen d) Increased levels of fibrin

Increased number of red blood cells

During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which of the following? a) Increased venous pressure leads to increased gingival friability. b) Elevated progesterone levels cause smooth muscle relaxation. c) Influence of estrogen and blood vessel proliferation d) Effects of regurgitation from relaxation of the cardiac sphincter

Influence of estrogen and blood vessel proliferation

Why is a Papanicolaou smear done at the first prenatal visit? a) It identifies abnormal cervical cells. b) It predicts whether cervical cancer will occur. c) It detects if uterine cancer is present. d) It helps to date the pregnancy.

It identifies abnormal cervical cells.

A pregnant woman is being evaluated for HELLP. The nurse reviews the client's diagnostic test results. An elevation in which result would the nurse interpret as helping to confirm this diagnosis? LDH white blood cells hematocrit platelet count

LDH

Using Naegele's Rule, calculate the estimated due date (EDD) if the woman's last menstrual period (LMP) was June 11.

March 18

The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client? Gastrointestinal bleeding Tachycardia Sweating Halos around lights

Tachycardia

A 28-year-old client complains of skipping her menses and suspects she is pregnant. When assessing this client, which of the following would the nurse identify as a presumptive sign of pregnancy? a) Abdominal enlargement b) Softening of the cervix c) Urinary frequency d) Positive home pregnancy test

Urinary frequency

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: 1 a sleepy, sedated affect. 2 a respiratory rate of 10 breaths/min. 3 deep tendon reflexes of 2+. 4 absent ankle clonus.

a respiratory rate of 10 breaths/min.

10. A woman in her first trimester reports to the office with abdominal pain and vaginal bleeding. On ultrasound, it is found that the blastocyst has implanted in the fallopian tube. The nurse recognizes the condition as which of the following? a. Placenta accreta b. Eclampsia c. Ectopic pregnancy d. Hyperemesis gravidarum

c

A home health care nurse is visiting a pregnant client with preeclampsia who is being managed at home. The nurse is reviewing the situations for which the client should contact the nurse. The nurse determines that the client demonstrates understanding when identifying which situation(s) as needing to be reported? Select all that apply. blurred vision excessive heartburn increased urination dizziness sinus headache

dizziness excessive heartburn blurred vision

The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours. Why would the nurse do this? pulmonary atelectasis pulmonary edema pulmonary hypertension pulmonary emboli

pulmonary edema

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios. Which information would the nurse use to support this suspicion? Select all that apply. reports of shortness of breath difficulty obtaining fetal heart rate history of diabetes fundal height below that for expected gestational age identifiable fetal parts on abdominal palpation

reports of shortness of breath difficulty obtaining fetal heart rate history of diabetes

The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving betamethasone and magnesium sulfate. The nurse recognizes the client is being treated for which condition? gestational diabetes gestational hypertension severe preeclampsia postterm pregnancy

severe preeclampsia

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which of the following data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. a) Amenorrhea b) Morning sickness c) Hydatidiform mole d) Ultrasound pictures e) Breast changes f) Fetal heartbeat

• Amenorrhea • Morning sickness • Breast changes

A client wants to know if she can engage in intercourse during pregnancy. Which of the following should the nurse confirm to ensure that sexual intercourse or orgasm is not contraindicated in the client? Select all that apply. a) Client does not have dependent edema b) Client does not face a risk of threatened abortion c) Client is not at risk for pre-term labor d) Client does not have breast tenderness e) Client has experienced quickening

• Client does not face a risk of threatened abortion • Client is not at risk for pre-term labor

A client who is 32 weeks gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response? a) "Oxygen requirements are increasing in your body because the fetus is growing" b) "The enlarging uterus pushes against your diaphragm and this makes breathing shallow" c) "You only have a few more weeks until you deliver and then you will breathe fine again" d) "Don't worry about this because it is a normal change that occurs with pregnancy"

"The enlarging uterus pushes against your diaphragm and this makes breathing shallow"

A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which of the following patient statements alerts the nurse to the need for further teaching? a) "I will avoid having intercourse following the rupture of the membranes." b) "If I experience bleeding, I will abstain from vaginal intercourse." c) "I should substitute intercourse with nonsexual touch to avoid harming the fetus." d) "I will experience a heightened need for touch throughout my pregnancy."

"I should substitute intercourse with nonsexual touch to avoid harming the fetus."

A pregnant woman has developed varicosities. Which statement would suggest she needs additional health teaching? "I dorsiflex my feet and ankles frequently." "I wear knee-highs rather than pantyhose." "I'll try not to stand for long periods." "I maintain a high fluid intake."

"I wear knee-highs rather than pantyhose." Women with varicosities should not wear knee-high stockings as they put pressure on leg veins and reduce venous return.

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? "If I develop this complication, I will have bright red vaginal bleeding," "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." "I need a cesarean section if I develop this problem." "Since I am over 30, I run a much higher risk of developing this problem."

"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

The mother the two hormones that control lactation and letdown are...

-Prolactin and oxytocin.

A client who is entering her third trimester comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which findings would the nurse expect? Select all that apply. -Pallor of the areolae -Prominent veins -Hyperpigmentation of the nipple -Warmth increased sensitivity

-Prominent veins -Hyperpigmentation of the nipple -Increased sensitivity Normal breast findings include prominent veins, nodular breasts, increased sensitivity to touch, and hyperpigmentation of the nipples and areolae. Warmth would suggest possible infection.

A client in her 10th week of gestation arrives at the maternity clinic reporting morning sickness. The nurse needs to inform the client about the body system adaptations during pregnancy. Which factors correspond to the morning sickness period during pregnancy? Select all that apply. -Reduced stomach acidity -Elevated human chorionic gonadotropin (hCG) -Increased red blood cell (RBC) production -Increased estrogen level elevated human placental lactogen (hPL)

-Reduced stomach acidity -Elevated human chorionic gonadotropin (hCG) -Increased estrogen level

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. -Breast changes -Ultrasound pictures -Fetal heartbeat -Amenorrhea -Hydatidiform mole morning sickness

-Breast changes -Amenorrhea -Morning sickness

Which information provided by a client would be considered a presumptive sign of pregnancy? -Reports of increased hunger -Weight gain -Breast tenderness -Ballottement

-Breast tenderness

A multiparous client asks the nurse what she can do to help with leaking urine when she coughs or sneezes. Which intervention would the nurse recommend? 1. Perform Kegel exercises 2. See a urology specialist for surgery 3. Empty her bladder every hour 4. Obtain a specimen for urinalysis

1

A primiparous woman in active labor is having uterine contractions that are weak and becoming less frequent. She has not made any cervical change in 1 hour. Which is the best nursing action? 1. Assist the patient with ambulation or position changes. 2. Prepare the patient for a cesarean delivery. 3. Administer tocolytic medications. 4. Warn the woman of the second stage disorder and risks of cesarean delivery.

1

During a physical examination, the nurse observed that a client in her late pregnancy has hemorrhoids and varicosities in her legs. Which statement by the nurse explains the cause for these two conditions in a pregnant client? 1. "Increased venous pressure and decreased blood flow to the extremities, due to compression of the iliac veins and inferior vena cava." 2. "Increased action of adrenocorticosteroids leads to cutaneous elastic tissues becoming fragile." 3. "The stretching of the abdominal muscle, due to the enlarging uterus." 4. "Increased plasma fibrin by 40% and the fibrinogen by 50%."

1

The nurse is caring for a patient when the provider decides to perform an amniotomy. Which is initial nursing action performed by the nurse during an amniotomy? 1. Assess the fetal heart rate. 2. Document the color of amniotic fluid. 3. Perform a sterile vaginal exam. 4. Provide pericare.

1

The nurse is planning care for a group of clients. Which client would need to receive Rho (D) Immune Globulin (RhoGAM)? 1. A client whose blood type is O-negative 2. A client whose white blood cell count was below normal 3. A client with an autoimmune disorder 4. A client whose blood type is O-positive

1

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 2,000 per 100,000 live births. 2. There were 17 maternal deaths in the United States in 2,000 per 100,000 women of childbearing age. 3. There were 17 maternal deaths in the United States in 2,000 per 100,000 pregnancies. 4. There were 17 maternal deaths in the United States in 2,000 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.

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.

The nurse is caring for a patient that is being induced with oxytocin. Upon assessment of the oxytocin infusion and patient status, the nurse would determine effectiveness with which clinical finding? 1. The patient reports a pain level of 4 on the numeric pain scale with bloody show noted on the peripad. 2. Contractions last 40 to 60 seconds every 2 to 3 minutes with cervical change. 3. Contractions are 4 to 5 minutes apart lasting 30 to 40 seconds with no cervical change. 4. Intensity of contractions is at least 75 to 100 mm/Hg with IUPC.

2

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.

During a patient's second trimester office visit, the nurse performs Leopold's maneuvers. What is the appropriate rationale for this intervention? 1. To assess fetal movement 2. To identify the position of the fetus in utero 3. To change the presentation of the fetus from breech to cephalic 4. To determine fetal heart rate

2. To identify the position of the fetus in utero Fetal movement counts or kick counts, not Leopold's maneuvers, are performed to assess fetal movement. Leopold's maneuvers, or palpation of the abdomen, are performed to identify the position of the fetus in utero. Leopold's maneuvers are not used to change the presentation of the fetus. A Doppler device, not Leopold's maneuvers, is used to determine fetal heart rate.

b) Dark, leafy green vegetables Pg. 303 Dark leafy green vegetables are a source of calcium. Red and orange vegetables contain a variety of vitamins, bread and rice contain carbohydrates, and meat and fish contain protein, but none of these foods are a good source of calcium.

22. A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client? a) White bread and rice b) Dark, leafy green vegetables c) Meat, poultry, and fish d) Deep red or orange vegetables

The nurse is caring for a patient who is undergoing a term gestation pregnancy induction. Which is the nurse aware of regarding the induction of labor? 1. It is achieved by external and internal version techniques. 2. It is always done for medical indications. 3. It is rated for probability of success by a Bishop score. 4. It is only achieved through oxytocin infusion.

3

A nurse is explaining to a patient who has just learned that she is pregnant the overall plan for her prenatal visits beginning now, at her first visit, and continuing until labor and delivery. The pregnancy is expected to be low risk. About how many prenatal visits should the nurse tell the patient to expect? 1. 6 to 8 2. 10 to 12 3. 14 to 16 4. 18 to 20

3. 14 to 16 The standard accepted frequency of prenatal care visits in a low-risk population in the United States results in approximately 14 to 16 prenatal visits per pregnancy.

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.

A patient has a prepregnancy body mass index (BMI) of 28. How many pounds should the nurse recommend that this patient gain over the course of her pregnancy? 1. 28 to 40 2. 25 to 35 3. 15 to 25 4. 11 to 20

3. 15 to 25 A woman who is underweight (BMI less than 18.5) should gain 28 to 40 pounds during pregnancy. A woman who is normal weight (BMI 18.5 to 24.9) should gain 25 to 35 pounds during pregnancy. A woman who is overweight (BMI 25.0 to 29.9) should gain 15 to 25 pounds during pregnancy. A woman who is obese (BMI greater than or equal to 30.0) should gain 11 to 20 pounds during pregnancy.

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 to determine a prenatal client's health teaching needs.

Regarding oxytocin for labor induction, what is the most concerning side effect of oxytocin? 1. Fetal heart rate baseline change from 140 to 130 beats per minute 2. Increased blood pressure 3. Oliguria 4. Tachysystole

4

After reviewing a clients history, which factor would the nurse identify as placing her at risk for gestational hypertension? A) Mother had gestational hypertension during pregnancy. B) Client has a twin sister. C) Sister-in-law had gestational hypertension. D) This is the clients second pregnancy.

A) Mother had gestational hypertension during pregnancy.

A 10-week pregnant woman with diabetes has a glycosylated hemoglobin (HbA1C. level of 13%. At this time the nurse should be most concerned about which of the following possible fetal outcomes? A)Congenital anomalies B)Incompetent cervix C)Placenta previa D)Abruptio placentae

A)Congenital anomalies

In a woman who is suspected of having a ruptured ectopic pregnancy, the nurse would expect to assess for which of the following as a priority? A)Hemorrhage B)Jaundice C)Edema D)Infection

A)Hemorrhage

Which finding during a nonstress test is most reassuring to the nurse? A. Acceleration of 15 bpm for 15 seconds B. deceleration of 5 bpm for 15 seconds C. No change in fetal heart rate D. Acceleration of 30 bpm for 10 seconds

A. Acceleration of 15 bpm for 15 seconds

What are common risk factors affecting adequate nutrition during pregnancy? (select all that apply) A. Age B. Culture C. Socioeconomic status D. Fetus gender

A. Age B. Culture C. Socioeconomic status

a client comes into the Dr. office stating that she thinks she is pregnant. What are some statements by the client that are presumptive signs of pregnancy? A. Amenorrhea B. breast changes C. nausea and vomiting D. positive pregnancy test E. softening and compressibility of lower uterus.

A. Amenorrhea

The nurse in the OB triage area has four patients to see. Which patient should the nurse see first? a. First trimester, vomiting for an hour b. Second trimester, fingers swollen c. Third trimester, painful urination d. Third trimester, painful vaginal bleeding

ANS: D This patient may have a placenta previa or abruptio placentae or might be having a spontaneous abortion. The nurse needs to see this patient first. The other patients may have normal vomiting of the first trimester. Swollen fingers indicate edema that needs to be investigated. Painful urination probably indicates a urinary tract infection. The priority patient is the one with bleeding.

During a routine antepartal visit, a pregnant woman reports a white thick vaginal discharge. Which of the following would the nurse do next? a) Check the discharge for evidence of ruptured membranes. b) Tell the woman that this is entirely normal. c) Ask the woman if she is having any itching or irritation. d) Advise the woman about the need to culture the discharge.

Ask the woman if she is having any itching or irritation.

A client with preeclampsia is receiving magnesium sulfate to suppress or control seizures. Which nursing intervention should a nurse perform to determine the effectiveness of therapy? Monitor intake and output. Assess the client's skin turgor. Assess the client's mucous membrane. Assess deep tendon reflexes.

Assess deep tendon reflexes.

At 37 weeks' gestation, a woman presents to labor and delivery complaining of intense, knife-like abdominal pain that started suddenly about 1 hour ago and has not subsided. On palpation, the abdomen is rigid and board-like and no vaginal bleeding is evident. What should the nurse do next? Assess fetal heart rate Prepare the client for an epidural Insert a Foley catheter Administer oxygen by face mask

Assess fetal heart rate

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication? A)Urinary output of 20 mL per hour B)Respiratory rate of 10 breaths/minute C)Deep tendons reflexes 2+ D)Difficulty in arousing

C)Deep tendons reflexes 2+

What are positive signs that can only be explained by pregnancy? Select all that apply A. uterine enlargement B. positive pregnancy test C. fetal heart sounds D. fetal outline felt by examiner E. visualization of fetus by ultrasound

C. fetal heart sounds E. visualization of fetus by ultrasound

A young woman in her first trimester confesses to the nurse when questioned that she is probably not consuming enough calories. The nurse should explain to this client that deficient nutrition can hinder the baby's growth, which at this point in her pregnancy is primarily via an increase in the number of cells formed. This type of growth is known as which of the following? a) Hypertrophy b) Hyperemesis gravidarum c) Hypercholesterolemia d) Hyperplasia

Hyperplasia

Based on the incidence of disease in woman, which assessment of lower extremities would be most important to make in a pregnant woman? a) Diameter of the calf muscle b) Lateral movement of the kneecap c) Presence of varicosities d) Blanching and refilling of toenails

Presence of varicosities

A client in her third trimester of pregnancy visits the healthcare center and asks why she is constipated. Which of the following would the nurse include as the most likely cause when responding to the client? a) Engorgement of veins by the weight of the uterus b) Relaxation of cardioesophageal sphincter c) Pressure of fetal head on the bladder d) Pressure on intestine by the growing fetus

Pressure on intestine by the growing fetus

Early in pregnancy, frequent urination results mainly from which of the following? a) Decreased glomerular selectivity b) Increased concentration of urine c) Addition of fetal urine to maternal urine d) Pressure on the bladder from the uterus

Pressure on the bladder from the uterus

A nurse is caring for a client in her second trimester of pregnancy. During a regular follow-up visit, the client complains of varicosities of the legs. Which of the following instructions should the nurse provide to help the client alleviate varicosities of the legs? a) Avoid sitting in one position for long. b) Refrain from crossing legs when sitting for long periods. c) Refrain from wearing any kind of stockings. d) Apply heating pads on the extremities.

Refrain from crossing legs when sitting for long periods.

A woman in the third trimester of her first pregnancy expresses fear about the birth canal being wide enough for her to push the baby through it during labor. She is a petite person, and the baby seems so large. She asks the nurse how this will be possible. To help alleviate the patient's fears, the nurse should mention the role of the hormone that softens the cervix and collagen in the joints, which allows dilation and enlargement of the birth canal. This hormone is which of the following? a) Estrogen b) Human placental lactogen c) Relaxin d) Progesterone

Relaxin

Which intervention will help prevent the risk of pulmonary edema in a pregnant patient with severe preeclampsia? 1 Assess fetal heart rate (FHR) abnormalities regularly. 2 Place the patient on bed rest in a darkened environment. 3 Restrict total intravenous (I.V.) and oral fluids to 125 mL/hr. 4 Ensure that magnesium sulfate is administered as prescribed.

Restrict total intravenous (I.V.) and oral fluids to 125 mL/hr.

A pregnant client is planning a vacation to a different state and questions the nurse concerning precautions. Which suggestion should the nurse prioritize for this client who will be traveling by automobile? Stop and walk every 2 hours. Travel no more than 120 miles daily. Limit trips away from home, greater than 200 miles. Sit in the back seat with feet elevated.

Stop and walk every 2 hours. Walking increases venous return and reduces the possibility of thrombophlebitis, a risk for pregnant women who sit for extended periods of time. Limiting mileage, sitting in the back with the feet elevated, and limiting trips may help, but they are not enough to prevent phlebitis.

A pregnant client complains of an increase in a thick, whitish vaginal discharge. Which of the following information should a nurse provide to this client? a) Such discharge is normal during pregnancy. b) Refrain from any sexual activity. c) Consult physician for fungal infection. d) Use local antifungal agents regularly.

Such discharge is normal during pregnancy.

A nurse urges a pregnant patient at the first prenatal office visit to begin taking iron supplements immediately. What is the rationale for this intervention? a) To maintain proper blood glucose levels b) To prevent megalohemoglobinemia c) To reduce the risk for hypertension d) To avoid anemia

To avoid anemia

A patient who has just given a blood sample for pregnancy testing in the doctor's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. Which of the following should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? a) Laboratory test of a urine specimen for hCG b) Laboratory test of a blood serum specimen for hCG c) Visualization of the fetus by ultrasound d) Absence of a period

Visualization of the fetus by ultrasound

One function of the nurse when dealing with a pregnant client is to teach self-care during pregnancy. One of the topics that the nurse provides teaching about is breast care. What does the nurse teach the client about keeping the breasts clean? a) Use a mild soap and cool water to keep the nipples clean b) Wash the nipples with clean water only c) Wash the nipples with a deodorant soap to keep them clean and help toughen them d) Use hot water and a mild soap to keep the nipples clean

Wash the nipples with clean water only

At 38 weeks of gestation, a 24-year-old primipara delivers a 6 pound 2 ounce infant whose five-minute Apgar was 8. How should the neonatal nurse evaluate the outcome of this pregnancy because his mother had been experiencing hyperemesis gravidarum since the eighth week of pregnancy? 1 High risk and needs extensive monitoring. 2 Within healthy parameters for gestation, weight, and Apgar. 3 Very small for gestational age and needs frequent feedings. 4 At high risk for hypoglycemia and tremors.

Within healthy parameters for gestation, weight, and Apgar.

The clinic nurse teaches a client with pregestational type 1 diabetes that maintaining a constant insulin level is very important during pregnancy. The nurse tells the client that the best way to maintain a constant insulin level is to use: an insulin pen. an insulin pump. an insulin drip. regular insulin twice a day.

an insulin pump. Because a pregnant client will have some periods of relative hyperglycemia and hypoglycemia no matter how carefully the client maintains diet and balances exercise levels, an effective method to keep serum glucose levels constant is to administer insulin with a continuous pump during pregnancy.

8. A woman who is in her first trimester of pregnancy has been admitted to the hospital with severe vomiting. She is dehydrated and her electrolytes are out of balance. The nurse recognizes this condition as which of the following? a. Preeclampsia b. Eclampsia c. Hyperemesis gravidarum d. Placent previa

c

The best time to discuss birthing classes, parenting classes, and signs of impending birth is _________. a. at admission to the unit when labor has begun b. at the first trimester visit c. during preconceptual screening d. during the third trimester visits

d. during the third trimester visits

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding? urinary output of 20 mL per hour deep tendons reflexes 2+ difficulty in arousing respiratory rate of 10 breaths/minute

deep tendons reflexes 2+

One specific vitamin is known to prevent up to 70 percent of birth defects of the central nervous system, called neural tube defects. Which vitamin should all woman who are at risk for getting pregnant have daily in their diet? a) Folic Acid b) Vitamin A c) Iodine d) Zinc

Folic Acid

Green tea should be avoided during pregnancy. a) True b) False

True

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.

After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which of the following as being good sources of iron in her diet? (Select all that apply.) A) Dried fruits B) Peanut butter C) Meats D) Milk E) White bread

A) Dried fruits B) Peanut butter C) Meats

After teaching a woman who has had an evacuation for a hydatidiform mole (molar pregnancy. about her condition, which of the following statements indicates that the nurses teaching was successful? A)I will be sure to avoid getting pregnant for at least 1 year. B)My intake of iron will have to be closely monitored for 6 months. C)My blood pressure will continue to be increased for about 6 more months. D)I won't use my birth control pills for at least a year or two.

A)I will be sure to avoid getting pregnant for at least 1 year.

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which of the following would lead the nurse to suspect that the woman is developing an infection? (Select all that apply.) A) Fetal bradycardia B) Abdominal tenderness C) Elevated maternal pulse rate D) Decreased C-reactive protein levels E) Cloudy malodorous fluid

B) Abdominal tenderness C) Elevated maternal pulse rate E) Cloudy malodorous fluid

A nursing student is reviewing an article about preterm premature rupture of membranes. Which of the following would the student expect to find as factor placing a woman at high risk for this condition? (Select all that apply.) A) High body mass index B) Urinary tract infection C) Low socioeconomic status D) Single gestations E) Smoking

B) Urinary tract infection C) Low socioeconomic status E) Smoking

A client is in her first trimester. what statement by the client indicates a need for further teaching? A. I should eat crackers or dry toast if I feel nausea. B. I should not wear a bra because my breasts will be tender. C. I should urinate frequently. D. I should engage in frequent rest periods.

B. I should not wear a bra because my breasts will be tender.

As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because a) Her cerebral arteries are growing congested with blood b) Sympathetic nerve responses cause dyspnea when a woman lies supine c) The uterus requires more blood in a supine position d) Blood is trapped in the vena cava in a supine position

Blood is trapped in the vena cava in a supine position

A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. Which drug would the nurse emphasize as being contraindicated at this time? A) Hydroxychloroquine B) Nonsteroidal anti-inflammatory drug C) Glucocorticoid D) Methotrexate

D) Methotrexate

Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance? A)Marijuana B)Alcohol C)Heroin D)Cocaine

D)Cocaine

The nurse is caring for a pregnant patient who is receiving antibiotic therapy to treat a urinary tract infection (UTI). Which dietary changes does the nurse suggest for the pregnant patient who is receiving antibiotic therapy for UTI? 1 "Include yogurt, cheese, and milk in your diet." 2 "Avoid folic acid supplements until the end of therapy." 3 "Include vitamins C and E supplementation in your diet." 4 "Reduce your dietary fat intake by 40 to 50 g per day."

"Include yogurt, cheese, and milk in your diet."

The fundus reaches its highest level at the xiphoid process at approximately __ weeks

-36

At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy? -Normally, blood pressure increases steadily throughout pregnancy. -Blood pressure remains stable until decreasing the day of the birth. -A decrease in the second trimester may occur because of placental growth. -Blood pressure progressively decreases throughout the entire pregnancy.

-A decrease in the second trimester may occur because of placental growth. Because the placenta "traps" a great deal of blood for fetal circulation as it expands at about 3 months, maternal blood pressure may temporarily be slightly decreased. Otherwise, blood pressure stays fairly constant throughout pregnancy.

A new mother asks the postpartum nurse if her baby is getting enough nourishment from breast-feeding within the first 24 hours following birth. The nurse would provide her what information? -The mother needs to supplement breast-feedings with formula until her milk comes in. -Breast milk comes in within 12 hours after delivery and nourishment should not be a problem. -Most infants need minimal nourishment for the first 24 hours, so the mother should not be concerned. -Colostrum, which is the first milk produced, is rich in calories and protein that nourishes the infant well.

-Colostrum, which is the first milk produced, is rich in calories and protein that nourishes the infant well. Colostrum is present prior to delivery and provides the infant with adequate nutrition for the first 3 days of life, at which time the mother's actual milk should come in. Formula is not recommended. Infants need nutrition shortly after birth to keep their blood glucose normal.

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting? -Slack, soft breast tissue -Deeply fissured nipples -Enlarged lymph nodes -Darkened breast areolae

-Darkened breast areolae

During a birth, the nurse notes the fetal head retracts against the maternal perineum after delivery of the head. Which nursing actions would the nurse implement? Select all that apply. 1. Perform McRoberts maneuver. 2. Apply fundal pressure. 3. Apply suprapubic pressure. 4. Assist the provider in pulling harder on the fetal head. 5. Request the mother not to push until directed by the provider.

1, 3, 5

A client in her 24th week of pregnancy is exhibiting signs and symptoms of preeclampsia. The nurse would be alert for which finding indicating that the client has developed eclampsia? 1. Seizures 2. Headaches 3. Blurred vision 4. Weight gain

1. Seizures The primary difference between preeclampsia and eclampsia is the occurrence of seizures, which occur when the client develops eclampsia. Headaches, blurred vision, weight gain, increased blood pressure, and edema of the hands and feet are all indicative of preeclampsia.

A patient who is pregnant comments to the nurse that her breasts have begun to enlarge recently. She asks the nurse what causes this. Which of the following hormones should the nurse mention as being responsible for stimulating this change? 1. Progesterone 2. Estrogen 3. Human chorionic gonadotropin 4. Human placental lactogen

2. Estrogen Progesterone facilitates implantation and decreases uterine contractility. Estrogen stimulates the enlargement of the breasts and uterus. Human chorionic gonadotropin stimulates the corpus luteum so that it will continue to secrete estrogen and progesterone until the placenta is mature enough to secrete these hormones. Human placental lactogen promotes fetal growth by regulating glucose available to the developing human and stimulates breast development in preparation for lactation.

A nurse is reinforcing the instructions given to a client in her education plan about the signs of labor. The nurse determines that the client has an accurate understanding of the instructions when which statement is made by the client? 1. "False contractions are regular" 2. "False contractions intensify with walking." 3. "False contractions usually occur in the abdomen." 4. "False contractions move from the back to the front of the abdomen."

3. "False contractions usually occur in the abdomen." False labor contractions are usually felt in the abdomen, are irregular, and are typically relieved by walking. True labor contractions move from the back to the front of the abdomen, are regular, and aren't relieved by walking.

A client in her third trimester has come to the clinic for a routine check-up. The nurse reinforces the importance of lying on the left side when resting or sleeping. Which rationale should the nurse give to the client for this position? 1. It will relieve heartburn 2. It will facilitate bladder emptying 3. It will prevent compression of the vena cava 4. It will prevent the development of fetal anomalies

3. It will prevent compression of the vena cava The weight of the pregnant uterus is sufficiently heavy to compress the vena cava, which could impair blood flow to the uterus, and subsequently interfere with supplying sufficient oxygen to the fetus. The side-lying position, especially the left side-lying position, helps to prevent compression, thereby ensuring adequate blood flow and oxygenation to the fetus. The side-lying position hasn't been shown to prevent fetal anomalies, nor does it facilitate bladder emptying or heartburn.

The nurse has taken a health history on four multigravida clients at their first prenatal visits. It is high priority that the client whose first child was diagnosed with which of the following diseases receives nutrition counseling? 1. Development dysplasia of the hip 2. Achondroplastic dwarfism 3. Spina bifida 4. Muscular dystrophy

3. Spina bifida The incidence of spina bifida is much higher in women with poor folic acid intake. It is a priority that this client receives nutrition counseling

A woman is in her early second trimester of pregnancy. The nurse would instruct the woman to return for a follow-up visit every: a) 4 weeks b) 1 week c) 3 weeks d) 2 weeks

4 weeks

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.

A client has just been diagnosed with having a hydatidiform mole. When reviewing the client's medical record, what is the most significant risk factor? 1. Age in 20s or 30s 2. High socioeconomic status 3. Primigravida 4. Prior molar gestation

4. Prior molar gestation A previous molar gestation increases a woman's risk for developing a subsequent molar gestation by four to five times. Adolescents and women age 40 years and older are at increased risk for molar pregnancies. Multigravidas, especially women with a prior pregnancy loss, and those with lower socioeconomic status are at an increased risk for this problem.

a) Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy Pg. 285 Expected weight gain is 1.5 lb (0.68 kg) per month in the first trimester and 1 lb (.45 kg) per week for the second and third trimester. This client needs to continue to gain 1 lb (.45 kg) per week. Restricting weight gain near the end of pregnancy can negatively impact fetal growth.

8. At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy? a) Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy b) Watch the diet so no additional weight is gained during this pregnancy c) Increase weight gain to 1.5 lb (0.68 kg) per week during this pregnancy d) Limit weight gain to less than 5 lb (2 kg) for the remainder of this pregnancy

A. Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. Career responsibilities may have demands that make the grandparents not as accessible but are not a major factor in determining the woman's response to becoming a grandmother. Being divorced is not a major factor that determines the adaptation of grandparents. The age of the daughter is not a major factor that determines the adaptation of grandparents. The age of the grandparent is a major factor

A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old daughter is expecting her first child. Which is a major factor in determining how this woman will respond to becoming a grandmother? a. Her age b. Her career c. Being divorced d. Age of the daughter

The nurse notes that the hemoglobin level of a woman at 35 weeks of gestation is 11.5 g/dL. The nurses next action should be to a. Note that this is within the normal range for pregnancy b. Note that this is within the normal range for an average adult c. Call the physician; this shows mild anemia d. Recall that the RBC count increases slightly during pregnancy

A. A. The normal range of hemoglobin for pregnancy is greater than 11 g/dL in the first and third trimesters and greater than 10.5 g/dL in the second trimester. B. The normal range of hemoglobin for an average female is 12 to 16 g/dL. With pregnancy the levels are lower due to the increase iron requirements of the fetus. C. The normal range of hemoglobin for pregnancy is greater than 11 g/dL in the first and third trimesters and greater than 10.5 g/dL in the second trimester. The woman's range of 11.5 g/dL would be within normal limits. D. The RBC count decreases slightly because of hemodilution

A pregnant patient of 28 weeks' gestation complains of pain in the right inguinal area. What action by the nurse is best? a. Assess the woman for early labor. b. Position the woman on the right side. c. Palpate the woman's abdomen. d. Document the findings in the chart.

ANS: B Pain in the right inguinal area is most likely due to the round ligament. The nurse can position the woman on her right side to see if that relieves the pain. Heat can also help. There is no need to assess for labor or palpate the abdomen. The findings should be documented after the nurse responds.

4. Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria d. Ketonuria

ANS: B Small amounts of glucose may indicate "physiologic spilling," which occurs because the filtered load exceeds the renal tubules' ability to absorb them. The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

28. The maternity nurse understands that vascular volume increases 40% to 45% during pregnancy to: a. compensate for decreased renal plasma flow. b. provide adequate perfusion of the placenta. c. eliminate metabolic wastes of the mother. d. prevent maternal and fetal dehydration.

ANS: B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume.

3. A woman has several relatives who had gestational hypertension and wants to decrease her risk for it. What information does the nurse provide this woman? (Select all that apply.) a. There is no way to reduce risk factors for gestational hypertension. b. Losing weight before you get pregnant will help prevent it. c. Eating a diet high in protein and iron may help prevent it. d. The father contributes no risk factors for hypertension in pregnancy e. Waiting until you are 35 to get pregnant cuts the risk in half.

ANS: B, C There are many risk factors for gestational hypertension, including obesity and anemia. The woman can take action to address these factors prior to becoming pregnant. The father's risks include the first baby and having fathered other preeclamptic pregnancies. Maternal age >35 increases the risk. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 536 | Box 25.2 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

7. Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth? a. Epulis b. Chloasma c. Telangiectasia d. Striae gravidarum

ANS: D Striae gravidarum, or stretch marks, reflect separation within the underlying connective tissue of the skin. They usually fade after birth, although they never disappear completely. An epulis is a red, raised nodule on the gums that bleeds easily. Chloasma, or mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasia, or vascular spiders, are tiny, star-shaped or branch-like, slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen. These usually disappear after birth.

21. What does the student learn about recent trends in multiple births? a. The rate of twin births has declined. b. The rate of higher order pregnancies has increased. c. Higher order pregnancies are now very rare. d. Twinning is the most common form of multiple pregnancy.

ANS: D Twinning is the most common form of multiple pregnancy, and the rate has been increasing, not declining. Higher order births increased for a time but have now decreased, although they are not rare.

A 25 y/o gravida 2, para 0, L 0, AB 1 African American female comes in for prenatal visit, which of the following is the priority patient education? A) Need for flu immunization B) Education on physiological changes C) Pet waste products should be handled by another family member D) Instruct patient on use of over-the-counter supplements

C) Pet waste products should be handled by another family member

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate? A) My mother lives next door and can drive me here if necessary. B) I have a toddler and preschooler at home who need my attention. C) I know to call my health care provider right away if I start to bleed again. D) I realize the importance of following the instructions for my care.

B) I have a toddler and preschooler at home who need my attention.

A woman in her third trimester complains to the nurse of significant back pain. The nurse questions the client carefully and records a detailed account of her back symptoms. What is the best rationale for the nurse evaluating the client's back symptoms with such care? a) Back pain could be a sign of bladder or kidney infection b) Back pain could be a result of a soft mattress c) Back pain could be a result of improper lifting d) Back pain could be a sign of degenerated discs

Back pain could be a sign of bladder or kidney infection

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

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.

A nurse is teaching a pregnant woman with preterm premature rupture of membranes who is about to be discharged home about caring for herself. Which statement by the woman indicates a need for additional teaching? A) I need to keep a close eye on how active my baby is each day. B) I need to call my doctor if my temperature increases. C) Its okay for my husband and me to have sexual intercourse. D) I can shower but I shouldn't take a tub bath.

C) Its okay for my husband and me to have sexual intercourse.

A woman who is 3 months pregnant enjoys a slow, long walk daily. Which of the following would be most appropriate for her concerning this for the remainder of her pregnancy? a) Engage in aerobics for greater benefits. b) Stop and rest every block. c) Reduce walking to half a block daily. d) Continue this as long as she enjoys it.

Continue this as long as she enjoys it.

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called? a) Pseudo pregnancy b) Cretinism c) Pregnancy syndrome d) Couvade syndrome

Couvade syndrome

Which assessment finding would lead the nurse to suspect infection as the cause of a clients PROM? A) Yellow-green fluid B) Blue color on Nitrazine testing C) Ferning D) Foul odor

D) Foul odor

If a woman is 3 months pregnant, which of the following findings related to breast changes would you expect to assess? a) Slack, soft breast tissue b) Enlarged lymph nodes c) Deeply fissured nipples d) Darkened breast areolae

Darkened breast areolae

The client states that the first day of her last menstrual period is March 23. The nurse is most correct to calculate using Naegele rule that the estimated date of delivery is: December 16 December 30 November 23 January 30

December 30 Using Naegele rule, since the first day of the client's last menstrual period is March 23, 7 days are added leading to the 30th. Subtracting 3 months from March is December. Thus, December 30 is the estimated date of delivery.

When providing preconception care to a client, which medication would the nurse identify as being safe to continue during pregnancy? a) Accutane b) Lithium c) Famotidine d) Warfarin

Famotidine

A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond? a) Fats are not essential during pregnancy and thus are optional b) Fats are essential during pregnancy, and fish such as marlin and orange roughy are good sources c) Fats are essential during pregnancy, and vegetable oils are a good source d) Fats should be avoided during pregnancy

Fats are essential during pregnancy, and vegetable oils are a good source

23. A nurse is assessing a patient's risk factors for preterm labor and birth. Which of the following characteristics of this patient would increase her risk for preterm labor and birth? (Select all that apply.) a. Prior preterm birth b. Periodontal disease c. Body mass index (BMI) of 24 d. Age 37 years e. Intimate partner violence

a,b,d,e

27. A nurse is assisting in the vaginal birth of a patient who has AIDS. Which of the following actions should be a priority for the nurse in this situation? (Select all that apply.) a. Leaving fetal membranes intact b. Using fetal scalp electrodes when possible c. Performing an episiotomy if possible d. Providing and reinforcing education about the disease e. Providing emotional support to the mother

a,d,e

Preconceptual education_______________. a. is only important for patients who are at increased risk for pregnancy complications b. should be offered only if the patients seem interested and are asking questions c. should encompass health promotion, disease prevention, and nutrition for both the male and female d. should focus on what the patient and family are doing wrong before they conceive in order to prevent infertility

c. should encompass health promotion, disease prevention, and nutrition for both the male and female

A nurse is educating a prenatal client at her second visit. The client is worried about "blotchy brown spots" on her forehead. The nurse reassures the client about this change by giving which appropriate response? "Apply over-the-counter bleach cream to the area once a day." "This discoloring could be permanent, and you could use makeup to cover it up." "Avoid sun because it will make the discoloring darker." "This discoloring could be the start of skin cancer. We can refer you to the primary care provider."

"Avoid sun because it will make the discoloring darker." Increased estrogen levels during pregnancy can cause pigmentation to increase. This discoloration is not harmful and will eventually fade; however, sunlight can make it darker. Bleaching is not an appropriate suggestion. The nurse should not tell the client that the discoloration is permanent or a sign of cancer.

Yvonne, a 27-year-old client, is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell Yvonne about the potential effects of smoking in pregnancy? a) "Smoking during pregnancy places your baby at an increased risk of mental retardation." b) "Smoking is unhealthy for anyone's heart, but your baby faces an especially high risk of heart trouble if you smoke while you're pregnant." c) "Babies of women who smoke tend to weigh significantly less than other infants." d) "Smoking during pregnancy means that your child will be born with a dependence on nicotine and will have to endure a period of withdrawal in his or her first days of life."

"Babies of women who smoke tend to weigh significantly less than other infants."

A 27-year-old client is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell the client about the potential effects of smoking in pregnancy? "Smoking is unhealthy for anyone's heart, but your baby faces an especially high risk of heart trouble if you smoke while you're pregnant." "Smoking during pregnancy places your baby at an increased risk of intellectual disability." "Babies of women who smoke tend to weigh significantly less than other infants." "Smoking during pregnancy means that your child will be born with a dependence on nicotine and will have to endure a period of withdrawal in his or her first days of life."

"Babies of women who smoke tend to weigh significantly less than other infants." Smoking during pregnancy is linked with low birth weight but not cardiac anomalies, intellectual disability, or nicotine dependence.

What statement by the patient should the nurse provide correction? A. "I should eat 300 calories more in my first and second trimester." B. "I need to double my caloric intake because I'm eating for two." C. "I need to consume 2-3 liters of fluid daily." D. "I need to limit my caffeine intake to less than 300mg/day."

"I need to double my caloric intake because I'm eating for two."

A pregnant woman at her first prenatal visit asks the nurse if it is safe to have sex during her pregnancy. Which client statement alerts the nurse to the need for further teaching? "I will experience a heightened need for touch throughout my pregnancy." "I should substitute intercourse with nonsexual touch to avoid harming the fetus." "I will avoid having intercourse following the rupture of the membranes." "If I experience bleeding, I will abstain from vaginal intercourse."

"I should substitute intercourse with nonsexual touch to avoid harming the fetus." Sexual needs may be met through sexual intercourse with a partner as long as the pregnancy is healthy and there are no other risk factors, such as bleeding or rupture of membranes. Pregnancy is a time of a heightened need for touch, which may be met partially by sexual expression, but which can also be met through nonsexual touch, such as massage, caressing, or holding.

A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse? "You should talk to the doctor about that; the medications you're on can damage the fetus." "That's great. I've got a 4-year-old and a 2-year-old myself." "I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?"

"I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." Any woman with epilepsy needs to discuss medication management with her provider. The current research indicates the medications used for epileptic management are the major cause of birth defects for these clients. The nurse should be careful about mentioning that some epilepsy medications are teratogenic; some women may stop taking their medications in order to get pregnant. Suggesting adoption is inappropriate as the mother has given no indication she is interested in adoption; also, the mother needs to discuss this with the physician so that she can get accurate information about being on anti-seizure medications and being pregnant. The nurse should not share personal information as it does not assist this client in making a serious decision. The client should be referred to the health care provider to help the client make the best decision.

A client at 36 weeks' gestation comes in for her weekly physician visit. She tells the nurse, "I am having contractions, but they are irregular and go away when I rest. Do you think I am going into labor?" The best response by the nurse would be: a) "These are called Braxton-Hicks contractions and are preparing your body for labor but are not 'true' labor contractions." b) "It is too early for you too be in labor. Something may be wrong with the pregnancy." c) "I think we better send you to the hospital for admission. You could be in labor." d) "I think you are going into labor. We may need to give you medications to stop the contractions."

"These are called Braxton-Hicks contractions and are preparing your body for labor but are not 'true' labor contractions."

When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy? "You need to avoid all prescription, over-the-counter, and herbal medications when you are pregnant." "It is safe for you to take over-the-counter medications." "You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications." "You should switch to herbal remedies because they are safer to use than other types medicines."

"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications." Medication use is common during pregnancy, with prevalence estimates generally exceeding 65% and increasing over the years. Pregnant women use a wide variety of both prescription and over-the-counter medications for both pregnancy-related conditions and conditions unrelated to pregnancy conditions. Little is known about the effects of taking most medications during pregnancy. It is best for pregnant women to not take any medications during their pregnancy. At the very least, they should be encouraged to discuss with the health care provider their current medications and any herbal remedies they take so that they can learn about any potential risks should they continue to take them during pregnancy. A common concern of many pregnant women involves the use of over-the-counter medications and herbal agents. Many women consider these products benign simply because they are available without a prescription. Although herbal medications are commonly thought of as "natural" alternatives to other medicines, they can be just as potent as some prescription medications. The nurse should encourage pregnant women to check with their health care providers before taking anything.

_______ increases during the second half of pregnancy, and it helps in the preparation of mammary glands for lactation and is involved in the process of making glucose available for fetal growth by altering maternal carbohydrate, fat, and protein metabolism.

-hPL

32. The nurse who practices in a prenatal clinic understands that a major concern of lower socioeconomic groups is to a. maintain group health insurance on their families. b. meet health needs as they occur. c. practice preventive health care. d. maintain an optimistic view of life

. ANS: B Because of economic uncertainty, lower socioeconomic groups place more emphasis on meeting the needs of the present rather than on future goals. Lower socioeconomic groups usually do not have group health insurance. They may value health care but cannot afford preventive health care. They may struggle for basic needs and often do not see a way to improve their situation. It is difficult to maintain optimism.

A mother who had a stillbirth 2 months ago stated that she has been trying to get pregnant. The nurse determines that she may be at risk for iron-deficiency anemia. Which advice would the nurse give to this woman? 1. "Take iron supplements." 2. "Continue taking megadoses of vitamins and minerals." 3. "Increase your intake of calcium and magnesium." 4. "Take Folic acid 0.6mg once per day."

1

A nurse is attending to two pregnant clients. The first client was assessed as "early term." The second was assessed as "full term." In order for the nurse to make such assessments, how mature are the clients' pregnancies? 1. The first client is between 37 0/7 weeks and 38 6/7 weeks. The second client is between 39 0/7 weeks and 40 6/7 weeks. 2. The first client is between 41 0/7 weeks and 41 6/7 weeks. The second client is between 42 0/7 weeks and beyond. 3. The first client is between 39 0/7 weeks and 40 6/7 weeks. The second client is between 37 0/7 weeks and 38 6/7 weeks. 4. The first client is between 42 0/7 weeks and beyond. The second client is between 41 0/7 weeks and 41 6/7 weeks.

1

A nurse is caring for a 16-week pregnant client whose obstetrical history includes 5-year-old twins born at 38 weeks gestation and an abortion at 24-weeks after the twins were born. How would the nurse document the client's obstetrical status? 1. G3P2 2. G3P3 3. G2P3 4. G3P4

1

A pregnant client at term visits the clinic and tells the nurse that she is feeling tired all the time. A review of her laboratory results show that her hematocrit level is low. The nurse documented "Fatigue" in the client's health records. Which recommendations by the nurse is correct? 1. "Eat iron-rich foods, ask for assistance from family, and get adequate rest." 2. "Wear loose fitting clothes, elevate legs when sitting, and position yourself on your side when lying." 3. "Maintain adequate hydration, rise slowly from sitting to standing, and avoid lying on your back." 4. "Avoid lying on your back, keep your feet moving when standing, and avoid standing for prolonged periods."

1

The labor nurse is performing a vaginal exam on a patient whose membranes just ruptured spontaneously. The nurse feels a loop of umbilical cord in the vagina. Which nursing action has the highest priority? 1. Lift the presenting part off the umbilical cord. 2. Administer oxygen via face mask. 3. Discontinue oxytocin infusion. 4. Give an IV fluid bolus of 300 cc.

1

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) 1.5 lb b) 2/3 lb c) 2 lb d) 1 lb

1 lb

A client in her second trimester presented at the clinic with a history of vaginal bleeding. She has no history of trauma. Which condition in the client's history would assist the nurse to determine the cause for the bleeding? Select all that apply. 1. Friable cervix 2. Placenta previa 3. Urinary frequency 4. Hyperemesis gravidarum 5. Absence of fetal movement

1, 2

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.

The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that are within normal limits during the latter half of the pregnancy. Which of the following comments by the client indicates that teaching was successful? Select all that apply. 1. "During the third trimester I may experience frequent urination." 2. "During the third trimester I may experience heartburn." 3. "During the third trimester I may experience nagging backaches." 4. "During the third trimester I may experience persistent headache." 5. "During the third trimester I may experience blurred vision."

1, 2, and 3 are correct.

Which of the following findings in an 8-week gestation client, G2 P1001, should the nurse highlight for the nurse midwife? Select all that apply. 1. Body mass index of 17 kg/ mm2. 2. Rubella titer of 1:8. 3. Blood pressure of 100/60 mm Hg. 4. Hematocrit of 30%. 5. Hemoglobin of 13.2 g/dL.

1, 2, and 4 are correct.

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.

A couple that recently emigrated from another country visited the prenatal clinic for the first time. The nurses decided to conduct a cultural assessment of the couple. Which assessment by the nurse could assist in planning a culture-specific prenatal care for this couple? Select all that apply. 1. The couple's expectation of the health care system 2. The couple's need for one-on-one prenatal care 3. The couple's beliefs relating to pregnancy 4. History of intimate partner violence 5. A review of systems

1, 3

A nurse is caring for a full-term pregnant client undergoing an induction with oxytocin. Upon assessment, the nurse determines that the fetus is in distress and identifies a Category III fetal heart rate pattern. The nurse will complete interventions in which order? 1 Discontinue oxytocin. 2 Notify the provider. 3 Change maternal position to left lateral position. 4 Assess emotional response and provide reassurance.

1, 3, 2, 4

During a prenatal appointment, the nurse assesses the client's blood pressure and obtains a reading of 152/94 mmHg. The nurse should assess for which additional symptoms? Select all that apply. 1. Facial edema 2. Dyspnea 3. Vision changes 4. Severe headache 5. Pelvic pressure

1, 3, 4

A couple has decided to terminate their pregnancy based on the results of genetic testing, which showed that the fetus has the genetic disorder trisomy 21. Which of the following are appropriate nursing actions? (Select all that apply) 1. Explain the stages of grief the couple will experience 2. Persuade the couple to reconsider their decision, as a human life is at stake 3. Encourage the couple to communicate with each other and share emotions 4. Refer the couple to a support group available in their community 5. Praise the couple for their decision and explain how difficult it is to raise a child with Down syndrome

1, 3, 4 1. Explain the stages of grief the couple will experience 3. Encourage the couple to communicate with each other and share emotions 4. Refer the couple to a support group available in their community Feedback 1: The nurse should explain the stages of grief the couple will experience. Feedback 2: It would be inappropriate for the nurse to express his or her own opinion regarding the couple's decision; it is their decision to make, and it is not the nurse's place to second-guess it. Feedback 3: The nurse should encourage the couple to communicate with each other and share emotions Feedback 4: The nurse should refer the couple to a support group available in their community. Feedback 5: It would be inappropriate for the nurse to express his or her own opinion regarding the couple's decision, even if in agreement.

A patient has undergone an extensive evaluation to confirm that she is pregnant. Which of the following would constitute a positive sign of pregnancy in this patient? (Select all that apply) 1. Auscultation of a fetal heart beat using a Doppler device 2. Amenorrhea 3. Observation and palpation of fetal movement by the nurse 4. Chadwick's sign 5. Sonographic visualization of the fetus

1, 3, 5 1. Auscultation of a fetal heart beat using a Doppler device 3. Observation and palpation of fetal movement by the nurse 5. Sonographic visualization of the fetus Feedback 1: Auscultation of a fetal heart beat using a Doppler device constitutes a positive sign of pregnancy because it is objective, meaning that the examiner can verify it, and that it can only be attributed to the fetus. Feedback 2: Amenorrhea is a presumptive, not positive, sign of pregnancy, because it is subjective, meaning it is perceived only by the woman herself. Feedback 3: Observation and palpation of fetal movement by the nurse constitute a positive sign of pregnancy because they are objective, meaning that the examiner can verify them, and that they can only be attributed to the fetus. Feedback 4: Chadwick's sign, which is a bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6 to 8 weeks, is a probable, not positive, sign of pregnancy, because it can be caused by factors other than pregnancy. Feedback 5: Sonographic visualization of the fetus constitutes a positive sign of pregnancy because it is objective, meaning that the examiner can verify it, and that it can only be attributed to the fetus.

A nurse is reviewing triggers from the Early Obstetric Warning System Chart after a client has had concerning changes in her condition. Which assessment findings would be classified as a red trigger? Select all that apply. 1. Systolic BP < 90, >160 2. Maternal heart rate 100 to 120 (beats per minute) 3. Respiratory rate 21 to 30 (breaths per minute) 4. Oxygen saturation < 95% 5. Diastolic BP > 100

1, 4, 5

An ultrasound of a fetus' heart shows that "normal fetal circulation is occurring." Which of the following statements is consistent with the finding? 1. A right to left shunt is seen between the atria 2. Blood is returning to the placenta via the umbilical vein 3. Blood is returning to the right atrium from the pulmonary system 4. A right to left shunt is seen between the umbilical arteries

1. A right to left shunt is seen between the atria The foramen ovale is a duct between the atria. In fetal circulation, there is a right to left shunt through the duct

A client who is 34 weeks' pregnant arrives at the emergency department with severe abdominal pain, uterine tenderness, and increased uterine tone between contractions, but no vaginal bleeding. The external fetal monitor shows fetal distress with severe, variable decelerations. Which condition does the nurse anticipate this client will be treated for? 1. Abruptio placentae 2. Ectopic pregnancy 3. Molar pregnancy 4. Placenta previa

1. Abruptio placentae A client with severe abruptio placentae will commonly have severe abdominal pain. The uterus will start to show signs of distress, with decelerations in the heart rate or even fetal death with a large placental separation. An ectopic pregnancy, which usually occurs in the fallopian tubes, would rupture well before 34 weeks. A molar pregnancy generally would be detected before 34 weeks' gestation. Placenta previa usually involves painless vaginal bleeding without uterine contractions.

The nursing instructor asks a nursing student to list the characteristics of the amniotic fluid. The student responds correctly by listing which as characteristics of amniotic fluid? Select all that apply. 1. Allows for fetal movement 2. Surrounds, cushions, and protects the fetus 3. Maintains the body temperature of the fetus 4. Can be used to measure fetal kidney function 5. Prevents large particles such as bacteria from passing to the fetus 6. Provides an exchange of nutrients and waste products between the mother and the fetus

1. Allows for fetal movement 2. Surrounds, cushions, and protects the fetus 3. Maintains the body temperature of the fetus 4. Can be used to measure fetal kidney function The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the mother and the fetus.

A pregnant client in the second trimester is scheduled for amniocentesis. What should the nurse do to prepare the client for the procedure? (Select all that apply) 1. Ask the client to void. 2. Have the client drink 1 L of fluid. 3. Ask the client to lie on her left side. 4. Assess fetal heart rate. 5. Insert an IV catheter. 6. Monitor maternal vital signs.

1. Ask the client to void. 4. Assess fetal heart rate. 6. Monitor maternal vital signs. To prepare a client for amniocentesis, the nurse should ask her to empty her bladder to reduce the risk of bladder perforation. Before the procedure, the nurse should also assess fetal heart rate and maternal vital signs to establish baselines. The client should be asked to drink 1 L of fluid before transabdominal ultrasound, not amniocentesis. The client should be supine during amniocentesis; afterward, she should be placed on her left side to avoid supine hypotension, promote venous return, and ensure adequate cardiac output. IV access isn't necessary for this procedure.

A 36-week gestation client is being seen in the prenatal clinic. Where would the nurse expect the fundal height to be felt? 1. At the xiphoid process 2. At a point between the umbilicus and the xiphoid 3. At the umbilicus 4. At a level directly above the symphysis pubis

1. At the xiphoid process At 36 weeks' gestation, the fundus should be felt at the xiphoid process At 20 weeks' gestation, the fundus should be felt at the umbilicus At 12 weeks' gestation, the fundus should be felt directly above the symphysis pubis

The nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Which are probable signs of pregnancy? Select all that apply. 1. Ballottement 2. Chadwick's sign 3. Uterine enlargement 4. Braxton Hicks contractions 5. Fetal heart rate detected by a nonelectronic device 6. Outline of fetus via radiography or ultrasonography

1. Ballottement 2. Chadwick's sign 3. Uterine enlargement 4. Braxton Hicks contractions The probable signs of pregnancy include uterine enlargement, Hegar's sign (compressibility and softening of the lower uterine segment that occurs at about week 6), Goodell's sign (softening of the cervix that occurs at the beginning of the second month), Chadwick's sign (violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 4), ballottement (rebounding of the fetus against the examiner's fingers on palpation), Braxton Hicks contractions, and a positive pregnancy test for the presence of human chorionic gonadotropin. Positive signs of pregnancy include fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation, active fetal movements palpable by the examiner, and an outline of the fetus by radiography or ultrasonography.

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 pain medicine used in labor. 3. Provide the couple with a list of items that they should take to the hospital for the labor and delivery. 4. Give the high-risk couple a sense of control over the likelihood of having a surgical delivery.

1. Birth plans help to facilitate communication between couples and their health care providers.

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.

A nurse is discussing diet with a pregnant woman. Which of the following foods should the nurse advise the client to avoid during her pregnancy? 1. Brie cheese 2. Bartlett pears 3. Sweet potatoes 4. Grilled lamb

1. Brie cheese Soft cheese may harbor Listeria. The client should avoid consuming uncooked soft cheese

A client with severe preeclampsia is receiving an intravenous infusion of magesium sulfate. The client is exhibiting signs and symptoms of magnesium toxicity. Which medication would the nurse expect to be given? 1. Calcium gluconate 2. Hydralazine 3. Naloxone 4. Rho(D) immune globulin

1. Calcium gluconate Calcium gluconate is the antidote for magnesium toxicity. Ten milliliters of 10% calcium gluconate is given by IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressure in clients with preeclampsia. Naloxone is used to correct narcotic toxicity. Rho(D) immune globulin is given to women with Rh-negative blood to prevent antibody formation from Rh-positive conceptions.

The nurse is interviewing a gravid client during the first prenatal visit. The client confides to the nurse that she owns a number of pet animals. The nurse should advise the client to be especially careful to refrain from coming in contact with the stools of which of the pets? 1. Cat 2. Dog 3. Hamster 4. Bird

1. Cat The client should refrain from coming into contact with cat feces. Cats often harbor toxoplasmosis, a teratogenic illness

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 of their teeth and gums. Ptyalism is often accompanied by gingivitis and nausea and vomiting.

A client in her early second trimester tells the nurse that she is experiencing a significant amount of heartburn. Which suggestion would be most appropriate for the nurse to make? (Select all that apply.) 1. Eat small, frequent meals throughout the day 2. Eat crackers on waking every morning. 3. Drink a preparation of salt and vinegar 4. Drink orange juice frequently during the day. 5. Keep the head of the bed elevated

1. Eat small, frequent meals throughout the day 5. Keep the head of the bed elevated Eating small, frequent meals and keeping the head of the bed elevated place less pressure on the esophageal sphincter, reducing the likelihood of the regurgitation of stomach contents into the lower esophagus. Eating crackers, drinking a salt and vinegar solution, or drinking orange juice have not been shown to decrease heartburn.

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. Diarrhea. 2. Pedal edema. 3. Blurred vision. 4. Tinnitus.

1. Evening primrose has been shown to cause skin rash in some women.

A pregnant client develops iron-deficiency anemia and is prescribed supplemental iron along with prenatal vitamins. After reviewing possible adverse effects of iron supplementation with the client, the nurse determines that the education was successful when the client identifies which adverse effect? (Select all that apply) 1. Gastric upset 2. Bright red blood in stools 3. Constipation 4. Anorexia 5. Metallic taste

1. Gastric upset 3. Constipation 4. Anorexia 5. Metallic taste Adverse effects of iron supplementation include gastric upset, nausea, vomiting, anorexia, diarrhea, metallic taste, and constipation. Typically, iron makes stools appear black and tarry. Bright red blood in the stools is not associated with iron therapy.

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.

Because nausea and vomiting are such common complaints of pregnant women, the nurse provides anticipatory guidance to a 6-week gestation client by telling her to do which of the following? 1. Avoid eating greasy foods. 2. Drink orange juice before rising. 3. Consume 1 teaspoon of nutmeg each morning. 4. Eat 3 large meals plus a bedtime snack.

1. Greasy foods should be avoided.

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.

During a routine visit to the clinic, a client tells the nurse that she thinks she may be pregnant. Which pregnancy test result would the nurse identify as most accurate in confirming pregnancy? 1. Increase in human chorionic gonadotropin (HCG) 2. Decrease in HCG 3. Increase in luteinizing hormone (LG) 4. Decrease in LH

1. Increase in human chorionic gonadotropin (HCG) HCG increases in a woman's blood an uterine to fairly large concentrations until the 15th week of pregnancy. The other hormone values aren't indicative of pregnancy.

Which of the following S&S would the nurse expect to see in a woman with concealed abruption placentae? 1. Increasing abdominal girth measurements 2. Profuse vaginal bleeding 3. Bradycardia with an aortic thrill 4. Hypothermia with chills

1. Increasing abdominal girth measurements The nurse would expect to see increasing abdominal girth measurements Profuse vaginal bleeding rarely seen in abruption placentae and is never seen when abruption is concealed With excessive blood loss, the nurse would expect to see tachycardia Temp would be stable

A nurse calculates a patient's body mass index (BMI) and finds it to be 37. The nurse understands that this patient is at increased risk for which of the following pregnancy-related outcomes? 1. Infertility 2. Low blood pressure 3. Vaginal delivery 4. Small for gestational age neonate

1. Infertility Obesity, which is defined as having a BMI of greater than or equal to 30.0, increases a woman's risk for infertility. Obesity, which is defined as having a BMI of greater than or equal to 30.0, increases a woman's risk for antepartum hypertension (high blood pressure), not low blood pressure. Obesity, which is defined as having a BMI of greater than or equal to 30.0, increases a woman's risk of having to undergo a cesarean delivery, not a vaginal delivery. Obesity, which is defined as having a BMI of greater than or equal to 30.0, increases a woman's risk of delivering a neonate who is large for gestational age, not small.

A patient has just learned that she is pregnant and would like to know when her estimated date of delivery (EDD) is. The nurse should tell the patient that most likely she will be told her EDD at which visit? 1. Initial visit (today) 2. Follow-up visit in 4 weeks 3. First visit of the second trimester 4. Second visit of the second trimester

1. Initial visit (today) The patient's EDD will be determined at the initial visit.

The nurse is providing health teaching to a group of gravid women. One woman, who states that is a smoker, asks about its impact on her pregnancy. The nurse responds that which of the following fetal complications may develop? 1. Low neonatal birth weight 2. Excess pregnancy weight 3. Severe neonatal anemia 4. Maternal hyperbilirubinemia

1. Low neonatal birth weight Low neonatal birth weight is the most common complication seen in pregnancies complicated by cigarette smoking

A nurse is providing preconception counseling to a woman who is hoping to become pregnant for the first time. Which of the following terms most accurately describes this patient's status and thus should be recorded in the patient's health record? 1. Nulligravida 2. Primigravida 3. Multigravida 4. Gravida

1. Nulligravida A nulligravida is a woman who has never been pregnant or given birth, which applies to the patient in this case. A primigravida is a woman who is pregnant for the first time. A multigravida is a woman who is pregnant for at least the second time. Gravida refers to the number of times a woman has been pregnant.

A nurse is explaining the process of the development of sperm to a couple who are having trouble conceiving and who are being tested for possible infertility. Which of the following should the nurse mention as the site of spermatogenesis, or the production of sperm? 1. Seminiferous tubules 2. Seminal vesicles 3. Prostate gland 4. Bulbourethral glands

1. Seminiferous tubules Spermatogenesis takes place in the seminiferous tubules within the testes. Seminal vesicles produce secretions that contain fructose, which is an energy source for sperm, but not the sperm themselves. The prostate gland secretes an alkaline fluid that enhances sperm mobility, but does not produce the sperm themselves. The bulbourethral glands, also referred to as Cowper's glands, secrete an alkaline solution that coats the interior of the urethra to neutralize the acidic urine that is present. They do not produce the sperm.

A pregnant client tells the clinic nurse that she wants to know the gender of her baby as soon as it can be determined. The nurse understands that the client should be able to find out the gender at 12 weeks' gestation because of which factor? 1. The appearance of the fetal external genitalia 2. The beginning of differentiation in the fetal groin 3. The fetal testes are descended into the scrotal sac 4. The internal differences in males and females become apparent

1. The appearance of the fetal external genitalia By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the gender of the fetus can be determined visually. Differentiation of the external genitalia occurs at the end of the ninth week. Testes descend into the scrotal sac at the end of the thirty-eighth week. Internal differences in the male and female occur at the end of the seventh week.

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.

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.

d) Walk for 30 minutes 5 days a week Pg. 287 For a sedentary client a walking program is an appropriate goal. Dieting/weight reduction is never recommended during pregnancy. A daily aerobic or weight lifting program are not appropriate goals for a sedentary client with a high BMI.

1. The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client? a) Begin lifting weights for 30 minutes per day b) Adhere to a weight reduction diet c) Participate in a daily aerobic dance program d) Walk for 30 minutes 5 days a week

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.

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.

A gravid woman and her husband inform the nurse that they have just moved into a three-story home that was built in the 1930s. Which of the following is critical for the nurse to advise the woman to protect the unborn child? 1. Stay out of any rooms that are being renovated. 2. Drink water only from the hot water tap. 3. Refrain from entering the basement. 4. Climb the stairs only once per day.

1. The woman should stay out of rooms that are being renovated.

The nurse is teaching a couple about fetal development. Which statement by the nurse is correct about the morula stage of development? 1. "The fertilized egg has yet to implant into the uterus." 2. "The lung fields are finally completely formed." 3. "The sex of the fetus can be clearly identified." 4. "The eyelids are unfused and begin to open and close."

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.

A nurse, who is providing nutrition counseling to a new gravid client, advises the woman that a serving of meat is approximately equal in size to which of the following items? 1. Deck of cards. 2. Paperback book. 3. Clenched fist. 4. Large tomato.

1. This is an accurate statement. A serving of meat—typically a 2 to 3 oz serving—is approximately equal to a deck of cards.

A client, 8 weeks' pregnant, comes to the emergency department with reports of severe, stabbing, lower abdominal pain. A ruptured ectopic pregnancy is suspected based on which signs and symptoms? (Select all that apply) 1. Thready, rapid pulse 2. Increased blood pressure 3. Scant vaginal bleeding 4. Abdominal tenderness with distention 5. Referred shoulder pain

1. Thready, rapid pulse 3. Scant vaginal bleeding 4. Abdominal tenderness with distention 5. Referred shoulder pain Signs and symptoms associated with an ectopic pregnancy include a rapid, thready pulse and decreased blood pressure due to internal bleeding, scant vaginal bleeding, abdominal tenderness with distention, and referred shoulder pain due to irritation of the phrenic nerve.

As a patient is lying down for an antepartum examination, the nurse instructs her to lie on her side. Which of the following is the primary rationale for this instruction? 1. To prevent supine hypotensive syndrome 2. To maximize the patient's comfort 3. To prevent diastasis recti 4. To prevent lordosis

1. To prevent supine hypotensive syndrome Supine hypotensive syndrome is a hypotensive condition resulting from a woman lying on her back in mid- to late pregnancy. In a supine position, the enlarged uterus compresses the inferior vena cava, leading to a significant drop in cardiac output and blood pressure, and resulting in the woman feeling dizzy and faint. Although the side-lying position may be the most comfortable for the client, it is not the primary reason for the instruction: prevention of supine hypotensive syndrome is. The side-lying position would not prevent diastasis recti, which is the separation of the rectus abdominis muscle in the midline caused by abdominal distention. The side-lying position would not prevent lordosis, which is abnormal an

A client is diagnosed with hyperemesis gravidarum after coming to the antepartum unit with persistent vomiting, weight loss, and hypovolemia. While gathering data from the client, which information is most significant? 1. Trophoblastic disease 2. Maternal age older than 35 years 3. Malnutrition 4. Low levels of human chorionic gonadotropin (HCG)

1. Trophoblastic disease Trophoblastic disease is associated with hyperemesis gravidarum. Obesity and maternal age younger than 20 years are risk factors for developing hyperemesis gravidarum. High levels of estrogen and HCG have been associated with hyperemesis.

A pregnant client is lactose intolerant. Which of the following foods could this woman consume to meet her calcium needs? 1. Turnip greens. 2. Green beans. 3. Cantaloupe. 4. Nectarines.

1. Turnip greens are calcium rich

A nurse should teach a client who is pregnant for the first time that she should be able to feel the baby move at about how many weeks gestation? a) 14 to 16 b) 10 to 12 c) 12 to 14 d) 18 to 20

18 to 20

c) 50% of women report pyrosis at some point in pregnancy Pg. 298 Fifty percent of pregnant women have nausea and vomiting. Only 1 in 200 or 1 in 300 women develop hyperemesis gravidarum (severe nausea and vomiting). Hypercholesterolemia predisposes women to development of cholelithiasis (gallstones).

19. Which of the following is true regarding problems that commonly affect nutritional health in pregnancy? a) 15% of women develop hyperemesis gravidarum b) Although nausea is very common in pregnancy, vomiting is rare and is a concern only in women with hyperemesis gravidarum c) 50% of women report pyrosis at some point in pregnancy d) Women who have hyperemesis gravidarum are at highest risk for developing cholelithiasis

A 19-year-old primigravida client's initial prenatal laboratory results show that she has Rh negative blood. Which action by the nurse is correct? 1. Provide antiretroviral therapy during pregnancy and around the time of delivery. 2. Rescreen the client in the second trimester and give RhoGAM at 28-weeks. 3. Monitor for signs and symptoms of anemia and give the client iron supplements. 4. Request a cytology screening every 3 years.

2

The nurse is admitting a client whose blood type is A-negative and had a miscarriage at 5-weeks gestation. which is the appropriate nursing intervention? 1. Prepare the client for a dilation and curettage (D&C) 2. Administer Rho (D) Immune Globulin (RhoGAM) 3. Instruct the client to use contraception for the next 6 months 4. Perform an ultrasound to confirm all products of conception have been expelled

2

The nurse is obtaining a 24-hour diet history from a pregnant client. which food consumed by the client would indicate the need for further teaching by the nurse? 1. Pasteurized milk 2. Alfalfa sprouts 3. Cheddar cheese 4. A cup of coffee

2

A client is in the 10th week of her pregnancy. Which of the following symptoms would the nurse expect the client to exhibit? Select all that apply. 1. Backache. 2. Urinary frequency. 3. Dyspnea on exertion. 4. Fatigue. 5. Diarrhea.

2 and 4 are correct

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? Select all that apply. 1. Glucose. 2. Fibrinogen. 3. Hematocrit. 4. Bilirubin. 5. White blood cells.

2 and 5 are correct.

The nurse educator is teaching a class of pregnant teenagers about the importance of receiving regular prenatal care. which are the maingoals of prenatal care that the nurse would include in the teaching? Select all that apply. 1. To complete a one-time assessment of health risk status of the pregnancy 2. To provide referrals to resources 3. To maintain maternal fetal health 4. To build rapport with the physician and nursing staff 5. To determine the gestational age of the fetus

2, 3, 5

The nurse is reviewing the prenatal history of a post-term pregnant patient during an appointment in the provider office. It has been determined that the patient will need to be admitted for an induction. Upon reviewing the patient's history, which conditions does the nurse report to the provider that would prohibit the patient from having labor induction? Select all that apply. 1. A lower transverse uterine incision from a previous cesarean section 2. A vertical uterine incision from a previous cesarean section 3. A history of a precipitous birth that occurred at home 4. A fetus in the breech position 5. A history of human papillomavirus infection (HPV)

2, 4

The nurse is preparing to administer an oxytocin infusion for labor induction for a patient who is post-term. Which of the following are true regarding oxytocin for induction of labor? Select all that apply. 1. The starting dose is 5 to 10 mU/min. 2. The dose is increased by 1 to 2 mU/min every 30 to 60 minutes, until adequate labor progress is achieved. 3. Oxytocin can be given via IV infusion or by IM injection for induction. 4. Tachysystole is a potential side effect. 5. Water intoxication can occur.

2, 4, 5

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

The nurse is teaching a childbirth education class. Which statements regarding induction of labor would be included in the teaching? Select all that apply. 1. Labor induction is used only for medical reasons. 2. Prior to using oxytocin for labor induction, the cervix should be favorable. 3. As long as you are over 37 weeks gestation, your doctor may induce you for convenience. 4. The risks of labor induction are the same as the risks with spontaneous labor. 5. You should not have a labor induction if you have active herpes.

2, 5

A nurse is instructing a patient on how to avoid nausea and vomiting during her first trimester. Which of the following should the nurse mention? 1. Take vitamins first thing in the morning 2. Drink ginger ale 3. Brush teeth before eating 4. Eat at a rapid pace

2. Drink ginger ale The patient should take vitamins at bedtime with a snack, not in the morning. The patient should drink cold, clear carbonated beverages such as ginger ale. The patient should brush her teeth after, not before, eating. The patient should eat at a slow, not rapid, pace.

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.

A pregnant client who reports painless vaginal bleeding at 28 weeks' gestation is diagnosed with placenta previa, in which the placental edge reaches the internal os. The nurse would suspect the client has which type of placenta previa? 1. Low-lying placenta previa 2. Marginal placenta previa 3. Partial placenta previa 4. Total placenta previa

2. Marginal placenta previa A marginal placenta previa is characterized by implantation of the placenta in the margin of the cervical os, not covering the os. A low-lying placenta is implanted in the lower uterine segment but doesn't reach the cervical os. A partial placenta previa is the partial occlusion of the cervial os by the placenta. The internal cervical os is completely covered by the placenta in a total placenta previa.

A patient in her 20th week of gestation is concerned because she has developed a brownish pigmentation of the skin over her cheeks, nose, and forehead. The nurse should explain that this phenomenon is normal and that it is known as which of the following? 1. Linea nigra 2. Melasma 3. Striae 4. Palmar erythema

2. Melasma (chloasma), also referred to as mask of pregnancy, is a brownish pigmentation of the skin over the cheeks, nose, and forehead. Linea nigra is a type of hyperpigmentation of the skin caused by increased levels of estrogen and progesterone and characterized by a darkened line in the middle of the abdomen. Striae, or stretch marks, are streaks of pigmentation on the skin of the breasts, hips, abdomen, and buttocks resulting from stretching in these areas and the subsequent tearing of subcutaneous connective tissue and/or collagen. Palmar erythema is a redness in the palms of the hands resulting from vascular changes related to hormonally induced increased elasticity of vessels and increased venous pressure from an enlarged uterus.

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.

A nurse is calculating a patient's estimated date of delivery (EDD) using Naegele's rule. Given that the patient's first day of her last normal menstrual period (LMP) was January 11, which of the following should the nurse determine is the woman's EDD? 1. October 11 2. October 18 3. October 4 4. October 25

2. October 18 Naegele's rule, which is the standard formula for determining EDD based on the LMP, is calculated as follows: first day of LMP - 3 months + 7 days = EDD. Thus, in this case, the equation would be as follows: January 11 - 3 months + 7 days = October 18.

A nurse is caring for a 30-week gestation client who is high risk for preterm labor. The nurse would expect that the client would exhibit which of the following test results? 1. Marked amniotic fluid density 2. Positive fetal fibronectin test 3, Cervix that is over 1 inch long 4. Biophysical profile of 10

2. Positive fetal fibronectin test A 30-week gestation client with a positive fetal fibronectin test is high risk for preterm labor Marked amniotic fluid density may be seen in pregnancies complicated by blood incompatibilities. It is not associated with preterm labor A 30-week gestation client with a cervix that is SHORTER than 1 inch is high risk for preterm labor A biophysical profile is performed to determine the well-being of the fetus. It is not related to preterm labor

The nurse notes each of the following findings in a 12-week gestation client. Which of the finding would enable the nurse to tell the client that she is PROBABLY pregnant? 1. Fetal heart rate via Doppler 2. Positive pregnancy test 3. Positive ultrasound assessment 4. Absence of menstrual period

2. Positive pregnancy test A positive pregnancy test is a PROBABLE sign of pregnancy. It is not a POSITIVE sign since the hormone tested for - human chorionic gonadotropin (hCG) - may be produced by, for example, a hydatidiform mole FHR is a positive sign Positive ultrasound is a positive sign Amenorrhea is a presumptive sign

A nurse is assisting with the education of a client who receives a dose of human Rho(D) immune globulin at 28 weeks' gestation to prevent Rh isoimmunization. What should the nurse inform the client regarding the reason for administering the medication? 1. Rh-Positive maternal blood crosses into fetal blood, stimulating fetal antibodies. 2. Rh-Positive fetal blood crosses into maternal blood, stimulating maternal antibodies. 3. Rh-negative fetal blood crosses into maternal blood, stimulating maternal antibodies. 4. Rh-negative maternal blood crosses into fetal blood, stimulating fetal antibodies.

2. Rh-Positive fetal blood crosses into maternal blood, stimulating maternal antibodies. Rh isoimmunization occurs when Rh-positive fetal blood cells cross into the maternal circulation and stimulate maternal antibody production. In subsequent pregnancies with Rh-positive fetuses, maternal antibodies may cross back into the fetal circulation and destroy the fetal blood cells.

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.

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.

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

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.

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.

A nurse is developing a standard of care plan for teen women in an obstetrical clinic. Which f the following client care outcomes would be appropriate to include in the plan of care? 1. The teen gravida will have her fetus assessed for chromosomal anomalies 2. The teen gravida will eat a diet high in calcium and iron 3. The teen gravida will deliver the baby before 37 weeks gestation 4. The teen gravida will gain no more than 25 pounds during the pregnancy

2. The teen gravida will eat a diet high in calcium and iron Teens tend to consume less calcium and iron than they should consume during their pregnancies; therefore. this is an appropriate patient care outcome for pregnant teens

A client who was seen in the prenatal clinic at 20 weeks' gestation weighed 128 lb at that time. Approximately how many pounds would the nurse expect the client to weigh at her next visit at 24 weeks' gestation? 1. 129 to 130 lb. 2. 131 to 132 lb. 3. 133 to 134 lb. 4. 135 to 136 lb.

2. The woman would be expected to weigh 131 to 132 lb. At this stage of pregnancy, the woman is expected to gain about 0.8 to 1 lb a week.

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 cup cottage cheese, 8 oz whole milk, 1 cup 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 cottage cheese.

2. This client consumed 31/2 servings: 1 cup yogurt = 1 serving, 8 oz chocolate milk = 1 serving; 1 cup cottage cheese = 1/2 serving; and 11/2 oz hard cheese = 1 serving.

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.

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.

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.

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.

b) "Usually after 12 weeks, when the placenta starts managing the production of progesterone, morning sickness ends" Pg. 295 The nurse commonly instructs on morning sickness as it is a common discomfort of early pregnancy. By 12 weeks' gestation, the placenta has grown sufficiently to take over production of progesterone and the corpus luteum is absorbed. Most clients who have morning sickness start feeling better once the placenta takes over. It is uncommon to have morning sickness late in pregnancy or throughout the entire pregnancy. Estrogen is maintained throughout pregnancy and does not become depleted.

20. A pregnant client states, "I am only 6 weeks' pregnant and I have been absent from work five times due to morning sickness. Most days, I am just able to get there. When is it going to stop?" What is the appropriate response by the nurse? a) "Morning sickness is going to occur for the first 16 weeks of the pregnancy, until estrogen stores are depleted" b) "Usually after 12 weeks, when the placenta starts managing the production of progesterone, morning sickness ends" c) "Since you are so sensitive to hormonal levels of pregnancy, you will have morning sickness your entire pregnancy" d) "Morning sickness is part of pregnancy for some women until the third trimester when the fetus is just gaining weight"

c) Make sure the client receives nutritional counseling and reinforce the teaching Pg. 286 There are many important nursing interventions for an adolescent who is pregnant. Nutritional counseling must be emphasized as part of prenatal care for adolescent clients because adolescents already have higher nutritional demands due to their growth status. Nutrition is also a priority due to the fetus' development. Adolescents are not at increased risk for developing gestational diabetes, so the client does not need a glucose tolerance test at this time. Adolescents do need 8 to 10 hours of sleep per night, but this is not the priority education over nutrition education. Instruction on fetal development at the first visit may be overwhelming and is not the priority at this time.

21. The nurse is praising an adolescent for seeking health care as soon as the adolescent found out about being pregnant. Which nursing intervention is the priority for this client in the first trimester of pregnancy? a) Schedule the client for a screening glucose tolerance test b) Teach the client about needing 8 to 10 hours of sleep each night c) Make sure the client receives nutritional counseling and reinforce the teaching d) Instruct on fetal development throughout the pregnancy

d) More consistent regulation of glucose and insulin Pg. 288 Advise women to obtain their carbohydrate calories from complex carbohydrates (cereals and grains) rather than simple carbohydrates (sugar and fruits) because complex carbohydrates are more slowly digested. Doing so will help regulate glucose and insulin levels more consistently. All carbohydrates contain roughly the same amount of calories per gram (4 kcal/g). Carbohydrates of any kind are not a significant source of fatty acids.

23. A nurse counsels a pregnant woman regarding her recommended daily allowance of calories. She advises her to obtain her carbohydrate calories from complex carbohydrates rather than simple carbohydrates. What is the best rationale for this guidance? a) Faster digestion of complex than simple carbohydrates b) Greater fatty acid content c) Provision of a greater amount of calories per gram d) More consistent regulation of glucose and insulin

The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? 30 cm 32 cm 24 cm 18 cm

24 cm An anticipated fundal height for 24 weeks' gestation (6 months) is 24 cm. Between 18 and 32 weeks' gestation, the fundal height in centimeters should match the gestational age. All of the other measurements would require further intervention.

c) Inadequate calcium for skeletal growth Pg. 292 Lactose intolerance can lead to inadequate calcium intake, which can impact fetal skeletal growth. There are many nondairy sources of protein. Iron and folate intake are not altered by lactose intolerance.

24. When caring for a client with lactose intolerance, the nurse would be aware of which potential problem during pregnancy? a) Inadequate folate for neural tube closure b) Inadequate iron for red blood cell production c) Inadequate calcium for skeletal growth d) Inadequate protein for muscle development

a) Severe dehydration resulting in hypoperfusion of the placenta Pg. 304 With severe dehydration there is hypoperfusion to the placenta, and preterm labor may be initiated. Ketonuria impacts the fetus' neurologic development but does not initiate preterm labor. Medications used to control nausea and vomiting do not induce labor.

26. Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth? a) Severe dehydration resulting in hypoperfusion of the placenta b) Class B drugs used to control the vomiting resulting in uterine contractions c) Ketonuria resulting in neurologic changes in the fetus d) Poor nutrient intake resulting in poor fetal growth

A nurse is performing a physical assessment on a newborn who was born 6 hours ago via a vacuum-assisted vaginal birth. The mother states, "I am concerned about the cephalohematoma on my baby's head. Can you tell me more about the condition?" Which statement would be most appropriate by the nurse? 1. "No need to worry. Cephalohematoma is caused by the cranial bones changing shape to get through the maternal pelvis." 2. "Cephalohematoma is a concern and I need to call the pediatrician right away." 3. "Although cephalohematoma is self-limiting, it can put your baby at risk for jaundice." 4. "Cephalohematoma only occurs with vacuum-assisted birth; I'm sure it will be fine."

3

A nurse is providing prenatal education to a group of primigravida clients with gestational diabetes. Which is the nurse's best explanation for increased maternal insulin needed during the second trimester? 1. "Human chorionic gonadotropin (hCG) causes maternal insulin resistant." 2. "Degesterone causes maternal insulin resistant." 3. "Human chorionic somatomammotropin (hCS) causes maternal insulin resistant." 4. "Oxytocin causes maternal insulin resistant."

3

A patient in labor is noted to have an occiput posterior presentation. Which complications would the nurse anticipate? 1. Prolapsed cord 2. Facial bruising in neonate 3. Dystocia 4. Shortened second stage

3

After completing a physical examination of a pregnant women, the nurse states, "You are definitely pregnant." Which positive finding would have prompted the nurse to make that statement? 1. An enlarged abdomen 2. Hyperpigmentation of the skin 3. The palpation of fetal movement 4. An increase in the vascularity of the breasts

3

The nurse is caring for a term gestation pregnant patient who is desiring an external cephalic version (ECV). Which statement made by the patient would indicate that further education is required? 1. "During this procedure, my provider will manually turn by baby vertex by manipulating my abdomen." 2. "I will need a dose of Anti-D immune globulin since I do not plan to be induced in the next few days and my blood type is Rh-negative." 3. "The ECV procedure will also help move my vasa previa out of the way so I can deliver vaginally." 4. "You are going to place monitors on my belly to see if I am contracting, and I may need a dose of medication to stop my contractions if needed."

3

A nurse is providing preconception counseling to a woman. Which prenatal vitamin should the nurse recommend to the patient specifically to reduce the risk of neural tube defects? 1. Calcium 2. Vitamin D 3. Folic acid 4. Iron

3. Folic acid Calcium, magnesium, and vitamin D contribute to bone health and prevention of osteoporosis throughout the life span, including during the childbearing years. Folic acid supplementation decreases the risk of neural tube defects. Iron supplementation is not associated with prevention of neural tube defects.

A woman who has had no prenatal care was found to have hydramnios (excessive amniotic fluid) on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings? 1. Pyelonephritis 2. Pregnancy-induced hypertention 3. Gestational diabetes 4. Abruptio placentae

3. Gestational diabetes Untreated gestational diabetics often have hydramnios and often deliver macrosomic (big body) babies

A client hospitalized for premature labor tells the nurse she's having occasional contractions. Which nursing intervention would be most appropriate? 1. Inform the client about the possible complications of premature birth 2. Tell the client to walk around to see if she can get rid of contractions. 3. Give IV and oral fluids, encouraging her to empty her bladder 4. Notify the anesthesia department for immediate epidural placement for pain relief.

3. Give IV and oral fluids, encouraging her to empty her bladder An empty bladder and adequate hydration may help decrease or stop labor contractions. Educating the client on potential complications is likely to increase her anxiety rather than help her relax. Walking may encourage contractions to become stronger. It would be inappropriate to call the anesthesia department to have an epidural placed because further assessment of the contractions is necessary.

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 heartbeat often increases fathers' interests in their partners' pregnancies.

The nurse is performing an assessment on a client who is at 38 weeks' gestation and notes that the fetal heart rate is 174 beats/minute. On the basis of this finding, what is the priority nursing action? 1. Document the finding. 2. Check the mother's heart rate. 3. Notify the health care provider (HCP). 4. Tell the client that the fetal heart rate is normal.

3. Notify the health care provider (HCP). The fetal heart rate (FHR) depends on gestational age and ranges from 160 to 170 beats/minute in the first trimester, but slows with fetal growth to 110 to 160 beats/minute near or at term. At or near term, if the FHR is less than 110 beats/minute or more than 160 beats/minute with the uterus at rest, the fetus may be in distress. Because the FHR is increased from the reference range, the nurse should notify the HCP. Options 2 and 4 are inappropriate actions based on the information in the question. Although the nurse documents the findings, based on the information in the question, the HCP needs to be notified.

Antepartum testing from a client pregnant with twins reveals a twin-to-twin transfusion syndrome. The nurse is assisting with development of a plan of care. Which condition will the nurse likely provide interventions for? 1. Anemia 2. Oligohydramnios 3. Polycythemia 4. Small size

3. Polycythemia the recipient twin in twin-to-twin transfusion syndrome (also known as twin-twin transfusion syndrome) is transfused by the other twin. The recipient twin then becomes polycythemic and commonly as heart failure due to circulatory overload. The donor twin becomes anemic. The recipient twin has polyhydramnios, not oligohydramnios. The recipient twin is usually large, whereas the donor twin is usually small in size.

A pregnant client is obese. The nurse is working as part of the interdisciplinary team developing the client's plan of care. Based on the understanding of potential complications, the nurse would expect to monitor the client closely for which condition on follow-up visits? 1. Mastitis 2. Placenta previa 3. Preeclampsia 4. Rh isoimmunization

3. Preeclampsia The incidence of preeclampsia in obese clients is significantly greater than in a pregnant client who is not obese. Placenta previa, mastitis, and Rh isoimmunization aren't associated with increased incidence in pregnant clients who are obese.

A client who is 27 weeks' pregnant arrives at her health care provider's office reporting fever, nausea, vomiting, malaise, unilateral flank pain, and costovertebral angle tenderness. About which condition does the nurse anticipate reinforcing education? 1. Asymptomatic bacteriuria 2. Bacterial vaginosis 3. Pyelonephritis 4. Urinary tract infection (UTI)

3. Pyelonephritis The symptoms indicate acute pyelonephritis, a serious condition in a pregnant client. Asymptomatic bacteriuria doesn't cause symptoms. Bacterial vaginosis causes milky-white vaginal discharge but no systemic symptoms. UTI symptoms include dysuria, urgency, frequency, and suprapubic tenderness.

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.

a) Delay eating breakfast until the nausea and vomiting has passed c) Take small amounts of liquids between meals, not with them e) Eat a saltine cracker before getting out of bed in the morning Pg. 297 Eating a saltine cracker before getting out of bed, delaying breakfast, and taking small amount of liquids between meals are all appropriate interventions to cope with morning sickness. Morning sickness is related to hormone levels. The fat, protein, or carbohydrate content of the diet is not the causative factor.

32. A client reports prolonged nausea, vomiting every morning for the past week, and no appetite. The pregnancy test comes back positive. What recommendation should the nurse give this client? Select all that apply. a) Delay eating breakfast until the nausea and vomiting has passed b) Eat a low-fat diet and eliminate all caffeine c) Take small amounts of liquids between meals, not with them d) Eat a high-protein, low-carb snack during the night e) Eat a saltine cracker before getting out of bed in the morning

A gravid patient in labor suddenly has dyspnea, hypotension, frothy sputum, and loss of consciousness. The nurse knows these are signs and symptoms of which obstetrical emergency? 1. Placental abruption 2. Uterine rupture 3. Uterine inversion 4. Amniotic fluid embolism

4

The nurse is providing education regarding exercise and pregnancy. Which response by the client indicates an understanding of the teaching? 1. "I should start a new exercise routine to keep in shape." 2. "I will perform non-weight-bearing exercises." 3. "Exercise will help me lose weight during the pregnancy." 4. "Walking and stretching exercises will help with overall body conditioning."

4

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.

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.

A woman whose prenatal weight was 105 lb weighs 109 lb at her 12-week visit. Which of the following comments by the nurse is appropriate at this time? 1. "We expect you to gain about 1 lb per week, so your weight is a little low at this time." 2. "Most women gain no weight during the 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.

A pregnant client has a contraction stress test (CST). Which findings would the nurse interpret as indicative of a negative CST result? 1. Persistent late decelarations in fetal heartbeat occurred, with at least three contractions in a 10-minute window. 2. Accelerations of fetal heartbeat occurred, with at least 15 beats/minute, lasting 15 to 30 seconds in a 20-minute window. 3. Accelerations of fetal heartbeat were absent or didn't increase by 15 beats/minute for 15 to 30 seconds in a 20-minute period. 4. There was moderate fetal heart rate variability, and no decelerations from contraction, in a 10-minute period in which there were three contractions.

4. There was moderate fetal heart rate variability, and no decelerations from contraction, in a 10-minute period in which there were three contractions. A CST measures the fetal response to uterine contractions. A client must have three contractions in a 10-minute period. A negative CST shows moderate fetal heart rate variability with no decelerations from uterine contractions. Persistent late decelerations with contractions is a positive CST. Reactive nonstress test (NSTs) show accelerations in the fetal heartbeat of at least 15 beats/minute, lasting 15-30 seconds in a 20-minute period. No accelerations in the heartbeat of at least 15 beats/minute, for 15 to 30 seconds in a 20-minute period, indicate a nonreactive NST.

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.

A client with painless vaginal bleeding is suspected of having placenta previa. The nurse will assist in preparing the client for which procedure? 1. Amniocentesis 2. Speculum examination 3. External fetal monitoring 4. Ultrasound

4. Ultrasound When the mother and fetus are stabilized, ultrasound evaluation of the placenta should be done to determine the cause of bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldn't be done, as this may lead to severe bleeding or hemorrhage. External fetal monitoring won't detect a placenta previa, although it will detect fetal distress, which may result from blood loss or placental separation.

A nurse who sees the follow tracing on an electronic fetal monitor determines that the frequency and duration of the contractions are which of the following? 1. q 2 min x 60 secs 2. q 2 min x 90 secs 3. q 3 min x 30 secs 4. q 3 min x 60 secs

4. q 3 min x 60 secs

a) Taking a folic acid supplement Pg. 289 All of the instructions are important when the client has the noted family history but, when having a niece with spina bifida, it is important to encourage the client to take a folic acid supplement. A minimum of 400 mcg of folic acid (vitamin B9) is recommended in pregnancy to prevent neural tube defects, including spina bifida. Some guidelines recommend beginning folic acid supplements up to 12 weeks prior to pregnancy and continuing through the first trimester. This is timely instruction at the first prenatal visit. Completing breast examinations and exercising are overall healthy choices. Blood pressure monitoring should be completed throughout pregnancy as the risk for gestational hypertension increases throughout the pregnancy.

5. The nurse is assessing a pregnant client's family history at the first prenatal visit. The client states that heart disease, diabetes and breast cancer are in the family and that a niece has spinal bifida. Which instruction is most important at this time? a) Taking a folic acid supplement b) Monitoring blood pressure during pregnancy c) Completing breast examinations monthly d) Exercising 20 to 30 minutes daily

b) Excessive vomiting Pg. 304 Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy.

6. The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy? a) Dyspnea b) Excessive vomiting c) Swelling of extremities d) Lower abdominal pressure

A 25-year-old client at 18 weeks' gestation has returned to the clinic for her second prenatal visit. Her initial pulse was 60. The nurse can expect her pulse to be _______ bpm at term.

70-75. Rationale: The pulse can increase by 10-15 bpm at term.

D. The patient has presumptive and probable indications of pregnancy. However, she has not sought out health care until late in the first or early in the second trimester. The nurse must assess for barriers to seeking health care, physical or emotional, because regular prenatal care is key to a positive pregnancy outcome. Asking if the patient has nausea or vomiting will only add to the list of presumptive signs of pregnancy, and this information will not add to the assessment data to determine whether the patient is pregnant. The patient needs to see a health care provider before the next 4 weeks because she is late in seeking early prenatal care. Ultrasound testing must be prescribed by a health care provider

A patient reports to the clinic nurse that she has not had a period in over 12 weeks, she is tired, and her breasts are sore all of the time. The patient's urine test is positive for hCG. What is the correct nursing action related to this information? a. Ask the patient if she has had any nausea or vomiting in the morning b. Schedule the patient to be seen by a health care provider within the next 4 weeks c. Send the patient to the maternity screening area of the clinic for a routine ultrasound d. Determine if there are any factors that might prohibit her from seeking medical care

Which of the following is a probable sign of pregnancy? A. A positive pregnancy test B. Amenorrhea C. Quickening D. Uterineenlargement

A positive pregnancy test

D. This condition is known as chloasma or melasma (mask of pregnancy) and is a result of pigmentation changes relative to hormones. It can be exacerbated by exposure to the sun. There is no need to refer to a dermatologist. Intake of foods is not associated with exacerbation of this process. There is no need for a C&amp;amp;S to be taken. The patient should be assured that this is a normal finding of pregnancy

A pregnant woman notices that she is beginning to develop dark skin patches on her face. She denies using any different type of facial products as a cleansing solution or makeup. What would the priority nursing intervention be in response to this situation? a. Refer the patient to a dermatologist for further examination b. Ask the patient if she has been eating different types of foods c. Take a culture swab and send to the lab for culture and sensitivity d. Let the patient know that this is a common finding that occurs during pregnancy

A nurse has been invited to speak at a local high school about adolescent pregnancy. When developing the presentation, the nurse would incorporate information related to which of the following? (Select all that apply.) A) Peer pressure to become sexually active B) Rise in teen birth rates over the years. C) Latinas as having the highest teen birth rate D) Loss of self-esteem as a major impact E) Majority of teen pregnancies in the 1517-year-old age group

A) Peer pressure to become sexually active C) Latinas as having the highest teen birth rate D) Loss of self-esteem as a major impact

Because a pregnant clients diabetes has been poorly controlled throughout her pregnancy, the nurse would be alert for which of the following in the neonate at birth? A)Macrosomia B)Hyperglycemia C)Low birth weight D)Hypobilirubinemia

A)Macrosomia

A woman who is 10 weeks' pregnant is complaining of nausea and vomiting every morning. Which action can the nurse suggest to the woman to alleviate the nausea? a. Eat dry crackers before arising in the morning. b. Eat only three meals a day. c. Drink plenty of fluids with meals. d. Eat mostly protein foods and very little carbohydrates.

A. A. Eating dry crackers or toast before arising in the morning has been found to decrease nausea. The woman needs to get out of bed slowly. B. It is recommended to eat five or six small meals a day instead of three larger meals. Each meal needs to include a form of carbohydrates. C. Fluid and solid food need to be ingested at separate times. D. Eating small amounts of carbohydrates frequently during the day helps to prevent nausea. A protein snack prior to bedtime also will help.

Which of the following procedures require the client to have a full bladder? select all that apply A. Ultrasound (abdominal, transvaginal, Doppler). B. nonstress test (NST) C. amniocentesis D. chorionic villus sampling

A. Ultrasound (abdominal, transvaginal, Doppler). D. chorionic villus sampling

What factors could possibly negatively impact a pregnant mother's nutrition? Select all that apply. A. Vegetarian diet B. anemia C. Excessive weight gain D. Fluid intake of 2-3 L/day.

A. Vegetarian diet B. anemia C. Excessive weight gain

A nurse is teaching a group of first-trimester prenatal clients about the discomforts of pregnancy. A client asks the nurse, "What causes my nausea and vomiting?" The nurse responds indicating which of the following as contributing factors to first-trimester emesis? Select all that apply. a. Alterations in carbohydrate metabolism. b. Elevated human chorionic gonadotropin. c. Prostaglandins. d. Alterations in taste and smell. e. Estrogen.

A., B., D., Elevated human chorionic gonadotropin. Alterations in carbohydrate metabolism. Alterations in taste and smell. Rationale: Nausea and vomiting are common during the first trimester because of elevated human chorionic gonadotropin levels and changed carbohydrate metabolism. Estrogen stimulates the growth of the uterus and breast tissue. Prostaglandins stimulate uterine contractions.

2. A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time? a. Ultrasound examination b. Maternal serum alpha-fetoprotein (MSAFP) screening c. Amniocentesis d. Nonstress test (NST)

ANS: A An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. It is too early in the pregnancy to perform MSAFP screening, amniocentesis, or NST. MSAFP screening is performed at 16 to 18 weeks of gestation, followed by amniocentesis if MSAFP levels are abnormal or if fetal/maternal anomalies are detected. NST is performed to assess fetal well-being in the third trimester.

27. The nurse learns that which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Immunologic factors

ANS: A Around 60% of pregnancy losses from spontaneous abortion in the first trimester result from chromosomal abnormalities that are incompatible with life. Maternal infection, endocrine imbalances, and immunologic factors may also be causes of early miscarriage. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 523 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A pregnant woman's mother is worried that her daughter is not "big enough" at 20 weeks. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. What should the nurse report to the woman and her mother? a. "The body of the uterus is at the belly button level, just where it should be at this time." b. "You're right. We'll inform the practitioner immediately." c. "When you come for next month's appointment, we'll check you again to make sure that the baby is growing." d. "Lightening has occurred, so the fundal height is lower than expected."

ANS: A At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks of gestation is located at the level of the umbilicus. There is no need to inform the practitioner. The nurse should reassure both mother and patient that the findings are normal. The descent of the fetal head (lightening) occurs in late pregnancy.

5. During a patient's physical examination the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: a. Hegar's sign. b. McDonald's sign. c. Chadwick's sign. d. Goodell's sign.

ANS: A At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occurs; this is called Hegar's sign. McDonald's sign indicates a fast food restaurant. Chadwick's sign is the blue-violet coloring of the cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called Goodell's sign, which may be observed around the sixth week of pregnancy.

A patient at 32 weeks of gestation reports that she has severe lower back pain. The nurse's assessment should include a. observation of posture and body mechanics. b. palpation of the lumbar spine. c. exercise pattern and duration. d. ability to sleep for at least 6 hours uninterrupted.

ANS: A Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis. Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in the pregnancy. Exercise and sleep are not as important to assess as are posture and body mechanics, which can contribute to the pain.

3. The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what other tool would be useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts

ANS: A Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, CST is not performed on a woman whose fetus is preterm. Indications for amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

16. A nurse is teaching a prenatal class. The nurse teaches that during weeks 25 to 28, which fetal development occurs? a. Eyes reopen. b. Vernix caseosa covers the skin. c. Lanugo may develop. d. Brown fat is deposited.

ANS: A During this time frame the eyes reopen, and the fetus becomes plumper with smoother skin. The other changes occur during weeks 17 to 20.

10. A woman is in her seventh month of pregnancy. She has been reporting nasal congestion and occasional epistaxis. The nurse suspects that: a. this is a normal respiratory change in pregnancy caused by elevated levels of estrogen. b. this is an abnormal cardiovascular change, and the nosebleeds are an ominous sign. c. the woman is a victim of domestic violence and is being hit in the face by her partner. d. the woman has been using cocaine intranasally.

ANS: A Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract. This may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in lower extremities. Determining that the woman is a victim of domestic violence and was hit in the face cannot be made on the basis of the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings. Determination of the use of cocaine by the woman cannot be made on the basis of the sparse facts provided.

11. The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by a. contact between maternal blood and fetal capillaries within the chorionic villi. b. interaction of maternal and fetal pH levels within the endometrial vessels. c. a mixture of maternal and fetal blood within the intervillous spaces. d. passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries.

ANS: A Fetal capillaries within the chorionic villi are bathed with oxygen- and nutrient-rich maternal blood within the intervillous spaces. The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. Maternal and fetal blood do not normally mix. Maternal carbon dioxide does not enter into the fetal circulation.

17. Rh incompatibility can occur if the woman is Rh negative and her a. fetus is Rh positive. b. husband is Rh positive. c. fetus is Rh negative. d. husband and fetus are both Rh negative.

ANS: A For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh negative, the blood types are compatible and no problems should occur. If the fetus is Rh negative, the blood type with the mother is compatible. The husband's blood type does not enter into the problem. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 545 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

17. A patient notices that the doctor writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. The nurse's best response is a. "It refers to the bluish color of the cervix in pregnancy." b. "It means the cervix is softening." c. "The doctor was able to flex the uterus against the cervix." d. "That refers to a positive sign of pregnancy."

ANS: A Increased vascularity of the pelvic organs during pregnancy results in the bluish color of the cervix, vagina, and labia, called Chadwick's sign. The nurse should also know that this is a presumptive, not positive, sign of pregnancy. Softening of the cervix is Goodell's sign. The softening of the lower segment of the uterus (Hegar's sign) can allow the uterus to be flexed against the cervix.

A patient notices that the doctor writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. The nurse's best response is a. "It refers to the bluish color of the cervix in pregnancy." b. "It means the cervix is softening." c. "The doctor was able to flex the uterus against the cervix." d. "That refers to a positive sign of pregnancy."

ANS: A Increased vascularity of the pelvic organs during pregnancy results in the bluish color of the cervix, vagina, and labia, called Chadwick's sign. The nurse should also know that this is a presumptive, not positive, sign of pregnancy. Softening of the cervix is Goodell's sign. The softening of the lower segment of the uterus (Hegar's sign) can allow the uterus to be flexed against the cervix.

16. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Multiple-marker screening b. Lecithin/sphingomyelin [L/S] ratio c. Biophysical profile d. Type and crossmatch of maternal and fetal serum

ANS: A Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. The L/S ratio is used to determine fetal lung maturity. A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. The blood type and crossmatch would not predict chromosomal defects in the fetus.

12. Which behavior indicates that a woman is "seeking safe passage" for herself and her infant? a. She keeps all prenatal appointments. b. She "eats for two." c. She drives her car slowly. d. She wears only low-heeled shoes.

ANS: A The goal of prenatal care is to foster a safe birth for the infant and mother. Although eating properly, driving carefully, and using proper body mechanics all are healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

1. Which part of the mature sperm contains the male chromosomes? a. The head of the sperm b. The middle portion of the sperm c. X-bearing sperm d. The tail of the sperm

ANS: A The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum. The middle portion of the sperm supplies energy for the tail's whip-like action. If an X-bearing sperm fertilizes the ovum, the baby will be female. The tail of the sperm helps propel the sperm toward the ovum.

20. Which statement is accurate about the development of fetal organs and systems? a. The cardiovascular system is the first organ system to function in the developing human. b. Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks. c. The body changes from straight to C-shaped at 8 weeks. d. The gastrointestinal system is mature at 32 weeks.

ANS: A The heart is developmentally complete by the end of the embryonic stage. Hematopoiesis begins in the liver during the 6th week. The body becomes C-shaped at 21 weeks. The gastrointestinal system is complete at 36 weeks.

5. The multiple marker test is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosome anomalies. The multiple marker test would not detect diaphragmatic hernia, congenital cardiac abnormality, or anencephaly. Additional testing, such as ultrasonography and amniocentesis, would be required to diagnose these conditions.

20. The multiple marker screen is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A The maternal serum level of alpha-fetoprotein is used to screen for trisomy 18 or 21 and neural tube defects. The quadruple marker test does not detect hernias. Additional testing, such as ultrasonography, would be required to diagnose diaphragmatic hernia. Congenital cardiac abnormality would most likely be identified during an ultrasound examination.

The multiple marker screen is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A The maternal serum level of alpha-fetoprotein is used to screen for trisomy 18 or 21 and neural tube defects. The quadruple marker test does not detect hernias. Additional testing, such as ultrasonography, would be required to diagnose diaphragmatic hernia. Congenital cardiac abnormality would most likely be identified during an ultrasound examination.

15. A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is: a. "The test results are within normal limits." b. "Immediate delivery by cesarean birth is being considered." c. "Further testing will be performed to determine the meaning of this score." d. "An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery."

ANS: A The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed.

The nurse is caring for a patient whose English is limited. When the nurse provides information, the patient smiles and nods her head. What action by the patient indicates that the goal for a primary nursing diagnosis for this patient has been met? a. Keeps next appointment and brings a translator with her. b. Gains an appropriate amount of weight at next visit. c. Husband accompanies patient to appointments. d. Continues to eat culturally appropriate foods.

ANS: A The primary goal for this situation is Impaired Verbal Communication due to lack of English proficiency. If the patient is able to understand and keep her next appointment and brings a translator with her to help facilitate communication that shows that the goal of adequate communication has been met. The other actions do not address communication

38. The nurse is caring for a patient whose English is limited. When the nurse provides information, the patient smiles and nods her head. What action by the patient indicates that the goal for a primary nursing diagnosis for this patient has been met? a. Keeps next appointment and brings a translator with her. b. Gains an appropriate amount of weight at next visit. c. Husband accompanies patient to appointments. d. Continues to eat culturally appropriate foods.

ANS: A The primary goal for this situation is Impaired Verbal Communication due to lack of English proficiency. If the patient is able to understand and keep her next appointment and brings a translator with her to help facilitate communication that shows that the goal of adequate communication has been met. The other actions do not address communication.

2. One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered within normal limits? a. Two arteries and one vein b. Two arteries and two veins c. Two veins and one artery d. One artery and one vein

ANS: A The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta. Any option other than two arteries and one vein is considered abnormal and requires further assessment.

19. What order should the nurse expect for a patient admitted with a threatened abortion? a. Abstinence from sexual activity b. Pitocin IV c. NPO d. Narcotic analgesia every 3 hours, prn

ANS: A The woman may be counseled to avoid sexual activity with a threatened abortion. Activity restrictions were once recommended, but they have not shown effectiveness as treatment. Pitocin would be contraindicated. There is no reason for the woman to be NPO. In fact, hydration is important. Narcotic analgesia is not indicated. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 524 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

26. A first-time mother at 18 weeks of gestation comes for her regularly scheduled prenatal visit. The patient tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the patient that this type of contraction: a. is painless. b. increases with walking. c. causes cervical dilation. d. impedes oxygen flow to the fetus.

ANS: A Uterine contractions can be felt through the abdominal wall soon after the fourth month of gestation. Braxton Hicks contractions are regular and painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying. Braxton Hicks contractions usually cease with walking or exercise. They can be mistaken for true labor; however, they do not increase in intensity or frequency or cause cervical dilation. In addition, they facilitate uterine blood flow through the intervillous spaces of the placenta and promote oxygen delivery to the fetus.

3. The student learns about shunts that support fetal circulation. Which of the following are included in this support system? (Select all that apply.) a. Ductus venosus b. Foramen ovale c. Ductus arteriosus d. Foramen magnum e. Ductus deferens

ANS: A, B, C The ductus venosus, foramen ovale, and ductus arteriosus are part of fetal circulation. The foramen magnum is located at the base of the skull. The ductus (or vas) deferens is part of the male reproductive system.

1. Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors. (Select all that apply.) a. Poor material weight gain b. Chronic maternal infections c. Gestational hypertension d. Premature rupture of membranes e. Smoking

ANS: A, B, C, E Poor material weight gain, chronic infections disease, gestational hypertension, and smoking are all risk factors associated with IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR.

2. Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations. (Select all that apply) a. Establish gestational age b. Obesity c. Fetal abnormalities d. Amniotic fluid volume e. Ectopic pregnancy

ANS: A, B, C, E Transvaginal ultrasound is useful in obese women whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used for identifying ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.

MULTIPLE RESPONSE 1. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E Early signs of ectopic pregnancy include pelvic pain, abdominal pain, spotting or light bleeding, and a woman's report of a "missed period." Heavy bleeding is a later sign and occurs after the tube has ruptured. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 526 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

1. The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that apply.) a. Identification of fetal heartbeat b. Palpation of fetal outline c. Visualization of the fetus d. Verification of fetal movement e. Positive hCG test

ANS: A, C, D Identification of fetal heartbeat, visualization of the fetus, and verification of fetal movement are all positive, objective signs of pregnancy. Palpation of fetal outline and a positive hCG test are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests.

4. A pregnant woman asks the nursing student what to do about her frequent heartburn. What suggestions can the student make that are appropriate? (Select all that apply.) a. Try chewing gum during the day. b. Take Alka-Seltzer or other antacid. c. Drink a small sip of cream before meals. d. Eat small amounts of dry crackers. e. Wear loose-fitting clothing.

ANS: A, C, E Chewing gum, a small sip of cream before meals, and wearing loose clothing all can help relieve heartburn. The patient can take antacids recommended by the provider, but Alka-Seltzer has too much sodium. Dry crackers help with morning sickness.

3. During pregnancy there are a number of changes that occur as a direct result of the presence of the fetus. Which of these adaptations meet these criteria? (Select all that apply.) a. Leukorrhea b. Development of a mucous plug c. Quickening d. Ballottement e. Lightening

ANS: A, C, E Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements, or "feeling life." Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descent into the pelvis. This occurs 2 weeks before labor in the nullipara and at the start of labor in the multipara. Mucus fills the cervical canal, creating a plug that acts as a barrier against bacterial invasion during pregnancy. Passive movement of the unengaged fetus is referred to as ballottement.

15. What type of cultural concern is the most likely deterrent to many women seeking prenatal care? a. Religion b. Modesty c. Ignorance d. Belief that physicians are evil

ANS: B A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs.

31. A woman is in the emergency department with severe abdominal pain. When her pregnancy test comes back positive, she yells "I can't be pregnant! I had a tubal ligation two months ago!" What action by the nurse is the priority? a. Provide emotional support to the woman. b. Facilitate an ultrasound examination. c. Call the lab to have them repeat the test. d. Administer an opioid pain medication.

ANS: B A failed tubal ligation is a risk factor for ectopic pregnancy. After a blood pregnancy test, a trans-vaginal ultrasound is needed to look for a gestational sac within the uterus. Of course the nurse provides emotional support, but that is not the priority. There is no need to repeat the test. Pain medications may be contraindicated if surgery is needed and consents have not yet been signed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: pp. 526-527 | Box 25.1 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

6. A woman who is 32 weeks' pregnant is informed by the nurse that a danger sign of pregnancy could be: a. constipation. b. alteration in the pattern of fetal movement. c. heart palpitations. d. edema in the ankles and feet at the end of the day.

ANS: B An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation, heart palpitations, and ankle and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.

9. A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a. tocolytic. b. anticonvulsant. c. antihypertensive. d. diuretic.

ANS: B Anticonvulsant drugs act by blocking neuromuscular tr... ANSmission and depress the central nervous system to control seizure activity. A tocolytic drug does slow the frequency and intensity of uterine contractions, but it is not used for that purpose in this scenario. Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. Diuresis is a therapeutic response to magnesium sulfate. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 539 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse enquires about the woman's last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan that reveals she is not pregnant. What is the most likely cause of the false-positive pregnancy test result? a. She took the pregnancy test too early. b. She takes anticonvulsants. c. She has a fibroid tumor. d. She has been under considerable stress and has a hormone imbalance.

ANS: B Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use enzyme-linked immunosorbent assay technology, which can yield positive results 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, she would be into her third week at this point (having missed her period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on hCG pregnancy tests. Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect human chorionic gonadotropin levels or produce positive pregnancy test results.

21. To reassure and educate pregnant patients about changes in their cardiovascular system, maternity nurses should be aware that: a. a pregnant woman experiencing disturbed cardiac rhythm, such as sinus arrhythmia requires close medical and obstetric observation, no matter how healthy she otherwise may appear. b. changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term. c. palpitations are twice as likely to occur in twin gestations. d. all of the above changes will likely occur.

ANS: B Auscultatory changes should be discernible after 20 weeks of gestation. A healthy woman with no underlying heart disease does not need any therapy. The maternal heart rate increases in the third trimester, but palpitations may not occur. Auditory changes are discernible at 20 weeks.

12. A patient is sent from the physician's office for assessment of oligohydramnios. The nurse is aware that this condition can result in a. excessive fetal urine secretion. b. newborn respiratory distress. c. central nervous system abnormality. d. gastrointestinal blockage.

ANS: B Because an abnormally small amount of amniotic fluid restricts normal lung development, the infant may have inadequate respiratory function after birth, when the placenta no longer performs respiratory function. Oligohydramnios may be caused by a decrease in urine secretion. Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality. Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid.

The nurse who practices in a prenatal clinic understands that a major concern of lower socioeconomic groups is to a. maintain group health insurance on their families. b. meet health needs as they occur. c. practice preventive health care. d. maintain an optimistic view of life.

ANS: B Because of economic uncertainty, lower socioeconomic groups place more emphasis on meeting the needs of the present rather than on future goals. Lower socioeconomic groups usually do not have group health insurance. They may value health care but cannot afford preventive health care. They may struggle for basic needs and often do not see a way to improve their situation. It is difficult to maintain optimism.

1. The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

ANS: B Beta-hCG levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it may obscure the presence of the potentially carcinogenic cells. Any contraceptive method except an IUD is acceptable. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 528 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Physiologic Integrity

6. Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? a. Less audible heart sounds (S1, S2) b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production

ANS: B Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester, blood pressure usually remains the same as at the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and the diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

13. A 3-year-old girl's mother is 6 months pregnant. What concern is this child likely to verbalize? a. How the baby will "get out"? b. What the baby will eat? c. Whether her mother will die? d. What color eyes the baby has?

ANS: B By age 3 or 4, children like to be told the story of their own beginning and accept its comparison with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it wears. School-age children take a more clinical interest in their mother's pregnancy and may want to know, "How did the baby get in there?" and "How will it get out?" Whether her mother will die does not tend to be the focus of a child's questions about the impending birth of a sibling. The baby's eye color does not tend to be the focus of children's questions about the impending birth of a sibling.

37. A student nurse is teaching a pregnant woman ways to manage constipation. Which instruction by the student causes the nurse to provide a correction? a. Drink at least 8 glasses of liquids a day. b. The fat in cheese helps lubricate the bowels. c. You do need to continue your iron pills. d. Add extra fiber, which can be found in fruit.

ANS: B Cheese tends to cause constipation, so this statement by the student needs correction by the nurse. The other statements are all correct.

24. Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Positive KB test b. Presence of fibrin split products c. Thrombocytopenia d. Positive drug screen

ANS: B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. The other lab tests are not indicative of DIC. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 525 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

24. To reassure and educate pregnant patients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that: a. increased urinary output makes pregnant women less susceptible to urinary infection. b. increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty. c. renal (kidney) function is more efficient when the woman assumes a supine position. d. using diuretics during pregnancy can help keep kidney function regular.

ANS: B First bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often. Numerous anatomic changes make a pregnant woman more susceptible to urinary tract infection. Renal function is more efficient when the woman lies in the lateral recumbent position and less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems.

4. A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level? a. Not palpable above the symphysis at this time b. Slightly above the symphysis pubis c. At the level of the umbilicus d. Slightly above the umbilicus

ANS: B In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.

2. Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. In a partial abruptio placentae, if the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted. If the fetus has died, a vaginal delivery is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 531 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

20. What data on a patient's health history places her at risk for an ectopic pregnancy? a. Use of oral contraceptives for 5 years b. Recurrent pelvic infections c. Ovarian cyst 2 years ago d. Heavy menstrual flow of 4 days' duration

ANS: B Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. Oral contraceptives, ovarian cysts, and heavy menstrual flows do not increase risk. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 526 | Box 25.1 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

30. Which situation best describes a man "trying on" fathering behaviors? a. Spending more time with his siblings b. Taking a nephew to the park to play c. Reading books on newborn care d. Exhibiting physical symptoms related to pregnancy

ANS: B Interacting with children and assuming the behavior and role of a father best describe a man "trying on" being a father. The man normally will seek closer ties with his father during this time, not his siblings. While some fathers do everything they can to learn about infant care, others are not ready to learn when the information is presented, so the nurse should provide the information again after the baby is born and it is more relevant. Exhibiting symptoms related to pregnancy is called couvade.

7. A woman is 16 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is a. "You should have felt the baby move by now." b. "Within the next month, you should start to feel fluttering sensations." c. "The baby is moving, but you can't feel it yet." d. "Some babies are quiet, and you don't feel them move."

ANS: B Maternal perception of fetal movement usually begins 17 to 20 weeks after conception, particularly if this is the first pregnancy. "The baby is moving, but you can't feel it yet" is a true statement. The fetus's movements are not strong enough to be felt until 17 to 20 weeks; however, this statement does not answer the concern of the woman. If no movement is felt at the end of 20 weeks, further assessment is needed.

4. An abortion in which the fetus dies but is retained in the uterus is called ________ abortion. a. inevitable b. missed c. incomplete d. threatened

ANS: B Missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 524 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

15. A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

ANS: B Nausea and vomiting are believed to be caused by increased levels of hormones and decreased gastric motility. Glucose levels decrease in the first trimester. Hypoglycemia, if experienced, can also lead to nausea. Gastric secretions do decrease, but this is not the main cause of nausea and vomiting.

30. A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is: a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

ANS: B Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Although gastric secretions decrease, this is not the main cause of nausea and vomiting.

6. Which statement related to changes in the breasts during pregnancy is the most accurate? a. During the early weeks of pregnancy there is decreased sensitivity. b. Nipples and areolae become more pigmented. c. Montgomery tubercles are no longer visible around the nipples. d. Venous congestion of the breasts is more visible in the multiparous woman.

ANS: B Nipples and areolae become more pigmented, and the nipples become more erectile and may express colostrum. Fullness, heightened sensitivity, tingling, and heaviness of the breasts occur in the early weeks of gestation in response to increased levels of estrogen and progesterone. Montgomery tubercles may be seen around the nipples. These sebaceous glands may have a protective role in that they keep the nipples lubricated for breastfeeding. Venous congestion in the breasts is more obvious in primigravidas.

Which statement related to changes in the breasts during pregnancy is the most accurate? a. During the early weeks of pregnancy there is decreased sensitivity. b. Nipples and areolae become more pigmented. c. Montgomery tubercles are no longer visible around the nipples. d. Venous congestion of the breasts is more visible in the multiparous woman.

ANS: B Nipples and areolae become more pigmented, and the nipples become more erectile and may express colostrum. Fullness, heightened sensitivity, tingling, and heaviness of the breasts occur in the early weeks of gestation in response to increased levels of estrogen and progesterone. Montgomery tubercles may be seen around the nipples. These sebaceous glands may have a protective role in that they keep the nipples lubricated for breastfeeding. Venous congestion in the breasts is more obvious in primigravidas.

36. A pregnant patient of 28 weeks' gestation complains of pain in the right inguinal area. What action by the nurse is best? a. Assess the woman for early labor. b. Position the woman on the right side. c. Palpate the woman's abdomen. d. Document the findings in the chart.

ANS: B Pain in the right inguinal area is most likely due to the round ligament. The nurse can position the woman on her right side to see if that relieves the pain. Heat can also help. There is no need to assess for labor or palpate the abdomen. The findings should be documented after the nurse responds.

8. A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she: a. do Kegel exercises. b. do pelvic rock exercises. c. use a softer mattress. d. stay in bed for 24 hours.

ANS: B Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. Stretching and other exercises to relieve back pain should be performed several times a day.

14. Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring patient with diabetes mellitus, the nurse is aware that she is at a greater risk for: a. oligohydramnios. b. polyhydramnios. c. postterm pregnancy. d. Chromosomal abnormalities.

ANS: B Polyhydramnios (amniotic fluid >2000 mL) is 10 times more likely to occur in diabetic compared with nondiabetic pregnancies. Polyhydramnios puts the mother at risk for premature rupture of membranes, premature labor, and after birth hemorrhage. Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the patient at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age older than 35 years and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities.

3. The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: a. a positive pregnancy test. b. fetal movement palpated by the nurse-midwife. c. Braxton Hicks contractions. d. quickening.

ANS: B Positive signs of pregnancy are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. A positive pregnancy test and Braxton Hicks contractions are probable signs of pregnancy. Quickening is a presumptive sign of pregnancy.

1. The nurse caring for a newly pregnant woman would advise her that ideally prenatal care should begin: a. before the first missed menstrual period. b. after the first missed menstrual period. c. after the second missed menstrual period. d. after the third missed menstrual period.

ANS: B Prenatal care ideally should begin soon after the first missed menstrual period. Regular prenatal visits offer opportunities to ensure the health of the expectant mother and her infant.

4. A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. Maternal serum alpha-fetoprotein (MSAFP) screening d. Percutaneous umbilical blood sampling (PUBS)

ANS: B Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have been performed earlier in the pregnancy. It is too late in the pregnancy to perform MSAFP screening. Also, MSAFP screening does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of a fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

27. Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria in the urine d. Ketones in the urine

ANS: B Small amounts of glucose may indicate "physiologic spilling." The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

1. A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a. 3-1-1-1-3 b. 4-1-2-0-4 c. 3-0-3-0-3 d. 4-2-1-0-3

ANS: B The correct calculation of this woman's gravidity and parity is 4-1-2-0-4. The numbers reflect the woman's gravidity and parity information. Using the GPTAL system, her information is calculated as: G: The first number reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term. P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L: This number signifies the number of children born who are currently living; the woman has four children.

19. With regard to the structure and function of the placenta, the maternity nurse should be aware that a. as the placenta widens, it gradually thins to allow easier passage of air and nutrients. b. as one of its early functions, the placenta acts as an endocrine gland. c. the placenta is able to keep out most potentially toxic substances, such as cigarette smoke, to which the mother is exposed. d. optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B The placenta produces four hormones necessary to maintain the pregnancy. The placenta widens until week 20 and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.

8. The maternity nurse understands that vascular volume increases 40% to 60% during pregnancy to a. compensate for decreased renal plasma flow. b. provide adequate perfusion of the placenta. c. eliminate metabolic wastes of the mother. d. prevent maternal and fetal dehydration.

ANS: B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. However, this answer is not the best because it doesn't explain the overall purpose and only includes one purpose. Prevention of dehydration is not the reason for increased vascular volume.

The maternity nurse understands that vascular volume increases 40% to 60% during pregnancy to a. compensate for decreased renal plasma flow. b. provide adequate perfusion of the placenta. c. eliminate metabolic wastes of the mother. d. prevent maternal and fetal dehydration.

ANS: B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. However, this answer is not the best because it doesn't explain the overall purpose and only includes one purpose. Prevention of dehydration is not the reason for increased vascular volume.

9. A nurse is taking vital signs on a pregnant woman. Preconception pulse was 76 beats/minute. Today the pulse is 97 beats/minute. What action by the nurse is best? a. Inform the provider immediately. b. Document findings in the chart. c. Prepare to start an IV infusion. d. Retake the pulse in 15 minutes.

ANS: B The pulse of a pregnant woman increases about 15 to 20 beats/minute throughout the pregnancy. The nurse should document the findings, but no other actions are needed as this is a normal finding.

A nurse is taking vital signs on a pregnant woman. Preconception pulse was 76 beats/minute. Today the pulse is 97 beats/minute. What action by the nurse is best? a. Inform the provider immediately. b. Document findings in the chart. c. Prepare to start an IV infusion. d. Retake the pulse in 15 minutes.

ANS: B The pulse of a pregnant woman increases about 15 to 20 beats/minute throughout the pregnancy. The nurse should document the findings, but no other actions are needed as this is a normal finding.

17. To reassure and educate pregnant patients about changes in the uterus, nurses should be aware that: a. lightening occurs near the end of the second trimester as the uterus rises into a different position. b. the woman's increased urinary frequency in the first trimester is the result of exaggerated uterine anteflexion caused by softening. c. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise. d. the uterine souffle is the movement of the fetus.

ANS: B The softening of the lower uterine segment is called Hegar's sign. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

5. The nursing faculty explains to students that the upper uterus is the best place for the fertilized ovum to implant because it is here that the a. placenta attaches most firmly. b. developing baby is best nourished. c. uterine endometrium is softer. d. maternal blood flow is lower.

ANS: B The uterine fundus is richly supplied with blood and has the thickest endometrium, both of which promote optimal nourishment of the fetus. If the placenta attaches too deeply, it does not easily detach after birth. Softness is not a concern with implantation; attachment and nourishment are the major concerns. The blood supply is rich in the fundus, which allows for optimal nourishment of the fetus.

13. A woman's last menstrual period was June 10. The nurse estimates the date of delivery (EDD) to be a. April 7. b. March 17. c. March 27. d. April 17.

ANS: B To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17). The year is corrected if needed. April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days. March is the correct month, but instead of adding 7 days, 17 days were added to get March 27. April 17 is subtracting 2 months instead of 3 months.

A woman's last menstrual period was June 10. The nurse estimates the date of delivery (EDD) to be a. April 7. b. March 17. c. March 27. d. April 17.

ANS: B To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17). The year is corrected if needed. April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days. March is the correct month, but instead of adding 7 days, 17 days were added to get March 27. April 17 is subtracting 2 months instead of 3 months.

29. Physiologic anemia often occurs during pregnancy as a result of: a. inadequate intake of iron. b. dilution of hemoglobin concentration. c. the fetus establishing iron stores. d. decreased production of erythrocytes.

ANS: B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman has physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. There is an increased production of erythrocytes during pregnancy.

10. Physiologic anemia often occurs during pregnancy as a result of a. inadequate intake of iron. b. dilution of hemoglobin concentration. c. the fetus establishing iron stores. d. decreased production of erythrocytes.

ANS: B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. There is an increased production of erythrocytes during pregnancy.

Physiologic anemia often occurs during pregnancy as a result of a. inadequate intake of iron. b. dilution of hemoglobin concentration. c. the fetus establishing iron stores. d. decreased production of erythrocytes.

ANS: B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. There is an increased production of erythrocytes during pregnancy.

18. Which nursing intervention is necessary before a second-trimester transabdominal ultrasound? a. Place the woman NPO for 12 hours. b. Instruct the woman not void until after the test. c. Administer an enema. d. Perform an abdominal preparation.

ANS: B When the uterus is still in the pelvis, visualization may be difficult. It is necessary to perform the test when the woman has a full bladder, which provides a "window" through which the uterus and its contents can be viewed. The woman needs a full bladder to elevate the uterus; therefore being NPO is not appropriate. Neither an enema nor an abdominal preparation is necessary for this procedure.

2. What assessment findings indicate to the nurses that a woman's preeclampsia should now be considered severe? (Select all that apply.) a. Urine output 40 mL/hour for the past 2 hours b. Serum creatinine 3.1 mg/dL c. Seeing "sparkly" things in the visual field d. Crackles in both lungs e. Soft, non-tender abdomen

ANS: B, C, D Signs of severe preeclampsia include elevated creatinine, seeing sparkles, and pulmonary edema (manifested by crackles). The urine output is above the minimum requirements, and a soft non-tender abdomen is a reassuring sign. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 538 | Table 25.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

19. With regard to the initial visit with a patient who is beginning prenatal care, nurses should be aware that: a. the first interview is a relaxed, get-acquainted affair in which nurses gather some general impressions. b. if nurses observe handicapping conditions, they should be sensitive and not enquire about them because the patient will do that in her own time. c. nurses should be alert to the appearance of potential parenting problems, such as depression or lack of family support. d. because of legal complications, nurses should not ask about illegal drug use; that is left to physicians.

ANS: C Besides these potential problems, nurses need to be alert to the woman's attitude toward health care. The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. Nurses must be sensitive to special problems, but they do need to inquire because discovering individual needs is important. People with chronic or handicapping conditions forget to mention them because they have adapted to them. Getting information on drug use is important and can be done confidentially. Actual testing for drug use requires the patient's consent.

17. While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at: a. 4 weeks. b. 8 weeks. c. 10 weeks. d. 14 weeks.

ANS: C CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, the risk of limb reduction is no greater than in the general population

25. A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should a. vigorously stimulate the woman. b. instruct her to take deep breaths. c. administer calcium gluconate. d. increase her IV fluids.

ANS: C Calcium gluconate reverses the effects of magnesium sulfate. Stimulation, instruction on taking deep breaths, and increasing her fluid rate will not increase the respirations. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 539 | Drug Guide Box OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

14. The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area? a. +1 edema b. +2 edema c. +3 edema d. +4 edema

ANS: C Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is termed +2 edema. Generalized massive edema (+4) includes accumulation of fluid in the peritoneal cavity. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 537 | Table 25.2 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

The nurse teaches a pregnant woman that one of the most effective methods for preventing venous stasis is to a. wear elastic stockings in the afternoons. b. sleep with the foot of the bed elevated. c. rest often with the feet elevated. d. sit with the legs crossed.

ANS: C Elevating the feet and legs improves venous return and prevents venous stasis. Elastic stockings should be applied before lowering the legs in the morning. Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis.

26. A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." The nurse's best response is a. "There is nothing to worry about." b. "The doctor is taking good care of you and your baby." c. "Tell me about your concerns." d. "Your baby is doing fine."

ANS: C Encouraging the client to discuss her feelings is the best approach. Women during their third trimester need reassurance that such fears are not unusual in pregnancy. An open-ended request to share information will encourage the patient to explain concerns further. The other statements belittle the patient's concerns and provide false hope.

23. Some pregnant patients may complain of changes in their voice and impaired hearing. The nurse can tell these patients that these are common reactions to: a. a decreased estrogen level. b. displacement of the diaphragm, resulting in thoracic breathing. c. congestion and swelling, which occur because the upper respiratory tract has become more vascular. d. increased blood volume.

ANS: C Estrogen levels increase, causing the upper respiratory tract to become more vascular producing swelling and congestion in the nose and ears leading to voice changes and impaired hearing. The diaphragm is displaced, and the volume of blood is increased. However, the main concern is increased estrogen levels.

3. The purpose of the ovum's zona pellucida is to a. make a pathway for more than one sperm to reach the ovum. b. allow the 46 chromosomes from each gamete to merge. c. prevent multiple sperm from fertilizing the ovum. d. stimulate the ovum to begin mitotic cell division.

ANS: C Fertilization causes the zona pellucida to change its chemical composition so that multiple sperm cannot fertilize the ovum. Each gamete (sperm and ovum) has only 23 chromosomes. There will be 46 chromosomes when they merge. Mitotic cell division begins when the nuclei of the sperm and ovum unite.

10. What is the only known cure for preeclampsia? a. Magnesium sulfate b. Antihypertensive medications c. Delivery of the fetus d. Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C If the fetus is viable and near term, delivery is the only known definitive treatment for preeclampsia. Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of ASA (81 mg) have been administered to women at high risk for developing preeclampsia. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 539 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

16. With regard to a woman's reordering of personal relationships during pregnancy, the maternity nurse should understand that: a. because of the special motherhood bond, a woman's relationship with her mother is even more important than with the father of the child. b. nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other. c. women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father. d. the woman's sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier.

ANS: C Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman is usually the father. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings. The second trimester is the time when a woman's sense of well-being, along with certain physical changes, increases her desire for sex. Desire is decreased in the first and third trimesters.

28. Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 3.5 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole, a missed abortion, or abruptio placentae. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 527 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

13. The nurse providing care for the antepartum woman should understand that contraction stress test (CST): a. sometimes uses vibroacoustic stimulation. b. is an invasive test; however, contractions are stimulated. c. is considered negative if no late decelerations are observed with the contractions. d. is more effective than nonstress test (NST) if the membranes have already been ruptured.

ANS: C No late decelerations are good news. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by intravenous oxytocin but not if by nipple stimulation and is contraindicated if the membranes have ruptured.

8. When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that: a. alcohol or cigarette smoke can irritate the fetus into greater activity. b. "kick counts" should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off. c. the fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. obese mothers familiar with their bodies can assess fetal movement as well as average-size women.

ANS: C No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity ("kick counts") two or three times daily for 60 minutes each time. Obese women have a harder time assessing fetal movement.

23. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a. vaginal bleeding. b. rupture of membranes. c. presence of abdominal pain. d. changes in maternal vital signs.

ANS: C Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding, but both may have vaginal bleeding. Rupture of membranes may occur with both conditions. Maternal vital signs may change with both if bleeding is pronounced. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 529 | p. 532 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

12. A patient at 24 weeks of gestation contacts the nurse at her obstetric provider's office to complain that she has cravings for dirt and gravel. The nurse is aware that this condition is known as ________ and may indicate anemia. a. ptyalism b. pyrosis c. pica d. decreased peristalsis

ANS: C Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings of gastrointestinal change during pregnancy. Food cravings during pregnancy are normal.

15. The prenatal clinic nurse monitored women for preeclampsia. If all four women were in the clinic at the same time, which one should the nurse see first? a. Blood pressure increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. A dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ is indicative of severe preeclampsia and should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or higher. Preeclampsia may be manifested as a rapid weight gain. Gaining 0.5 kg during the past 2 weeks does not qualify as rapid. Edema occurs in many normal pregnancies as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia. PTS: 1 DIF: Cognitive Level: Analysis/Analyzing REF: p. 538 | Table 25.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment

12. A woman is currently pregnant; she has a 5-year-old son and a 3-year-old daughter born at full term. She had one other pregnancy that terminated at 8 weeks. Her gravida and para are a. gravida 3 para 2. b. gravida 4 para 3. c. gravida 4 para 2. d. gravida 3 para 3.

ANS: C She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion, which is not included in the gravida-para classification.

14. A nurse sees a woman in her first trimester of pregnancy. The nurse explains that the woman can expect to visit her physician every 4 weeks so that a. she develops trust in the health care team. b. her questions about labor can be answered. c. the condition of the mother and fetus can be monitored. d. problems can be eliminated.

ANS: C This routine allows monitoring of maternal health and fetal growth and ensures that problems will be identified early. If the woman begins prenatal care in the first trimester, every 4 weeks is the recommended schedule for visits. Developing a trusting relationship should be established during these visits, but that is not the primary reason. Most women do not have questions concerning labor until the last trimester of the pregnancy. All problems cannot be eliminated because of prenatal visits, but they can be identified.

A nurse sees a woman in her first trimester of pregnancy. The nurse explains that the woman can expect to visit her physician every 4 weeks so that a. she develops trust in the health care team. b. her questions about labor can be answered. c. the condition of the mother and fetus can be monitored. d. problems can be eliminated.

ANS: C This routine allows monitoring of maternal health and fetal growth and ensures that problems will be identified early. If the woman begins prenatal care in the first trimester, every 4 weeks is the recommended schedule for visits. Developing a trusting relationship should be established during these visits, but that is not the primary reason. Most women do not have questions concerning labor until the last trimester of the pregnancy. All problems cannot be eliminated because of prenatal visits, but they can be identified.

5. Which suggestion is appropriate for the pregnant woman who is experiencing nausea and vomiting? a. Eat only three meals a day so the stomach is empty between meals. b. Drink plenty of fluids with each meal. c. Eat dry crackers or toast before arising in the morning. d. Drink coffee or orange juice immediately on arising in the morning.

ANS: C This will assist with the symptoms of morning sickness. It is also important for the woman to arise slowly. Instruct the woman to eat five to six small meals rather than three full meals per day. Nausea is more intense when the stomach is empty. Fluids should be taken separately from meals. Fluids overstretch the stomach and may precipitate vomiting. Coffee and orange juice stimulate acid formation in the stomach. It is best to suggest eating dry carbohydrates when rising in the morning.

Which suggestion is appropriate for the pregnant woman who is experiencing nausea and vomiting? a. Eat only three meals a day so the stomach is empty between meals. b. Drink plenty of fluids with each meal. c. Eat dry crackers or toast before arising in the morning. d. Drink coffee or orange juice immediately on arising in the morning.

ANS: C This will assist with the symptoms of morning sickness. It is also important for the woman to arise slowly. Instruct the woman to eat five to six small meals rather than three full meals per day. Nausea is more intense when the stomach is empty. Fluids should be taken separately from meals. Fluids overstretch the stomach and may precipitate vomiting. Coffee and orange juice stimulate acid formation in the stomach. It is best to suggest eating dry carbohydrates when rising in the morning.

13. The labor of a pregnant woman with preeclampsia is going to be induced. The nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. What action by the nurse is most important? a. Palpate the woman's abdomen for tenderness. b. Document findings and begin the Pitocin infusion. c. Instruct the woman to ask for help getting out of bed. d. Assess the woman's drinking history.

ANS: C This woman has HELLP syndrome, with is characterized by low platelet counts and hepatic dysfunction. She is at risk for bleeding, so the nurse instructs her to call for assistance in getting in and out of bed. The nurse does not palpate the abdomen even though the woman may complain of abdominal pain because of possible rupture of a subcapsular hematoma. The findings should be documented but the nurse should intervene based on the abnormal findings. The liver enzymes are not elevated because of alcohol intake. HELLP (A serious complication of high blood pressure during pregnancy) H--Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body. EL--Elevated liver enzymes. High levels of these chemicals can be a sign of liver problems. LP--Low platelet count. Platelets help the blood clot.

34. A nurse in labor and delivery is caring for a Muslim woman during the active phase of labor. You note that when you touch her, she quickly draws away. Which response by the nurse is best? a. Continue to touch her as much as you need to while providing care. b. Assume that she doesn't like you and decrease your time with her. c. Limit touching to a minimum, as this may not be acceptable in her culture. d. Ask the charge nurse to reassign you to another patient.

ANS: C Touching is an important component of communication in various cultures, but if the patient appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her. By continuing to touch her, the nurse is showing disrespect for her cultural beliefs. A cultural response to touch does not reflect like or dislike. Being assigned to another patient is inappropriate; all nurses must be able to provide culturally appropriate care.

A nurse in labor and delivery is caring for a Muslim woman during the active phase of labor. You note that when you touch her, she quickly draws away. Which response by the nurse is best? a. Continue to touch her as much as you need to while providing care. b. Assume that she doesn't like you and decrease your time with her. c. Limit touching to a minimum, as this may not be acceptable in her culture. d. Ask the charge nurse to reassign you to another patient.

ANS: C Touching is an important component of communication in various cultures, but if the patient appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her. By continuing to touch her, the nurse is showing disrespect for her cultural beliefs. A cultural response to touch does not reflect like or dislike. Being assigned to another patient is inappropriate; all nurses must be able to provide culturally appropriate care.

4. A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: a. "You don't need to modify your exercising any time during your pregnancy." b. "Stop exercising because it will harm the fetus." c. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." d. "Jogging is too hard on your joints; switch to walking now."

ANS: C Typically running should be replaced with walking around the seventh month of pregnancy. The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.

2. During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criterion? (Select all that apply.) a. Leukorrhea b. Development of the operculum c. Quickening d. Ballottement e. Lightening

ANS: C, D, E Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements or "feeling life." Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descend into the pelvis. This occurs 2 weeks before labor in the nullipara and at the start of labor in the multipara. Mucus fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy. Passive movement of the unengaged fetus is referred to as ballottement.

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would require further discussion with the nurse? a. "My husband and I have agreed that my sister will be my coach." b. "We plan to use Lamaze to reduce the pain during labor." c. "We want the labor and birth to take place in a birthing room with our son present. d. "We will not use the fetal monitor during labor."

ANS: D A birth plan consists of what the woman and partner wish to have happen during labor and delivery. Intermittent or continuous fetal monitoring is one aspect of care for consideration; however, it is unrealistic to state that monitoring will not be used. The nurse should explain the purpose to ensure the couple is making an informed decision. The woman can refuse this procedure but would need to understand how this might negatively impact her child. The couple also need to understand that the entire plan is tentative depending on what events actually occur. The other statements are appropriate for a birth plan.

5. A placenta previa in which the placental edge just reaches the internal os is called a. total. b. partial. c. complete. d. marginal.

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa the placenta completely covers the os. With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 529 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

26. The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the: a. mother of the pregnant woman. b. couple's teenage daughter. c. sister of the pregnant woman. d. expectant father.

ANS: D An expectant father's experiencing pregnancy-like symptoms is called the couvade syndrome.

A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. What action by the nurse is best? a. Refer the patient to an ear, nose, and throat specialist. b. Explain that nasal stuffiness and nosebleeds are caused by a decrease in progesterone. c. Attach the woman to a cardiac monitor, and draw blood for hemoglobin and hematocrit. d. Teach that the increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

ANS: D As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy. No referral is needed. The patient does not need to be attached to a cardiac monitor or have lab drawn. The patient should be taught that estrogen causes these changes, not progesterone.

28. While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D Blood pressure is affected by maternal position during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

While the nurse assesses the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension

2. While the nurse assesses the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

18. In which situation is a dilation and curettage (D&C) indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks

ANS: D D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation. After that there is a greater risk of excessive bleeding, and this procedure may not be used. If all the products of conception have been passed (complete abortion), a D&C is not used. If the pregnancy is still viable (threatened abortion), a D&C is not used. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 525 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

The maternal task that begins in the first trimester and continues throughout the neonatal period is called a. seeking safe passage for herself and her baby. b. securing acceptance of the baby by others. c. learning to give of herself. d. developing attachment with the baby.

ANS: D Developing attachment (strong ties of affection) to the unborn baby begins in early pregnancy when the woman accepts that she is pregnant. By the second trimester, the baby becomes real, and feelings of love and attachment surge. Seeing safe passage is a task that ends with delivery. During this task the woman seeks health care and cultural practices. Securing acceptance continues throughout pregnancy as the woman reworks relationships. Learning to give of herself occurs during pregnancy and is sometimes noticed as the woman gives to others in the form of food or presents

16. Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and the basis for many tests. A maternity nurse should be aware that: a. hCG can be detected 2.5 weeks after conception. b. the hCG level increases gradually and uniformly throughout pregnancy. c. much lower than normal increases in the level of hCG may indicate a postdate pregnancy. d. a higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

ANS: D Higher levels also could be a sign of multiple gestation. hCG can be detected 7 to 8 days after conception. The hCG level fluctuates during pregnancy: peaking, declining, stabilizing, and increasing again. Abnormally slow increases may indicate impending miscarriage.

30. A woman with preeclampsia has a seizure. What action by the nurse takes priority? a. Insert an oral airway. b. Suction the mouth to prevent aspiration. c. Administer oxygen by mask. d. Stay with the patient and call for help.

ANS: D If a patient seizes, the nurse should stay with her and call for help. Nursing actions during a seizure are directed toward ensuring a patent airway and patient safety. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the patient's mouth. Oxygen may or may not be needed after the seizure has ended. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 544 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

18. To reassure and educate pregnant patients about changes in the cervix, vagina, and position of the fetus, nurses should be aware that: a. because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are much easier to evaluate. b. Quickening is a technique of palpating the fetus to engage it in passive movement. c. the deepening color of the vaginal mucosa and cervix (Chadwick's sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor. d. increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

ANS: D Increased sensitivity and an increased interest in sex sometimes go together. This frequently occurs during the second trimester. Cervical changes make evaluation of abnormal Pap tests more difficult. Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. Chadwick's sign appears from the sixth to eighth weeks.

25. Which statement about a condition of pregnancy is accurate? a. Insufficient salivation (ptyalism) is caused by increases in estrogen. b. Acid indigestion (pyrosis) begins early but declines throughout pregnancy. c. Hyperthyroidism often develops (temporarily) because hormone production increases. d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

ANS: D Normal nausea and vomiting rarely produce harmful effects, and nausea and vomiting periods may be less likely to result in miscarriage or preterm labor. Ptyalism is excessive salivation, which may be caused by a decrease in unconscious swallowing or stimulation of the salivary glands. Pyrosis begins in the first trimester and intensifies through the third trimester. Increased hormone production does not lead to hyperthyroidism in pregnant women.

11. While assessing her patient, what does the nurse interpret as a positive sign of pregnancy? a. Fetal movement felt by the woman b. Amenorrhea c. Breast changes d. Visualization of fetus by ultrasound

ANS: D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Fetal movement felt by the woman, amenorrhea, and breast changes are all presumptive signs.

While assessing her patient, what does the nurse interpret as a positive sign of pregnancy? a. Fetal movement felt by the woman b. Amenorrhea c. Breast changes d. Visualization of fetus by ultrasound

ANS: D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Fetal movement felt by the woman, amenorrhea, and breast changes are all presumptive signs.

14. In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose? a. To promote family unity b. To ward off the "evil eye" c. To appease the gods of fertility d. To protect the mother and fetus during pregnancy

ANS: D The purpose of all cultural practices is to protect the mother and fetus during pregnancy. Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus.

7. A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her: a. "Since you're in your second trimester, there's no problem with having one drink with dinner." b. "One drink every night is too much. One drink three times a week should be fine." c. "Since you're in your second trimester, you can drink as much as you like." d. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."

ANS: D The statement "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy" is accurate. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.

9. A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she does not know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate? a. "Don't worry about it; you'll feel better in a month or so." b. "Have you talked to your husband about how you feel?" c. "Perhaps you really don't want to be pregnant." d. "Hormonal changes during pregnancy commonly result in mood swings."

ANS: D The statement "Hormonal changes during pregnancy commonly result in mood swings" is accurate and the most appropriate response by the nurse. The statement "Don't worry about it; you'll feel better in a month or so" dismisses the patient's concerns and is not the most appropriate response. Although women should be encouraged to share their feelings, "Have you talked to your husband about how you feel" is not the most appropriate response and does not provide the patient with a rationale for the psychosocial dynamics of her pregnancy. "Perhaps you really don't want to be pregnant" is completely inappropriate and deleterious to the psychologic well-being of the woman. Hormonal and metabolic adaptations often cause mood swings in pregnancy. The woman's responses are normal. She should be reassured about her feelings.

A step in maternal role attainment that relates to the woman giving up certain aspects of her previous life is termed a. looking for a fit. b. role playing. c. fantasy. d. grief work.

ANS: D The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back. Looking for a fit is when the woman observes the behaviors of mothers and compares them with her own expectations. Role playing involves searching for opportunities to provide care for infants in the presence of another person. Fantasies allow the woman to try on a variety of behaviors. This usually deals with how the child will look and the characteristics of the child.

17. What represents a typical progression through the phases of a woman's establishing a relationship with the fetus? a. Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has a feeling of caring and responsibility. b. Fantasizes about the child's gender and personality—views the child as part of herself—becomes introspective. c. Views the child as part of herself—has feelings of well-being—accepts the biologic fact of pregnancy. d. "I am pregnant."—"I am going to have a baby."—"I am going to be a mother."

ANS: D The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions, "I am pregnant," "I am going to have a baby," and "I am going to be a mother" sum up the progression through the three phases.

15. After implantation, tiny projections develop out of the trophoblast and extend into the endometrium. These projections are referred to as a. decidua basalis. b. decidua capsularis. c. decidua vera. d. chorionic villi.

ANS: D These villi are vascular processes that obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood. The deciduas basalis is the portion of the endometrium where the chorionic villi tap into the maternal blood vessels. The deciduas capsularis is the portion of the endometrium that covers the blastocyst. The portion of the endometrium that lines the rest of the uterus is called decidua vera.

A woman with gestational hypertension experiences a seizure. Which of the following would be the priority? A) Fluid replacement B) Oxygenation C) Control of hypertension D) Delivery of the fetus

B) Oxygenation

A woman who is 10 weeks' pregnant asks the nurse about the multiple marker screen testing that the nurse-midwife has ordered. The nurse should base her Answer on the knowledge that a. A multiple marker screen test will test for three types of sexual trANSmitted diseases so that Patsy can be treated if necessary b. A multiple marker screen test will screen for fetal anomalies c. A triple screen test will test for gestational diabetes so treatment can be started early in the pregnancy d. A multiple marker screen test will test Patsy's blood and the fetal blood for compatibility

B. A. The multiple marker screen test consists of maternal serum alpha-fetoprotein, human chorionic gonadotropin, and estriol levels. These tests screen for fetal anomalies such as Down syndrome or neural tube defects. To test for STDs, individual tests are used for each disease. B. The multiple marker screen test consist of maternal serum alpha-fetoprotein, human chorionic gonadotropin, and estriol levels. These tests screen for fetal anomalies such as Down syndrome or neural tube defects. C. The multiple marker screen test consists of maternal serum alpha-fetoprotein, human chorionic gonadotropin, and estriol levels. These tests screen for fetal anomalies such as Down syndrome or neural tube defects. The maternal blood glucose test and 3-hour glucose tolerance test are used to diagnosis gestational diabetes. D. The multiple marker screen test consists of maternal serum alpha-fetoprotein, human chorionic gonadotropin, and estriol levels. These tests screen for fetal anomalies such as Down syndrome or neural tube defects. Blood grouping, Rh factor, and antibody screens are used to determine blood compatibility.

The nurse is teaching a parenting class to prospective fathers. The nurse correctly teaches that couvade refers to the: a. Development of attachment and bonding behaviors in the father of the baby. b. Development of the physical symptoms of pregnancy in the father of the baby. c. Expectant father's transition from nonparent to parent. d. Expectant father's fear of hurting the unborn baby during intercourse.

B. Development of the physical symptoms of pregnancy in the father of the baby. Rationale: Couvade is the unintentional development of the physical symptoms of pregnancy in the father of the baby. The expectant father's fear of hurting the unborn baby during intercourse, transition from nonparent to parent, and development of attachment and bonding behaviors are third-trimester paternal concerns.

A pregnant client with a normal BMI of 22 asks how much weight she should gain during pregnancy. The appropriate response by the nurse is A. you should gain 1 to 2 kg or 2.2 to 4.4 pounds in the first trimester then 1 pound per week for the remainder of the pregnancy. B. a total of 20 to 25 pounds. C. 1 pound a week during the first two trimesters, then 2 pounds per week during the third trimester. D. A pound a week during pregnancy.

B. a total of 20 to 25 pounds.

The nurse will be assisting a client during an amniocentesis. Which nursing intervention should the nurse prioritize? Caution about the narcotic premedication. Be certain she is aware of potential complications. Expect test results within 1 week. Ensure she understands the need for 2 days of bed rest.

Be certain she is aware of potential complications. The client should be aware of the potential complications and risks, and should sign an informed consent. Narcotics are contraindicated for pregnant woman due to side effects. She should maintain bed rest for the remainder of the day, with light housework the following day and a return to normal activities on the third day. It may take 2 or 3 weeks before the test results come back from the laboratory.

A 38-year-old client comes into the office for prenatal care, stating that she is about 12 weeks' pregnant with her first child. What action will the nurse take, considering the client's age and potential sensitivity to being labeled an "older" primipara? Ask about chronic illnesses that the health care provider should know about due to the client being older. Inquire about any family history of chromosomal abnormalities since older women are more likely to have infants with a chromosomal defect. Offer genetic counseling and an early amniocentesis to determine if termination is needed. Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore.

Be nonjudgmental in your history gathering and offer her pregnancy resources to read and explore. This client is pregnant for the first time later in life. The nurse must be supportive of this choice. Most women realize the increased risks for having giving birth after 35 years of age and do not need constant reminding of the potentially poor outcomes that can occur. The majority of pregnancies to women older than 35 years of age end with healthy newborns and mothers.

Which of the following statements is true regarding sexual activity and pregnancy? a) Because of pelvic congestion, women may experience increased clitoral sensitivity. b) Intercourse is not recommended before 36 weeks because it can induce labor. c) Women who have a partially dilated or effaced cervix at term must refrain from sexual activity. d) Female orgasm on the EDC will cause labor to begin.

Because of pelvic congestion, women may experience increased clitoral sensitivity.

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which of the following would the nurse identify as an abnormal finding? a) Bruising b) Darkening of the umbilicus c) Linea nigra d) Striae

Bruising

The health care provider orders PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which of the following would be most important for the nurse to do? A) Use clean technique to administer the drug. B) Keep the gel cool until ready to use. C) Maintain the client for hour after administration. D) Administer intramuscularly into the deltoid area.

C) Maintain the client for hour after administration.

A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia? A) Urine protein 300 mg/24 hours B) Blood pressure 150/96 mm Hg C) Mild facial edema D) Hyperreflexia

C) Mild facial edema

After teaching a group of nursing students about the impact of pregnancy on the older woman, the instructor determines that the teaching was successful when the students state which of the following? A) The majority of women who become pregnant over age 35 experience complications. B) Women over the age of 35 who become pregnant require a specialized type of assessment. C) Women over age 35 and are pregnant have an increased risk for spontaneous abortions. D) Women over age 35 are more likely to have substance abuse problems.

C) Women over age 35 and are pregnant have an increased risk for spontaneous abortions.

The nurse is researching the topic of uteroplacental blood flow. Which of the following accurately describes funic souffle? a. Increased blood pulsating through the placenta. b. Increased blood pulsating through the uterine arteries. c. A soft blowing sound of blood that is at the same rate as the maternal pulse. d. A soft blowing sound of blood that is at the same rate as the fetal heart rate.

C. A soft blowing sound of blood that is at the same rate as the maternal pulse. Rationale: Uterine souffle can be heard when the examiner auscultates the abdomen over the uterus. It is a soft, blowing sound that occurs at the same rate as the maternal pulse, and is caused by the increased uterine blood flow and blood pulsating through the placenta. It is sometimes confused with the funic souffle; a soft, blowing sound of blood pulsating through the umbilical cord. The funic souffle occurs at the same rate as the fetal heart rate.

A nurse practitioner is taking an initial history of a prenatal client. Which of the following, if detected by the nurse practitioner, would indicate a positive, or diagnostic, sign of pregnancy? a. Uterine enlargement and amenorrhea. b. Goodell's sign. c. Fetal heartbeat with a Doppler at 11 weeks' gestation. d. Positive pregnancy test.

C. Fetal heartbeat with a Doppler at 11 weeks' gestation. Rationale: The positive signs of pregnancy are completely objective, cannot be confused with a pathologic state, and offer conclusive proof of pregnancy. The fetal heartbeat can be detected with an electronic Doppler device as early as weeks' 10-12 of pregnancy. Pregnancy tests detect the presence of hCG in the maternal blood or urine. These are not considered a positive sign of pregnancy, because other conditions can cause elevated hCG levels. Physical changes, like Goodell's sign and uterine enlargement, also can have other causes and do not confirm pregnancy. The subjective changes of pregnancy, like amenorrhea, are the symptoms the woman experiences and reports. Because they can be caused by other conditions, they cannot be considered proof of pregnancy.

The nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results, which instruction should the nurse prioritize? Check blood sugar levels daily. Take daily iron supplements. the signs and symptoms of urinary tract infection Include iron-enriched foods in the diet.

Check blood sugar levels daily. An elevated blood glucose is concerning for diabetes. A fasting blood glucose level of greater than 140 mg/dl (7.77 mmol/L) or random level of greater than 200 mg/dl (11.10 mmol/L) is concerning; this must be followed up to ensure the client is not developing gestational diabetes. The hemoglobin and hematocrit are within normal limits for this client. The values should be hemoglobin greater than 11 g/dl (110 g/L) and hematocrit greater than 33% (0.33). Values lower than that are possible indications of anemia and would necessitate further evaluation. An individual with higher than normal blood glucose levels is at risk for developing urinary tract infection. This will usually happen after the glucose levels are elevated. Anemia can be treated by increasing the consumption of iron-enriched foods and taking a daily iron supplement.

The nurse is assessing a client at 12 weeks' gestation who reports enjoying her usual slow, long daily walk. The nurse should point out which recommendation to this client? Continue this as long as she enjoys it. Engage in aerobics for greater benefits. Stop and rest every block. Reduce walking to half a block daily.

Continue this as long as she enjoys it. Walking is an excellent exercise during pregnancy because it is low impact and increases venous circulation. Exercise should be maintained as long as it is comfortable, but intensity should not increase over what is normally performed.

While the vital signs of a pregnant woman in her third trimester are being assessment, the woman, who is lying supine, complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up; retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes; recheck her blood pressure on both arms. d. Have the patient turn to her left side; recheck her blood pressure in 5 minutes.

D. A. Having the patient stand up would cause an increase in systolic and diastolic pressures. B. Having the patient hold her arm in a dependent position will cause a false reading. C. The supine position may cause occlusion of the vena cava and descending aorta. This will produce supine hypotension. D. Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension.

During a prenatal visit at 36 weeks of gestation, the nurse tested a woman's urine for glucose and protein. The results indicated a trace amount of glucose. The nurse's next action should be to a. Retest the urine for accuracy b. Have the woman give another sample for retesting c. Report the results immediately to the physician so further testing can be preformed d. Consider this as a normal result for this stage of pregnancy

D. A. Small amounts of glucose in the urine may indicate physiologic spilling that occurs during normal pregnancy and further testing is not necessary. Larger amounts of glucose in the urine require further testing. B. Small amounts of glucose in the urine may indicate physiologic spilling that occurs during normal pregnancy and further testing is not necessary. Larger amounts of glucose in the urine require further testing. C. Small amounts of glucose in the urine may indicate physiologic spilling that occurs during normal pregnancy and further testing is not necessary. Larger amounts of glucose in the urine require further testing. D. Small amounts of glucose in the urine may indicate physiologic spilling that occurs during normal pregnancy and further testing is not necessary. Larger amounts of glucose in the urine require further testing.

Which of the following neonates would be a priority for monitoring for hypoglycemia? A. neonate of a substance abuser. B. Neonate with RH incompatibility. C. Postmature neonate born at 42 weeks. D. Neonate who is LGA (large for gestational age)

D. Neonate who is LGA (large for gestational age)

When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use including: a) Increased risk of stillbirth b) Decreased birth weight in neonates c) Increased risk of placenta abruptio d) Increased risk of spontaneous abortion

Decreased birth weight in neonates

A client reports bright red, painless vaginal bleeding during her 32nd week of pregnancy. A sonogram reveals that the placenta has implanted low in the uterus and is partially covering the cervical os. Which immediate care measures are initiated? Select all that apply. Place the woman on bed rest maintaining the supine position. Determine the time the bleeding began and about how much blood has been lost. Obtain baseline vital signs and compare to those vital signs previously obtained. Assist the client in stirrups and perform a pelvic examination. Attach external monitoring equipment to record fetal heart sounds and kick counts.

Determine the time the bleeding began and about how much blood has been lost. Obtain baseline vital signs and compare to those vital signs previously obtained. Attach external monitoring equipment to record fetal heart sounds and kick counts.

The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate? Document this and continue to monitor the murmur at future visits. Inquire if the client has chest pain. Refer her for cardiac catheterization. Ask another nurse to assess the heart.

Document this and continue to monitor the murmur at future visits. Due to the increased blood volume that occurs with pregnancy, soft systolic murmurs may be heard and are considered normal.

Mary Jones's maternal serum alpha-fetoprotein (MSAFP) screening results show that her MSAFP levels are high. What is the best response by the nurse? a) Her child is at risk for neural tube defects b) Her child is at risk for Down syndrome c) Further test are required based on the results d) The test may have been run during the wrong weeks gestation

Further test are required based on the results

The nurse is conducting the first prenatal assessment on a newly pregnant client. She shares with the nurse that she has 3 children, 2 born at full-term and one at 34 weeks' gestation. Her last pregnancy ended in a miscarriage. How should the nurse document this client's obstetrical history? G4 T3 P0 A1 L3 G4 T2 P1 A1 L3 G5 T2 P1 A1 L3 G3 T2 P1 A1 L3

G5 T2 P1 A1 L3 One of the most common methods of recording the obstetric history is to use the acronym GTPAL. "G" stands for gravida, the total number of pregnancies including the current one. "T" stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks' gestation); "P" is for preterm, the number of pregnancies that ended after 20 weeks and before the end of 37 weeks' gestation. "A" represents abortions, the number of pregnancies that ended before 20 weeks' gestation to include miscarriage. "L" is for living, the number of children delivered who are alive at the time of history collection. . For this client, G5 = current pregnancy (1) + children (3) + miscarriage (1); T2 = children born at 38+ weeks (2); P1 = children born between 20 and 37 weeks (1); A1 = abortion (0) + miscarriage (1); L3 = number of living children at time of assessment (3).

A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which of the following nursing diagnoses would best apply to her? a) Risk for ineffective breathing pattern related to pressure of the growing uterus b) Impaired urinary elimination related to inability to excrete creatine from her muscles c) Pain related to severe complications of pregnancy d) Health-seeking behaviors related to ways to relieve discomforts of pregnancy

Health-seeking behaviors related to ways to relieve discomforts of pregnancy

A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which of the following interventions should the nurse perform to prepare the client for the physical examination? a) Instruct the client to empty her bladder. b) Ensure that the client's family is present. c) Ensure that the client is lying down. d) Instruct the client to keep taking deep breaths.

Instruct the client to empty her bladder.

A woman in her third trimester shows the nurse a narrow, brown line that has formed on her abdomen, running from her belly button down to her pubic region. She expresses concern about this and asks the nurse whether it is normal. The nurse explains that this is a normal occurrence of pregnancy and that it results from the release of melanocyte-stimulating hormone from the pituitary, causing the appearance of extra pigmentation on the skin. This phenomenon is known as which of the following? a) Linea nigra b) Diastasis c) Striae gravidarum d) Melasma

Linea nigra

A woman at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination would lead to a diagnosis of placental abruption (abruptio placentae)? Fetus is in a breech position Sonogram shows the placenta covering the cervical os Uterus is soft between contractions Onset of vaginal bleeding was sudden and painful

Onset of vaginal bleeding was sudden and painful

While providing an education to a prenatal class for first time mothers and fathers during the first trimester, you include information that the father may experience which of the following as normal during the pregnancy: a) Desire to be the women and give birth b) No changes, only the mother has changes during pregnancy c) Feeling distanced from the mother d) Physical symptoms similar to the mother

Physical symptoms similar to the mother

What action does the nurse take before performing cardiopulmonary resuscitation (CPR) to revive a pregnant patient undergoing a cardiac arrest? 1 Administer normal saline solution. 2 Assess for fetal-maternal hemorrhage. 3 Call two staff nurses to hold the patient. 4 Place a rolled blanket under the patient's hips.

Place a rolled blanket under the patient's hips.

A client in her 29th week of gestation complains of dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which of the following interventions should the nurse implement to help alleviate this client's condition? a) Keep the client's legs slightly elevated. b) Place the client in an orthopneic position. c) Place the client in the left lateral position. d) Keep the head of the client's bed slightly elevated.

Place the client in the left lateral position.

A woman calls the clinic to schedule an appointment because "I think I might be pregnant." Upon further assessment gathering of information from the woman, which of the following would be a probable sign of pregnancy? a) Fatigue b) Nausea and vomiting c) Amenorrhea d) Positive home pregnancy test

Positive home pregnancy test

The hormone responsible for the initiation of lactation is what? a) Progesterone b) Prolactin c) Oxytocin d) Estrogen

Prolactin

Which finding in a urine specimen of a pregnant patient indicates the client has proteinuria? 1 Value of ≥0.5+ protein in a dipstick testing 2 Protein concentration that is >300 mg/24 hours 3 Concentration of ≥1 g protein in a 24-hour urine collection 4 Protein concentration at 10 mg/dL in random urine specimen

Protein concentration that is >300 mg/24 hours

During pregnancy, which of the following should the expectant mother reduce or avoid? a. Raw meat or uncooked shellfish b. Fresh, washed fruits and vegetables c. Whole grains d. Protein and iron from meat sources

Raw meat or uncooked shellfish

A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her? Apply lanolin ointment to the nipple and areola to prevent cracking. Perform nipple exercises and stimulation on a regular basis. Take a hot water bath or shower daily to maintain hygiene. Rest on the left side for at least 1 hour in the morning and afternoon.

Rest on the left side for at least 1 hour in the morning and afternoon. During the last months of pregnancy, the nurse should instruct the woman to rest on her left side for at least 1 hour in the morning and afternoon. This position relieves fetal pressure on the renal veins, helps the kidneys excrete fluid, and increases flow of oxygenated blood to the fetus. The body's oil and sweat glands are more active than usual during pregnancy. Thus, a daily warm bath or shower is important, rather than a hot bath, which may produce hyperthermia. Nipple exercises and stimulation should not be done, especially in the third trimester, when they can cause uterine contractions and premature labor. Lanolin ointment may damage the areola and nipple. It has not been shown to be effective in preventing sore and cracked nipples. Lanolin is also a common allergen and may contain insecticide residuals such as DDT.

The pregnant patient is asking about medications, supplements, and vaccines. Which of the following would the nurse indicate as potentially teratogenic? a) Penicillin b) Folic Acid c) Tylenol d) Rubella vaccine

Rubella vaccine

A pregnant woman is planning on taking a vacation that involves extensive travel by automobile. Which of the following guidelines should you give her? a) Sit in the back seat with feet elevated b) Travel no more than 120 miles daily c) Stop and walk every few hours d) Limit trips away from home, great than 200 miles

Stop and walk every few hours

A 15-year-old adolescent arrives at the office with a report of flu symptoms, including nausea and vomiting and recent weight loss. A pregnancy test is done and is positive. The client begins crying and tells the nurse her mother will be furious with her. What can the nurse do to assist this adolescent at this point? Tell the adolescent that this is too big of a problem for her to make decisions about and she needs to listen to her mother. Recommend some adoption agencies for her to talk to in the near future. Support her by respecting her right to privacy and confidentiality. Contact the mother of the adolescent to be sure the child gets prenatal care.

Support her by respecting her right to privacy and confidentiality. The nurse needs to be an advocate for the adolescent and respect her privacy and confidentiality. It would be advisable for the nurse to encourage the adolescent to talk to her mother or some other support person for help. The nurse has no right to contact the adolescent's mother or to share any information with her. Also, the nurse should not mention adoption at this point to the adolescent. That would be a topic for later discussion.

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? The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. The BPP is a blood test to detect placental problems. The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid. The BPP is a screening for neural tube defects.

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.

A non-stress test is performed on a pregnant woman. The nurse informs the client the test was reactive. Which of the following statements by the patient indicates understanding of the test results? a) The test is non-reactive, which is reassuring b) The results indicate a contraction stress test is needed for evaluation c) The fetal heart rate increases with activity and indicates fetal well-being d) There is no evidence of congenital anomalies or deformities

The fetal heart rate increases with activity and indicates fetal well-being

A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting? Threatened abortion Cervical insufficiency Ectopic pregnancy Habitual abortion

Threatened abortion

Morning sickness is associated with rising levels of human chorionic gonadotropin (hCG) and progesterone. a) True b) False

True

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which of the following danger signs of pregnancy needing immediate attention by the physician. a) Vaginal bleeding b) Painful urination c) Severe, persistent vomiting d) Lower abdominal and shoulder pain

Vaginal bleeding

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy? a) Finding of hCG in the blood b) Positive home pregnancy test c) Finding hCG in the urine d) Visualization of the gestational sac or fetus

Visualization of the gestational sac or fetus

C. Providing factual information based on physiologic mechanisms is the best option. Although having the patient write down her concerns is reasonable, the nurse should not refer this conversation to the physician but rather address the patient's specific concerns. Switching to a high-iron diet will not correct this condition. This physiologic pattern occurs during pregnancy as a result of hemodilution from excess blood volume. Iron medication is not indicated for correction of this condition. There is no need to contact the physician for a prescription.

What is the best explanation that the nurse can provide to a patient who is concerned that she has "pseudoanemia" of pregnancy? a. Have her write down her concerns and tell her that you will ask the physician to respond once the lab results have been evaluated b. Tell her that this is a benign self-limiting condition that can be easily corrected by switching to a high-iron diet. c. Inform her that because of the pregnancy, her blood volume has increased, leading to a substantial dilution effect on her serum blood levels, and that most women experience this condition. d. Contact the physician and get a prescription for iron pills to correct this condition.

D. Ambivalence refers to conflicting feelings. Expressing a concern about being a mother indicates possible ambivalent feelings. Not feeling well since the pregnancy began does not reflect conflicting feelings. The woman is trying to confirm the pregnancy when she is stating the rapid changes to her body. She is not expressing conflicting feelings. By expressing concerns over gaining weight, which is normal, the woman is trying to confirm the pregnancy.

Which comment made by a patient in her first trimester indicates ambivalent feelings? a. "My body is changing so quickly." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "I wanted to become pregnant, but I'm scared about being a mother."

D. The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Amenorrhea is a presumptive sign of pregnancy. Breast changes are a presumptive sign of pregnancy. Fetal movement is a presumptive sign of pregnancy

Which finding is a positive sign of pregnancy? a. Amenorrhea b. Breast changes c. Fetal movement felt by the woman d. Visualization of fetus by ultrasound

B. With pregnancy, one would expect the serum creatinine and BUN levels to decrease. An elevation in the serum creatinine level should be investigated. With pregnancy, the GFR increases because of increased renal blood flow and is thus a normal expected finding. A decrease in the blood urea nitrogen level and mild proteinuria is expected findings in pregnancy.

Which of these findings would indicate a potential complication related to renal function during pregnancy? a. Increase in glomerular filtration rate (GFR) b. Increase in serum creatinine level c. Decrease in blood urea nitrogen (BUN) d. Mild proteinuria

D. Decreased motility in the intestines leading to increased water absorption would cause constipation. Increased emptying time in the intestines leads to increased nutrient absorption. Abdominal distention and bloating are a result of increased emptying time in the intestines. Decreased absorption of water would not cause constipation

Which physiologic adaptation of pregnancy may lead to increased constipation during the pregnancy? a. Increased emptying time in the intestines b. Abdominal distention and bloating c. Decreased absorption of water d. Decreased motility in the intestines

B. Cardiac output increases during pregnancy as a result of increased stroke volume and heart rate. Systemic vascular resistance decreases while blood pressure remains the same. Maternal blood pressure changes in response to patient positioning. In response to increased metabolism, maternal vasodilation is seen during pregnancy

Which physiologic finding is consistent with normal pregnancy? a. Systemic vascular resistance increases as blood pressure decreases b. Cardiac output increases during pregnancy c. Blood pressure remains consistent independent of position changes d. Maternal vasoconstriction occurs in response to increased metabolism

D. Prolonged emptying time is seen during pregnancy and may lead to the development of gallstones. In pregnancy, there is a twofold to fourfold time increase in alkaline phosphatase levels as compared with those in nonpregnant woman. During pregnancy, a decrease in albumin level and total protein is seen as a result of hemodilution. Gallbladder tissue becomes hypotonic during pregnancy.

Which physiologic findings related to gallbladder function may lead to the development of gallstones during pregnancy? a. Decrease in alkaline phosphatase levels compared with nonpregnant women b. Increase in albumin and total protein as a result of hemodilution c. Hypertonicity of gallbladder tissue d. Prolonged emptying time

11. A nurse in the birth center is working with a patient in her third trimester who has ischemic heart disease. Which of the following should be the primary goal of nursing actions in this situation? a. Prevention of complications b. Reduction of serum cholesterol levels c. Reduction of blood pressure d. Adoption of a heart-healthy diet by the patient

a

15. A patient in her first trimester is found to have developed gestational diabetes mellitus (GDM). Which of the following should be the nurse's primary goal for this patient in helping manage this condition? a. Glycemic control b. Lowering blood pressure c. Reducing cholesterol level d. Weight loss

a

22. A nurse is observing a woman in preterm labor who has been given a tocolytic as well as a corticosteroid. Which of the following should cause the greatest concern in the nurse and be reported to the primary care provider? a. Blood pressure of 145/95 mm Hg b. Heart rate of 110 beats per minute c. Temperature of 99.9F (37.7C) d. Elevated white blood cell count

a

25. A patient in her first trimester is found on ultrasound to have a hydatiform mole pregnancy. Which of the following would be an appropriate nursing action associated with this condition? a. Offer emotional support related to pregnancy loss b. Administer magnesium sulfate per orders c. Instruct the patient on how to maintain glycemic control d. Prepare the patient for cesarean birth

a

During her first prenatal visit to the clinic, a woman gives the following obstetric history: a boy born 9 years ago at full term, twin girls born 5 years ago at 36 weeks, a miscarriage at 9 weeks 2 years ago. The nurse correctly records her obstetric history as A. Gravida 4, para 2, abort 1 B. Gravida 3, para 3, abort 1 C. Gravida 4, para 3, abort 1 D. Gravida 3, para 2, abort 1

a. A. The woman is currently pregnant and has been pregnant 3 more times; that makes her a gravida 4. She has delivered two pregnancies after 20 weeks of gestation; that makes her a para 2. The twin girls count as one pregnancy. She delivered one pregnancy prior to 20 weeks; that makes her an aborta 1. B. The woman is currently pregnant and has been pregnant three additional times; that makes her a gravid 4, not a gravida 3. She has delivered two pregnancies after 20 weeks; that makes her a para 2. The twin girls count as one pregnancy. She is an aborta 1. C. The woman is a gravida 4. She has delivered two pregnancies after 20 weeks; that makes her a para 2. The twin girls count as one pregnancy. She is an aborta 1. D. The woman is currently pregnant and has been pregnant 3 more times; that makes her a gravid 4, not a gravida 3. She is a para 2, aborta 1.

A woman who is 8 months pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which medication would the nurse anticipate the physician will prescribe? amoxicillin tetracycline bactrim septra

amoxicillin Amoxicillin is a penicillin antibiotic and can be used in the pregnant woman to treat a UTI. Tetracycline should never be given to a pregnant woman, because it may cause retardation of bone growth and staining of the fetal teeth. The sulfonamides (bactrim and septra) can be used in early pregnancy but not near term, because they can interfere with protein binding of bilirubin, which then can lead to hyperbilirubinemia in the newborn.

The nurse understands that the maternal uterus should be at what location at 20 weeks' gestation? at the level near the bottom of the sternum three finger-breadths above the umbilicus at the level of the symphysis pubis at the level of the umbilicus

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

A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client? at the level of the umbilicus halfway between the symphysis pubis and the umbilicus at the xiphoid process at the top of the symphysis pubis

at the level of the umbilicus In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

13. On examination, a nurse finds that a patient in her third trimester is experiencing hyperventilation and increased tidal volume. An increase in which hormone during pregnancy can account for this phenomenon? a. Estrogen b. Progesterone c. Testosterone d. Adrenaline

b

21. On ultrasound, it is discovered that a patient's trophoblast of the placenta has invaded the uterine wall beyond the normal boundary but not +into the uterine myometrium. The nurse should recognize that the patient has which of the following conditions? a. Placenta previa b. Placenta accreta c. Placcenta incereta d. Placenta percreta

b

3. A woman who smokes 2 packs a day just found out she is pregnant. What is the healthiest advice the nurse can give for smoking cessation? a. "You'll need to stop today, no ifs, ands, or butts" (pun intended) b. "You may want to consider weening off by increasing the amount of cigarettes eliminated each pack". c. "Beginning cessation may start during your second trimester" d. "You may want to continue your normal smoking routine to because cessation may have severe side effects for the fetus"

b. "You may want to consider weening off by increasing the amount of cigarettes eliminated each pack".

You are the nurse for a busy midwife who offers a free clinic day twice a week for the large migrant worker population in the area. The first appointment of the day is with Isabella Martinez, a 32-year-old patient from Honduras who speaks English fluently and arrived in the United States 3 weeks ago. She was receiving care in Honduras from a lay midwife but moved to the United States to follow her husband as he works in the local peanut fields. She has just a rudimentary written record of care. This is her first appointment at the office. Her preliminary information states she is 24 weeks, a G2P1, and that she's had no complications with either of her pregnancies that she's aware of. As you prepare for Isabella's appointment, what priority assessments would you expect to be performed based on her known history and gestational age? Select all that apply. a. Swab for group beta strep. b. A fundal height measurement c. An abdominal ultrasound d. Full set of vital signs along with weight and fundal height e. Urinary dipstick

b. A fundal height measurement c. An abdominal ultrasound d. Full set of vital signs along with weight and fundal height e. Urinary dipstick Fundal height measurement and an ultrasound can help to confirm the estimated date of delivery, particularly when a patient hasn't had a previous ultrasound at the typical 20 weeks. A full set of vital signs would be obtained at every visit to insure there are no concerns. A urine dipstick for glucose, albumin, and ketones is a routine check at every visit. Group beta strep swabbing wouldn't occur until approximately 35 to 37 weeks.

As you measure Isabella's fundal height during her appointment, you ask her questions about her nutritional intake, exposure to environmental hazards, use of over-the-counter or other medications, and her relationship with her husband. Her fundal height measurement is 22 cm. Vital signs are as follows: Blood pressure 122/67 mm Hg, pulse 72, respirations 20, temperature 99.0. Her BMI is 18%. Based on your assessment findings and your discussion, which of the following answers from Isabella would indicate a need for further assessment and possibly a referral for outside assistance? a. Her husband has a bottle of beer several nights a week because it helps him to fall asleep. Isabella used to join him but hasn't since she became pregnant. b. Her husband is able to bring home a bucket of peanuts a day, and between those and the small garden they planted, they are able to eat three meals a day. c. The house they are sharing with two other couples from Honduras has no air conditioning, but they do have several fans and keep the windows open. d. She lists Benadryl, prenatal vitamins, and an occasional Tylenol as her over-the-counter medications.

b. Her husband is able to bring home a bucket of peanuts a day, and between those and the small garden they planted, they are able to eat three meals a day. Peanuts and a limited supply of fresh vegetables may not be providing enough calories and nutrients to Isabella and her fetus. According to USDA guidelines, she should be consuming several cups of fruit and vegetables a day, along with grains, protein, and dairy. Her fundal height is measuring smaller than her stated 24 weeks as well, and her BMI places her in the underweight category. This indicates a possible nutritional deficit and should be addressed during this visit with a referral to assistive services within the community.

The maternal health nurse is caring for a pregnant client with iron-deficiency anemia who reports "extreme fatigue and shortness of breath" during a prenatal checkup at the outpatient clinic. The nurse prepares to educate the client regarding proper nutrition for this condition. Which dietary choice(s) will the nurse suggest? Select all that apply. beef stew with potatoes and milk dark leafy green salad with sunflower seeds and water fortified dried cereal with milk and orange juice red beans and rice with cranberry juice oatmeal with banana and tea

beef stew with potatoes and milk dark leafy green salad with sunflower seeds and water fortified dried cereal with milk and orange juice red beans and rice with cranberry juice The nurse should provide the client guidance on proper nutrition to help with the treatment of the client's disease. Nutrition should focus on foods high in iron, such as animal protein, dried beans, fortified grains and cereals, dried fruits, and any food cooked in cast iron cookware. The nurse should instruct the client that vitamin C enhances iron absorption. Therefore, the client should try to eat foods high in vitamin C along with iron-rich foods. Beef stew is animal protein that is high in iron. Fortified cereal is high in folate and fiber. Additionally, eating fortified food with orange juice increases its absorption. Dark leafy greens contain a large amount of folic acid, which is beneficial in the treatment of iron deficiency anemia. Red beans contain a large amount of iron and cranberry juice contains vitamin C, which aids in the iron absorption.

20. A woman has been diagnosed with preeclampsia in the 25th week of her pregnancy. Her primary care provider orders magnesium sulfate to be administered to her. The nurse recognizes that which of the following is the proper rationale for this intervention? a. Lower the blood pressure b. Clear up a group B streptococcus infection c. Reduce the risk of seizures d. Decrease blood glucose level

c

18. A nurse is observing a patient with severe preeclampsia when she receives the patient's latest laboratory values. Which of the following changes indicated by the laboratory results are indicative of a life-threatening condition that occurs as a complication of severe preeclampsia? (Select all that apply.) a. Increased blood glucose b. Elevated triglycerides c. Hemolysis d. Elevated liver enzymes e. Low platelets

c,d,e

Isabella has come back for her 32-week checkup, and you notice she has now gained a significant amount of weight. When you record her weight and vitals, you note she's had a 40-pound weight gain in the last 8 weeks. Her vital signs are as follows: Blood pressure 128/76 mm Hg, pulse 76, respirations 20, temperature 98.9. Knowing that pregnancy is often a time when women are more receptive to talking about weight gain and obesity, you ask her how she feels about her weight gain. Isabella states she's very pleased, her husband is very pleased, and she knows this means she will have a very healthy baby. She says that everyone in her family at home in Honduras knows that the bigger you are, the better everything will be. You shake your head and tell her, "No, this significant weight gain puts you at great risk for developing many life-threatening complications, including high blood pressure and gestational diabetes, and threatens your baby. I'm glad you're eating better and have gained weight, but this is too much, your family is wrong." Isabella appears angry, and then begins to cry. She gathers her things and leaves the office without saying another word. What did you do wrong? a. You did nothing wrong, it's not your fault Isabella is so emotional due to her pregnancy. b. By speaking so frankly, you came off as abrupt and untherapeutic, hurting her feelings. Next time you'll be sure to not sound so scary. c. By not recognizing the cultural influences behind Isabella's reaction to her weight gain, your response was untherapeutic and also culturally insensitive. Next time, you'll be sure to validate her cultural influences and discuss her weight in terms of her and her baby's health. d. By not recognizing the cultural influences behind Isabella's reaction to her weight gain, your response was untherapeutic and also culturally insensitive. Next time, you'll be sure to impress upon her the importance of the advanced health care system in the United States and how much she can learn from it now that she's here.

c. By not recognizing the cultural influences behind Isabella's reaction to her weight gain, your response was untherapeutic and also culturally insensitive. Next time, you'll be sure to validate her cultural influences and discuss her weight in terms of her and her baby's health. Immigrants to the United States are one of the most vulnerable pregnant populations to be seen within the health care system. In order to ensure that both the mom and the fetus receive the most optimal care, cultural sensitivity and respect for the practices from the country of origin are imperative during care. Without that understanding, many of these women go without care during their pregnancies.

While assessing a client's breast during the third trimester, which finding would the nurse expect? breasts becoming soft pink-colored nipples pain in the nipple area colostrum from the nipples

colostrum from the nipples During the third trimester, the nipples express colostrum. Areolae and nipples appear enlarged with darker pigmentation during the third trimester. The nurse assesses for the softness of the breast, color, and pain in the nipple area in nursing mothers.

5. A nurse is caring for a patient in her third trimester who has gonorrhea. The nurse recognizes that which major complication in the mother is associated with this sexually transmitted infection? a. Hemorrhagic and hypovolemic shock b. Seizures c. Disseminated intravascular coagulation d. Pelvic inflammatory disease

d

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client? seizures serum magnesium level of 6.5 mEq/L diminished reflexes elevated liver enzymes

diminished reflexes

C. Blood pressure is affected by positioning during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This would cause an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

during vital sign assessment of a pregnant patient in her 3rd trimester, the patient complains of feeling faint, dizzy, and agitated. which nursing intervention is most appropriate? a. have the pt stand up and retake her blood pressure b. have the pt sit down and hold her arm in a dependent position c. have the pt turn to her left side and recheck her blood pressure in 5 min d. have the pt lie supine for 5 min and recheck her bp on both arms

Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a woman who presents with premature prelabor rupture of membranes (PPROM) has completed how many weeks of gestation? less than 38 weeks less than 40 weeks less than 39 weeks less than 37 weeks

less than 37 weeks

Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply. mumps influenza Tdap vaccine (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) measles rubella

mumps measles rubella Live virus vaccines, such as measles, HPV, mumps, rubella, and poliomyelitis (Sabin type), are contraindicated during pregnancy because they may transmit a viral infection to a fetus. Women are advised to be vaccinated against influenza before/during pregnancy. Tetanus is also treated the same in pregnant women as in others by Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) injection.

A pregnant woman has been diagnosed with pica since she eats lead paint chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus? neurological challenges spontaneous abortion fetal growth restriction cataracts

neurological challenges Lead ingestion during pregnancy may lead to a newborn who is both cognitively and neurologically challenged. Formaldehyde exposure can lead to spontaneous abortions. Breathing air filled with pollutants (such as carbon monoxide) has been shown to lead to fetal growth restriction. The rubella virus' teratogenic effects on a fetus can be devastating, such as hearing impairment, cognitive and motor challenges, cataracts, and cardiac defects.

A pregnant client reports difficulty sleeping well. Which suggestion for sleeping should the nurse prioritize to assist this client? on her stomach with a pillow under her breasts on her side with the weight of the uterus on the bed on her back with a pillow under her head on her back with a pillow under her knees and hips

on her side with the weight of the uterus on the bed Resting on the side prevents pressure from the uterus against the vena cava and therefore allows blood to return to the uterus. Other positions may be more uncomfortable or may exacerbate the problems associated with pressure on the vena cava.

The nurse is assisting a primigravida on calculating the due date of her baby using Naegele rule. The most important information provided by the mother is: the ovulation date between her periods. the last day of her menstrual period. the date that intercourse occurred. the first day of the last menstrual period.

the first day of the last menstrual period. Naegele rule is calculated using the first day of the last menstrual period. From there, 7 days are added and then 3 months are subtracted. The ovulation date, intercourse date, or last day of the menstrual period are not needed.

A woman in her first trimester shares with the nurse that she has been experiencing terrible nausea when she gets up in the morning. Which of the following should the nurse advise her to do? (Select all that apply.) a) Eat two regular meals later in the day b) Eat some saltine crackers before rising in the morning c) Delay breakfast until 10 or 11 AM d) Try eating soups or vegetable drinks in the morning e) Use a scopolamine patch f) Suck on sourball candies

• Eat some saltine crackers before rising in the morning • Suck on sourball candies • Delay breakfast until 10 or 11 AM • Try eating soups or vegetable drinks in the morning

The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which of the following would the nurse include? Select all that apply. a) Headache with visual changes in the third trimester b) Nausea with vomiting during the first trimester c) Lower abdominal pain with shoulder pain in the first trimester d) Backache during the second trimester e) Sudden leakage of fluid during the second trimester f) Urinary frequency in the third trimester

• Headache with visual changes in the third trimester • Lower abdominal pain with shoulder pain in the first trimester • Sudden leakage of fluid during the second trimester

A client who is in her 6th week of gestation is being seen for a routine prenatal care visit. The client asks the nurse about changes in her eating habits that she should make during her pregnancy. The client informs the nurse that she is a vegetarian. The nurse knows that she has to monitor the client for which of the following risks arising from her vegetarian diet? Select all that apply. a) Increased risk of constipation b) Iron-deficiency anemia c) Low gestational weight gain d) Decreased mineral absorption e) Risk of epistaxis

• Iron-deficiency anemia • Decreased mineral absorption • Low gestational weight gain

The obstetrical nurse knows that a woman's hormone levels change dramatically during pregnancy. Which of the following hormonal actions accurately represent these changes? Select all that apply. a) Maintaining the endometrium so that the embryo can implant b) Causing changes in the mother's metabolism so that nutrients are available for both c) Preparing the breasts for lactation, keeping the milk from coming in until birth occurs d) Relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly e) Decreasing the blood supply to the gastrointestinal tract and slowing peristaltic waves f) Decreasing the mother's blood volume and red blood cell mass to increase oxygen

• Maintaining the endometrium so that the embryo can implant • Causing changes in the mother's metabolism so that nutrients are available for both • Relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly • Preparing the breasts for lactation, keeping the milk from coming in until birth occurs

A client comes to the prenatal clinic for a follow-up examination. When assessing the breasts, which of the following would the nurse expect to find? Select all that apply. a) Hyperpigmentation of the nipple b) Pallor of the areolae c) Increased sensitivity d) Prominent veins e) Warmth

• Prominent veins • Hyperpigmentation of the nipple • Increased sensitivity

Which statement made by the nursing student about the management of reduced cervical competence (premature dilation of the cervix) in a pregnant patient indicates effective learning? 1 "Progesterone supplementation is the only effective treatment." 2 "An abdominal cerclage is performed at the first week of gestation." 3 "Surgical treatment is ineffective in patients with an extremely short cervix." 4 "A prophylactic cerclage is used to constrict the internal os of the cervix."

"A prophylactic cerclage is used to constrict the internal os of the cervix."

The nurse is assessing a pregnant client who has a long history of asthma. She states, "I'm trying not to use my asthma medications because I certainly don't want my baby exposed to them." What is the nurse's best response? "Actually, having uncontrolled asthma is much riskier for your baby than the medication." "Your health care provider will likely agree with your decision." "I'm glad to hear that you're focused on ensuring your baby's health." "In fact, most modern asthma medications are categorized as safe for use in pregnancy."

"Actually, having uncontrolled asthma is much riskier for your baby than the medication." It is important for pregnant clients with asthma to keep taking their medications because the risks of exacerbations exceed the risks of the medications.

The nurse is caring for a pregnant client in the first trimester with a preexisting condition of rheumatic heart disease. The client reports mild shortness of breath with strenuous activity. When teaching the client, which statement(s) will the nurse include? Select all that apply. "Avoid cardiac medications in the first trimester." "Be sure to drink an adequate amount of fluids." "Be sure to receive an influenza vaccine." "Maintain bed rest to avoid cardiac exertion." "Perform moderate exercises as tolerated."

"Be sure to drink an adequate amount of fluids." "Be sure to receive an influenza vaccine." "Perform moderate exercises as tolerated." A woman with a preexisting cardiac valve disease is at an increased risk for heart failure during pregnancy, especially during certain periods of time of the client's pregnancy. The client should be advised to maintain hydration, avoid infection (by receiving the influenza vaccine), and perform moderate exercise as tolerated. The client with only mild cardiovascular disease may not require total bed rest and should be encouraged to maintain activity level as tolerated. The health care provider will advise the nurse regarding stopping or starting any cardiac medications during pregnancy.

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? "Come to the health facility with any vaginal material passed." "Continue normal activity, but take the pulse every hour." "Maintain bed rest, and count the number of perineal pads used." "Come to the health care facility if uterine contractions begin."

"Come to the health facility with any vaginal material passed."

What does the nurse advise a pregnant patient who is prescribed phenazopyridine (Pyridium) for cystitis? 1 "Avoid sweet foods in diet." 2 "Limit exposure to sunlight." 3 "Do not wear contact lenses." 4 "Restrict oral fluids to 125 mL per hour."

"Do not wear contact lenses."

In light of the high incidence of some illnesses in women, which of the following questions is most important to include in a review of systems for a pregnant woman? a) "Have you had any neurologic diseases?" b) "Have you had any urinary tract infections?" c) "Have you ever had a heart attack?" d) "Do you have a peptic ulcer?"

"Have you had any urinary tract infections?"

A pregnant client with iron-deficiency anemia is prescribed an iron supplement. After teaching the woman about using the supplement, the nurse determines that more teaching is needed based on which client statement? "If I happen to miss a dose, I will take it as soon as I remember." "Taking the iron supplement with food will help with the side effects." "I will take the iron with milk instead of orange or grapefruit juice." "I will need to avoid coffee and tea when I take this supplement."

"I will take the iron with milk instead of orange or grapefruit juice." The pregnant client should take the iron supplement with vitamin C-containing fluids such as orange juice, which will promote absorption, rather than milk, which can inhibit iron absorption. Taking iron on an empty stomach improves its absorption, but many women cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman is advised to take it with meals. The woman also needs instruction about adverse effects, which are predominantly gastrointestinal and include gastric discomfort, nausea, vomiting, anorexia, diarrhea, metallic taste, and constipation. Taking the iron supplement with meals and increasing intake of fiber and fluids helps overcome the most common side effects. If the woman misses a dose, she should take a dose as soon as she remembers.

After teaching the pregnant woman about ways to minimize flatulence and bloating during pregnancy, which statement indicates the need for additional teaching? a) "I'll switch to chewing gum instead of using mints." b) "I'll increase my time spent on walking each day." c) "I'll try to drink more fluids to help move things along." d) "I'll stay away from foods like cabbage and brussels sprouts."

"I'll switch to chewing gum instead of using mints."

A pregnant woman is experiencing morning sickness. Which of the following responses indicates a need for further teaching? a) "I'll avoid an empty stomach." b) "I'll eat frequent small servings of bland foods." c) "I'll take antacid between meals." d) "I'll snack on unsalted cracker."

"I'll take antacid between meals."

The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or during the birth for the infant. Which statement by the mother indicates that further teaching is needed by the nurse? "My baby may be very large and I may need a cesarean birth to have him." "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born." "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day."

"If my blood sugars are elevated, my baby's lungs will mature faster, which is good." Elevated blood sugars delay the maturation of fetal lungs, not increase maturation time, resulting in potential respiratory distress in newborns born to mothers with diabetes. Doing fetal movement (kick) counts is standard practice, as is the possibility of an amniocentesis to determine lung maturity during the third trimester. Health care personnel should also prepare the mother for the potential of a cesarean birth if the infant is too large.

A nurse you know is 5 weeks pregnant. She works on a unit where chemotherapy is administered. Which of the following statements would make you believe she needs additional health teaching about avoiding teratogens during pregnancy? a) "I never accompany clients to the x-ray department." b) "I care for about five clients a day." c) "Latex gloves irritate my hands, so I don't use them." d) "I find giving emotional support taxing."

"Latex gloves irritate my hands, so I don't use them."

The nurse is assessing a client at her first prenatal visit and notes that she is exposed to various chemicals at her place of employment. Which statement by the client would indicate she needs additional health education to protect her and her fetus? "I only work four hours a day so I don't get exposed too much." "I have an assistant helping me now to handle the chemicals." "The gloves they provide irritate my hands, so I don't use them." "There hasn't been a chemical spill in three years."

"The gloves they provide irritate my hands, so I don't use them." There are various chemicals which are recognized for their teratogenic effects and must be avoided during pregnancy. The nurse should find out which chemicals the client is exposed to and determine the risk factor. The greatest danger is the client handling chemicals without a barrier protection such as gloves. The other issues may also be dangers depending on the chemicals and the environment in which the client is working and should also be evaluated.

The nurse is teaching a prenatal class about preparing for their expanding families. Which of the following is helpful advice from the nurse? a) "Caring for your new infant is instinctual and will come naturally to you." b) "Your old coping methods will adequately get you through this period of adjustment." c) "Expect your other children to react positively to their new brother/sister." d) "The hormones of pregnancy may cause anxiety or depression postpartum."

"The hormones of pregnancy may cause anxiety or depression postpartum."

A client reports occasional headaches. She wants to know what she can take to alleviate the discomfort. What would be the best response by the nurse? a) "The safest medication to take for your headaches during your pregnancy would be Ibuprofen." b) "Wait until you reach your third trimester. You can take something to relieve headaches then." c) "The safest medication to take for your headaches during your pregnancy would be acetaminophen (Tylenol)." d) "You don't want to harm the baby by taking medications now, do you?"

"The safest medication to take for your headaches during your pregnancy would be acetaminophen (Tylenol)."

A student nurse asks the instructor about maternal pulse and blood pressure changes during the prenatal period. Which of the following responses from the nurse about cardiovascular changes during the first and second trimesters is accurate? a) "Women experience increased pulse rate and blood pressure." b) "Women experience increased pulse rate and decreased blood pressure." c) "Women experience decreased pulse rate and increased blood pressure." d) "Women experience no change in pulse rate or blood pressure."

"Women experience increased pulse rate and decreased blood pressure."

A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy? -FSH and LH -FSH and T4 -T4 and GH -LH and MSH

-FSH and LH

What is Amenorrhea?

-An abnormal absence of menstruation

During a routine antepartal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse do next? -Notify the healthcare provider of a possible infection. -Tell the woman that this is entirely normal. -Advise the woman about the need to culture the discharge. -Check the discharge for evidence of ruptured membranes.

-Tell the woman that this is entirely normal. Vaginal secretions increase during pregnancy and this is considered normal leukorrhea based on the woman's report that she is not experiencing any itching or irritation. There is no evidence indicating the need to notify the healthcare provider, check for rupture of membranes, or advise her about the need for a culture.

A laboring patient is experiencing labor dystocia. Which statement correctly describes labor dystocia? 1. Difficult labor characterized by abnormally slow labor progress 2. Fetal shoulder impacted under the maternal symphysis pubis 3. Fetal head larger than maternal pelvis 4. Uterine contractions >25 mm Hg with intrauterine pressure catheter

1

The nurse is caring for a client in preterm labor who reports that she fell down the stairs. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After instituting electronic fetal monitoring, starting tocolytic therapy, and examining the monitor strips, what action should the nurse take next?

1 Ambulating the client to promote circulation 2 Inserting two small-bore intravenous catheters Correct3 Determining whether the client feels safe at home 4 Ensuring that the client has her glasses to ambulate

A client is 9 weeks pregnant. Which of the following symptoms would the nurse expect the client to exhibit? 1. Urinary frequency 2. Occipital headache 3. Diarrhea 4. Leg cramps

1. Urinary frequency Urinary frequency is a common complaint of women during their first trimester H/A may be benign or, especially if noted after 20 weeks' gestation, may be a symptom of pregnancy-induced hypertension (PIH) Diarrhea rarely seen in pregnancy; constipation is a common complaint Leg cramps commonly seen in second and third trimesters

A nurse midwife has advised a 39-week gestation gravid to take evening primrose oil 2,500 mg daily as a complementary therapy. This suggestion was made because evening primrose has been shown to perform which of the following actions? 1. Relieve back strain. 2. Improve development of colostrum. 3. Ripen the cervix. 4. Reduce the incidence of hemorrhoids.

3. Evening primrose converts to a prostaglandin substance in the body. Prostaglandins are responsible for readying the cervix for dilation.

While performing Leopold's maneuvers on a laboring woman, the nurse palpates a flat area in the fundal region, a hard round mass on the left side, a soft round mass on the right side, and small parts just above the symphysis. The nurse concludes which of the following? 1. The fetal position is right occiput posterior 2. The fetal attitude is flexed 3. The fetal presentation is scapular 4. The fetal lie is vertical

3. The fetal presentation is scapular This is a shoulder presentation

After delivery of the fetal head, the head retracts back into the maternal perineum. Which action would the nurse expect to be performed first? 1. Apply pressure to the fundus. 2. Deliver the posterior arm of the fetus. 3. Prepare for emergency cesarean section. 4. Flex the patient's thighs against the abdomen.

4

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.

b) The serum iron level Pg. 297 The nurse is correct to assess for other indications for pica. Iron deficiency was thought to be a risk factor for pica but iron deficiency may be a consequence. Eating clay or soil may displace the intake of iron-rich foods from the diet and may interfere with iron absorption. A serum iron level to assess is most helpful. Weight gain and skin turgor are not associated with pica. Pulse oximetry level is not as indicative.

7. The nurse is caring for a client with a history of pica. After obtaining a nutritional assessment, which other assessment data would be helpful for the nurse to obtain? a) The client's weight gain b) The serum iron level c) The client's skin turgor d) The pulse oximeter reading

D. The patient is exhibiting behaviors associated with introversion and/or narcissism. These are normal findings during pregnancy as long as they do not become obsessive to the exclusion of everything else. The patient is talking about the pregnancy but there is no evidence that it is affecting her perception of reality and/or ability to perform ADLs. It is normal for pregnant women to focus on the self as being of prime importance in their life initially during the pregnancy. Some women may feel ambivalent about their pregnancy, which is a normal reaction. However, this patient's behavior does not support this finding. Some women react with uncertainty at the news of being pregnant, which is a normal reaction. However, this patient's behavior does not support this finding

A pregnant patient comes into the medical clinic stating that her family and friends are telling her that she is always talking about the pregnancy and nothing else. She is concerned that something is wrong with her. What psychological behavior is she exhibiting? a. Antepartum obsession b. Ambivalence c. Uncertainty d. Introversion

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that which result indicates good glucose control? A) 90 mg/dL B) 100 mg/dL C) 110 mg /dL D) 120 mg/dL

A) 90 mg/dL

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia? A) Calcium gluconate B) Potassium chloride C) Ferrous sulfate D) Calcium carbonate

A) Calcium gluconate

21.A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.) A) Dark red vaginal bleeding B) Insidious onset C) Absence of pain D) Rigid uterus E) Absent fetal heart tones

A) Dark red vaginal bleeding D) Insidious onset E) Absent fetal heart tones

A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which of the following would the nurse most likely include? A) Frequent handwashing B) Immunization C) Prenatal screening D) Antibody titer screening

A) Frequent handwashing

A pregnant woman tests positive for HBV. Which of the following would the nurse expect to administer? A) HBV immune globulin B) HBV vaccine C) Acylcovir D) Valacyclovir

A) HBV immune globulin

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios based on which of the following? (Select all that apply.) A) History of diabetes B) Complaints of shortness of breath C) Identifiable fetal parts on abdominal palpation D) Difficulty obtaining fetal heart rate E) Fundal height below that for expected gestataional age

A) History of diabetes B) Complaints of shortness of breath D) Difficulty obtaining fetal heart rate

A 30-week gestation G-1, P-0 client with DMII comes to the clinic distressed that she has noticed long periods where she has noticed no fetal movement. What would be the appropriate test to confirm movement and fetal viability? A) NST B) Amniocentesis C) CST D) CVS

A) NST

When teaching a class of pregnant women about the effects of substance abuse during pregnancy, which of the following would the nurse most likely include? A)Low-birth-weight infants B)Excessive weight gain C)Higher pain tolerance D)Longer gestational periods

A)Low-birth-weight infants

After teaching a group of students about the use of antiretroviral agents in pregnant women who are HIV- positive, the instructor determines that the teaching was successful when the group identifies which of the following as the underlying rationale? A)Reduction in viral loads in the blood B)Treatment of opportunistic infections C)Adjunct therapy to radiation and chemotherapy D)Can cure acute HIV/AIDS infections

A)Reduction in viral loads in the blood

A woman is expecting her second child. She expressed concern to the nurse about how her 4-year-old will adapt to the new baby. The following are some suggestions the nurse should include in her teaching. (Choose all that apply.) a. Come in and listen to the baby's heartbeat. b. Spend more time with grandmother to prepare him for being away from mother during the birth. c. Take a sibling class offered by the hospital. d. Decide which of your toys you would like to give to the new baby.

A, B, C 4-year-old is curious about the changes in mothers body and the baby. By being included in the process, the child will not feel left out. It will also give the child an opportunity to ask questions. Children need to prepare for being away from mother during the birth and hospitalization. Starting early in the pregnancy to spend more time with the individual who will care for them will assist in the trANSition. Sibling classes provide an opportunity for children to discuss what newborns are like and what changes the new baby will bring to the family<br><br><i>Nursing Process: Implementation<br>Cognitive Level: Application<br>Client Needs: Health Promotion and Maintenance</i></div> </div><div class="fdbk_incorrect">Incorrect Feedback: <div>Children need to be reassured that they are still maintaining an important role in the family. When they are asked to give up their possessions for the new baby, they may feel resentment. <br><br><i>Nursing Process: Implementation<br>Cognitive Level: Application<br>Client Needs: Health Promotion and Maintenance</i></div> </div>

A nurse is assessing a prenatal client's cardiovascular function. When should the nurse expect this client's cardiac output (CO) to begin rising? a. 8-10 weeks. b. 12-18 weeks. c. 31-38 weeks. d. 20-24 weeks.

A. 8-10 weeks. Rationale: Since cardiac output (CO) begins to rise early in pregnancy, 8-10 weeks is the best answer. 12-18, 20-24, and 31-38 weeks are too late.

The nurse in the prenatal clinic assesses a 26-year-old client at 13 weeks' gestation. Which presumptive (subjective) signs and symptoms of pregnancy should the nurse anticipate? a. Excessive fatigue and urinary frequency. b. Chadwick's sign and uterine souffle. c. Hegar's sign and quickening. d. Ballottement and positive pregnancy test.

A. Excessive fatigue and urinary frequency. Rationale: Excessive fatigue and urinary frequency both are presumptive (subjective) signs and symptoms of pregnancy. Hegar's sign, ballottement, a positive pregnancy test, Chadwick's sign, and uterine souffle are probable (objective) signs or symptoms of pregnancy.

Heartburn may occur during the second and third trimester is due to the stomach being displaced by the uterus and slowing of G.I. motility. What actions should be taken to reduce symptoms? (Select all that apply). A. client should eat small frequent meals B. not allow stomach to get too empty C. take antacids that is needed. D. Sit up at least 30 minutes after meals

A. client should eat small frequent meals B. not allow stomach to get too empty D. Sit up at least 30 minutes after meals

25. Which comment by a woman in her first trimester indicates ambivalent feelings? a. "I wanted to become pregnant, but I'm scared about being a mother." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "My body is changing so quickly."

ANS: A Ambivalence refers to conflicting feelings. This woman is demonstrating this conflict. The other statements do not indicate ambivalence.

35. A nurse is encouraging a patient to attend an early pregnancy class for the second trimester. What topic would be inconsistent with the nurse's knowledge of topics presented in this class? a. Fetal development b. Body mechanics c. Childbirth choices d. Managing morning sickness

ANS: D Managing morning sickness would be taught in a first trimester early pregnancy class. The other topics are appropriate for second trimester classes.

11. The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is: a. estrogen. b. human chorionic gonadotropin (hCG). c. oxytocin. d. progesterone.

ANS: D Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels increase at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

A nurse is teaching a group of pregnant adolescents about the anatomy and physiology of reproduction. The nurse determines that the teaching was effective when the adolescents identify the area where fertilization occurs. Which area is identified?

After ejaculation, the sperm travel by flagellar movement through the fluids of the cervical mucus into the fallopian tube to meet the descending ovum in the ampulla, where fertilization occurs.

What advice should the nurse provide to a pregnant patient who admits to continuing to drink alcohol 1 to 2 times a week? a) The affects of alcohol on the fetus are not fully understood b) She should avoid alcohol in the first trimester c) She may have an occasional drink after the first trimester d) Alcohol should not be consumed during pregnancy

Alcohol should not be consumed during pregnancy

Question: Place the following events in the sequence the pregnant woman would experience them, from first to last. 1. Amennorhea 2. Quickening 3. Braxton Hicks contractions 4. Uterine enlargement 5. Labor

Amennorhea Uterine enlargement Quickening Braxton Hicks contractions Labor

A young couple are very excited to discover they are pregnant and ask the nurse when to expect the baby. Based on a July 20 LMP, which day will the nurse predict for delivery? April 13 May 20 April 27 March 13

April 27 Naegele rule is to subtract 3 months and add 7 days from the first day of the last menstrual period to determine an expected due date, making the client's due date April 27.

A client in her third month of pregnancy arrives at the health care facility for a regular follow-up visit. The client reports discomfort due to increased urinary frequency. Which instruction should the nurse offer the client to reduce the client's discomfort? Munch on dry crackers and toast in the early morning. Avoid an empty stomach at all times. Drink fluids with meals rather than between meals. Avoid consumption of caffeinated drinks.

Avoid consumption of caffeinated drinks. To reduce the client's urinary frequency, the nurse should instruct the client to avoid consuming caffeinated drinks, since caffeine stimulates voiding patterns. The nurse instructs the client to drink fluids between meals rather than with meals if the client complains of nausea and vomiting. The nurse instructs the client to avoid an empty stomach at all times, to prevent fatigue. The nurse also instructs the client to munch on dry crackers or toast early in the morning before arising if the client experiences nausea and vomiting; this would not help the client experiencing urinary frequency.

What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances? Maintain personal hygiene. Avoid intake of coffee. Avoid medications. Eat a well-balanced diet.

Avoid medications. The nurse should instruct a client who is pregnant or one who wants to conceive to avoid medications and thus avoid exposure to any kind of teratogenic substance. Eating a well-balanced diet and maintaining personal hygiene, though important during pregnancy, will not prevent a client's exposure to teratogenic substances. Coffee is not a teratogenic substance, so the client need not avoid coffee. However, coffee is not recommended during pregnancy because it may increase the risk of spontaneous abortion (miscarriage).

A group of students are reviewing information about sexually transmitted infections and their effect on pregnancy. The students demonstrate understanding of the information when they identify which infection as being responsible for ophthalmia neonatorum? A) Syphilis B) Gonorrhea C) Chlamydia D) HPV

B) Gonorrhea

A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which of the following would the nurse assess? (Select all that apply.) A) Low whimpering cry B) Hypertonicity C) Lethargy D) Excessive sneezing E) Overly vigorous sucking F) Tremors

B) Hypertonicity C) Lethargy D) Excessive sneezing

A nurse is developing a program for pregnant women with diabetes about reducing complications. Which factor would the nurse identify as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes? A)Stability of the woman's emotional and psychological status B)Degree of glycemic control achieved during the pregnancy C)Evaluation of retinopathy by an ophthalmologist D)Blood urea nitrogen level (BUN. within normal limits

B)Degree of glycemic control achieved during the pregnancy

The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman's increased risk? A)Oligohydramnios B)Preeclampsia C)Post-term labor D)Chorioamnionitis

B)Preeclampsia

A woman is 35 weeks' pregnant during her clinic visit. She complains of numerous vaginal infections during the pregnancy. She tells the nurse, "I'm afraid I have diabetes, because I have some infections." The best response by the nurse would be a. "Diabetes is a possibility. I will set you up for testing." b. "A vaginal infection is a symptom of diabetes, but it also is a problem with normal pregnancies due to the changes in your vaginal area." c. "Itching is a problem with pregnancies and it makes you think you have an infection. The physician can order you some cream to help with the itching and pain." d. "This seems to be a concern with all of our patients today."

B. A. Diabetes is a possibility, but there are other considerations that need to be assessed first. B. During pregnancy, the glycogen levels of the vaginal area increase. This favors the growth of yeast-causing infections. C. Vulva itching is not a common problem with pregnancy. These symptoms should be investigated for the cause and treated. D. This statement is avoiding the issue the patient addressed and belittling her concerns. It is a closed-ended statement: the woman may not feel she can ask about it again.

A Muslim couple has given birth to a baby girl. After the baby is assessed, the nurse goes to talk with the father. The nurse puts her hand on his shoulder and states, "Come over and look at your new baby girl." The father immediately pulls away from the nurse and refuses to go with her. The nurse understands that this action is due to the father being a. Upset that the baby is a girl b. Offended by being touched by the female nurse c. Addressed by anyone other than the physician d. Concerned about the well-being of his wife

B. A. In some Muslim cultures, touching by a woman other than the wife is offensive to men. B. In some Muslim cultures, touching by a woman other than the wife is offensive to men. C. In some Muslim cultures, touching by a woman other than the wife is offensive to men. D. In some Muslim cultures, touching by a woman other than the wife is offensive to men.

A woman is expecting her first baby in 7 months. During the nurses assessment Anna continues to ask questions about changes in her body. The nurse can recommend which type of class to assist the woman with her questions? a. Preconception class b. Early pregnancy class c. Childbirth preparation class d. Parenting class

B. A. Preconception class is for couples thinking about having a baby. They are designed to help them prepare to have a healthy pregnancy. B. An early pregnancy class focuses on the first two trimesters. They cover information on adapting to pregnancy, dealing with discomforts, and understanding what to expect. C. Childbirth preparation class focuses on preparation for labor and delivery. D. Parenting classes focuses on care of the newborn.

Which of the following nursing interventions is appropriate when preparing a woman for an amniocentesis? a) Suggest that she take a deep breath and hold it during needle insertion b) Inform her that a narcotic premedication will be given to prevent pain during needle insertion c) Be certain she knows that there is are risks of complication, such as premature labor, from amniocentesis d) Instruct her not to empty her bladder prior to the procedure

Be certain she knows that there is are risks of complication, such as premature labor, from amniocentesis

Gestational diabetes occurs around the 24th week of gestation. When should every woman be screened for gestational diabetes? a) Between 20 and 24 weeks' gestation b) Between 24 and 28 weeks' gestation c) Between 28 and 32 weeks' gestation d) Between 16 and 20 weeks' gestation

Between 24 and 28 weeks' gestation

A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? A) Rubella B) Hepatitis B C) Cytomegalovirus D) Parvovirus B19

C) Cytomegalovirus

A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make? A) Make sure that anything around your waist is quite snug. B) Try to eat three large meals a day with less snacking. C) Drink fluids in between meals rather than with meals. D) Lie down for about an hour after you eat

C) Drink fluids in between meals rather than with meals.

After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching? A) I should take my iron with milk. B) I should avoid drinking orange juice. C) I need to eat foods high in fiber. D) I'll call the doctor if my stool is black and tarry.

C) I need to eat foods high in fiber.

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the clients plan of care? A) Clear liquid diet B) Total parenteral nutrition C) Nothing by mouth D) Administration of labetalol

C) Nothing by mouth

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate? A)Why are you crying? B)Will a pill help your pain? C)I'm sorry you lost your baby. D)A baby still wasn't formed in your uterus.

C)I'm sorry you lost your baby.

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurses teaching was successful? A)I'll basically follow the same diet that I was following before I became pregnant. B)Because I need extra protein, I'll have to increase my intake of milk and meat. C)Pregnancy affects insulin production, so I'll need to make adjustments in my diet. D)I'll adjust my diet and insulin based on the results of my urine tests for glucose.

C)Pregnancy affects insulin production, so I'll need to make adjustments in my diet.

Which of the following data on a clients health history would the nurse identify as contributing to the clients risk for an ectopic pregnancy? A)Use of oral contraceptives for 5 years B)Ovarian cyst 2 years ago C)Recurrent pelvic infections D)Heavy, irregular menses

C)Recurrent pelvic infections

In trying to confirm that she is pregnant, a woman says to the nurse a. "I have been eating too much lately; that is why my clothes are too tight." b. "I think I have the flu; I have been sick every morning." c. "I have been going to the bathroom more often; do you think I could be pregnant?" d. "My periods have always been irregular."

C. A. In this statement, the woman is finding an excuse for a symptom of pregnancy. She is not confirming but denying the pregnancy. B. In this statement, the woman is finding an excuse for a symptom of pregnancy. She is not confirming but denying the pregnancy. C. The woman is looking for confirmation, so she is observing her body carefully for changes indicating pregnancy. D. In this statement, the woman is finding an excuse for a symptom of pregnancy. She is not confirming but denying the pregnancy.

During prenatal teaching it is important for the nurse to inform the patient about danger signs in pregnancy. Which sign need to be reported immediately to the health care provider? a. Clear mucous vaginal discharge b. Frequent urination c. Vaginal bleeding d. Backache that occurs after standing for a long period

C. A. Mucous discharge may increase during pregnancy and is considered normal. B. Frequent urination is common during the first trimester and later in the third trimester. C. Vaginal bleeding during pregnancy needs to be reported immediately. It may be an indication of several complications of pregnancy, such as placenta previa or abruptio placenta. D. Backaches are the most common complaint during the third trimester.

A woman tells the nurse she is 16 weeks' pregnant. During the assessment, the nurse measures the fundus of the uterus to be at the umbilicus. The nurse correctly interprets the comparison of the dates with the measurements to be A. Not comparable B. Congruent C. Incongruent D. Irrelevant

C. A. The gestational age and the fundal height are comparable. They should be assessed at each clinic visit. If the fundal heights are too high or too low for the gestational age, then further assessment is necessary. B. The data are incongruent. The fundal height should be midway between the symphysis pubis and the umbilicus at 16 weeks. The woman's fundus is higher, so further assessment is necessary. C. The fundus should be at the umbilicus by 20 weeks. At 16 weeks, it is normally midway between the symphysis pubis and the umbilicus. The two sets of data do not match, and more assessment is necessary. D. From 16 to 18 weeks until 36 weeks, the fundal height, measured in centimeters, is approximately equal to the gestational age of the fetus in weeks.

A woman who is 7 months' pregnant states, "I'm worried that something will happen to my baby." The nurse's best response is a. "There is nothing to worry about." b. "The doctor is taking good care of you and your baby." c. "Tell me about your concerns." d. "Your baby is doing fine."

C. A. This statement belittles the woman's feelings. It also is a closed-ended statement that does not encourage the woman to discuss her feelings. B. This statement belittles the woman's feelings. It also is a closed-ended statement that does not encourage the woman to discuss her feelings. C. Encouraging the woman to discuss her feelings is the best approach. The nurse should not disregard or belittle the woman's feelings. D. This statement belittles the woman's feelings. It also is a closed-ended statement that does not encourage the woman to discuss her feelings.

All of the following are positive signs of pregnancy except A. fetal heart sounds. B. Palpated fetal movement. C. positive pregnancy test D. visualization of fetus by ultrasound.

C. positive pregnancy test

The nurse observes that intravenous (I.V.) administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant patient with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP? 1 Calcium gluconate 2 Nifedipine (Adalat) 3 Hydralazine (Apresoline) 4 Labetalol hydrochloride (Normodyne)

Calcium gluconate

The maternal health nurse cares for a homeless pregnant woman who presented to the emergency room in precipitous labor. The woman has not had prenatal care. Upon delivery, her infant weighs 4.6 kg and notes the infant appears to be jittery. Which nursing action will the nurse perform first? Administer intramuscular (IM) vitamin K. Check the infant's axillary temperature. Administer glucose. Check the infant's blood glucose level.

Check the infant's blood glucose level. The infant larger than 4 kg is considered macrosomic (large birth weight), which may occur when the pregnant woman has pregestational or gestational diabetes. Babies born to mothers who have uncontrolled diabetes are at increased risk for hypoglycemia because the infant produces large amounts of insulin in order to compensate for the elevated serum glucose levels that may be present in the blood due to diabetes. An infant with macrosomia and a jittery appearance should have blood glucose levels checked immediately. Once the glucose level is determined, glucose may or may not need to be administered. Checking the infant's axillary temperature and administering IM vitamin K will occur after the assessment and stabilization of the infant's blood glucose level.

A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which of the following symptoms is an indicator of true labor? a) Increase in fetal kick count b) Lightening (descent of the fetus into the pelvis) c) Intermittent backache stronger than usual d) Contractions beginning in the back and sweeping forward across the abdomen

Contractions beginning in the back and sweeping forward across the abdomen

10.When assessing a pregnant woman with heart disease throughout the antepartal period, the nurse would be especially alert for signs and symptoms of cardiac decompensation at which time? A) 16 to 20 weeks gestation B) 20 to 24 weeks gestation C) 24 to 28 weeks gestation D) 28 to 32 weeks gestation

D) 28 to 32 weeks gestation

The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome? A) Hyperglycemia B) Elevated platelet count C) Leukocytosis D) Elevated liver enzymes

D) Elevated liver enzymes

It is determined that a clients blood Rh is negative and her partners is positive. To help prevent Rh isoimmunization, the nurse anticipates that the client will receive RhoGAM at which time? A)At 34 weeks gestation and immediately before discharge B) 24 hours before delivery and 24 hours after delivery C)In the first trimester and within 2 hours of delivery D)At 28 weeks gestation and again within 72 hours after delivery

D)At 28 weeks gestation and again within 72 hours after delivery

Which of the following findings on a prenatal visit at 10 weeks might lead the nurse to suspect a hydatidiform mole? A)Complaint of frequent mild nausea B)Blood pressure of 120/84 mm Hg C)History of bright red spotting 6 weeks ago D)Fundal height measurement of 18 cm

D)Fundal height measurement of 18 cm

Which of the following findings would the nurse interpret as suggesting a diagnosis of gestational trophoblastic disease? A)Elevated hCG levels, enlarged abdomen, quickening B)Vaginal bleeding, absence of FHR, decreased hPL levels C)Visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen D)Gestational hypertension, hyperemesis gravidarum, absence of FHR

D)Gestational hypertension, hyperemesis gravidarum, absence of FHR

A woman with diabetes is considering becoming pregnant. She asks the nurse whether she will be able to take oral hypoglycemics when she is pregnant. The nurses response is based on the understanding that oral hypoglycemics: A)Can be used as long as they control serum glucose levels B)Can be taken until the degeneration of the placenta occurs C)Are usually suggested primarily for women who develop gestational diabetes D)Show promising results but more studies are needed to confirm their effectiveness

D)Show promising results but more studies are needed to confirm their effectiveness

A nurse is teaching a prenatal client about cardiovascular changes during pregnancy. The client asks the nurse why she becomes dizzy when getting out of a chair or out of bed. What rationale should the nurse provide as to the cause of this dizziness during pregnancy? a. Decreased absorption of hemoglobin in the blood. b. Increased production of fibrinogen and plasma. c. Decreased production of estrogen and progesterone. d. Increased blood volume in the lower extremities.

D. Increased blood volume in the lower extremities. Rationale: Increased blood volume in the lower legs can make the pregnant woman prone to postural hypotension. Hormones, fibrinogen, plasma production, and hemoglobin are not related to orthostatic hypotension.

Which of the following is a correct interpretation of positive, probable, and presumptive sings? A. Probable = nausea B. Presumptive = Chadwicks sign C. Positive = urine test D. Presumtpive = quickening

D. Presumtpive = quickening

A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? Decrease activity and rest more often. Discuss induction of labor with the health care provider. Increase fluids and take more vitamins. Bed rest and bathroom privileges only until birth.

Decrease activity and rest more often. If the client is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity, and treat the symptoms. At 32 weeks' gestation, the suggestion to induce labor is not appropriate, and without knowledge of the type of heart condition one would not recommend an increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.

The nurse discovers a soft systolic murmur when auscultating the heart of a client at 32 weeks' gestation. Which action would be most appropriate? a) Ask another nurse to assess the heart. b) Refer her for cardiac catheterization. c) Document this and continue to follow at future visits. d) Inquire if the client has chest pain.

Document this and continue to follow at future visits.

A common complaint during pregnancy is heartburn. As the clinic nurse, what would you recommend to decrease the discomfort of heartburn? a) Eat easily digested carbohydrates b) Eat small, frequent meals c) Drink liquids immediately before meals d) Drink warm liquids with your meals

Eat small, frequent meals

A client in her second trimester of pregnancy has developed varicose veins and experiences leg cramps. Which suggestion would be most appropriate? Increase intake of folic acid. Increase intake of calcium. Elevate legs while sitting. Perform aerobic exercises.

Elevate legs while sitting. The nurse should encourage the client to elevate her legs while sitting; this will prevent pooling and engorgement of veins in the lower extremities. Aerobic exercises do not help in preventing varicose veins. Folic acid intake is recommended in the first trimester to prevent congenital abnormalities. Increasing the intake of calcium helps in strengthening bones.

Which of the following findings from a woman's initial prenatal assessment would be considered a possible complication of pregnancy that requires reporting to a physician for management? a) Increased lumbar curvature b) Nasal congestion and swollen nasal membranes c) Episodes of double vision d) Palpitations when lying on her back

Episodes of double vision

What does the nurse administer to a patient if there is excessive bleeding after suction curettage? 1 Nifedipine (Procardia) 2 Methyldopa (Aldomet) 3 Hydralazine (Apresoline) 4 Ergonovine (Methergine)

Ergonovine (Methergine)

The urine of a woman in her second trimester of pregnancy is found to contain glucose. For which condition should she be tested? a) Anemia b) Gestational diabetes c) Preeclampsia d) Hypothyroidism

Gestational diabetes

A nurse caring for a pregnant woman with a pre-existing heart problem realizes the importance of doing which of the following at the very beginning of the pregnancy to help diagnose a complication? Help the woman to establish a daily routine. Establish baseline vital signs. Instruct the client to discontinue her exercise program of walking daily. Advise the client to make plans to quit her job.

Establish baseline vital signs. It is important to establish baseline vital signs to later identify a complication related to a pre-existing condition.

A pregnant 36-year-old woman has presented to the emergency department with vaginal bleeding. While reviewing the client's history, the nurse suspects placenta previa when which risk factors are found in her record? Select all that apply. previous induced surgical abortion advancing maternal age infertility treatment hypotension smoking

Everything but hypotension

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control? Plenty of rest Oral hypoglycemic agents Vitamin supplements Exercise

Exercise The three main facets to glycemic control for the woman with pregestational diabetes are diet, exercise, and insulin. An individual with type 1 diabetes uses insulin and not oral hypoglycemic agents. Vitamin supplements may assist with helping to keep the woman healthy but not necessarily through glycemic control. It will be important for the woman to get enough rest throughout the pregnancy but this will not assist with glycemic control.

What instruction does the nurse provide to a pregnant patient with mild preeclampsia? 1 "You need to be hospitalized for fetal evaluation." 2 "Nonstress testing can be done once every month." 3 "Fetal movement counts need to be evaluated daily." 4 "Take complete bed rest during the entire pregnancy."

Fetal movement counts need to be evaluated daily.

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she's been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which of the following is the nurse most likely to observe? a) Fundal height is at its highest level at the xiphoid process. b) The lower uterine segment and cervix have softene c) Fundal height has dropped since the last recording. d) The fundus is at the level of the umbilicus and measures 20 cm.

Fundal height has dropped since the last recording.

Martha is pregnant and arrives for her second prenatal appointment. Her previous pregnancy ended at 19 weeks and she has 3-year-old twins born at 30 weeks gestation. How will you document her "G" and "L" for her records? a) G2 L2 b) G3 L2 c) G3 L0 d) G2 L0

G3 L2

A woman presents to the clinic in the first trimester of pregnancy. She has three children living at home. One of them was born prematurely at 34 weeks. The other two were full-term at birth. She has a history of one miscarriage. How do you record her obstetric history on the chart using the GTPAL format? a) G4 T3 P0 A1 L3 b) G3 T2 P1 A1 L3 c) G4 T2 P1 A1 L3 d) G5 T2 P1 A1 L3

G5 T2 P1 A1 L3

The nurse is appraising the laboratory results of a pregnant client who is in her second trimester and notes the following: thyroid stimulating hormone (TSH) slightly elevated, glucose in the urine, complete blood count (CBC) low normal, and normal electrolytes. The nurse prioritizes further testing to rule out which condition? Hyperthyroidism Anemia Gestational diabetes Preeclampsia

Gestational diabetes Glycosuria, glucose in the urine, may occur normally during pregnancy; however, if it appears in the urine, the client should be sent for testing to rule out gestational diabetes. Preeclampsia, anemia, and hyperthyroidism are not related to glucose nor to renal function. A slightly elevated TSH would indicate possible hypothyroidism instead of hyperthyroidism. Anemia would be indicated by below normal hematocrit. If the client's CBC is low normal than the nurse should monitor future results to ensure the client's counts are not dropping. It would also be appropriate for the nurse to investigate possible dietary issues. Preeclampsia would be best monitored by the blood pressure readings.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? Heart rate of 84 beats/min Blood pressure of 100/68 mm Hg Hemoglobin of 13 g/dl (130 g/L) or lower Hematocrit of 32% or less

Hematocrit of 32% or less Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dl (110 g/L). Tachycardia, hypotension, and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria

The nurse teaches the pregnant client how to perform Kegel exercises as a way to accomplish which of the following? a. Prevent perineal lacerations b. Stimulate labor contractions c. Increase pelvic muscle tone d. Lose pregnancy weight quickly

Increase pelvic muscle tone

The husband of a pregnant woman tells the nurse that his wife is increasingly preoccupied with herself and her fetus. The woman is in her first trimester of pregnancy. The nurse interprets this as which of the following? a) Ambivalence b) Emotional lability c) Introversion d) Acceptance

Introversion

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. Which of the following conditions should the nurse monitor for in the client as a manifestation of consuming soil? a) Tooth fracture b) Constipation c) Iron-deficiency anemia d) Inefficient protein metabolism

Iron-deficiency anemia

The nurse is caring for a pregnant client with pregestational diabetes. Which goal does the nurse identify as priority during the client's pregnancy? Encourage minimal weight gain. Maintain glycemic control. Ensure compliance of glucose monitoring. Monitor for associated complications.

Maintain glycemic control. The most important goal when caring for a pregnant client with pregestational diabetes is to maintain glycemic control. The scenario does not give enough information on the client's weight to determine if the client should gain only minimal weight during pregnancy. Ensuring compliance of glucose monitoring and monitoring for associated complications are appropriate nursing interventions; however, these do not take priority.

A client in her second trimester of pregnancy visits a healthcare facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which of the following precautions should the nurse instruct the pregnant client to take when practicing aerobic exercises? a) Wear support hose when exercising b) Maintain tolerable intensity of exercise c) Reduce the amount of exercise d) Begin a new exercise regimen

Maintain tolerable intensity of exercise

A nurse counsels a pregnant woman regarding her recommended daily allowance of calories. She advises her to obtain her carbohydrate calories from complex carbohydrates rather than simple carbohydrates. What is the best rationale for this guidance? a) Faster digestion of complex than simple carbohydrates b) Provision of a greater amount of calories per gram c) More consistent regulation of glucose and insulin d) Greater fatty acid content

More consistent regulation of glucose and insulin

A client in her second trimester of pregnancy visits a health care facility. The client frequently engages in aerobic exercise and asks the nurse about doing so during her pregnancy. Which precaution should the nurse instruct the pregnant client to take when practicing aerobic exercises? Maintain tolerable intensity of exercise. Wear support hose when exercising. Begin a new exercise regimen. Reduce the amount of exercise.

Maintain tolerable intensity of exercise. Women accustomed to exercise before pregnancy are instructed to maintain a tolerable intensity of exercise. They are instructed not to begin a new exercise regimen. A nurse does not tell the client to wear a support hose when exercising or to reduce the amount of exercises.

A pregnant client's last normal menstrual period was on August 10. Using Nagele's rule, the nurse calculates that her estimated date of birth (EDB) will be which of the following? a. June 23 b. July 10 c. July 30 d. May 17

May 17 using Nagele's rule, 3 months are subtracted and 7 days are added, plus 1 year from the date of the last menstrual period.

The nurse explains to a pregnant client, who is anemic, that she will need to take vitamins with iron during her pregnancy. What are food would you include on the patient's diet plan? a) Grains b) Meats c) Dairy d) Legumes

Meats

You advise your pregnant patient to keep a small high-carbohydrate snack on the bedside table. This advice is given to ameliorate which condition? a) Faintness b) Slowed GI transit time c) Nausea and vomiting d) Heartburn

Nausea and vomiting

Which of the following biophysical profile findings indicate poor oxygenation to the fetus? a. Two pockets of amniotic fluid b. Well-flexed arms and legs c. Nonreactive fetal heart rate d. Fetal breathing movements noted

Nonreactive fetal heart rate

A pregnant woman comes in for a routine third-trimester exam, which included a pelvic exam. She calls several hours later, very worried, to report a small amount of bleeding. What should you tell her? a) That the bleeding, called Chadwick's sign, is a normal part of pregnancy b) That her cervical mucous plug may have been expelled c) To return right away d) Not to worry but to report any heavy increase in bleeding

Not to worry but to report any heavy increase in bleeding

What is the term that refers to a woman who has never been pregnant? a) Nulligravida b) Multigravida c) Gravida d) Parity

Nulligravida

Which actions does the nurse take when a pregnant patient has convulsions? Select all that apply. 1 Obtains a prescription for magnesium sulfate 2 Assesses the patient's airway, breathing, and pulse 3 Lowers the bed and turns the patient onto one side 4 Does not leave the patient for more than 10 minutes 5 Raises the side rails of the bed and pads with pillows

Obtains a prescription for magnesium sulfate Assesses the patient's airway, breathing, and pulse Lowers the bed and turns the patient onto one side Raises the side rails of the bed and pads with pillows

When discussing rest and sleep with a pregnant woman, which of the following positions would you suggest that she use for napping? a) On her back with a pillow under her knees and hips b) On her side with the weight of the uterus on the bed c) On her back with a pillow under her head d) On her stomach with a pillow under her breasts

On her side with the weight of the uterus on the bed

The nurse teaches a pregnant woman about breastfeeding, stating that stimulation of the breast through sucking or touching stimulates the secretion of which hormone? a) Cortisol b) Oxytocin c) Antidiuretic hormone d) Follicle stimulating hormone

Oxytocin

C. When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. There is increased production of erythrocytes during pregnancy

Physiologic anemia often occurs during pregnancy due to a. inadequate intake of iron b. the fetus establishing iron stores c. dilution of hemoglobin concentration d. decreased production of erythrocytes

A pregnant patient after 20 weeks' gestation reports painless, bright red vaginal bleeding. Upon assessment, the nurse finds that the patient's vital signs are normal. Which condition does the nurse suspect in the patient? 1 Eclampsia 2 Preeclampsia 3 Pyelonephritis 4 Placenta previa

Placenta previa

A woman accustomed to daily exercise complains late in her second trimester of pregnancy that she is experiencing "terrible" heartburn at night. What would you advise her to do? a) Seek emergency medical care. b) Take sodium bicarbonate. c) Put 6-inch blocks under the head of her bed. d) Stop or severely curtail her exercise.

Put 6-inch blocks under the head of her bed.

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence? a) Quickening b) Placenta previa c) Lightening d) Linea nigra

Quickening

A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy? cerclage blood typing of mothers with type A or B blood Rho(D) immune globulin administration to Rh-negative women amniocentesis

Rho(D) immune globulin administration to Rh-negative women

As part of a 31-year-old client's prenatal care, the nurse is assessing immunization history. Which of the following immunizations is most relevant to ensuring a healthy fetus? a) Diphtheria, tetanus, and pertussis b) Rubella c) Hepatitis A and B d) Measles

Rubella

Which intervention does the nurse implement for a patient immediately after a severe abdominal trauma? 1 Prep the patient for cesarean birth. 2 Send the patient for pelvic computed tomography (CT) scanning. 3 Provide fluids to the patient as part of the protocol for ultrasound examination. 4 Prepare to administer Rho(D) immunoglobulin.

Send the patient for pelvic computed tomography (CT) scanning.

The nurse is assessing a client at her first prenatal visit and reports her LMP started December 1. Which date will the nurse predict for the EDD? July 7 August 8 October 7 September 8

September 8 According to Naegele rule, the estimated date of birth is September 8. Add 7 days and subtract 3 months to the LMP to determine the estimated date of birth.

A client in her third trimester of pregnancy wishes to use the method of feeding formula to her baby? a) Mix one scoop of powder with an ounce of water. b) Refrigerate any leftover formula. c) Feed the infant every 8 hours. d) Serve the formula at room temperature.

Serve the formula at room temperature.

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy? Premature ventricular contractions S4 (atrial gallop) Soft systolic murmur Split S1S2

Soft systolic murmur A soft systolic murmur is common in pregnancy secondary to the increased blood volume. The other findings are not normal and require further assessment by the nurse.

The nurse is educating the client at 12 weeks' gestation regarding the best types of exercise throughout pregnancy. Which activities should the nurse encourage? High-impact movements enabling less time in the activity All activities that the client does in a prepregnant state Relaxing activities such as hot baths and jacuzzis Stretching and breathing exercises such as yoga

Stretching and breathing exercises such as yoga It is important to exercise during pregnancy. One excellent type of exercise includes yoga, which reduces stress and increases relaxation. Yoga also gently stretches muscles and can increase muscle tone. Contact and high-impact sports are not appropriate for the pregnant mother. Hot areas such as a jacuzzi, hot tub, and sauna are also inappropriate.

A nurse working at the local health district clinic assists numerous adolescents who become pregnant. Which factor will the nurse tell the teens is crucial for a positive pregnancy outcome? Acceptance by peers Support network Involvement of the father Cultural sensitivity

Support network One crucial part of management of teenage adolescent pregnancy includes helping the teens to develop an adequate support network. The network may include parents, teachers, friends and the father of the baby, in addition to resources needed to provide care for the infant and self. Cultural sensitivity, involvement of the father, and acceptance by peers are important to the teenager who is pregnant, but they are not considered crucial for a positive pregnancy and outcome for the mother and fetus.

500 The prepregnant capacity of the uterus is about 10 mL, and it reaches 5000 mL (5 L) by the end of the pregnancy, which reflects a 500-fold increase

The capacity of the uterus in a term pregnancy is how many times its prepregnant capacity? Record your answer as a whole number. __ times

A teenager in the clinic is refusing to eat during her pregnancy because she does not want to "get fat". What information should the nurse provide on the outcomes of the infant related to poor maternal weight gain? a) The fetus could develop congenital anomalies b) The infant will be small and could have problems c) It will just make the baby smaller but there are no other problems associated d) There is little impact on the infant, the mother will suffer complications

The infant will be small and could have problems

Which of the following statements would the nurse include in the teaching plan for a pregnant woman related to changes in the uterus? a) The uterus reaches its maximum height in the abdomen at 39 weeks. b) The uterus changes from a pear-shaped organ to an oval one. c) Uterine growth occurs because of an increase in the number of cells in the uterus. d) The uterus moves into the abdomen by the second month of pregnancy.

The uterus changes from a pear-shaped organ to an oval one.

Which change in the breasts should a nurse recognize as a normal change associated with pregnancy? a) Disappearance of superficial veins b) Hypopigmentation of the areola and nipples c) Tingling sensations and tenderness d) Expression of colostrum in the first trimester

Tingling sensations and tenderness

There is a strong correlation between poor oral health and preterm birth. a) True b) False

True

A pregnant woman states that she would like to take a tub bath but has heard from her aunt that this could be dangerous to the baby. Which of the following instructions should the nurse give to the patient? a) Avoid tub baths at all times during pregnancy, as they may be dangerous for the fetus b) Tub baths are fine, but avoid using soap, as this may prove a teratogen to the fetus c) Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding d) Long soaks in very hot water are encouraged during pregnancy to promote relaxation

Tub baths are fine unless you are unstable on your feet or are experiencing vaginal bleeding

A client in her third trimester complains to the nurse of shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem? a) Use extra pillows b) Lie on a firmer mattress c) Avoid overeating d) Avoid spicy food

Use extra pillows

A 24-year-old pregnant woman complains of excessive vaginal discharge. The discharge is not associated with a strong odor, itching, or irritation but she finds it messy and unpleasant. What do you advise her to do? a) Use sanitary pads b) Decrease her fluid intake c) Douche and wash frequently with mild soap and warm, not hot, water d) See her primary care provider to be tested for STIs

Use sanitary pads

A client in her 39th week of gestation complains of swelling in the legs after standing for long periods of time. The nurse recognizes that these factors increase the client's risk for which of the following conditions? a) Hemorrhoids b) Venous thrombosis c) Supine hypotension syndrome d) Embolism

Venous thrombosis

19. On ultrasound during a routine prenatal visit, it is discovered that a patient's placenta is completely covering her internal cervical os. The nurse recognizes that the biggest risk for the patient associated with this condition in the third trimester is which of the following? a. Hemorrhagic and hypovolemic shock b. Eclampsia c. Heart attack d. Aneurysm

a

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy? a) Positive home pregnancy test b) Visualization of the gestational sac or fetus c) Finding of hCG in the blood d) Finding hCG in the urine

Visualization of the gestational sac or fetus

The nurse is teaching a pregnant woman about how to prevent contracting cytomegalovirus (CMV) during pregnancy. What tips would the nurse share with this client? Select all that apply. Wash your hands thoroughly with soap and water after touching saliva or urine. If you have CMV, it is suggested that you not breastfeed your infant. Do not share food or drinks with young children, especially if they are in day care. If you contract CMV, your practitioner will give you some oral medicine to treat it. If you develop any flu-like symptoms, notify your pratitioner immediately to be evaluated for CMV.

Wash your hands thoroughly with soap and water after touching saliva or urine. Do not share food or drinks with young children, especially if they are in day care. If you develop any flu-like symptoms, notify your pratitioner immediately to be evaluated for CMV. Cytomegalovirus (CMV) is a mild infection and women may not know they have contracted it. The problem arises when a pregnant woman contracts it during the first 20 weeks of gestation. Prevention is the key, so the nurse would reinforce handwashing, not eating or drinking from a container after a small child has done so, and notifying the physician if the client develops mild flu-like symptoms so she can be tested to rule out CMV.

C. Coaching a little league baseball team shows interaction with children and assuming the behavior and role of a father. This best describes a man trying on the role of being a father. Men do not normally read information that is provided in advance. The nurse should be prepared to present information after the baby is born, when it is more relevant. The man will normally seek closer ties with his father. Exhibiting physical symptoms related to pregnancy is called &lt;i&gt;couvade&lt;/i&gt;

Which situation best describes a man trying on fathering behaviors? a. Reading books on newborn care b. Spending more time with his siblings c. Coaching a little league baseball team d. Exhibiting physical symptoms related to pregnancy

A woman in the last trimester of pregnancy complains of sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she can't sleep at all if she lies on her side. How would you suggest she try sleeping? a) Without a pillow b) With a pillow under both hips c) With a pillow under her right hip d) With a pillow under her shoulders

With a pillow under her right hip

24. A woman in her 35th week of gestation experiences premature rupture of membranes (PROM). Which of the following courses of action should the nurse most expect the primary care provider to take in this situation? a. Induction of labor and treatment for group B streptococcal prophylaxis b. A 48-hour course of intravenous ampicillin and erythromycin followed by 5 days of amoxicillin and erythromycin c. A single course of antenatal corticosteroids d. Patient counseling about risks to fetus

a

7. A nurse is counseling an obese client who is in her third trimester on a sleeping position that can decrease the nagative effects that obesity has on respiratory function. Which of the following should the nurse suggest? a. Sitting position b. Prone position c. Supine position d. Side-lying position

a

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply. leukocytosis hemolysis elevated liver enzymes low platelet count hyperthermia

hemolysis elevated liver enzymes low platelet count

A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority? infection edema jaundice hemorrhage

hemorrhage

Isabella has called the office at 36 weeks and a few days and complained of sharp shooting pains going from her back to the front of her belly. She knows this is a common discomfort, and she remembers from her first pregnancy that it's round ligament pain, but she doesn't remember what she's supposed to do for it. Which of the following recommendations are appropriate? Select all that apply. a. "Do pelvic tilt exercises." b. "Go for a walk and try to stretch those ligaments by stretching your arms up high while taking large steps." c. "Place several pillows between your knees while lying on your side and bringing your knees up to your belly as high as you can." d. "Take a warm bath or place warm compressions around your belly as you lie on your side." e. "You're probably going into labor; you should go to the hospital immediately."

a. "Do pelvic tilt exercises." c. "Place several pillows between your knees while lying on your side and bringing your knees up to your belly as high as you can." d. "Take a warm bath or place warm compressions around your belly as you lie on your side." Round ligament pain and discomfort is a common discomfort in the third trimester of pregnancy. Applying warmth in some form and also taking the weight of the uterus and fetus off the ligaments is the best and simplest solution. Rest is also a good idea, so encouraging walking with big movements would not be a good solution. There is no indication this is labor and Isabella recognizes the pain, so going to the hospital before trying comfort measures in the absence of other symptoms isn't needed.

A woman comes into the health clinic reporting she believes she may be pregnant. What would qualify as probable signs of pregnancy? Select all that apply. a. Chadwicks sign b. amenorrhea c. positive pregnancy test d. fetal movement palpated by an examiner. e. abdominal enlargement.

a. Chadwicks sign c. positive pregnancy test e. abdominal enlargement.

Which statement below is true when discussing fetal kick counts? a. Kick counts, or daily fetal movement counts, should be done for about an hour every day, and include any movement, not just kicking, such as swishes, rolling, or fluttering. b. At 36 weeks gestation, patients should be taught to feel for kicking motions hourly. If the fetus isn't forcefully kicking, the patient should immediately come to the hospital. c. Daily kick counts are only important if dealing with high-risk pregnancies, otherwise they will unnecessarily worry the patient. d. Kick counts should be monitored on the external monitors at the provider's office or at the hospital.

a. Kick counts, or daily fetal movement counts, should be done for about an hour every day, and include any movement, not just kicking, such as swishes, rolling, or fluttering.

Isabella is back for her next checkup 4 weeks later. You note that she appears to have gained some weight, but you notice her wince a few times as you begin your routine assessment. You ask if she's feeling ok, and she tells you she's been having some cramping over the last few days, but she knew she had this appointment and figured she could wait. Which of the following signs and symptoms that she states she's having could indicate preterm labor when paired with the cramping? Select all that apply. a. Pelvic pressure b. Vaginal spotting c. Nausea d. Constipation e. Backache

a. Pelvic pressure b. Vaginal spotting e. Backache Preterm labor can be indicated by an increase in vaginal discharge, vaginal bleeding, backache, pelvic pressure, leaking amniotic fluid, or rhythmic cramping.

The midwife has called Isabella and she's agreed to return to the office for her 36-week checkup. Isabella states her baby has been very active; she's felt it roll over five times while waiting in the waiting room but has only kicked on the occasion. She's very worried that the baby isn't doing enough kicking for the daily kick counts. What education has been left out of the teaching on kick counts for Isabella? a. That any fetal movement qualifies as a "kick," including flutters, swishes, and rolls, along with kicks. You speak slowly and use hand movements to help describe what you're saying to ensure she understands. b. Due to her cultural misinterpretation, she doesn't know what kick means. You look it up in Spanish and explain the definition of kick. c. You know you very specifically described what kick means, and Isabella is trying to get you in trouble after her last upsetting visit. You leave the explanation to the midwife and leave the room. d. Isabella is right, the fetus isn't moving enough. You immediately call in the midwife and begin to put her on the monitors.

a. That any fetal movement qualifies as a "kick," including flutters, swishes, and rolls, along with kicks. You speak slowly and use hand movements to help describe what you're saying to ensure she understands. "Kick counts", or daily fetal movement counts, are one of the best ways to ensure fetal well-being. Four movements in an hour, or 10 in 2 hours, is considered reassuring. Any fetal movement counts, including kicking, rolling, fluttering, or swishes. It's important to make that distinction to parents so they don't focus on the word "kick."

A pregnant client is brought to the health care facility with signs of premature rupture of the membranes (PROM). Which conditions and complications are associated with PROM? Select all that apply. placenta previa abruptio placenta preterm labor prolapsed cord spontaneous abortion

abruptio placenta preterm labor prolapsed cord

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: 1 eclamptic seizure. 2 rupture of the uterus. 3 placenta previa. 4 abruptio placentae.

abruptio placentae.

A potential complication for the mother and fetus is Rh incompatibility; therefore, assessment should include blood typing. If the mother is Rh negative, her antibody titer should be evaluated. If treatment with Rho(D) immune globulin is indicated, the nurse would expect to administer it at which time? only at birth at 32 weeks at 28 weeks at 36 weeks

at 28 weeks If indicated, Rho(D) immune globulin should be given at 28 weeks for prophylaxis and again following birth if the infant is Rh+.

A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? consumption of a low-fat diet administration of immunoglobulins constipation prevention avoidance of infection

avoidance of infection Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis. Fat intake does not need to be decreased and immunoglobulins are not normally administered. Constipation is not usually a result of sickle cell anemia.

14. A nurse is caring for a patient who has an acute asthma exacerbation during labor. Which of the following interventions should the nurse make? a. Measure blood pressure b. Administer oxygen c. Assist patient in performing breathing exercises d. Take a detailed history of respiratory status

b

26. A nurse is observing a patient with severe preeclampsia when the patient begins to have a seizure. The nurse calls for help. Which of the following is the most critical intervention for the nurse to perform next? a. Rais side rails and pad them b. Lower the head of the bed and turn the woman's head to one side c. Record the time, length, and type of seizure activity d. Administer magnesium sulfate per orders

b

3. A woman who is at 22 weeks of gestation reports pelvic pressure and increased mucoid vaginal discharge. On examination, her cervix is found to be dilated, and on ultrasound, it appears to be funneling. She is not experiencing any contractions. The primary care provider diagnoses her with incompetent cervix. Which of the following courses of action does the nurse anticipate next in this situation? a. Prophylactic cerclage b. Rescue cerclage c. Adminstration of oxytocin d. Administration of a tocolytic

b

A woman is concerned that she has developed numerous nosebleeds during this pregnancy. She feels this is a sign of leukemia and wants to be screened. The nurse's response to the woman should be based on the fact that a. Leukemia is a major concern during pregnancy b. Nose bleeds are a common occurrence during pregnancy c. Nose bleeds are rare in pregnancy; therefore further assessment is necessary d. Platelet count decreases significantly during pregnancy

b. A. Leukemia rates do not increase during pregnancy. B. Estrogen causes increased vascularity of the mucous membranes of the upper respiratory tract. The congestion may result in epistaxis. C. Nose bleeds are not rare in pregnancy. With the higher levels of estrogen causing increased vascularity in the upper respiratory tract, epistaxis is a common occurrence. D. There is a slight decrease in the platelet count but within normal range.

4. A patient has gone into preterm labor at week 33 of gestation. The attending physician has ordered that the patient be given the calcium channel blocker nifedipine, a common tocolytic drug. The nurse should recognize that which of the following is the appropriate rationale for this intervention? a. To stop preterm labor and ensure a full-term delivery b. To facilitate fetal lung maturity c. To delay delivery for up to 72 hours d. To clear up group B Strptococcus infections

c

9. A nurse sees a patient who is in the second trimester of pregnancy smoking outside the doctor's office just before her antepartal appointment. Which of the following should the nurse do when meeting with the patient later in the office? a. Adopt an adversarial approach if the woman does not agree to seek treatment b. Assume that the patient will not quit and proceed with the examination c. Provide nonjudgmental health education about the risks to the fetus of substance use during pregnancy d. Let the physician know that the woman is a smoker so that the physician can discuss it during the exam

c

After an hour and a few more glasses of water, Isabella states the cramping is gone. No uterine activity was noted on the monitor tracing, but she did have to use the restroom several times in the hour. You question her about urgency and burning, and she responds that she has had some burning. The midwife orders a urinary analysis be sent to the laboratory. Results show that Isabella has a urinary tract infection (UTI). She asks why she is more prone to developing a UTI now than when she isn't pregnant, stating she's never had one before. What is your best response? a. Because your bladder has become more rigid in pregnancy, it can't empty completely, causing you to hold urine there longer, leading to a bladder infection. It's very important that you drink at least a gallon of water a day to flush out your bladder better. b. Hormonal changes have changed the way your kidneys and bladder work, making you more susceptible to a UTI. Your kidneys are working harder to eliminate waste for both you and your baby, and your bladder is stretching and holding more urine, which increases the chance that bacteria will grow. c. You aren't more prone now, you probably aren't washing as well, and are wiping the wrong way when you have a bowel movement. It's important you clean your genitalia and perineum well after every void and bowel movement, and this won't happen again. d. Your bladder is under a lot of pressure during this time in your pregnancy from the baby, which is causing it to become inflamed and infected. There really isn't anything you can do about it except drink lots of water, wear loose clothes, and stay as clean as possible.

b. Hormonal changes have changed the way your kidneys and bladder work, making you more susceptible to a UTI. Your kidneys are working harder to eliminate waste for both you and your baby, and your bladder is stretching and holding more urine, which increases the chance that bacteria will grow. The bladder does not become more rigid, it will actually relax in tone, increasing the amount of urine it can hold. The kidneys will also have significant changes, including dilation of the renal pelvis and an increased glomerular filtration rate. These things can all lead to urinary stasis, or urine pooling, in turn leading to increased bacterial growth and a possible UTI. While increased frequency is a common side effect of pregnancy, burning is not. We should encourage patients to drink a minimum of eight glasses of liquid daily, but a gallon is not necessary. Next

A woman in her first trimester is receiving education on prenatal health promotion. The woman informs the nurse that she currently walks 3 days a week. Which statement by the client indicates need for further teaching? a. I can continue my current exercise routine. b. I will join a kickboxing class 2 days a week along with my regular walking routine. c. I can walk 5 days a week instead of 3. d. I will consult my primary care provider before beginning a new exercise routine.

b. I will join a kickboxing class 2 days a week along with my regular walking routine.

A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available? ferrous sulfate potassium chloride calcium gluconate calcium carbonate

calcium gluconate

A pregnant client at 20 weeks' gestation arrives at the health care facility reporting excessive vaginal bleeding and no fetal movements. Which assessment finding would the nurse anticipate in this situation? congenital malformations placenta previa ectopic pregnancy cervical insufficiency

cervical insufficiency

A pregnant client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to: begin oral hyperglycemic medications along with the insulin she is currently taking. check her blood sugars frequently and adjust insulin accordingly. limit weight gain to 15 pounds during the pregnancy. exercise for 1 to 2 hours each day to keep the blood glucose down.

check her blood sugars frequently and adjust insulin accordingly. The goal for a mother who has type I diabetes mellitus is to keep tight control over her blood sugars throughout the pregnancy. Therefore, she needs to test her blood sugar frequently during the day and make adjustments in the insulin doses she is receiving.

6. Soon after learning that she was pregnant, a patient calls the office reporting heavy vaginal bleeding. On examination in the office, it is discovered that the patient has lost her pregnancy. The nurse should record this event as which of the following in the patient's record? a. Induced abortion b. Elective abortion c. Therapeutic abortion d. Spontaneous abortion

d

A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client? long-acting insulin glucagon oral hypoglycemic drugs diet

diet Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are usually not given during pregnancy and would not be the first option. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.

Backache and cramping can both be a sign of ________________. a. hyperemesis gravidarum b. a large for gestational age fetus c. preeclampsia d. preterm labor

d. preterm labor

When preparing a class for a group of pregnant women about nicotine use during pregnancy, the nurse describes the major risks associated with nicotine use, including: increased risk of placental abruption (abruptio placentae). increased risk of spontaneous abortion (miscarriage). increased risk of stillbirth. decreased birth weight in neonates.

decreased birth weight in neonates. The nurse should inform the client that children born of mothers who use nicotine will have a decreased birth weight. Spontaneous abortion (miscarriage) is associated with caffeine use. Increased risks of stillbirth and placental abruption (abruptio placentae) are associated with mothers addicted to cocaine.

Some pregnant women hire a trained professional to provide support during pregnancy and birth, to provide emotional support during labor and birth, and to aid in establishing breastfeeding. What is the name of the woman who takes this role? partera pregnancy aide midwife doula

doula The pregnant woman may hire a doula to provide support for labor and birth and help with establishing breastfeeding. A doula can also provide support for the postpartum period.

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? disseminated intravascular coagulation (DIC) hyperglycemia elevated liver enzymes elevated platelet count

elevated liver enzymes

The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy? lower abdominal pressure swelling of extremities excessive vomiting dyspnea

excessive vomiting Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy.

One vitamin has been identified as helping to prevent neural tube defects when consumed in adequate amounts before conception through the early weeks of pregnancy. Which vitamin is it? vitamin B6 niacin folic acid riboflavin

folic acid It is well established that daily supplements of folic acid taken prior to pregnancy decrease the risk of neural tube defects by as much as two thirds.

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? preeclampsia abruptio placenta gestational hypertension placenta previa

gestational hypertension

The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which signs and symptoms would the nurse include? Select all that apply. urinary frequency in the third trimester headache with visual changes in the third trimester lower abdominal pain with shoulder pain in the first trimester nausea with vomiting during the first trimester sudden leakage of fluid during the second trimester backache during the second trimester

headache with visual changes in the third trimester sudden leakage of fluid during the second trimester lower abdominal pain with shoulder pain in the first trimester Danger signs and symptoms that need to be reported immediately include headache with visual changes in the third trimester; sudden leakage of fluid in the second trimester; and lower abdominal pain accompanied by shoulder pain in the first trimester. Urinary frequency in the third trimester, nausea and vomiting during the first trimester, and backache during the second trimester are common discomforts of pregnancy.

A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when? in weeks 12 to 20 in weeks 20 to 28 in weeks 8 to 12 in weeks 28 to 32

in weeks 28 to 32 The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks.

The nurse is assessing a client at 30 weeks' gestation who reports increased constipation. Which suggestion should the nurse prioritize for this client? reducing iron supplement increasing fluid intake taking mineral oil increasing intake of meat

increasing fluid intake Increasing fluid content by drinking at least 8 glasses of noncaffeinated beverages helps relieve constipation in both pregnant and nonpregnant women. Reducing an iron supplement could lead to anemia; mineral oil can reduce absorption of fat-soluble vitamins. The client should add foods rich in fiber, which would include grains, vegetables, and fruits (instead of meat).

The nurse reviews the medication therapy regimen of a pregnant woman with chronic hypertension. Which medication would the nurse most likely expect to find? carvedilol metoprolol labetalol atenolol

labetalol Although beta-blockers and calcium channel blockers may be prescribed to reduce blood pressure by peripheral dilation to a safe level, it should not be reduced below the threshold that allows for good placenta circulation. Labetalol and nifedipine are typical drugs that may be prescribed.

A nurse is reviewing an article about preterm prelabor rupture of membranes. Which factors would the nurse expect to find placing a woman at high risk for this condition? Select all that apply. low socioeconomic status single gestations smoking high body mass index urinary tract infection

low socioeconomic status smoking urinary tract infection

A nursing instructor is teaching students about caring for a pregnant client with a pre-existing disease. Which of the following does the instructor suggest has added to an increased incidence of pregnant women with a pre-existing disease? women seeking out earlier prenatal care better assessment skills by physicians better tests to diagnose diseases more women waiting until after age 30 years to get pregnant

more women waiting until after age 30 years to get pregnant As more women wait until they are older than 30 years to have their first child, more also enter pregnancy with a pre-existing disorder.

The nurse advises a pregnant client to keep a small high-carbohydrate, low-fat snack at the bedside. The nurse should point out this will assist with which condition? heartburn slowed GI transit time nausea and vomiting faintness

nausea and vomiting Women will commonly experience nausea and vomiting upon awakening first thing in the morning. Clients who experience this should be encouraged to have small snacks at their bedside for eating prior to moving from the bed. Heartburn is a result of pressure and hormone action. Faintness is due to pressure on the vena cava, not blood sugar. GI transit time is not affected.

A nurse is providing care to a multiparous client. The client has a history of cesarean births. The nurse anticipates the need to closely monitor the client for which condition? placenta accreta preeclampsia oligohydramnios placenta abruption

placenta accreta

A young woman with scoliosis has just learned that she is pregnant. Several years ago, she had stainless-steel rods surgically implanted on both sides of her vertebrae to strengthen and straighten her spine. However, her pelvis is unaffected by the condition. Which of the following does the nurse anticipate in this woman's pregnancy? potential for greater than usual back pain increased risk of fetal trauma cesarean birth increased risk of miscarriage

potential for greater than usual back pain urgical correction of scoliosis (lateral curvature of the spine) involves implanting stainless-steel rods on both sides of the vertebrae to strengthen and straighten the spine. Such rod implantations do not interfere with pregnancy; a woman may notice more than usual back pain, however, from increased tension on back muscles. If a woman's pelvis is distorted due to scoliosis, a cesarean birth may be scheduled to ensure a safe birth, but this is not required in this scenario. Vaginal birth, if permitted, requires the same management as for any woman. With the improved management of scoliosis, the high maternal and perinatal risks associated with the disorder reported in earlier literature no longer exist.

A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem? chorioamnionitis post-term labor preeclampsia oligohydramnios

preeclampsia

Which two tests are generally performed on urine at a prenatal visit? protein and glucose occult blood and protein pH and glucose protein and sodium

protein and glucose Protein is assessed to help detect hypertension of pregnancy; glucose is assessed to help detect gestational diabetes.

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client? monoamine oxidase inhibitors (MAOIs) methadone therapy ginger therapy restricted sodium intake

restricted sodium intake The client with peripartum cardiomyopathy should be prescribed a restricted sodium intake to control the blood pressure. Monoamine oxidase inhibitors are given to treat depression in pregnancy, not peripartum cardiomyopathy. Methadone is a drug given for the treatment of a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.

The nurse is preparing to administer a prescribed medication to the pregnant client. Which order should the nurse question? folic acid penicillin rubella acetaminophen

rubella Most vaccines are contraindicated during pregnancy and are considered teratogenic, such as rubella. Penicillin and acetaminophen may be taken under provider supervision. Folic acid supplementation should be encouraged.

A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? spontaneous abortion (miscarriage) preterm labor premature birth hypertension

spontaneous abortion (miscarriage)

A pregnant adolescent asks the nurse which sport would be safe for her to learn during pregnancy. Which activity would the nurse suggest as safe? skiing bicycling swimming jogging

swimming Sports that require balance (bicycling, skiing) become difficult during pregnancy. Jogging can be difficult because of lax knee cartilage. Swimming would be a safe activity to partake in during pregnancy.

In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include? family history of pregnancy complications the importance of healthy lifestyle the use of OTC drugs with teratogens importance of taking adequate vitamin and mineral supplements

the use of OTC drugs with teratogens Risk factors for adverse pregnancy have been demonstrated by statistics gathered for smoking during pregnancy, consuming alcohol during pregnancy, not taking adequate folic acid supplements during pregnancy, being obese, taking prescription or OTC drugs that are known teratogens, and having a preexisting condition that can negatively affect pregnancy if unmanaged.

A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply. rectum conjunctiva vagina throat nasal cavity

vagina rectum According to Centers for Disease Control and Prevention guidelines, all pregnant women should be screened for GBS at 35 to 37 weeks' gestation and treated. Vaginal and rectal specimens are cultured for the presence of the bacterium. Specimens from the throat, nasal cavity, or conjunctiva are not used.

A nurse is caring for a pregnant client in her second trimester of pregnancy. The nurse educates the client to look for which danger sign of pregnancy needing immediate attention by the primary care provider? severe, persistent vomiting painful urination lower abdominal and shoulder pain vaginal bleeding

vaginal bleeding In a client's second trimester of pregnancy, the nurse should educate the client to look for vaginal bleeding as a danger sign of pregnancy needing immediate attention from the primary care provider. Generally, painful urination, severe/persistent vomiting, and lower abdominal and shoulder pain are the danger signs that the client has to monitor for during the first trimester of pregnancy.

A woman is concerned about the safety of continuing coitus with her partner during pregnancy. Which of the following should the nurse mention to her? (Select all that apply.) a) Avoid partner oral-female genital contact due to risk of air embolism b) Avoid coitus after your membranes have ruptured c) Coitus on the expected date of your period can initiate labor d) Coitus is generally not harmful to the fetus e) Have a non-monogamous sexual partner wear a condom f) Coitus can cause rupture of the membranes

• Avoid coitus after your membranes have ruptured • Coitus is generally not harmful to the fetus • Avoid partner oral-female genital contact due to risk of air embolism • Have a non-monogamous sexual partner wear a condom

A pregnant client arrives at the maternity clinic complaining of constipation. Which of the following factors could be the cause of constipation during pregnancy? Select all that apply. a) Reduced stomach acidity b) Increase in estrogen levels c) Intestinal displacement d) Use of iron supplements e) Decreased activity level

• Decreased activity level • Use of iron supplements • Intestinal displacement

Which of the following are purposes for prenatal care? (Select all that apply.) a) Determine the gestational age of the fetus. b) Identify women at risk for complications. c) Establish a baseline of present health. d) Monitor for fetal development and maternal well-being. e) Increase the business of the clinic. f) Maximize the risk of possible complications.

• Establish a baseline of present health. • Determine the gestational age of the fetus. • Monitor for fetal development and maternal well-being. • Identify women at risk for complications.

A fit 30-year-old woman in her first trimester would like to continue exercising during pregnancy. She says she normally jogs, but has been thinking about taking up cycling. She also would like to know how much exercise she should get. Which of the following instructions should the nurse give to the client? (Select all that apply.) a) Walking is an excellent exercise option during pregnancy b) Include warm-up and cool-down exercises c) Exercise three times weekly for 30 consecutive minutes d) Avoid sports that involve body contact e) Avoid exercises that involve movements of large muscle groups rhythmically f) Avoid taking up a new sport, such as cycling, during pregnancy

• Exercise three times weekly for 30 consecutive minutes • Include warm-up and cool-down exercises • Avoid sports that involve body contact • Avoid taking up a new sport, such as cycling, during pregnancy • Walking is an excellent exercise option during pregnancy

A client in her second trimester of pregnancy arrives at a health care facility complaining of heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply. a) Sleep in a semi-Fowler's position b) Limit consumption of food before bedtime c) Avoid use of antacids d) Consume lots of liquids before bedtime e) Avoid overeating

• Sleep in a semi-Fowler's position • Limit consumption of food before bedtime • Avoid overeating

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.

A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy." "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman with a chronic condition can put herself at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy."

"A pregnant woman does not have to worry about contracting new illnesses during pregnancy." When a woman enters a pregnancy with a chronic illness, it can put both her and the fetus at risk. She needs to be cautious about developing a new illness during her pregnancy as well as having an accident during the pregnancy.

A pregnant woman has developed varicosities. Which of the following statements would suggest she needs additional health teaching? a) "I maintain a high fluid intake." b) "I'll try not to stand for long periods." c) "I wear knee-highs rather than pantyhose." d) "I dorsiflex my feet and ankles frequently."

"I wear knee-highs rather than pantyhose."

A client in her second trimester of pregnancy arrives at the health care facility for a routine follow-up visit. The nurse is required to educate the client so that the client knows what to expect during her second trimester. Which of the following information should the nurse offer? a) "You may have mood swings that could overwhelm your partner." b) "You will experience quickening, and you will actually feel the baby." c) "You will be more conscious of the changes taking place in your body now." d) "You may feel physical discomfort as the baby inside grows."

"You will experience quickening, and you will actually feel the baby."

Which assessment findings, experienced by the client at 36 weeks' gestation, would the nurse document as diagnostic signs of severe preeclampsia? Select all that apply. +1 proteinuria blood pressure of 164/110 mm Hg Elevated serum creatinine elevated liver enzymes edema

+1 proteinuria blood pressure of 164/110 mm Hg Elevated serum creatinine elevated liver enzymes

A mother comes in with her 17-year-old daughter to find out why she has not had a menstrual cycle for a few months. Examination confirms the daughter is pregnant with a fundal height of approximately 24 cm. The nurse interprets this finding as indicating that the daughter is approximately how many weeks pregnant? -24 -22 -20 -18

-24 By 20 weeks' gestation, the fundus of the uterus is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly used to date the pregnancy.

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.

A woman comes to the clinic for her first prenatal checkup. The woman has a body mass index (BMI) of 22. The nurse would anticipate that this client should gain approximately how much weight during her pregnancy? -25 to 35 lbs (11 to 16 kg) -28 to 40 lbs (13 to 18 kg) -15 to 25 lbs (7 to 11 kg) -11 to 20 lbs (5 to 9 kg)

-25 to 35 lbs (11 to 16 kg) A woman with a BMI of 18.5 to 24.9 is of normal weight and should gain 25 to 35 pounds (11 to 16 kg) during the pregnancy. For a woman who is underweight (BMI <18.5), the total weight gain range is 28 to 40 pounds (13 to 18 kg). For a woman who is overweight (BMI = 25-29.9), total weight gain range should be 15 to 25 pounds (7 to 11 kg). For a woman who is obese (BMI = 30 or higher), the total weight gain range should be 11 to 20 pounds (5 to 9 kg).

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: -85 beats per minute. -90 beats per minute. -95 beats per minute. -100 beats per minute.

-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.

Fetal macrosomic

-A condition in which a baby has a weight of more the 8 pounds, 13 ounces at birth.

Match the common Probable sign of pregnancy with its correct description -Chadwick's sign -Hegar's sign -Goodell's sign (softening of the lower uterine segment or isthmus) (bluish-purple coloration of the vaginal mucosa and cervix) (softening of the cervix)

-Chadwick's sign: bluish-purple coloration of the vaginal mucosa and cervix -Hegar's sign: softening of the lower uterine segment or isthmus -Goodell's sign: softening of the cervix

The nurse notes that a patient receiving oxytocin had six uterine contractions in 10 minutes, three of which occurred within 1 minute of each other. In which order should the nurse provide care to this patient? 1. Reposition the patient. 2. Discontinue oxytocin infusion. 3. Reduce oxytocin infusion by half. 4. Apply oxygen 10 L/min via nonrebreather mask. 5. Provide intravenous fluid bolus of 500 mL lactated ringers.

1, 2, 3, 4, 5

During a routine antepartal visit, a pregnant woman reports a white, thick vaginal discharge. What would the nurse do next? -Ask the woman if she is having any itching or irritation. -Tell the woman that this is entirely normal. -Advise the woman about the need to culture the discharge. -Check the discharge for evidence of ruptured membranes.

-Ask the woman if she is having any itching or irritation. Although vaginal secretions increase during pregnancy, the nurse would need to ascertain if this discharge is the normal leukorrhea of pregnancy or if it is a monilial vaginitis, which is common during pregnancy. The nurse needs additional information to conclude that the woman's report is normal. A culture may or may not be necessary. There is no evidence to suggest that her membranes have ruptured.

Which change related to the vital signs is expected in pregnant women? -Pulse decreases. -Lung space increases. -Blood pressure decreases. -Temperature decreases.

-Blood pressure decreases. -Pulse and temperature often increase, while lung space is decreased in pregnant women. It is common for blood pressure to decrease during pregnancy. (Dilation of vessels)

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called? -Pseudo pregnancy -Pregnancy syndrome -Couvade syndrome -Cretinism

-Couvade syndrome Some fathers actually experience some of the physical symptoms of pregnancy, such as nausea and vomiting, along with their partner. This phenomenon is called couvade syndrome.

Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to: -Detect fetal heart sounds with a Doppler. -Feel fetal movements. -Hear the fetal heartbeat with a stethoscope. -Palpate the fetal outline.

-Detect fetal heart sounds with a Doppler. Fetal heart sounds are audible with a Doppler at 10 to 12 weeks of gestation but cannot be heard through a stethoscope until 18 to 20 weeks of gestation. Fetal movements can be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around 20 weeks' gestation. The fetal outline is also palpable around 20 weeks of gestation.

Which effect would the nurse identify as a normal physiologic change in the renal system due to pregnancy? -Decrease in glomerular filtration rate -Dilation of the renal pelvis -Reduction in kidney size -Shortening of the ureters

-Dilation of the renal pelvis The renal pelvis becomes dilated during pregnancy, possibly due to the effect of progesterone on smooth muscle. The glomerular filtration rate increases during pregnancy. The kidneys enlarge during pregnancy. The ureters elongate, widen, and become more curved above the pelvic rim.

A pregnant woman tells the nurse she often has allergic responses to drugs. She is concerned that she will be allergic to her fetus or her body will reject the pregnancy. The nurse's reply would be based on which statement? -Immunologic activity is decreased during pregnancy. -The level of aldosterone during pregnancy reduces production of IgG antibodies. -The decreased corticosteroid activity during pregnancy ensures this will not happen. -The kidneys release a hormone during pregnancy to prevent this from happening.

-Immunologic activity is decreased during pregnancy. It is unproven why women do not reject fetal (foreign) tissue, but a substance secreted by the placenta is thought to decrease the usual immunologic response and prevent this from happening.

Which physical change would the nurse expect to find in a pregnant client? Select all that apply. -Increased blood volume -Decreased clotting factors Supine hypotension -Negative Hagar sign -Increased hemoglobin

-Increased blood volume -Supine hypotension The pregnant client will experience blood volume increases of 40-45% over prepregnancy levels. Supine hypotension occurs when the pregnant client lies down on her back in the latter half of the pregnancy and the uterus pushes down on the aorta and vena cava, decreasing cardiac return. The hemoglobin decreases due to physiologic hemodilution. The blood clotting factors increase during pregnancy, not decrease. A positive Hagar sign is one of the presumptive signs of pregnancy.

____ supplementation is recommended for all pregnant women because it is almost impossible for the pregnant woman to get what is required from diet alone, especially after 20 weeks' gestation when the requirements of the fetus increase.

-Iron

A client who is in her sixth week of gestation is being seen for a routine prenatal care visit. The client asks the nurse about changes in her eating habits that she should make during her pregnancy. The client informs the nurse that she is a vegetarian. The nurse knows that she has to monitor the client for which risks arising from her vegetarian diet? Select all that apply. -epistaxis -iron-deficiency anemia -decreased mineral absorption -constipation -low gestational weight gain

-Iron-deficiency anemia -Decreased mineral absorption -Low gestational weight gain

The nurse is preparing to teach a community class to a group of first-time parents. Which information should the nurse include concerning what the pregnant woman's partner may experience as a normal response? -Feeling distanced from the mother -No changes, only the mother has changes during pregnancy -Physical symptoms similar to the mother -Desire to be the woman and give birth

-Physical symptoms similar to the mother Couvade syndrome is the occurrence of physical symptoms by the partner, similar to the physical symptoms of the mother. Other emotional symptoms may occur, but they are typically on a person-to-person basis.

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

-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 gall bladder or the liver.

In addition to increasing levels of hCG, which other two factors contribute to morning sickness?

-Reduced stomach acidity and high levels of circulating estrogens

A 33-week pregnant client is in the office for a routine visit. She lies down on her back and while the nurse is listening for fetal heart tones, the client tells the nurse that she is lightheaded and her blood pressure is 82/58. What is the most likely explanation for this problem? -She is experiencing supine hypotension syndrome -She did not drink enough fluids prior to coming to the office. -Her hematocrit is low and she needs additional iron supplements. -The baby is kicking her spinal column, causing a pinched nerve.

-She is experiencing supine hypotension syndrome As the uterus gets larger toward the end of the pregnancy, it presses the aorta and vena cava against the spine, causing decreased blood return to the heart. This reduces cardiac output and the woman may feel lightheaded and dizzy and her blood pressure will drop.

A client who suspects she is pregnant asks the nurse about the accuracy of home pregnancy tests. The nurse would tell the client that: -Home pregnancy tests often give a false positive result. -Their reliability is only about 90%. -Some of the home pregnancy tests can detect the presence of hCG within one day of the woman's missed period. -The test works best on a midday urine sample.

-Some of the home pregnancy tests can detect the presence of hCG within one day of the woman's missed period. Home pregnancy tests are 95% reliable if used according to the instructions on the kit. In fact, some can detect hCG within one day after a missed period. These tests often give a false negative, not false positive reading and results can be tested with the first voided specimen of the day.

A 24-week pregnant client calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding? -The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. -She may have a bleeding disorder so she needs to come back to the clinic for blood work. -It is possible she is losing her mucous plug, which can cause bloody show. -Some bleeding during pregnancy is not uncommon and this finding is expected.

-The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual.

The nurse is holding an education class for clients in their third trimester and their partners. What information would she share with them in preparation for the birth of their child? Select all that apply. -Urinary frequency will return toward the end of the pregnancy. -It is recommended that the couple attend childbirth classes soon. -If backaches occur, the mother needs to be examined due to the possibility of an often-seen disc problem induced by pregnancy. -The mother will sleep more at night during the third trimester in preparation of the birth. -Nesting instincts begin during this period, allowing the mother to prepare for the baby.

-Urinary frequency will return toward the end of the pregnancy. -It is recommended that the couple attend childbirth classes soon. -Nesting instincts begin during this period, allowing the mother to prepare for the baby. During the third trimester, the mother begins to shop for clothing and nursery furniture, which is nesting. Additionally, she will experience urinary frequency due to the gravid uterus pushing down on the bladder. Lastly, the couple needs to attend childbirth classes to better understand what to expect, as well as providing social contact with other parents going through the same thing.

A woman in a prenatal clinic tells the nurse that her pregnancy was unplanned and unwanted. At what point in pregnancy does the average woman change her mind about an unwanted pregnancy? -Around the third month -When quickening occurs -After lightening happens -After the seventh month

-When quickening occurs Quickening, or feeling the baby move inside the body, is such a dramatic event that it can cause a woman's perceptions about the pregnancy to change.

An elevation of which hormone corresponds to the morning sickness period of approximately 6 to 12 weeks during early pregnancy?

-hCG

The ____ levels in a normal pregnancy usually double every 48 to 72 hours, until they reach a peak at approximately 60 to 70 days after fertilization.

-hCG

A nurse is providing emotional support to a patient who just experienced a stillbirth at 38 weeks' gestation. Which statement would indicate a non-therapeutic response by the nurse when providing support to the patient? 1. "I am sorry for your loss, but don't worry, you still have time to become pregnant again." 2. "I am going to hang this image of a butterfly outside your door to maintain your privacy and comfort." 3. "I am going to provide your family when mementos to take home with you, such as photos of the baby." 4. "I am here to support you. Let's discuss any religious or cultural needs you may have."

1

A nurse reads the client's history and physical, which lists the GTPAL as 3-1-1-0-2. How would the nurse interpret this? 1. The client has been pregnant three times, delivered once at term, once at preterm, and has two living children. 2. The client has been pregnant three times, delivered once at term, once at preterm, and had one miscarriage. She now has two living children. 3. The client has been pregnant three times, had one set of twins, one delivery after 20 weeks, and two children are living. 4. The client has been pregnant three times, had one therapeutic abortion, one delivery after 20 weeks, no miscarriages, and two living children.

1

An amniotomy was just performed on a laboring patient. Which nursing action has highest priority following an amniotomy? 1. Assess fetal heart rate. 2. Assess maternal temperature. 3. Change the pad under the patient's buttocks. 4. Assess for odor of the amniotic fluid.

1

Cardiopulmonary resuscitation (CPR) is being performed on a gravid patient with suspected amniotic fluid embolism. The nurse knows that certain adjustments should be made during CPR on a pregnant woman. Which adjustment is recommended? 1. Displacement of the uterus to the left side 2. Hand placement for chest compressions slightly lower 3. Chest compressions performed at a faster rate 4. Bag-mask-valve ventilation instead of intubation

1

The nurse will be focusing on 'self-care' during a preconception counseling session with women who are seeking to get pregnant. Which advice should the nurse include in the counseling session? Select all that apply. 1. Discontinue the use of herbal supplements before pregnancy. 2. Avoid aerobic and regular weight-bearing exercise before pregnancy. 3. Continue with the same megadoses of vitamins and minerals as prescribed. 4. Ensure that smoke alarms and carbon monoxide detectors are in working order. 5. Maintain optimal oral health and treat any periodontal disease before pregnancy.

1, 4, 5

A father experiencing couvade syndrome is likely to exhibit which of the following symptoms/behaviors? Select all that apply. 1. Heartburn. 2. Promiscuity. 3. Hypertension. 4. Bloating. 5. Abdominal pain.

1, 4, and 5 are correct.

A client has gestational diabetes. When assisting with developing the plan of care for this client, which therapy would the nurse most likely identify as important for this client to manage her glucose levels? 1. Diet 2. Long-acting insulin 3. Oral hypoglycemic drugs 4. Glucagon

1. Diet Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually isn't needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are contraindicated in pregnancy. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.

A client with a history of hypertension is 15 weeks' pregnant. For which condition should the nurse closely monitor this client? 1. Abruptio placentae 2. Preterm labor 3. Spontaneous abortion 4. Anemia

1. Abruptio placentae A history of hypertension predisposes the client to developing abruptio placentae. She isn't at risk for developing preterm labor, spontaneous abortion, or anemia.

A term laboring patient is reporting severe lower back pain and has been pushing for two hours. The nurse would anticipate that the fetus is in which position? 1. Frank breech 2. Occiput posterior 3. Occiput anterior 4. Shoulder presentation

2

During childbirth education classes, a nurse is discussing the cardinal moves of labor with pregnant couples. Which of the collowing moves should the nurse tell couples are the first moves that babies make during a vaginal birth? Please select the 2 correct responses. 1. Descent 2. Expulsion 3. External rotation 4. Flexion 5. Internal rotation

1. Descent 4. Flexion The order of the cardinal moves of labor is: Flexion and descent, internal rotation, extension, external rotation, expulsion

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.

A pregnant client at 12 weeks' gestation comes to the clinic for a follow up visit and tells the nurse that she is "feeling really constipated." Which suggestion would be appropriate for the nurse to give the client? (select all that apply) 1. "Make sure that you attempt to move your bowels regularly." 2. "Try increasing the amount of fruits and vegetables in your diet." 3. "Be sure to increase the amount of fluids that you drink each day." 4. "Use mineral oil as a gentle laxative to get things moving." 5. "An enema once a week should give you adequate relief."

1. "Make sure that you attempt to move your bowels regularly." 2. "Try increasing the amount of fruits and vegetables in your diet." 3. "Be sure to increase the amount of fluids that you drink each day." For constipation during pregnancy, appropriate suggestions would include making sure to attempt to move one's bowels regularly (i.e., making time to have a bowel movement), ingesting an increase in foods high in fiber (such as fruits and vegetables), and increasing the amount of fluid ingested each day. Mineral oil interferes with the absorption of fat-soluble vitamins and should be avoided. Enemas also should be avoided because they can stimulate labor.

A nurse, who is discussing serving sizes of foods with a new prenatal client, would state that which of the following is equal to 1 (one) serving from the dairy group? 1. 1 cup chocolate milk 2. 1/2 cup vanilla yogurt 3. 2 cups cottage cheese 4. 1 ounce cream cheese

1. 1 cup chocolate milk I cup of any milk (e.g. whole milk, skim milk, buttermilk, chocolate milk) is equal to 1 serving size from the dairy group

A patient who has just learned that she is pregnant asks the nurse at what point the baby's heart will begin beating. Which of the following should the nurse say? 1. 4th gestational week 2. 8th gestational week 3. 12th gestational week 4. 16th gestational week

1. 4th gestational week The heart forms during the 3rd gestational week and begins to beat and circulate blood during the 4th gestational week.

A client is diagnosed with an unruptured ectopic pregnancy. Which medication does the nurse expect to administer to the client? 1. Methotrexate 2. Labetalol 3. Magnesium sulfate 4. Indomethacin

1. Methotrexate Unruptured ectopic pregnancies can be treated with medication therapy, most commonly methotrexate. Labetalol is used to treat hypertension. Magnesium sulfate is used to treat preeclampsia and eclampsia. Indomethacin would be used to slow contractions of preterm labor.

A gravida's fundal height is noted to be at the xiphoid process. The nurse is aware that which of the following fetal changes is likely to be occurring at the same time in the pregnancy? 1. Surfactant is formed in the fetal lungs. 2. Eyes begin to open and close. 3. Respiratory movements begin. 4. Spinal column is completely formed.

1. Surfactant is usually formed in the fetal lungs by the 36th week.

Place the following events in the sequence the pregnant woman would experience them, from first to last. All options must be used. -Braxton Hicks contractions -uterine enlargement -quickening -labor -amennorhea

1. amennorhea 2. uterine enlargement 3. quickening 4. Braxton Hicks contractions 5. labor

d) Ask the client to recall what was eaten and drank in the last 24 hours Pg. 292-293 The 24-hour recall is the best way to assess a client's dietary practices. It provides the actual eaten foods for a basis of discussion. Asking the client to list favorite foods (or if there is an ethnic style of cooking) would have to be followed by how often those foods are eaten. Assessing foods the client would like to have in the diet can be the start of instruction on obtaining and preparing nutritious foods. These foods are not currently part of (or only a small part of) the client's diet.

10. When interviewing a pregnant client, how can the nurse best assess the client's dietary intake? a) Ask the client what foods are desired so as to include more of these in the diet b) Ask the client to list favorite foods and how often they are eaten c) Ask the client if there is an ethnic style of cooking in the home d) Ask the client to recall what was eaten and drank in the last 24 hours

A student nurse asks the instructor what percentage of clinically recognized pregnancies end in miscarriages during the first trimester. The most accurate response from the registered nurse is which of the following? a) 31% to 40% b) 11% to 20% c) 21% to 30% d) 5% to 10%

11% to 20%

The nurse is providing care to a woman at 38 weeks gestation. Which is a contraindication for labor induction? 1. Post-term pregnancy 2. Fetal demise 3. Umbilical cord prolapse 4. History of rapid labor

3

A woman in the second stage of labor has been pushing for 3 hours. The provider is preparing for a vacuum-assisted delivery. Which anticipatory guidance should the nurse give to the patient? 1. "The blades of the forceps will be applied to the fetal head." 2. "The baby may have some bruising and edema of the head." 3. "You will need to push between contractions." 4. "An episiotomy is required for a vacuum delivery."

2

During a childbirth education class, a patient asks about "stripping of membranes." Which is the best explanation of this? 1. This is breaking the bag of water. 2. This is separating the membranes from the cervix to stimulate labor. 3. This is to manually remove the placenta. 4. This is done if the placenta is covering the cervix.

2

The nurse used Naegele's rule to calculate the expected date of delivery (EDD) for a primigravida whose last menstrual period (LMP) was September 7. How did the nurse arrive at June 14? 1. The nurse subtracted 3 months from September 7 and then added 14 days. 2. The nurse subtracted 3 months from September 7 and then added 7 days. 3. The nurse added 3 months to September 7 and then subtracted 14 days. 4. The nurse added 3 months to September 7 and then subtracted 7 days

2

A spouse calls the birthing center stating that his wife who is 36 weeks gestation is going into premature labor. Which data from the spouse would assist the nurse in determining that premature labor is imminent? Select all that apply. 1. "Her headache is not responding to the medication." 2. "She is having abdominal cramps every 6 minutes." 3. "She is having low back pain with pelvic pressure." 4. "Her bag of membranes has just ruptured." 5. "She has generalized edema."

2, 3, 4

The cervix of a patient in labor is not dilating. For which reason would mechanical ripening be contraindicated for this patient? Select all that apply. 1. Gestational diabetes 2. Fetal malpresentation 3. Unexplained vaginal bleeding 4. History of prior traumatic injury 5. Premature rupture of membranes

2, 3, 4

The nurse working in an outpatient obstetric office assesses four primigravid clients. Which of the client findings should the nurse highlight for the physician? Select all that apply. 1. 17 weeks' gestation; denies feeling fetal movement. 2. 24 weeks' gestation; fundal height at the umbilicus. 3. 27 weeks' gestation; salivates excessively. 4. 34 weeks' gestation; experiences uterine cramping. 5. 37 weeks' gestation; complains of hemorrhoidal pain.

2 and 4 are correct.

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? -Trace of glucose -2+ Protein in urine -Specific gravity of 1.010 -Straw-like color

2+ Protein in urine During pregnancy, there may be a slight amount of glucose found in the urine due to the fact that the kidney tubules are not able to absorb as much glucose as there were before pregnancy. However, there should be minimal protein in the urine. A specific gravity of 1.010 and a straw- like color are both normal findings.

A pregnant woman informs the nurse that her last normal menstrual period was on July 6, 2012. Using Naegele's rule, which of the following would the nurse determine to be the client's estimated date of delivery (EDC)? 1. January 9, 2013 2. April 13, 2013 3. April 20, 2013 4. September 6, 2013

2. April 13, 2013 The EDC is calculated as April 13, 2013. Naegeles rule: First, identify the first day of the last normal menstrual period. Then, subtract 3 months and add 7 days, adjust the year if needed

A nurse is reinforcing education for a client entering the third trimester of pregnancy. The nurse determines that the client understands the education when stating she will immediately report which symptom? 1. Hemorrhoids 2. Blurred vision 3. Dyspnea on exerction 4. Increased vaginal mucus

2. Blurred vision During pregnancy, blurred vision may be a danger sign of preeclampsia or eclampsia, complications that require immediate attention because they can cause severe maternal and fetal consequences. Although hemorrhoids may occur during pregnancy, they don't require immediate attention. Dyspnea on exertion and increased vaginal mucus are common discomforts caused by physiologic changes.

A pregnant client at 26 weeks' gestation undergoes a glucose tolerance test. The nurse identifies the need for further action based on which results? 1. A glucose level of 120 mg/dL (6.67 mmol/L) during a 1-hour glucose tolerance test 2. A 1-hour glucose level of 160 mg/dL (8.88 mmol/L) during a 3-hour glucose tolerance test 3. A 2-hour glucose level of 150 mg/dL (8.32 mmol/L) during a 3-hour glucose tolerance test 4. A 3-hour glucose level of 130 mg/dL (7.22 mmol/L) during a 3-hour glucose tolerance test

2. A 1-hour glucose level of 160 mg/dL (8.88 mmol/L) during a 3-hour glucose tolerance test Gestational diabetes is diagnosed when a 3-hour glucose tolerance test has a 1-hour glucose level of 140 mg/dL (7.78 mmol/L) or greater. Other diagnostic test indications of gestational diabetes include a 2-hour glucose level 165 mg/dL (9.16 mmol/L) during a 3-hour tolerance test; a 1-hour glucose test greater than 140 mg/dL (7.78 mmol/L); a 3-hour glucose tolerance test with a 2-hour glucose level of 165 mg/dL (9.16 mmol/L) or greater; or a 3-hour glucose tolerance test with a 3-hour glucose level of 145 mg/dL (8.06 mmol/L) or greater.

A client arrives at the clinic for a scheduled amniocentesis. Which question should the nurse ask? 1. "Have you had at least 1 L of water to drink?" 2. "Have you emptied your bladder?" 3. "Did you fast for the last 12 hours?" 4. "Do you have any problems lying on your left side?"

2. "Have you emptied your bladder?" Before amniocentesis, the client should void to empty the bladder, reducing the risk of bladder perforation. The client doesn't need to drink fluids before amniocentesis nor does she need to fast. The client should be placed in a supine position for the procedure.

A woman, who is being seen in the prenatal clinic, is found to be 12 weeks pregnant. She confides to the nurse that she is afraid her baby may be permanently damaged because she takes penicillin, a pregnancy B category medication, every day to prevent rheumatic fever. 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. "First-trimester abortions are very safe" 4. "An ultrasound will tell you if the baby was affected"

2. "It is unlikely that the baby was affected" Although o controlled human trials have been conducted, there is no evidence that category B medications cause birth defects in animals. They are, therefore, considered safe for women to take during pregnancy

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

2. 2 eggs = one 2 oz protein serving.

A pregnant woman has Marfan syndrome, n autosomal dominant disease. It has previously been determined that the woman is heterozygous for the condition. Her husband has no known genetic diseases. The nurse advises the couple that their unborn child has which of the following probabilities of having Marfan's? 1. 25% probability 2. 50% probability 3. 75% probability 4. 100% probability

2. 50% probability This couple has a 50% probability of having a child who has Marfan's

A client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? 1. 45 mg/dL (2.5 mmol/L) 2. 85 mg/dL (4.7 mmol/L) 3. 120 mg/dL (6.67 mmol/L) 4. 136 mg/dL (7.56 mmol/L)

2. 85 mg/dL (4.7 mmol/L) The recommended fasting blood glucose level in the pregnant client with diabetes is 60-95 mg/dL (3.33 - 5.28 mmol/L). A fasting blood glucose level of 45 mg/dL (2.5 mmol/L) is low and may result in symptoms of hypoglycemia. A blood glucose level above below 120 mg/dL (6.67 mmol/L) is recommended for 2-hour postprandial values. A blood glucose level above 136 mg/dL (7. 56 mmol/L) in a pregnant client indicates hyperglycemia.

The nurse is receiving shift report on multiple patients. After receiving the report and comparing the patient histories, the nurse knows that which patient is most at risk for uterine rupture? 1. This patient has had one lower transverse cesarean section, which is not a high risk for uterine rupture. 2. A G3P2 whose youngest child is 3 years old and was born vaginally 3. A G4P3 who has had three prior lower transverse cesarean sections and is pregnant with twins 4. A G4P3 whose last baby was 7lbs 4 oz at term gestation

3

The nurse has decided to implement the Centering Pregnancy model for prenatal care instead of the conventional antenatal care. which is the focus of this model of care? Select all that apply. 1. The nurse spends more time dealing with the complications of pregnancy. 2. The nurse will be better able to take responsibility for the clients' health. 3. The clients will be spending more time with the nurse in antenatal care. 4. More social support will be available for clients. 5. The clients will get one-on-one prenatal care

3, 4

A nurse is explaining to a pregnant client the functions of amniotic fluid. Which of the following should the nurse mention? (Select all that apply) 1. Delivers oxygen to the fetus 2. Stimulates enlargement of the breasts and uterus 3. Acts as a cushion for the fetus when there are sudden maternal movements 4. Prevents adherence of the developing human to the amniotic membranes 5. Provides a consistent thermal environment

3, 4, 5 3. Acts as a cushion for the fetus when there are sudden maternal movements 4. Prevents adherence of the developing human to the amniotic membranes 5. Provides a consistent thermal environment Feedback 1: Blood in the fetal circulation, not amniotic fluid, delivers oxygen to the fetus. Feedback 2: Estrogen, not amniotic fluid, stimulates enlargement of the breasts and uterus. Feedback 3: Amniotic fluid acts as a cushion for the fetus when there are sudden maternal movements. Feedback 4: Amniotic fluid prevents adherence of the developing human to the amniotic membranes. Feedback 5: Amniotic fluid provides a consistent thermal environment.

A nurse is working with a woman in labor who has sickle cell anemia. The nurse understands that this patient must have which of the following combinations of genes related to this disorder? 1. Two dominant genes 2. A recessive gene and a dominant gene 3. Only one dominant gene, with the other gene missing 4. Two recessive genes

4. Two recessive genes Genetic diseases or disorders, such as sickle cell anemia, are usually related to a defective recessive gene and present in the developing human when both pairs of the gene have the same defect.

A nurse is teaching a patient measures to help prevent urinary tract infections. Which of the following should the nurse mention? (Select all that apply) 1. Wipe from back to front after urinating 2. Urinate before intercourse 3. Empty the bladder frequently 4. Wash hands before and after urination 5. Drink at least eight glasses of fluid a day

3, 4, 5 3. Empty the bladder frequently 4. Wash hands before and after urination 5. Drink at least eight glasses of fluid a day Feedback 1: The patient should wipe from front to back after urinating, not back to front, to prevent introducing bacteria into the urethra from the anus. Feedback 2: The patient should urinate after intercourse, not before, to help cleanse the urinary tract of bacteria introduced during intercourse. Feedback 3: The patient should empty the bladder frequently, as urinary stasis promotes bacterial growth and increases the woman's risk for urinary tract infections. Feedback 4: The patient should wash her hands before and after urination: before to help remove bacteria from the hands that might be introduced to the urinary tract during the process of wiping after urination, and after to remove bacteria from the hands that might have been picked up during wiping. Feedback 5: The patient should maintain adequate hydration by drinking eight glasses of fluid a day, which helps prevent urinary tract infections.

The nurse is in the room with a laboring patient who was found to have a prolapsed umbilical cord. The nurse will place the patient in which positions to help relieve pressure on the cord? Select all that apply. 1. High-Fowlers 2. Left lateral 3. Knee-chest 4. Squatting 5. Trendelenburg

3, 5

The urine culture of a client who is at 36 weeks gestation revealed a urinary tract infection. The client's medical records also show that this is the third occurrence since the onset of pregnancy. which advice should the nurse give her on preventing a reoccurrence? Select all that apply. 1. "It is time that you explore different sexual positions." 2. "Practice doing Kegel exercises while urinating." 3. "Urinate immediately before and after sexual intercourse." 4. "Wipe from back to front after passing urine." 5. "Drink at least 8 glasses of liquid each day."

3, 5

When assisting with the education of an antepartum client on the passage of the fetus through the birth canal during labor, the nurse describes the cardinal mechanisms of labor. Places these events in the proper ascending chronological order. 1. Flexion 2. External rotation 3. Descent 4. Expulsion 5. Internal rotation 6. Extension

3. Descent 1. Flexion 5. Internal rotation 6. Extension 2. External rotation 4. Expulsion The fetus moving through the birth canal changes position to ensure that the smallest diameter of the fetal head always presents to the smallest diameter of the birth canal. Termed the cardinal mechanisms of labor, these position changes occur in this sequence: descent, flexion, internal rotation, extension, external rotation, and expulsion.

A nurse is advising a patient who is in her second trimester on her diet. What recommendation should the nurse give her regarding her daily caloric intake? 1. Decrease it by 250 kcal/day compared with non-pregnancy intake 2. Maintain normal non-pregnancy intake level 3. Increase it by 340 kcal/day compared with non-pregnancy intake 4. Increase it by 750 kcal/day compared with non-pregnancy intake

3. Increase it by 340 kcal/day compared with non-pregnancy intake The nurse should recommend that the patient increase daily caloric intake by 340 kcal/day during the second trimester.

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.

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 a 12 oz glass of fruit juice per day. Which of the following is the most important communication for the nurse to make? 1. "You are effectively meeting your daily fruit requirements." 2. "Fruit juices are excellent sources of folic acid." 3. "It would be even better if you were to consume more whole fruits and less fruit juice." 4. "Your fruit intake far exceeds the recommended daily fruit intake."

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.

b) "I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy" Pg. 285-286 A prepregnant BMI of 23 is in the normal category, and this client needs to gain 25 to 35 lbs (11 to 16 kg) during this pregnancy. Lower weight gain would be recommended for women with a BMI of over 25.

33. The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy? a) "I need to gain less than 25 pounds (11 kg) during this pregnancy" b) "I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy" c) "I need to gain 1 pound (0.45 kg) per week throughout this pregnancy" d) "I need to gain 0.5 pounds (0.23 kg) per week during this pregnancy"

A gravid patient at 41 weeks' gestation asks the clinic nurse about using complementary therapies to stimulate labor. Which is the best response by the nurse? 1. "Herbal preparations like black cohosh are perfectly safe because they are natural." 2. "Some couples have sex to stimulate labor, but that is not safe at this stage of pregnancy." 3. "It is a myth that complementary therapies start labor." 4. "Further research is needed to know if these methods are safe and effective. Let's talk with your provider about this."

4

A gravid patient is having a trial of labor after cesarean (TOLAC). The nurse knows to watch for which obstetrical emergency? 1. Dystocia 2. Shoulder dystocia 3. Amniotic fluid embolism 4. Uterine rupture

4

A woman diagnosed with Gestational Diabetes Mellitus (GDM) was referred to have a Group B Streptococcus (GBS) screening done. At which stage of the pregnancy would the nurse recommend the client to have this screening done? 1. 10 to 12 weeks of gestation 2. 15 to 23 weeks of gestation 3. 24 to 28 weeks of gestation 4. 35 to 37 weeks of gestation

4

The nurse caring for a multiparous patient in active labor suspects cephalopelvic disproportion (CPD). Which assessment finding supports this? 1. Fetal station descending 2. Large maternal stature 3. Tachysystole 4. Fetus not engaged in the pelvis

4

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She delivered one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation. a) 3, 2, 1, 1, 1 b) 4, 1, 1, 1, 1 c) 4, 2, 2, 1, 1 d) 3, 2, 1, 2, 1

4, 1, 1, 1, 1

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.

A client is having an ultrasound assessment done at her prenatal appointment at 8 weeks' gestation. She asks the nurse, "Can you tell what sex my baby is yet?" Which of the following responses would be appropriate for the nurse to make at this time? 1. "The technician did tell me the sex, but I will have to let the doctor tell you what it is." 2. "The organs are completely formed and present, but the baby is too small for them to be seen." 3. "The technician says that the baby has a penis. It looks like you are having a boy." 4. "I am sorry. It will not be possible to see which sex the baby is for another month or so."

4. This statement is true. The sex is not visible yet.

A pregnant client is concerned about lack of fetal movement. Which response by the nurse would be most therapeutic? 1. "You need to start taking additional prenatal vitamins." 2. "Try taking a warm bath to facilitate fetal movement." 3. "Eat foods that contain a high sugar content to stimulate the fetus." 4. "Lie down once a day and count the number of fetal movements for 15-30 minutes."

4. "Lie down once a day and count the number of fetal movements for 15-30 minutes." Instructing the client to lie down once during the day will allow her to concentrate on detecting fetal movement, making it easier to accomplish. The ability to feel fetal movement is reassuring and comforting to the mother. The mother who is up and actively walking around tends to soothe the fetus, resulting in sleep promotion. Instructing her to take an additional prenatal vitamin is beyond the nurse's scope of practice and isn't recommended because vitamins can be toxic. Taking a warm bath is likely to soothe and relax the fetus. There's also a risk for hyperthermia if the water is too warm or the client is immersed too long. Eating additional sugary foods isn't recommended because some pregnant clients are more susceptible to cavities. The additional sugar intake is not associated with stimulating fetal activity.

The nurse is caring for a client suspected of having a hydatidiform mole. Which signs and symptoms would confirm this diagnosis? 1. Heavy, bright red bleeding every 21 days 2. Fetal cardiac motion after 6 weeks' gestation 3. Benign tumors found in the smooth muscle of the uterus 4. "Snowstorm" pattern on ultrasound with no fetus or gestational sac

4. "Snowstorm" pattern on ultrasound with no fetus or gestational sac Ultrasound is the technique of choice in diagnosing a hydatidiform mole. The chorionic villi of a molar pregnancy resemble a "snowstorm" pattern on ultrasound. Bleeding with a hydatidiform mole is usually dark brown and may occur erratically for weeks or months. There's no cardiac activity because there's no fetus. Benign tumors found in the smooth muscle of the uterus are leiomyomas or fibroids.

d) Enacting a 24-hour nutrition recall Pg. 284 Nutritional status is an important assessment when caring for a pregnant client. Although all of the answers refer to interventions that the nurse should include in the assessment, the 24-hour nutrition recall is the best single method for assessing the client's nutritional intake. Depending upon the pre-pregnancy weight or BMI of the client, they may not be an indicator of current nutritional status. Food cravings are part of the nutritional recall.

4. A nurse is assessing a client's nutritional intake during pregnancy. What method will the nurse use to accomplish this? a) Calculating the client's body mass index (BMI) b) Weighing the client c) Having the client describe food cravings d) Enacting a 24-hour nutrition recall

B. Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Gastric secretions decrease, but this is not the main cause of nausea and vomiting.

A patient in her first trimester complains of nausea and vomiting. The patient asks, "Why is this happening?" What is the nurse's best response? a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

A nurse is reviewing a patient's completed health history form with the patient and wants to know whether the patient uses tobacco. Which component or section of the health history should the nurse consult to find this information? 1. Identifying information 2. Health status 3. Family medical 4. Self-care/lifestyle/safety behaviors

4. Self-care/lifestyle/safety behaviors Identifying information includes age, gravida/para, address, race/ethnicity, religion, marital/family status, occupation, and education. Health status includes prior and present health status. Family medical includes the current health status of family members, along with genetic and other medical conditions or diseases that family members may have. Self-care/lifestyle/safety behaviors include frequency of health maintenance visits, bowel patterns, sleep patterns, stress management, nutrition, body mass index, exercise history, use and abuse of substances (tobacco, alcohol, caffeine, etc.), use of complementary and alternative medicine modalities, and safety practices (use of seat belts, sunscreen, smoke alarms, carbon monoxide detectors, and guns).

A nurse is assisting with the development of a plan of care for a pregnant client. The interdisciplinary team determines that the client will require more frequent prenatal visits based on which data gathered? 1. Blood type O-positive 2. First pregnancy at age 33 3. History of allergy to honey bee pollen 4. Type 1 diabetes

4. Type 1 diabetes A woman with a history of diabetes has an increased risk for perinatal complications, including hypertension, preeclampsia, and neonatal hypoglycemia; therefore, she needs to be more closely monitored. The age of 33 without other risk factors doesn't necessarily increase the client's risk, nor does having type-O positive blood or environmental allergens.

A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 14% 12% 8% 6%

6% The upper normal level of HbA1C is 6% of total hemoglobin.

At her 16-week checkup, a patient's blood pressure is slightly decreased from her pre-pregnancy level. You evaluate this change based on which of the following statements concerning blood pressure during pregnancy? a) Normally, blood pressure increases steadily throughout pregnancy. b) Blood pressure remains stable until decreasing the day of the delivery. c) Blood pressure progressively decreases throughout the entire pregnancy. d) A decrease in the second trimester may occur because of placental growth.

A decrease in the second trimester may occur because of placental growth.

D. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman is at risk for or has a history of preterm labor. Intercourse can continue as long as the pregnancy is progressing normally. Rupture of the membranes may require abstaining from intercourse. Safer sex practices are always recommended. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy.

An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. What information should the nurse provide? a. Intercourse is safe until the third trimester b. Safer sex practices should be used once the membranes rupture c. Intercourse should be avoided if any spotting from the vagina occurs afterward. d. Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present

B. The linea nigra is a dark pigmented line from the fundus to the symphysis pubis. Epulis refers to gingival hypertrophy. Melasma is a different kind of dark pigmentation that occurs on the face. Striae gravidarum (stretch marks) are lines caused by lineal tears that occur in connective tissue during periods of rapid growth

An expected change during pregnancy is a darkly pigmented vertical midabdominal line. The nurse recognizes this alteration as a. epulis b. linea nigra c. melasma d. striae gravidarum

Mrs. Smith asks you to compute her expected date of birth. Based on the fact that her last menstrual flow began on July 20, her date would be a) May 20. b) April 27. c) March 13. d) April 13.

April 27.

A client in her second trimester of pregnancy is anxious about the blotchy, brown pigmentation appearing on her forehead and cheeks. She also complains of increased pigmentation on her breasts and genitalia. When educating the client, which of the following would the nurse identify as the condition experienced by the client? a) Vascular spiders b) Linea nigra c) Facial melasma (cholasma) d) Striae gravidarum

Facial melasma (cholasma)

During a routine visit to the clinic, a client tells the nurse that she thinks she may be pregnant. The physician orders a pregnancy test. The nurse should know the purpose of this test is to determine which change in the client's hormone level? a) Decrease in LH b) Increase in human chorionic gonadotropin (HCG) c) Increase in luteinizing hormone (LH) d) Decrease in HCG

Increase in human chorionic gonadotropin (HCG)

An infant is born to a mother with gestational diabetes. Which long-term maternal complication is associated with this diagnosis? Increased risk of development of type 2 diabetes Weight gain that is not lost after the pregnancy Heart disease Development of long-term hypertension

Increased risk of development of type 2 diabetes A mother who had gestational diabetes is at a 30% to 50% higher risk of developing type 2 diabetes mellitus than the general population. Long-term hypertension and heart disease are not associated with gestational diabetes, nor is weight gain following pregnancy. There is no data that validates long-term weight gain as a complication of gestational diabetes.

If constipation is a problem for a woman during pregnancy, which of the following measures would be best to recommend? a) Reducing her iron supplement b) Mineral oil c) Increasing intake of meat in her diet to provide fiber d) Increasing fluid intake

Increasing fluid intake

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which of the following data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. a) Ultrasound pictures b) Morning sickness c) Amenorrhea d) Fetal heartbeat e) Hydatidiform mole f) Breast changes

Morning sickness Amenorrhea Breast changes

Amanda's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is Amanda experiencing? a) Probable b) Presumptive c) No classification d) Positive

Presumptive

When describing the role of a doula to a group of pregnant women, which of the following would the nurse include? a) The doula is a professionally trained nurse hired to provide physical and emotional support. b) The doula primarily focuses on providing continuous labor support. c) The doula can perform any necessary clinical procedures. d) The doula is capable of handling high-risk births and emergencies.

The doula primarily focuses on providing continuous labor support.

A,B,E. Quickening, amenorrhea, and Chadwick's sign are presumptive signs of pregnancy. Ballottement and Goodell's sign are probable signs of pregnancy

Which findings are presumptive signs of pregnancy? a. Quickening b. Amenorrhea c. Ballottement d. Goodell's sign e. Chadwick's sign

D. Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks contractions. During the first two trimesters, the contractions are infrequent and usually not felt by the woman until the third trimester. Braxton Hicks contractions do not indicate preterm labor. Braxton Hicks contractions can cause some discomfort, especially in the third trimester. Braxton Hicks contractions occur throughout the whole pregnancy.

While providing education to a primiparous patient regarding the normal changes of pregnancy, what is an important information for the nurse to share regarding Braxton Hicks contractions? a. These contractions may indicate preterm labor b. These are contractions that never cause any discomfort c. Braxton Hicks contractions only start during the third trimester d. These occur throughout pregnancy, but you may not feel them until the third trimester

Which of the following is true about isoimmunization? Select all that apply. a. It only occurs in patients who have a positive Rh factor. b. It can be avoided with a RhoGAM injection at 28 weeks and again within 72 hours of delivery. c. The injection schedule is the same for every pregnancy to prevent it. d. It may cause hypoglycemia in the newborn after delivery. e. Abdominal trauma, such as a fall or motor vehicle accident, can also cause it.

b. It can be avoided with a RhoGAM injection at 28 weeks and again within 72 hours of delivery. c. The injection schedule is the same for every pregnancy to prevent it. e. Abdominal trauma, such as a fall or motor vehicle accident, can also cause it.

What anatomic area should be examined when assessing Montgomery glands (Montgomery tubercles)? abdomen breasts perineum thorax

breasts Montgomery glands (Montgomery tubercles) are sebaceous glands on the areola of the breasts and are prominent during pregnancy.

1. A patient in her third trimester has just been diagnosed with moderate (grade 2) placental abruption. Which of the following signs and symptoms should the nurse expect to find in this patient? a. No blood loss, normal vital signs and fetal heart rate pattern b. Blood loss less than 500 mL, vague lower abdominal discomfort, normal vital signs and fetal heart rate c. Blood loss 1,000 to 1,5000 mL, abdominal pain, mild shock, fetal heart rate shows signs of compromise d. Blood loss greater than 1,5000 mL, abrupt and knifelike uterine pain, moderate0to-profound shock, fetal rate shows signs of compromise

c

16. A nurse is describing to a patient how in pregnancy there are increased levels of coagulation factors and decreased fibrinolysis, venous dilation, and obstruction of the venous system by the gravid uterus. Which common complication associated with these changes should the nurse mention? a. Gestational diabetes mellitus b. Infertility c. Deep vein thrombosis d. Pelvic inflammatory disease

c

A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which symptom is an indicator of true labor? contractions beginning in the back and sweeping forward across the abdomen intermittent backache stronger than usual increase in fetal kick count lightening (descent of the fetus into the pelvis)

contractions beginning in the back and sweeping forward across the abdomen True labor contractions usually begin in the back and sweep forward across the abdomen similar to tightening of a rubber band. They gradually increase in frequency and intensity over a period of hours. Lightening and intermittent backache are preliminary signs of labor but do not indicate true labor. Increase in fetal kick count does not indicate true labor.

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? halts the progression of the abortion ensures passage of all the products of conception alleviates strong uterine cramping suppresses the immune response to prevent isoimmunization

ensures passage of all the products of conception

The nurse is required to assess a client for HELLP syndrome. Which are the signs and symptoms of this condition? Select all that apply. epigastric pain blood pressure higher than 160/110 mm Hg hyperbilirubinemia oliguria upper right quadrant pain

epigastric pain hyperbilirubinemia upper right quadrant pain

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? once every 3 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth once every 4 weeks for the first 28 weeks, then every 3 weeks until 36 weeks, and then every 2 weeks until the birth once every 4 weeks for the first 36 weeks, then weekly until the birth once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth

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.

The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best? "At 36 weeks' gestation, the fundus is in the normal expected location." "To be honest, the fundus should be lower since you have gained minimal weight." "Just get prepared, the fundus might actually get a little higher until a few days before you go into labor." "By this time, the fundus should drop down lower because the baby is moving towards the pelvic inlet."

"At 36 weeks' gestation, the fundus is in the normal expected location." The fundus grows to reach the umbilicus at 20 to 22 weeks and the xiphoid process of the sternum at 36 weeks. Therefore, this fundus is in the normal, expected location. After 36 weeks' gestation, lightening occurs and the fundus will drop ~4 cm below the xiphoid process. Once the fundus reaches the xiphoid process, it cannot go higher without severely compromising maternal respiratory efforts.

The nurse is screening for potential exposure to toxoplasmosis. Which question is most appropriate? "Do you lock your medications in a cabinet:" "Do you have a cat in the house?" "Do you have old paint in the house?" "Do you use well water for drinking?"

"Do you have a cat in the house?" Toxoplasmosis is caused by a protozoan that is passed from animals (such as cats) to humans via animal feces. If the woman contracts toxoplasmosis while she is pregnant, it can cause a miscarriage or fetal abnormalities.

A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time? "Let's discuss this with your health care provider before you continue douching." "Douching will definitely keep your vagina clean." "If you prepare your own douching solution, be sure to boil the water to kill bacteria." "During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection."

"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection." Even if vaginal discharge seems excessive, douching is contraindicated because the force of the irrigating fluid could cause the solution to enter the cervix, leading to a uterine infection. In addition, douching alters the pH of the vagina, leading to an increased risk of vaginal bacterial growth. Stating that douching will keep the client clean does not provide the client with the information she needs. Boiling water for a douche will not prevent development of infection. The nurse is capable of responding to the client directly without referring the client to the health care provider.

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I need to be aware of my triggers and avoid them as much as possible." "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on." "It is fine for me to use my albuterol inhaler if I begin to feel tight."

"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.

A nurse is teaching a client who is 30 weeks' pregnant about ways to deal with pyrosis (heartburn). The nurse determines a need for additional teaching based on which client statement? "I should chew my food slowly." "I need to cut out caffeine." "I should lie down for 1/2 hour after eating." "I need to raise the head of my bed about 15 to 30 degrees."

"I should lie down for 1/2 hour after eating." The client should remain sitting for 1 to 3 hours after eating and avoid lying down within 3 hours of eating. Cutting out caffeine, chewing food slowly, and raising the head of the bed are helpful in reducing pyrosis (heartburn) of pregnancy.

A multigravida woman is in her second trimester. Which of the following statements made by the client indicates appropriate understanding of prenatal care? A. "I should wait until my third trimester to formulate a birth plan." B. "I should not get my flu shot while I'm pregnant,to avoid harming my baby." C. "If I have painful urination I should report it to my healthcare provider." D."It's normal to expect some vision changes during this semester."

"If I have painful urination I should report it to my healthcare provider."

A client at 39 weeks' gestation calls the OB triage and questions the nurse concerning a bloody mucous discharge noted in the toilet after an OB office visit several hours earlier. What is the best response from the triage nurse? -"It might be nothing. If it happens again call your provider who is on-call." -"If the provider did an exam, it might be just normal vaginal secretions, so don't worry about it." -"A one time discharge of bloody mucus in the toilet might have been your mucous plug." -"Bloody mucus is a sign you are in labor. Please come to the hospital."

-"A one time discharge of bloody mucus in the toilet might have been your mucous plug." Bloody mucus can either be a mucous plug or bloody show. The one time occurrence would be more likely to be the mucous plug. A bloody show would continue if her cervix was changing, but this usually does not occur until after contractions start. It is a sign that something is happening and should be reported to the health care provider. The bloody mucus is not a sign of labor, but it can be an early sign that labor is coming soon.

The nurse is caring for a family with an intrauterine fetal demise. Which statement by the nurse is most helpful for grieving families? 1. "I am here if you want to talk about the baby." 2. "You can try to get pregnant again in 6 weeks." 3. "At least you did not get too attached to this baby." 4. "We will give you a lot of pain medication, so you don't feel anything."

1

_______ signs affirm that proof exists that there is a developing fetus in any trimester and are objective criteria seen by a trained observer or diagnostic study

-Positive (e.g., ultrasound.)

The nurse is educating a 32-weeks-pregnant client on how to perform kick counts. Which statement by the client would indicate a need for further teaching? 1. "I will perform the kick counts at a different time every day." 2. "I should call my doctor right away if the baby is not moving as much as usual." 3. "It is normal for the baby to move about 10 times or more in 2 hours." 4. "A kick, flutter, or roll counts as movements."

1

The nurse is educating a 34-week gestation client about danger signs to report to her health care provider. Which symptom would be added to the nursing care? 1. Blurry vision or seeing "floaters" 2. Edema in her feet and ankles after being on her feet at work 3. Frequent urination 4. Occasional nausea and vomiting

1

The nurse is providing preconception counseling to a client. Which topic is most important to educate the client on at this time? 1. Adequate intake of folic acid 2. Common discomforts of pregnancy 3. Infant safety at home 4. Gaining an appropriate amount of weight during pregnancy

1

The nurse obtains a fundal height measurement of 32 cm on a client experiencing a healthy, low-risk pregnancy. How does the nurse interpret this measurement? 1. The client is approximately 32-week gestation. 2. The weight of the fetus is approximately 3200 grams. 3. The amniotic fluid volume is 3.2 cm. 4. The distance from the fundus to the xiphoid process is 32 cm.

1

There are several patients on the labor and delivery unit. Which patients are at risk for disseminated intravascular coagulation (DIC)? Select all that apply. 1. Patient with term intrauterine fetal demise 2. Patient with severe preeclampsia 3. Patient with gestational diabetes 4. Patient with twin pregnancy 5. Patient with HELLP syndrome

1, 2, 5

A gravid patient with diabetes is in labor with suspected macrosomia. Which nursing actions would be done to prepare for the delivery? Select all that apply. 1. Notify the surgical team of the potential for an operative delivery. 2. Have an additional nurse available to assist with a shoulder dystocia. 3. Gather neonatal supplies for a small baby. 4. Have catheter available to empty bladder. 5. Anticipate the need for postpartum oxytocic medications.

1, 2, 4, 5

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.

A woman visits the clinic and states that she has missed four menstrual periods and is unsure if she is pregnant. The nurse informs her that a ballottement test will be done to diagnose pregnancy. How can a ballottement test assist the nurse in confirming a pregnancy? 1. Softening of the cervix and vagina 2. Softening of the lower uterine segment 3. Brownish pigmentation over the client's forehead 4. Bluish-purplish coloration of the vaginal mucosa 5. A dark line that runs from the umbilicus to the pubis

1, 2, 4

A patient is now in her third trimester of pregnancy. The nurse is explaining to her all of the changes that have occurred in her cardiovascular system since becoming pregnant. Which of the following should the nurse mention? (Select all that apply) 1. Increase in blood volume by 40% to 45% 2. Increase in cardiac output by 40% 3. Increase in blood pressure 4. Increase in heart size 5. Increase of heart rate by 3 to 5 beats per minute

1, 2, 4 1. Increase in blood volume by 40% to 45% 2. Increase in cardiac output by 40% 4. Increase in heart size Feedback 1: Pregnancy results in an increase in blood volume by 40% to 45%. Feedback 2: Pregnancy results in an increase in cardiac output by 40%. Feedback 3: Pregnancy results in a decrease, not an increase, in blood pressure. Feedback 4: Pregnancy results in an increase in heart size. Feedback 5: Pregnancy results in an increase of heart rate by 15 to 20, not 3 to 5, beats per minute.

The labor nurse is caring for a patient at risk for intraamniotic infection. Which assessment findings would alert the nurse of intraamniotic infection? Select all that apply. 1. Baseline fetal heart rate 170 2. Maternal fever 3. Meconium stained amniotic fluid 4. Severe headache 5. Foul-smelling vaginal discharge

1, 2, 5

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. The client is likely 12 weeks pregnant. At 12 weeks, the fundal height is at the top of the symphysis.

50. The nurse asks a woman about how the woman's husband is dealing with the pregnancy. The nurse concludes that counseling is needed when the woman makes which of the following statements? 1. "My husband is ready for the pregnancy to end so that we can have sex again." 2. "My husband has gained quite a bit of weight during this pregnancy." 3. "My husband seems more worried about our 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.

A gravida G4 P1203, fetal heart rate 142, is 13 weeks pregnant, fundal height 1 cm above the symphysis. She denies experiencing quickening. Which of the following nursing conclusions made by the nurse is correct? 1. The woman is experiencing a normal pregnancy 2. The woman may be having difficulty accepting this pregnancy 3. The woman must see a nutritionist as soon as possible 4. The woman will likely miscarry the conceptus

1. The woman is experiencing a normal pregnancy

c) "I am glad I can have my two cups of coffee in the morning again" Pg. 291 Breastfeeding mothers should avoid caffeine because it delays iron absorption and passes through the milk and can slow infant weight gain. Similarly, spicy foods pass into the breastmilk and can affect the baby. Breastfeeding mothers need added calories and fluids.

11. The nurse is conducting a teaching session for breastfeeding mothers. Which statement by a mother requires further clarification by the nurse? a) "I will drink a large glass of water each time I nurse my baby" b) "I will continue to take a prenatal multivitamin as long as I am breastfeeding" c) "I am glad I can have my two cups of coffee in the morning again" d) "I will continue to add about 300 calories per day to my diet"

c) Serum iron level Pg. 297 Pregnant clients who crave ice often have an iron deficiency. A low serum iron level needs to be checked. The client's electrolyte values are not associated with cravings for ice.

12. A pregnant client reports chewing on ice throughout the day. Which laboratory value would the nurse evaluate? a) Serum glucose level b) Serum sodium level c) Serum iron level d) Serum potassium level

The diagonal conjugate of a pregnant woman's pelvis is measured. Which measurement would the nurse interpret as presenting a potential problem? 13.5 cm 12.5 cm 13.0 cm 12.0 cm

12.0 cm The diagonal conjugate, usually 12.5 cm or greater, indicates the anteroposterior diameter of the pelvic inlet. The diagonal conjugate is the most useful measurement for estimating pelvic size because a misfit with the fetal head occurs if it is too small.

The nurse is assessing several gravid patients for complications. Which patient is most likely to have oligohydramnios? 1. G1P0 at 38 weeks gestation with Type 1 diabetes 2. G2P0 at 42 weeks gestation being induced 3. G6P5 at 39 weeks gestation with normal labor 4. G2P1 at 40 weeks gestation having a trial of labor after cesarean (TOLAC)

2

c) "In addition to protein from dairy, eat complementary proteins such as beans and rice together, or beans and wheat together" Pg. 302 It is important for the nurse to understand the vegetarian diet because nutrition is an important teaching point for intrapartal woman. Women who are vegetarian usually do not eat fish and some do not eat eggs. Most proteins from nonanimal sources are incomplete proteins that need to be combined with other nonanimal proteins to become complete proteins. Client education on how to eat complementary proteins such as beans and rice, legumes and rice, or beans and wheat can help vegetarians increase protein in the diet. It is not realistic for the client to eat tofu at every meal.

13. A client is 25 weeks' pregnant. The client explains that she is having difficulty getting an adequate amount of protein into the diet because she is a vegetarian. How can the nurse counsel this client? a) "Because you are a vegetarian, try to eat at least 5 servings of fish or seafood per week" b) "Eat more leafy greens such as spinach and romaine lettuce and more vegetable oils, almonds, and avocados" c) "In addition to protein from dairy, eat complementary proteins such as beans and rice together, or beans and wheat together" d) "Because you do not eat meats, eat the equivalent of tofu with each meal"

b) Eat small meals frequently rather than large meals Pg. 298 Pyrosis (heartburn) is a burning sensation along the esophagus caused by regurgitation of gastric contents into the lower esophagus. In pregnancy, it may accompany early nausea but also persist beyond the resolution of nausea and even increase in severity as pregnancy advances. Common suggestions to help prevent reflux into the esophagus and relieve pain are as follows: eat small meals frequently rather than large meals; sleep on the left side with two pillows to elevate the upper torso; do not lie down immediately after eating—try to wait at least 2 hours; avoid fatty and fried foods, coffee, carbonated beverages, tomato products, and citrus juices.

14. A woman in her third trimester is suffering from heartburn. What should the nurse advise her to do? a) Consume tomato products and citrus juices regularly b) Eat small meals frequently rather than large meals c) Lie down immediately after eating d) Sleep on the back with the feet elevated

d) Citrus juice Pg. 291 The citric acid in juice enhances absorption of iron in the GI tract. Ice water and tea do not enhance iron absorption, and milk can inhibit iron absorption.

15. The nurse is teaching about an iron supplement that the client is going to take every day. The nurse teaches the client to take the iron supplement with which type of fluid? a) Ice water b) Hot tea c) Low-fat milk d) Citrus juice

d) 150 to 160 pounds (68.2 to 72.7 kg) Pg. 285-286 A simple rule of thumb for a client of normal pre-pregnant weight is weight gain should be about 10 pounds (4.5 kg) by 20 weeks' gestation and about 1 lb (0.45 kg) per week for the remaining 20 weeks, for a total of 25 to 35 pounds (11.4 to 15.9 kg) during the pregnancy. With the client's weight being 125 pounds (56.8 kg), her estimated weight is 150 to 160 pounds (68.2 to 72.7 kg) if weight gain follows this trend. Gaining 10 to 15 pounds (4.5 to 6.8 kg) is not enough weight gained. Gaining over 160 pounds (72.7 kg) exceeds anticipated healthy weight gain.

16. A newly pregnant client weighing 125 pounds (56.8 kg) is concerned about excessive weight gain during her pregnancy. She states, "I don't want to get fat!" The nurse is correct to instruct that by birth, the woman's weight should be within which range? a) 180 to 190 pounds (81.8 to 86.4 kg) b) 170 to 180 pounds (77.3 to 81.8 kg) c) 135 to 140 pounds (61.4 to 63.6 kg) d) 150 to 160 pounds (68.2 to 72.7 kg)

A client states to the nurse, "This is my fourth pregnancy. Do I really need to have all these appointments?" Which is the most appropriate response by the nurse? 1. "I'm sure you are very busy with your other children." 2. "Early and regular prenatal care can catch problems early and reduce complications." 3. "Do you need assistance with transportation or have financial concerns?" 4. "Of course. Skipping appointments will jeopardize the health of you and your baby."

2

A couple is preparing to interview obstetric primary care providers to determine who they will go to for care during their pregnancy and delivery. To make the best choice, which of the following actions should the couple perform 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.

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.

A nurse is counseling a patient who has just learned that she is pregnant and who admits to drinking several beers a day about the characteristics of fetal alcohol syndrome. Which of the following should the nurse mention? (Select all that apply) 1. Increased risk of Down syndrome 2. Low birth weight 3. Microcephaly 4. Mental retardation 5. Increased risk of type I diabetes

2, 3, 4 2. Low birth weight 3. Microcephaly 4. Mental retardation Feedback 1: Fetal alcohol syndrome is not characterized by an increased risk of Down syndrome, which is a genetic disorder. Feedback 2: Low birth weight is a characteristic of fetal alcohol syndrome. Feedback 3: Microcephaly is a characteristic of fetal alcohol syndrome. Feedback 4: Mental retardation is a characteristic of fetal alcohol syndrome. Feedback 5: Fetal alcohol syndrome is not characterized by an increased risk of type I diabetes.

The nurse is caring for a gravid patient who was admitted for cervical ripening prior to her induction of labor. Which statements are correct regarding cervical ripening agents? Select all that apply. 1. Misoprostol (Cytotec) dose of 800 mcg should be given every 3 to 6 hours. 2. Prostaglandins should be avoided in women with prior uterine surgeries. 3. A balloon catheter is a mechanical method of cervical ripening and is an option in women with prior uterine incision. 4. Cervidil (Dinoprostone) can be removed quickly if tachysystole occurs. 5. Misoprostol (Cytotec) is inserted in the vaginal fornix.

2, 3, 4, 5

A woman asks the nurse about the function of amniotic fluid. Which of the following statements by the woman indicates that the teaching was successful? Select all that apply. 1. The fluid provides fetal nutrition. 2. The fluid cushions the fetus from injury. 3. The fluid enables the fetus to grow. 4. The fluid provides the fetus with a stable thermal environment. 5. The fluid enables the fetus to practice swallowing.

2, 3, 4, and 5 are correct.

A client is at 8 weeks gestation. Which of the following findings would the nurse expect to see? 1. Multiple pillow orthopnea 2. Maternal ambivalence 3. Fundus at the umbilicus 4. Pedal and ankle edema

2. Maternal ambivalence Ambivalence is a common finding of women during the first trimester

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.

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.

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.

b) A list of foods that contain calcium Pg. 296 Because dairy products often are not a part of the Japanese American diet, it can be helpful to point out alternative sources of calcium. A Japanese American diet is typically high in sodium and low in fat but rich in nutrients. Meat portions tend to be small, but fish is often consumed; therefore, the diet is adequate in omega-3 fatty acids.

2. When counseling a Japanese American about nutrition and diet in pregnancy, it would be important to include: a) Alternatives to foods high in monounsaturated fats b) A list of foods that contain calcium c) A list of foods that are high in omega-3 fatty acids d) Healthy ways to increase salt intake

The nurse is assessing a client at her first prenatal visit and notes the fundal height is palpable at the level of the umbilicus. The nurse predicts the client is at which gestational age? 24 weeks 20 weeks 18 weeks 22 weeks

20 weeks Some clients will not seek early prenatal care, especially if it is not their first pregnancy. The uterus expands to reach the height of the umbilicus by week 20. Before week 20 it is too low to be palpated, and after week 20 it may be beyond the umbilicus.

A woman in her first trimester of pregnancy is concerned about the effect that pregnancy will have on her appearance. She is fit but underweight, and she plans to restrict her weight gain as much as possible during pregnancy. How much weight do you advise her to gain? a) 28 to 40 pounds b) 15 to 25 pounds c) 16 to 30 pounds d) 25 to 30 pounds

28 to 40 pounds

b) Eggs Pg. 302 Lacto-ovo-vegetarians eat no animal flesh or fish, but they do eat dairy products, so eggs are a source of protein. Brown rice is not a source of protein.

28. When counseling a lacto-ovo-vegetarian client, the nurse would recommend including which source of protein in the diet during pregnancy? a) Brown rice b) Eggs c) Chicken d) Fish

A client comes to the clinic for her usual prenatal check up. The nurse measures the fundal height at 24 cm. What is the estimated length of her gestation? 24 weeks 20 weeks 28 weeks 32 weeks

24 weeks Fundal height is an approximation of the number of weeks of gestation. Between 20 to 32 weeks, SFH = gestation in weeks + or - 2 cm.

a) Complete a 24-hour food and fluid nutritional recall Pg. 304 Hyperemesis gravidarum causes dangerous health effects such as weight loss, dehydration, electrolyte imbalance, ketonuria, and ketonemia. It is important to complete a nutritional assessment, including everything that was ingested over the past 24 hours. The assessment includes both foods and fluids ingested. It is important to understand what was eaten in addition to what is recorded on the intake and output chart. It is most accurate to have the client recall the intake from the past 24 hours. It is unlikely that the client would recall all food and fluids ingested over the past 3 or 7 days.

25. A pregnant client in the second trimester is diagnosed with hyperemesis gravidarum with a 10% weight loss. The nurse is gathering data to form the foundation of a nutritional nursing care plan. Which way is best to obtain a nutritional assessment? a) Complete a 24-hour food and fluid nutritional recall b) Have the client complete an intake and output sheet c) Document food intake over the past 3 days d) Outline the meals eaten over the past 7 days

d) Blood glucose Pg. 304 The blood glucose level needs to be tested. If it is elevated, it suggests the concentration of glucose is too high for the body to metabolize.

27. A client with hyperemesis gravidarum is started on total parenteral nutrition (TPN). What parameter does the nurse need to assess at least twice a day? a) Potassium level b) Hemoglobin and hematocrit c) Blood ketones d) Blood glucose

c) Fats are essential during pregnancy, and vegetable oils are a good source Pg. 289 Omega-3 fatty acids, particularly linoleic acid, are fats that are essential for new cell growth but cannot be manufactured by the body. Vegetable oils such as safflower, corn, olive, peanut, and cottonseed, fatty fish, omega-3 infused eggs, and omega-3 infused spreads are all good sources. Pregnant women should ingest between 200 and 300 mg daily. Because some fish may be contaminated by mercury, alert women that the American Pregnancy Association (APA) recommends that marlin, orange roughy, tilefish, swordfish, shark, king mackerel, and bigeye and ahi tuna should be avoided during pregnancy.

29. A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond? a) Fats are not essential during pregnancy and thus are optional b) Fats are essential during pregnancy, and fish such as marlin and orange roughy are good sources c) Fats are essential during pregnancy, and vegetable oils are a good source d) Fats should be avoided during pregnancy

A client from a shelter for battered woman stated, "It is my fault, as I should have not stayed in the situation for so long." Which statement by the nurse is the best response? 1. "Did you alert your neighbors to call the police?" 2. "Tell your partner that you will be taking out a restraining order." 3. "The abuse was not your fault. No one deserves to be mistreated." 4. "Whether or not you give me consent, I will be reporting this to the police."

3

The nurse is caring for several patients requesting VBAC. Which patient would be the best candidate for a successful VBAC? 1. A patient who had an emergency cesarean section because of fetal distress with a vertical incision. 2. A patient who experienced arrest of dilation at 6 cm during her last pregnancy 3. A patient who had a breech presentation in her last pregnancy currently has a cephalic presentation in this pregnancy 4. A patient who experienced diabetes with a large for gestational age infant with her last and current pregnancy

3

The nurse is providing education for a patient who has been diagnosed with a vasa previa at 34 weeks' gestation. Which statement would the nurse identify that teaching has not been effective? 1. "At this point, I will need corticosteroids to mature my baby's lungs." 2. "I will have to be admitted to the hospital for surveillance." 3. "I still have the opportunity to labor and deliver my baby vaginally." 4. "My provider will perform a pre-term cesarean birth at 35 weeks."

3

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.

A nurse is caring for a pregnant woman who has been diagnosed with listeriosis. The nurse monitors the woman carefully for which of the following complications of pregnancy? 1. Uterine rupture 2. Pre-eclampsia 3. Fetal death 4. Polyhydramnios

3. Fetal death Fetal death is one of the complications associated with listeriosis (disease caused by infection with listeria)

A nurse is collecting data as part of an initial history on a pregnant client. The client asks about the chances of having dizygotic twins. Which statement by the nurse would be most accurate? 1. They occur most frequently in Asian women. 2. There's a decreased risk with increased parity. 3. There's an increased risk with increased maternal age. 4. Use of fertility drugs poses no additional risk.

3. There's an increased risk with increased maternal age. Dizygotic twinning is influenced by race (most frequent in black women and least frequent in Asian women), age (increased risk with increased maternal age), parity (increased risk with increased with parity), and fertility drugs (increased risk with the use of fertility drugs, especially ovulation-inducing drugs). The incidence of monosygotic twins isn't affected by rave, age, parity, heredity, or fertility medications.

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—G5 P1122.

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.

A client is diagnosed with placenta previa at 28 weeks' gestation. Which procedure should the nurse prepare the client for? 1. Stat culture and sensitivity 2. Antenatal steroids after 34 weeks' gestation 3. Ultrasound examination every 2-3 weeks 4. Scheduled birth of the fetus before fetal maturity

3. Ultrasound examination every 2-3 weeks Fetal surveillance through ultrasound examination every 2-3 weeks is indicated to evaluate fetal growth, amniotic fluid, and placental location in clients with placenta previa being expectantly managed. A stat culture and sensitivity would be done for severe bleeding, or maternal or fetal distress, and isn't part of expectant management. Antenatal steroids may be given to clients between 26-32 weeks' gestation to enhance fetal lung maturity. In a hemodynamically stable mother, birth of the fetus should be delayed until fetal lung maturity is attained.

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.

c) 25 to 35 lb (11 to 16 kg) Pg. A pregnant client whose weight falls into the normal BMI category (18.5 to 24.9) should aim to gain 25 to 35 lb (11 to 16 kg); pregnant clients whose weight falls in the underweight BMI category (less than 18.5) should gain 28 to 40 lb (13 to 18 kg); pregnant clients whose weight falls in the overweight BMI category (a BMI over 25 to 29.9) should gain 15 to 25 lb (7 to 11 kg); and pregnant clients whose weight falls in the obese BMI category (more than 30) should gain 11 to 20 lb (5 to 9 kg).

30. A pregnant client early in the first trimester asks the nurse how much weight to gain during the pregnancy. The nurse reviews the client's history and notes that the client's body mass index (BMI) is 23.6. Which amount will the nurse recommend? a) 11 to 20 lb (5 to 9 kg) b) 28 to 40 lb (13 to 18 kg) c) 25 to 35 lb (11 to 16 kg) d) 15 to 25 lb (7 to 11 kg)

A pregnant woman comes to the clinic for a visit. This is her third pregnancy. She had a miscarriage at 12 weeks and gave birth to a son, now 3 years old, at 32 weeks. Using the GTPAL system, the nurse would document this woman's obstetric history as: a) 20111 b) 21212 c) 30111 d) 31021

30111

c) Deficient fluid volume Pg. 304 The nurse should identify deficient fluid volume as a risk that needs immediate attention. The client may be at risk for hyperemesis gravidarum if she is dehydrated. Disturbed body image, deficient knowledge, or slow weight gain are not concerns that need immediate attention. The nurse attends to the client's concerns regarding disturbed body image and deficient knowledge by preparing a teaching plan with regard to exercise and hormonal changes during pregnancy. The nurse should prepare a diet plan that would help the client to receive adequate nutrition and achieve the desired weight gain.

31. A nurse assesses a primigravida client in the eighth week of gestation. The client reports nausea and vomiting in the mornings. The client tells the nurse, "I'm not able to keep liquids down and I'm eating like a bird." The client also expresses concerns about hormonal changes and how the pregnancy will affect her physical appearance. Which client problem should the nurse assess first? a) Slow weight gain b) Knowledge deficit c) Deficient fluid volume d) Disturbed body image

A woman visits the clinic and stated that she has missed four menstrual periods and remains unsure whether or not she is pregnant. The nurse informs her that a ballottement test will be done to diagnose whether or not she is pregnant. How can a ballottement test assist the nurse in confirming a pregnancy? 1. By using a transvaginal ultrasound the nurse will be able to visualize the gestational sac. 2. By detecting the presence of the human chorionic gonadotropin in the urine sample in a laboratory. 3. By detecting the presence of the human chorionic gonadotropin in the blood sample in a laboratory. 4. By tapping on the cervix the fetus will rise in the amniotic fluid and then rebound to its original position.

4

During the nursing assessment, a pregnant client reports that her spouse has been verbally abusive and slapped her recently. which is the priority nursing intervention at this time? 1. Document the statement in the woman's chart. 2. Call the police to report the incident. 3. Bring in another staff member as a witness to the statement. 4. Reassure her that she is not alone and help is available.

4

The nurse is caring for a term gestation laboring patient who just had a sudden onset of hypoxia and hypotension shortly after spontaneous rupture of membranes. Which is the nurse's priority action? 1. Assist the patient into High-Fowler's position. 2. Call the provider and prepare for imminent delivery. 3. Draw a blood panel and prepare to administer blood products. 4. Provide supplemental oxygen and left uterine displacement.

4

The nurse is conducting a presentation on the prevention of food-borne illnesses with the clients of the prenatal clinic. Which advice would the nurse emphasize? 1. Warm cooked food should be taken out of the refrigerator for more than two hours before consuming. 2. Drink plenty herbal teas such as peppermint and chamomile. 3. Refrigerate smoked seafood before consuming. 4. Wash hands before and after handling food.

4

A male patient who is undergoing fertility testing has just been informed by his urologist that he will need to provide a masturbated semen sample at his next office visit. Which of the following instructions should the nurse give the patient regarding this procedure? 1. Bring the sample to the office within 3 hours of collection 2. Engage in sexual activity at least daily the week before collecting the sample 3. Take your temperature immediately before collecting the sample 4. Abstain from any sexual activity for 2 to 3 days before producing the sample

4. Abstain from any sexual activity for 2 to 3 days before producing the sample Semen samples, when collected outside of the office, should be brought to the office within an hour of collection, not 3 hours. The patient should abstain from sexual activity for 2 to 3 days before providing the sample. The patient need not take his temperature before collecting the sample; this is a requirement for female patients who are assessing themselves for ovulatory dysfunction. The patient should abstain from sexual activity for 2 to 3 days before providing the sample.

A client informs the nurse that she is "very constipated." Which of the following foods would be best for the nurse to recommend to the client? 1. Pasta. 2. Rice. 3. Yogurt. 4. Celery.

4. Celery is an excellent food to reverse constipation. It is a high-fiber food.

A 39-year-old, 16-week gravida woman has had an amniocentesis. Before discharge, the nurse instructs the woman to call her doctor is she experiences which of the following side effects? 1. Pain at the puncture site 2. Macular rash on the abdomen 3. Decrease in urinary output 4. Cramping of the uterus

4. Cramping of the uterus The woman should report any uterine cramping. Although rare, amniocentesis could stimulate preterm labor

A client with a 4+ protein and 4+ reflexes is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following? 1. High leukocyte count 2. Explosive diarrhea 3. Fractured pelvis 4. Low platelet count

4. Low platelet count Low platelet count is one of the signs associated with HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)

During an examination, a client who's 32 weeks' pregnant becomes dizzy, light-headed, and pale while supine. What should the nurse do first? 1. Listen to fetal heart tones. 2. Take the client's blood pressure 3. Ask the client to breathe deeply 4. Turn the client on her left side.

4. Turn the client on her left side. As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous return, which can cause dizziness, light-headedness, and pallor when the client is supine. The nurse can relieve these symptoms by turning the client on her left side, which relieves pressure on the vena cava and restores venous return. Although they're valuable assessments, fetal heart tone and maternal blood pressure measurements don't correct the problem. Because deep breathing has no effect on venous return, it can't relieve the client's symptoms.

C. Provide factual information that will help reduce stress and modify acceptance. Telling her not to worry does not address the possibility that her boyfriend may be experiencing couvade syndrome. The patient is expressing concern but does not have all the facts related to couvade syndrome and requires education, rather than referral. Couvade syndrome is not an abnormal condition and should be treated with acceptance and understanding

A patient relates a story of how her boyfriend is feeling her aches and pains associated with her pregnancy. She is concerned that her boyfriend is making fun of her concerns. How would you respond to this patient statement? a. Tell her not to worry because it is natural for her boyfriend to make her feel better by identifying with her pregnancy. b. Refer the patient to a psychologist for counseling to deal with this problem because it is clearly upsetting her c. Explain that her boyfriend may be experiencing couvade syndrome and that this is a normal finding seen with male partners d. Ask the patient specifically to define her concerns related to her relationship with her boyfriend and suggest methods to stop this type of behavior by her significant other

B. Encouraging the patient to discuss her feelings is the best approach. The nurse should not disregard or belittle the patient's feelings. Responding that your baby is doing fine disregards the patient's feelings and treats them as unimportant. Responding that there is nothing to worry about does not answer the patient's concerns. Saying that the doctor is taking good care of you and your baby is belittling the patient's concerns

A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." Which is the nurse's best response? a. "Your baby is doing fine." b. "Tell me about your concerns." c. "There is nothing to worry about." d. "The doctor is taking good care of you and your baby."

C. The presentation of heartburn is a normal abnormal finding that can occur in pregnant woman because of relaxation of the lower esophageal sphincter as a result of the physiologic effects of pregnancy. Although foods may contribute to the heartburn, the patient is asking why this presentation is occurring, so the nurse should address the cause first. It is independent of gestation. There is no need to refer to the physician at this time because this is a normal abnormal finding. There is no evidence of complications ensuing from this presentation.

A pregnant woman complains of frequent heartburn. The patient states that she has never had these symptoms before and wonders why this is happening now. The most appropriate response by the nurse is to a. examine her dietary intake pattern and tell her to avoid certain foods b. tell her that this is a normal finding during early pregnancy and will resolve as she gets closer to term c. explain to the patient that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms d. refer her to her health care provider for additional testing because this is an abnormal finding

11. Nurses should be aware that the biophysical profile (BPP): a. is an accurate indicator of impending fetal death. b. is a compilation of health risk factors of the mother during the later stages of pregnancy. c. consists of a Doppler blood flow analysis and an amniotic fluid index. d. involves an invasive form of ultrasound examination.

ANS: A An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.

19. The mucous plug that forms in the endocervical canal is called the: a. operculum. b. leukorrhea. c. funic souffle. d. ballottement.

ANS: A The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

21. A nurse is caring for patients in the prenatal clinical who are all 35 weeks along. Which patient should the nurse see first? a. Shortness of breath when climbing stairs b. Abdominal pain c. Ankle edema in the afternoon d. Backache with prolonged standing

ANS: B Abdominal pain may indicate preterm labor or placental abruption so this patient should be seen first. Shortness of breath climbing stairs, afternoon ankle edema, and backache are all normal findings at this stage of pregnancy.

19. The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is: a. nonreactive. b. positive. c. negative. d. reactive.

ANS: D The NST is reactive (normal) when two or more FHR accelerations of at least 15 beats/min (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with NST. Contraction stress test (CST) uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term.

9. In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their patients that: a. both require the woman to have a full bladder. b. the abdominal examination is more useful in the first trimester. c. initially the transvaginal examination can be painful. d. the transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

ANS: D The transvaginal examination allows pelvic anatomy to be evaluated in greater detail and allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty bladder. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither method should be painful, although with the transvaginal examination the woman feels pressure as the probe is moved.

5. A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time? a. Biophysical profile (BPP) b. Amniocentesis c. Maternal serum alpha-fetoprotein (MSAFP) screening d. Transvaginal ultrasound

ANS: D Ultrasound would be performed at this gestational age for biophysical assessment of the infant. BPP would be a method of biophysical assessment of fetal well-being in the third trimester. Amniocentesis is performed after the 14th week of pregnancy. MSAFP screening is performed from week 15 to week 22 of gestation (weeks 16 to 18 are ideal).

B. Developing a strong tie in the first trimester and progressing to be in tune is the process of commitment, attachment, and interconnection with the infant. This stage begins in the first trimester and continues throughout the neonatal period. Learning to give of herself is the task that occurs during pregnancy as the woman allows her body to give space to the fetus. She continues with giving to others in the form of food and presents. Securing acceptance of the baby is a process that continues throughout pregnancy as the woman reworks relationships. Seeking safe passage is the task that ends with birth. During this task, the woman seeks health care and carries out cultural practices.

An expectant patient in her third trimester reports that she developed a strong tie to her baby from the beginning and now is really in tune to her baby's temperament. The nurse interprets this as the development of which maternal task of pregnancy? a. Learning to give of herself b. Developing attachment with the baby c. Securing acceptance of the baby by others d. Seeking safe passage for herself and her baby

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which of the following would be most appropriate? A) Monthly visits until 32 weeks, then bi-monthly visits B) Bi-monthly visits until 28 weeks, then weekly visits C) Monthly visits until 20 weeks, then bi-monthly visits D) Bi-monthly visits until 36 weeks, then weekly visits

B) Bi-monthly visits until 28 weeks, then weekly visits

A nurse is providing care to several pregnant women at the clinic. The nurse would screen for group B streptococcus infection in a client at: A) 16 weeks gestation B) 28 week gestation C) 32 weeks gestation D) 36 weeks gestation

D) 36 weeks gestation

A nursing student is educating a newly pregnant client. Which of the following statements would require the nurse's intervention? A) "You may experience constipation or firmer stools because your stools will be retained longer due to increased transit time" B) "You should notify your provider if you notice a change in areolar pigmentation" C) "You may notice an increase in your breathing, this is no cause for concern" D) "You may notice some physical changes early in pregnancy"

B) "You should notify your provider if you notice a change in areolar pigmentation"

A group of nursing students are preparing a presentation for their class about measures to prevent toxoplasmosis. Which of the following would the students be least likely to include? Select all that apply. A) Washing raw fruits and vegetables before eating them B) Cooking all meat to an internal temperature of 140 F C) Wearing gardening gloves when working in the soil D) Avoiding contact with a cats litter box.

B) Cooking all meat to an internal temperature of 140 F

The nurse in the prenatal clinic is taking a history from a prenatal client at 7 weeks' gestation. The client states, "I don't know if I want this baby. How will I know if I'll be a good mother?" What is the most appropriate response by the nurse? a. "This is a sign of depression, and I'd like you to see a mental health specialist." b. "Ambivalence can be a normal reaction to parenthood in the first trimester." c. "This is an abnormal reaction, and I'd like you to speak with Family Services." d. "This would be the best time to consider an abortion or adoption."

B. "Ambivalence can be a normal reaction to parenthood in the first trimester." Rationale: Not knowing if she wants the baby and wondering if she'll be a good mother are normal reactions to parenthood in the first trimester. Asking a newly pregnant woman to consider an abortion or adoption is a nontherapeutic response. The client did not introduce the topic of abortion or adoption. Not knowing if she wants the baby and wondering if she'll be a good mother are normal reactions to parenthood, not necessarily signs of depression, and do not warrant a referral.

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? -The heart rate increase may indicate that the client is experiencing cardiac overload. -The blood pressure should be higher since the cardiac volume is increased. -Both findings are normal at this point of the pregnancy. -Combined, both of these findings are very concerning and warrant further investigation.

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.

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse? If the mother goes into a crisis while pregnant, the baby will develop sickle cell anemia. There is a good chance the infant will inherit the disease from the mother. Both parents have to carry the trait. The infant inherits the disease from the father.

Both parents have to carry the trait. Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chances of the child inheriting the disease is zero. The infant will not develop the disease just because the mother has a crisis during the pregnancy.

After teaching a group of nursing students about the possible causes of spontaneous abortion, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of first trimester abortions? A) Maternal disease B) Cervical insufficiency C) Fetal genetic abnormalities D) Uterine fibroids

C) Fetal genetic abnormalities

The nurse understands that additional patient teaching is needed about the signs of pregnancy when the patient states a. "The nurse heard the heartbeat of the baby, so I finally know I am pregnant." b. "I think I felt the baby move last night, so I may be pregnant." c. "I know I am pregnant because I have missed two periods." d. "I think I am pregnant because I am vomiting every morning after breakfast."

C. A. The health care provider auscultating the fetal heart sounds is a positive indication of pregnancy. Positive sign of pregnancy are those caused only by pregnancy. B. Quickening is a presumptive indicator of pregnancy. These changes are the least reliable indicators of pregnancy, because they can be caused by conditions other than pregnancy. C. Amenorrhea is a presumptive indication of pregnancy. Presumptive indicators are mainly subjective changes that the woman experiences and reports. These changes are the least reliable indicators of pregnancy, because they can be caused by conditions other than pregnancy. D. Nausea and vomiting are presumptive indicators of pregnancy. These changes are the least reliable indicators of pregnancy, because they can be caused by conditions other than pregnancy.

A woman who is 26 weeks' pregnant asks the nurse educator during a childbirth class about herb use during pregnancy. The nurse should base his or her ANSwer on the knowledge that a. Herbs are natural and therefore safe with pregnancy b. Herbs have not been proved to be safe with pregnancy and should not be used c. Some herbs are safe for pregnancy; some are not. The patient needs to discuss which one she desires to use with her health care provider d. Herbs can be used with pregnancy, but the patient needs to inform the nursery staff to assess the newborn for complications after birth

C. A. There are some herbs that should not be used during pregnancy. For example, black cohosh when taken during pregnancy can produce contractions. B. Not all herbs are unsafe for pregnancy. C. Some complementary and alternative therapies are very safe and helpful during pregnancy. However, some can be harmful. Prior to ingesting any herb or using any therapy the patient needs to discuss them with her health care provider. D. If the herb may cause complications for the newborn, then they are considered unsafe to use during the pregnancy.

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called? a) Ballotment b) Chloasma c) Linea rubria d) Chadwick's sign

Chloasma

Ramona Silver, age 38, has one child with Tay-Sachs disease. She and her partner both carry the Tay-Sachs gene and did not intend to have more children, but she has just discovered that she is pregnant. She plans to have an abortion if tests show that the fetus has the Tay-Sachs gene. Which test will the primary care provider likely order? a) A multiple marker screening test b) Amniocentesis c) Chorionic villus sampling d) Percutaneous umbilical blood sampling

Chorionic villus sampling

Which hypertensive disorders can occur during pregnancy? Select all that apply. 1 Chronic hypertension 2 Preeclampsia-eclampsia 3 Hyperemesis gravidarum 4 Gestational hypertension 5 Gestational trophoblastic disease

Chronic hypertension Preeclampsia-eclampsia Gestational hypertension

A pregnant client wishes to know if sexual intercourse would be safe during her pregnancy. Which of the following should the nurse confirm before educating the client regarding sexual behavior during pregnancy? a) Client does not have anemia. b) Client does not experience facial and hand edema. c) Client does not have an incompetent cervix. d) Client does not have anxieties and worries.

Client does not have an incompetent cervix.

A patient in the OB clinic is complaining of being awakened by leg cramps while sleeping. Select the appropriate nursing intervention. a) Use plantar flexion exercises 3 times every day b) Dorsiflex the foot while extending her leg during the cramp c) Avoid any supplementation of vitamins or minerals d) Encourage her to drink more fluids, 10 glasses a day

Dorsiflex the foot while extending her leg during the cramp

Some women contract with other women to provide support during pregnancy and delivery, to provide emotional support during labor and delivery, and to aid in establishing breastfeeding. What is the name of the woman who is contracted? a) Midwife b) Doula c) Partera d) Pregnancy aide

Doula

The maternal health nurse is caring for a pregnant client with a history of epilepsy. The client's antiepileptic drug (AED) levels have been in the non-therapeutic range the last two times the labs were drawn. Which factor does the nurse associate with this finding? The action of many medications varies in pregnancy. Drug metabolism changes during pregnancy. Pregnant clients have high rates of noncompliance with maintenance medications. Most maintenance medications cannot be given in pregnancy.

Drug metabolism changes during pregnancy. Drug metabolism changes during pregnancy which may alter the therapeutic AED levels in the pregnant client. Some AEDs cannot be given in pregnancy due to risk of harm to the fetus; however, there are some that may be given. Pregnant clients do not have high rates of noncompliance and the action of medications does not change in pregnancy.

A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information? Further testing will be required to confirm any diagnosis. The blood tests are definitive. Treatment can be started once the test results are back. A second set of screening tests can be obtained to confirm results.

Further testing will be required to confirm any diagnosis. Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as: G = 4, T = 2, P = 0, A = 0, L = 1 G = 1, T = 1, P = 1, A = 0, L = 1 G = 2, T = 0, P = 0, A = 0, L = 1 G = 3, T = 1, P = 0, A = 1, L = 1

G = 3, T = 1, P = 0, A = 1, L = 1 The GTPAL stands for Gravida -- number of pregnancies, which is 3 (current, 4-year-old, and miscarriage); Term -- only one pregnancy thus far carried to term; Preterm deliveries -- 0; Abortions (including miscarriages) -- 1; Living children -- 1. Do not be distracted by the twins. That is still one pregnancy.

A woman who is 4 months pregnant notices frequent heart palpitations and leg cramps. She is anxious to learn how to alleviate these. Which nursing diagnosis would best apply to her? Pain related to severe complications of pregnancy Risk for ineffective breathing pattern related to pressure of the growing uterus Impaired urinary elimination related to inability to excrete creatine from her muscles Health-seeking behaviors related to ways to relieve discomforts of pregnancy

Health-seeking behaviors related to ways to relieve discomforts of pregnancy Health-seeking behaviors is a diagnosis used to describe clients who are actively interested in learning ways to improve their health.

A 28-year-old primigravida client with diabetes mellitus, in her first trimester, comes to the health care clinic for a routine visit. The client reports frequent episodes of sweating, giddiness, and confusion. What should the nurse tell the client about these experiences? a) Insulin resistance becomes minimal in the latter half of the pregnancy b) Tissue sensitivity to insulin increases as pregnancy advances c) Increased secretion of insulin occurs in the first trimester d) Use of insulin needs to be reduced as pregnancy advances

Increased secretion of insulin occurs in the first trimester

Leah is 28 weeks pregnant. In preparing for discomforts that occur during the final trimester of pregnancy, you would teach her about? a) Good oral hygiene to decrease ptyalism b) Eating a well-balanced diet to prevent anemia c) Increased shortness of breath and dyspnea before lightening d) Avoid exercise to prevent varicosities

Increased shortness of breath and dyspnea before lightening

Which of the following nursing interventions should the nurse perform when assessing fetal well-being through abdominal ultrasonography in a client? a) Instruct the client to refrain from emptying her bladder. b) Inform the client that she may feel hot initially. c) Instruct the client to report the occurrence of fever. d) Obtain and record vital signs of the client.

Instruct the client to refrain from emptying her bladder.

A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation? Urge the client to discontinue the anticoagulant to prevent pregnancy complications. Observe the client for signs of petechiae and premature separation of the placenta. Put the client on bed rest. Instruct the client to avoid wearing constrictive knee-high stockings.

Observe the client for signs of petechiae and premature separation of the placenta. Subclinical bleeding from continuous anticoagulant therapy in the woman has the potential to cause placental dislodgement. Observe a woman who is taking an anticoagulant for signs of petechiae and signs of premature separation of the placenta during both pregnancy and labor. The nurse should not urge the client to discontinue the anticoagulant, as this is not within the nurse's scope of practice and, in any case, the client still needs the anticoagulant to prevent clots. Bed rest is prescribed for clients with a thrombus to prevent it from moving and becoming a pulmonary embolus. Avoiding the use of constrictive knee-high stockings is to prevent thrombus formation.

The nurse is advising a pregnant woman during her first prenatal visit regarding the frequency of future visits. Which of the following is the recommended schedule for prenatal care? a) Once every 4 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 3 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.

Once every 4 weeks for the first 28 weeks, then every 2 weeks until 36 weeks, and then weekly until the birth.

The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? Fortified grains Dried beans Orange juice Dried apples

Orange juice Anemia is a condition in which the blood is deficient in red blood cells, from an underlying cause. The woman needs to take iron to manufacture enough red blood cells. Taking an iron supplement will help improve her iron levels, and taking iron with foods containing ascorbic acid, such as orange juice, improves the absorption of iron. Dried fruit (such as apples), fortified grains, and dried beans are additional food choices that are rich in iron and should be included in her daily diet.

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placental abruption requires "watchful waiting" during labor and birth. Placental abruption results in painless, bright red vaginal bleeding during labor

Placenta previa is an abnormally implanted placenta that is too close to the cervix.

A client at 36 weeks' gestation experiences vaginal bleeding. Which conditions might be the cause of the client's bleeding? Select all that apply. Bloody show Placental abruption (abruptio placentae) Ectopic pregnancy Placenta previa Spontaneous abortion (miscarriage)

Placental abruption (abruptio placentae) Placenta previa Bloody Show

The nurse is leading a discussion with a group of pregnant women who have diabetes. The nurse should point out which situation can potentially occur during their pregnancy? Polyhydramnios Hypotension of pregnancy Postterm birth Small-for-gestational-age (SGA) infant

Polyhydramnios Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes. An infant who is small-for-gestational-age is not associated with a mother who had diabetes prior to pregnancy. Other pregnancy-related complications associated with pregestational diabetes mellitus include hypertensive disorders, preterm birth, and shoulder dystocia.

The nurse is caring for a pregnant patient who is scheduled for surgery. Which nursing intervention will help provide sufficient fetal oxygenation during the surgery? 1 Positioning the patient with a lateral tilt 2 Providing clear liquids before the surgery 3 Palpating uterine contractions (UCs) manually 4 Giving an antacid before administering anesthesia

Positioning the patient with a lateral tilt

A 17-year-old primigravida with type 1 diabetes is at 37 weeks' gestation comes to the clinic for an evaluation. The nurse notes her blood sugar has been poorly controlled and the health care provider is suspecting the fetus has macrosomia. The nurse predicts which step will be completed next? Scheduling the woman for induction of labor today. Preparing for amniocentesis and fetal lung maturity assessment Scheduling a cesarean delivery at 39 weeks. Allowing her to continue without plans for delivery.

Preparing for amniocentesis and fetal lung maturity assessment If the infant has macrosomia, is large for gestation age, and the mother has had poor blood-sugar control, the provider will want further information on the fetus and readiness for delivery before making any decisions on delivery. After determining the readiness of the fetus, then plans for delivery can be determined and scheduled.

The nurse is preparing her teaching plan for a woman who has just had her pregnancy confirmed. Which of the following should be included in it? Select all that apply. a. Prevent constipation by taking a daily laxative b. Balance your dietary intake by increasing your calories by 300 to 500 daily c. Continue your daily walking routine just as you did before this pregnancy d. Tetanus, measles, mumps, and rubella vaccines will be given to you now e. Avoid tub baths now that you are pregnant to prevent vaginal infections f. Sexual activity is permitted as long as your membranes are intact g. Increase your consumption of milk to meet your iron needs

Prevent constipation by taking a daily laxative Balance your dietary intake by increasing your calories by 300 to 500 daily Continue your daily walking routine just as you did before this pregnancy Avoid tub baths now that you are pregnant to prevent vaginal infections Sexual activity is permitted as long as your membranes are intact Increase your consumption of milk to meet your iron needs

The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy? Pulmonary hypertension Loud systolic murmur Repaired atrial septal defect Secondary hypertension

Pulmonary hypertension Pulmonary hypertension is considered the greatest risk to a pregnancy because of the hypoxia that is associated with the condition. The remaining conditions represent potential cardiac complications that may increase the client's risk in pregnancy; however, these do not present the greatest risk in pregnancy.

A woman at 37 weeks of gestation is admitted with a placental abruption after a motor vehicle accident. Which assessment data are most indicative of her condition worsening? 1 Pulse (P) 112, respiration (R) 32, blood pressure (BP) 108/60; fetal heart rate (FHR) 166--178 2 P 98, R 22, BP 110/74; FHR 150--162 3 P 88, R 20, BP 114/70; FHR 140--158 4 P 80, R 18, BP 120/78; FHR 138--150

Pulse (P) 112, respiration (R) 32, blood pressure (BP) 108/60; fetal heart rate (FHR) 166--178

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? Magnesium sulfate level Reflexes Oxygen saturation Lung sounds

Reflexes

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? Hemoglobin Ability to sleep Urine protein Respiratory rate

Respiratory rate

A nurse is instructing a pregnant woman about monitoring fetal movements and informs her that normally the fetus will have the same amount every day. The nurse adds that if the patient notices an unusual increase of decrease, this is a sign of which of the following? a) Response to a need for oxygen b) Fetal shifting of activity-sleep balance c) Fetal heartburn d) Cramping in the uterus and trying to get comfortable

Response to a need for oxygen

A nurse is caring for a client who is 8 months pregnant. Which instruction is the nurse most likely to give her? a) Take a hot water bath or shower daily to maintain hygiene. b) Apply lanolin ointment to the nipple and areola to prevent cracking. c) Do nipple exercises and stimulation on a regular basis. d) Rest on the left side for at least 1 hour in the morning and afternoon.

Rest on the left side for at least 1 hour in the morning and afternoon.

The nurse midwife is performing a pelvic examination on a client who came to her following a positive home pregnancy test. The nurse checks the woman's cervix for the probable sign of pregnancy known as Goodell's sign. Which of the following describes this alteration? a) The cervix softens. b) The lower uterine segment softens. c) The cervix looks blue or purple when examined. d) The fundus enlarges.

The cervix softens.

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.

When describing the role of a doula to a group of pregnant women, the nurse would include which information? The doula primarily focuses on providing continuous labor support. The doula is a professionally trained nurse hired to provide physical and emotional support. The doula can perform any necessary clinical procedures. The doula is capable of handling high-risk births and emergencies

The doula primarily focuses on providing continuous labor support. Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies.

A,C,D As birth nears, the expectant patient will express a desire to see the baby. Most pregnant patients are concerned with their ability to determine when they are in labor. Many couples are anxious about getting to the birth facility in time for the birth. As birth nears, a nesting behavior occurs, which means getting the nursery ready. Not preparing the nursery at this stage is not a response that the nurse should expect to assess. Negotiation of tasks is done during this stage. Discussion regarding the division of household chores is not a response that the nurse should expect to assess at this stage.

The nurse is assessing a patient in her 37th week of pregnancy for the psychological responses commonly experienced as birth nears. Which psychological responses should the nurse expect to evaluate? (Select all that apply.) a. The patient is excited to see her baby. b. The patient has not started to prepare the nursery for the new baby. c. The patient expresses concern about how to know if labor has started d. The patient and her spouse are concerned about getting to the birth center in time e. The patient and her spouse have not discussed how they will share household tasks

A,B,D Watery vaginal discharge could mean that the membranes have ruptured. Puffiness of the face or around the eyes and visual disturbances may indicate preeclampsia or eclampsia. These three signs should be reported. Bloody show as labor starts may mean the mucus plug has been expelled. One of the earliest signs of labor may be bloody show, which consists of the mucus plug and a small amount of blood. This is a normal occurrence. Up to 70% of women have dependent edema during pregnancy. This is not a sign of a pregnancy complication

The nurse is teaching a pregnant patient about signs of possible pregnancy complications. Which should the nurse include in the teaching plan? (Select all that apply.) a. Report watery vaginal discharge b. Report puffiness of the face or around the eyes c. Report any bloody show when you go into labor d. Report visual disturbances, such as spots before the eyes e. Report any dependent edema that occurs at the end of the day

D. Increasing levels of estrogen cause hyperemia (congestion with blood) of the cervix, resulting in the characteristic bluish purple color that extends to include the vagina and labia. This discoloration, referred to as &lt;i&gt;Chadwick's sign&lt;/i&gt;, is one of the earliest signs of pregnancy. Although Chadwick's sign occurs with hyperemia (congestion with blood), the sign does not signify an increased risk of blood clots. The softening of the cervix is called Goodell's sign, not Chadwick's sign. Although the formation of a mucus plug protects from infection, it is not called Chadwick's sign.

The patient has just learned that she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the patient asks the nurse what this means, how would the nurse respond? a. "Chadwick's sign signifies an increased risk of blood clots in pregnant women because of a congestion of blood." b. "That sign means the cervix has softened as the result of tissue changes that naturally occur with pregnancy." c. "This means that a mucus plug has formed in the cervical canal to help protect you from uterine infection." d. "This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix."

What factors would change during a pregnancy if the hormone progesterone were reduced or withdrawn? a. The woman's gums would become red and swollen and would bleed easily. b. The uterus would contract more and peristalsis would increase. c. Morning sickness would increase and would be prolonged. d. The secretion of prolactin by the pituitary gland would be inhibited.

The uterus would contract more and peristalsis would increase.

C. The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Preventing maternal and fetal dehydration is not the primary reason for the increase in volume. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. Renal plasma flow increases during pregnancy.

What is the physiologic reason for vascular volume increasing by 40% to 60% during pregnancy? a. Prevents maternal and fetal dehydration b. Eliminates metabolic wastes of the mother c. Provides adequate perfusion of the placenta d. Compensates for decreased renal plasma flow

B. The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back. This is called grief work. Fantasies allow the woman to try on a variety of possibilities or behaviors. This usually deals with how the child will look and the characteristics of the child. Role playing involves searching for opportunities to provide care for infants in the presence of another person. Looking for a fit is when the woman observes the behaviors of mothers and compares them with her own expectations.

What is the term for the step in maternal role attainment that relates to the woman giving up certain aspects of her previous life? a. Fantasy b. Grief work c. Role playing d. Looking for a fit

D. It is important for a mother to seek time alone with her toddler to reassure him that he is loved. It is normal for a child to regress when a new sibling is introduced into the home. The toddler may have feelings of jealousy and resentment toward the new baby taking attention away from him. Frequent reassurance of parental love and affection is important. Changes in sleeping arrangements should be made several weeks before the birth so the child does not feel displaced by the new baby.

Which comment made by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult and I don't have time to deal with him." c. "When we brought the baby home, we made Michael stop sleeping in the crib." d. "My husband is going to stay with the baby so I can take Michael to the park tomorrow."

B. Looking to the grandmother for advice encourages her to become involved in the care of the infant. Housework does not encourage the grandmother to participate in the infant's care. Getting John's mother to help and calling the nurse about advice excludes the grandmother.

Which comment made by a new mother to her own mother is most likely to encourage the grandmother's participation in the infant's care? a. "Could you help me with the housework today?" b. "The baby is spitting up a lot. What should I do?" c. "I know you are busy, so I'll get John's mother to help me." d. "The baby has a stomachache. I'll call the nurse to find out what to do."

A pregnant woman with a history of mitral valve stenosis is to be prescribed medication as treatment. Which medication class would the nurse expect the client to be prescribed? vasodilator anticoagulant angiotensin receptor blockers inotropic

anticoagulant In mitral valve stenosis, it is difficult for blood to leave the left atrium. A secondary problem of thrombus formation may develop as a result of noncirculating blood. A woman may need to be prescribed an anticoagulant to prevent this complication. Vasodilators are used for peripartum cardiomyopathy. Inotropics are used for heart failure. Angiotensin receptor blockers are used for congestive heart failure.

A client who has experienced an incomplete abortion is prescribed mifepristone to assist in removing the retained products of conception. Which medication would the nurse expect to administer if prescribed before administering mifepristone? vitamin K to reduce bleeding opioid analgesic for relief of cramping diuretic to promote fluid loss antiemetic to minimize nausea

antiemetic to minimize nausea

During a follow-up visit to the prenatal clinic, a pregnant client asks the nurse about using a hot tub to help with her backache. The nurse recommends against the use based on the understanding that what can occur? urinary incontinence fetal tachycardia membrane rupture rebound maternal hypothermia

fetal tachycardia Pregnant women should avoid hot tubs, saunas, whirlpools, and tanning beds. The heat may cause fetal tachycardia as well as raise the maternal temperature. Exposure to bacteria in hot tubs that have not been cleaned sufficiently is another reason to avoid them during pregnancy. Membrane rupture and urinary incontinence are not associated with hot tub use.

The midwife orders Isabella to be placed on the monitors so she can track Isabella's uterine activity and fetal heart rate. You bring her a large glass of water and encourage her to drink, having noted ketones in her urine. While she's on the monitors you review her laboratory results from her last visit, which included a blood type and Rh factor with antibody screen of her blood. You see her blood type is B-negative, with a negative antibody screen. You discuss this with the midwife and then educate Isabella on what this means for her pregnancy. What education would you include in your teaching? Select all that apply. a. She'll need to get the RhoGAM shot now, at this visit, and that will complete any concerns with isoimmunization for this pregnancy. b. If she has any falls, is in a car accident, or has any abdominal trauma, she will need to receive another dose of RhoGAM. c. If she doesn't receive the RhoGAM, her infant could suffer from hypoglycemia after delivery. d. Any time she conceives, if the fetus is Rh-positive, she will be at risk for isoimmunization and will need have the screening and RhoGAM shot again each time. e. Isoimmunization is probably what is causing her signs of preterm labor.

b. If she has any falls, is in a car accident, or has any abdominal trauma, she will need to receive another dose of RhoGAM. d. Any time she conceives, if the fetus is Rh-positive, she will be at risk for isoimmunization and will need have the screening and RhoGAM shot again each time. Because Isabella is Rh-negative, she'll need a RhoGAM shot now at 28 weeks and then again within 72 hours of delivery if her infant is Rh-positive. This same injection schedule will be followed with all of her pregnancies. She will also receive another RhoGAM any time there is possible exposure of the infant's blood to Isabella's system, which can occur with any abdominal trauma and with some procedures such as an amniocentesis.

2. A nurse is counseling a woman with iron-deficiency anemia regarding when she should take iron supplements to increase absorption and decrease gastrointestinal upset. Which of the following recommendations should she give? a. Take iron supplements in the morning on a full stomach b. Take iron supplements in the morning on an empty stomach c. Take iron supplements at bedtime on an empty stomach d. Take iron supplements at betime on a full stomach

c

Isabella is now 38 weeks and 2 days. She's come to the office for her routine checkup. Everything has been going well and her weight gain has leveled off. She seems content but tired, is complaining of insomnia, and is ready to have her baby. What is the best advice you could give her at this time for her discomforts? a. "You should start walking at least an hour a day to get your body ready for delivery." b. "You may be eating too much meat. You should be sure to cut out extra portions during meal times." c. "You're growing another human, it's tiring work, you should be getting extra rest as much as possible during the day." d. "This is a normal discomfort of pregnancy. Have you tried drinking more coffee to help?"

c. "You're growing another human, it's tiring work, you should be getting extra rest as much as possible during the day." Walking an hour a day at 38 weeks and 2 days is excessive. She should instead be planning for extra rest periods during the day. As delivery approaches, Isabella's food preferences may change, and she should be taking in extra iron-rich foods such as meat, not cutting them out. Reminding Isabella of the hard work her body is doing by growing another human will help her to understand why she's experiencing fatigue and needs extra rest. Caffeine use can contribute to her insomnia and is not recommended.

The nurse is assessing a pregnant client at her 12 weeks' gestation and the client reports some new bumps on the dark part of her nipples. What is the best response from the nurse when questioned by the client as to what they are? -Normal bumps of pregnancy; they do nothing -Might be sign of cancer; need to speak with provider -Montgomery tubercles; secrete lubricant for the nipples -Striae, stretching of the breast tissue

-Montgomery tubercles; secrete lubricant for the nipples All women have Montgomery tubercles; they become more prominent during pregnancy and help to prepare the nipples for breastfeeding. The bumps are not specific to pregnancy and are not a sign of cancer. They are not the result of stretching.

Amanda's menstrual period is two weeks late. She has been feeling tired and has had bouts of nausea in the morning. What classification of pregnancy symptoms is Amanda experiencing? -Positive -Presumptive -Probable -No classification

-Presumptive The most common presumptive sign of pregnancy is a missed menstrual period, or amenorrhea. Other presumptive signs include nausea, fatigue, swollen, tender breasts, and frequent urination.

_________ signs are signs that appear in the first and early second trimesters, seen via objective criteria, but can also be indicators of other conditions...

-Probable signs (e.g., hydatidiform mole).

A client with preeclampsia is prescribed magnesium sulfate to prevent seizure activity. The nurse is reviewing the results of the client's serum magnesium level and determines that the client's level is therapeutic based on which result? 1. 6.8 mEq/L (3.4 mmol/L) 2. 9.2 mEq/L (4.6 mmol/L) 3. 11.5 mEq/L (5.75 mmol/L) 4. 16 mEq/L (8 mmol/L)

1. 6.8 mEq/L (3.4 mmol/L) The therapeutic level of magnesium for clients with preeclampsia ranges 4-8 mEq/L (2-4 mmol/L). A serum magnesium level of 8-10 mEq/L (4-5 mmol/L) may cause the absence of reflexes in the client. Serum levels of 10-12 mEq/L (5-6 mmol/L) may cause respiratory depression, and a serum level of magnesium greater than 15 mEq/L (7.5 mmol/L) may result in respiratory paralysis.

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.

A nurse is counseling a patient regarding discontinuing contraception in anticipation of trying to become pregnant. Which of the following instructions should the nurse give the patient? 1. Have two or three normal menstrual cycles before trying to conceive 2. Switch from hormonal contraception to an intrauterine device several months before trying to conceive 3. If using Depo-Provera, continue taking injections until 1 month before trying to conceive 4. Use only barrier methods of contraception for at least a year before trying to conceive

1. Have two or three normal menstrual cycles before trying to conceive Before conception, it is ideal for a woman to have at least two or three normal menstrual periods. Women using some form of hormonal contraception need to stop hormonal contraception and begin the use of a barrier method of birth control or fertility awareness technique (not an intrauterine device) for the next few months before conception. Women using Depo-Provera for contraception need to be informed that it may take from several months up to more than a year to conceive after discontinuing injections. Barrier methods need only be used for several months before conception, to allow for two or three normal menstrual cycles, not a year or more.

The nurse notes each of the following findings in a 10-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.

A client is pregnant with triplets and is at greater risk for complications. The nurse reinforces education about the signs and symptoms of which conditions? (Select all that apply) 1. Placenta previa 2. Preterm labor 3. Anemia 4. Hypertension of pregnancy 5. Hydatidiform mole

1. Placenta previa 2. Preterm labor 3. Anemia 4. Hypertension of pregnancy Women with multifetal preganancies are at greater risk for complications such a hypertension of pregnancy, placenta previa, preterm labor, and anemia. They are not considered to be a greater risk for the development of a hydatidiform mole.

A client with diabetes in the late third trimester has a nonstress test (NST) twice weekly. The 20-minute test showed three fetal heart rate accelerations that exceeded the baseline by 15 beats/minute and lasted longer than 15 seconds. The nurse knows these results are consistent with which interpretation of a nonstress test? 1. Reactive test 2. Nonreactive test 3. Positive test 4. Negative test

1. Reactive test The nonstress test is the preferred anterpartum heart rate screening test for pregnant clients with diabetes. A reactive nonstress test is two or more fetal heart rate accelerations that exceed baseline by at least 15 beats/minute and last longer than 15 seconds within a 20-minute period. A nonreactive nonstress test lacks accelerations in the fetal heart rate with fetal movement. The terms positive and negative aren't used to describe the interpretation of nonstress tests.

The laboratory reported that the L/S (lecithin/sphingomyelin) ratio results from and amniocentesis of a gravid client with preeclampsia are 2:1. The nurse interprets the result as which of the following? 1. The baby's lung fields are mature 2. The mother is high risk for hemorrhage 3. The baby's kidneys are functioning poorly 4. The mother is high risk for eclampsia

1. The baby's lung fields are mature An L/S ratio of 2:1 usually indicates that the fetal lungs are mature

A client who is in her first trimester is anxious to have an ultrasound at each visit. The nurse explains that it is not necessary and schedules a second ultrasound to be performed when she is about: 21 to 23 weeks' pregnant. 24 to 26 weeks' pregnant. 18 to 20 weeks' pregnant. 15 to 17 weeks' pregnant.

18 to 20 weeks' pregnant. There are no hard-and-fast rules as to how many ultrasounds a woman should have during her pregnancy; however, the first ultrasound is usually performed during the first trimester to confirm the pregnancy. A second scan may be performed at about 18 to 20 weeks' to look for congenital malformations. A third one may be done at around 34 weeks' to evaluate fetal size and verify placental position.

d) Limiting intake of heavy, greasy foods Pg. 297 Nausea and vomiting can be lessened by limiting intake of fatty and greasy foods and eating small frequent meals every 2 to 3 hours. Other interventions include eating carbohydrate foods such as dry crackers, Melba toast, dry cereal, or hard candy before getting out of bed in the morning. Avoid drinking liquids with meals; avoid coffee, tea, and spicy foods; and eliminate individual food intolerances. Drinking liquids, increasing fluid intake, and limiting carbohydrate intake does not lessen nausea and vomiting.

18. Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting? a) Increasing fluid intake b) Limiting carbohydrate intake c) Drinking liquids with meals d) Limiting intake of heavy, greasy foods

A pregnant client is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. The nurse determines that the result is positive based on which findings? 1. An indurated wheal under 10 mm in diameter appearing in 6-12 hours 2. An indurated wheal over 10 mm in diameter appearing in 48-72 hours 3. A flat, circumscribed area under 10 mm in diameter appearing in 6-12 hours. 4. A flat, circumscribed area over 10 mm in diameter appearing in 48-72 hours

2. An indurated wheal over 10 mm in diameter appearing in 48-72 hours A positive PPD result would be indicated by an indurated wheal over 10 mm in diameter that appears in 48-72 hours. The area must be a raised wheal, not a flat, circumscribed area, to be considered positive. The test is read in 48 to 72 hours, not 6-12 hours.

A gravid woman and her husband inform the nurse that they have purchased a three-story home that was built in the 1930's. It is critical that the nurse counsel the couple that before moving into the home they do which of the following? 1. Remove all old carpeting 2. Check the water for heavy metals 3. Replace ll copper pipes 4. Monitor the bathrooms for signs of mildew

2. Check the water for heavy metals The water should be checked for lead. Lead consumption by the woman during pregnancy and/or by the baby can result in permanent central nervous system damage in the child

A client is receiving IV magnesium sulfate for severe preeclampsia. While monitoring the client, the nurse would immediately report which finding? 1. Anemia 2. Decreased urine output 3. Hyperreflexia 4. Increased respiratory rate

2. Decreased urine output Magnesium is excreted through the kidneys, so a decreased urine output may result in retention of magnesium, which can accumulate to toxic levels. Urine output should be monitored closely and be greater than 30 mL/hour. Anemia isn't associated with magnesium therapy. Magnesium infusions may cause depression of deep tendon reflexes. The client should be monitored for respiratory depression and paralysis when serum magnesium levels reach approximately 15 mEq/L (7.5 mmol/L)

The nurse midwife tells a client that the baby is growing and that ballottement was evident during the vaginal examination. How should the nurse explain what the nurse midwife means by ballottement? 1. The nurse midwife saw that the mucous plug was intact. 2. The nurse midwife felt the baby rebound after being pushed. 3. The nurse midwife palpated the fetal parts through the uterine wall. 4. The nurse midwife assessed that the baby is head down.

2. This is the definition of ballottement.

A client arrives at the emergency department reporting cramping, abdominal pain, and mild vaginal bleeding. Pelvic examination shows a left adnexal mass that's tender when palpated. Culdocentesis shows blood in the cul-de-sac. The nurse would suspect which condition? 1. Abruptio placentae 2. Ectopic pregnancy 3. Hydatidiform mole 4. Pelvic inflammatory disease

2. Ectopic pregnancy Most ectopic pregnancies don't appear as obvious life-threatening medical emergencies. Ectopic pregnancies must be considered in any woman of childbearing age who reports menstrual irregularity, cramping abdominal pain, and mild vaginal bleeding. Blood in the cul-de-save is typically not seen with pelvic inflammatory disease, abruptio placentae, and hydatidiform mole

A client, 6 weeks' pregnant, is diagnosed with hyperemesis gravidarum. The nurse should monitor the client for the development of which condition? 1. Bowel perforation 2. Electrolyte imbalance 3. Miscarriage 4. Gestational hypertension

2. Electrolyte imbalance Excessive vomiting in clients with hyperemesis gravidarum commonly causes weight loss and fluid, electrolyte, and acid-base imbalances. Gestational hypertension and bowel perforation aren't related to hyperemesis. The effects of hyperemesis on the fetus depend on the severity of the disorder. Clients with severe hyperemesis may have a low-birth-weight infant, but the disorder isn't generally life-threatening

A nurse is working in the prenatal clinic. Which of the following findings would the nurse consider to be within normal limits for a client in the third trimester of pregnancy? 1. Diplopia 2. Epistaxis 3. Bradycardia 4. Oliguria

2. Epistaxis Epistaxis is commonly seen in pregnant clients. The bleeding is related to the increased vascularity of the mucous membranes. Unless the blood loss is significant, it is a normal finding.

A nurse is explaining to a young woman who is trying to become pregnant about the process of conception. Which organ should the nurse mention as the site at which fertilization takes place? 1. Ovaries 2. Fallopian tubes 3. Vagina 4. Uterus

2. Fallopian tubes Ovaries produce the ovum, or egg. From there, the ovum travels to the fallopian tubes, where fertilization takes place. Fertilization occurs in the fallopian tubes. The vagina is the muscular tube about 4 inches in length that extends from the cervix to the perineum. It receives the sperm during sexual intercourse, but fertilization occurs in the fallopian tubes. After fertilization of the ovum in the fallopian tubes, the resulting zygote travels into the uterus and implants on the uterine wall.

A client with preeclampsia is scheduled to undergo a nonstress test (NST) and asks the nurse why this is being performed. When responding to the client, which condition would the nurse most likely include as the reason? 1. Anemia 2. Fetal well-being 3. Intrauterine growth restriction (IUGR) 4. Oligohydramnios

2. Fetal well-being An NST is based on the theory that a healthy fetus has transient fetal heart rate accelerations with fetal movement. Because uteroplacental circulation is compromised in clients with preeclampsia, an NST would usually show a lack of these accelerations, which indicate a nonreactive NST. An NST can't detect anemia in a fetus. Serial ultrasounds will detect IUGR and oligohydramnious in a fetus.

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.

The nurse plans to provide anticipatory guidance to a 10-week gravid client who is being seen in the prenatal clinic. Which of the following information should be a priority for the nurse to provide? 1. Pain management during labor. 2. Methods to relieve backaches. 3. Breastfeeding positions. 4. Characteristics of the newborn.

2. It is appropriate for the nurse to provide anticipatory guidance regarding methods to relieve back pain.

The nurse is providing care to a pregnant adolescent client in her first trimester. Which intervention would the nurse identify as the highest priority? 1. Schedule the client for a screening glucose tolerance test 2. Make sure the client receives nutritional counseling and reinforce the education 3. Teach the client that she's at increased risk for having a macrosomic neonate 4. Monitor the client for signs and symptoms of placenta previa

2. Make sure the client receives nutritional counseling and reinforce the education Nutritional counseling must be emphasized as part of the prenatal care for adolescent clients. Adolescents need to meet nutritional needs for this rapid period of growth and development. The needs are further increased due to the pregnancy. Adolescents aren't at increased risk for developing gestational diabetes or placenta previa. Adolescent clients are at risk for developing low-birth-weight neonates, not macrosomic neonates.

A patient in her first trimester confesses that she has been craving and consuming starch and clay in recent weeks. The nurse recognizes this condition as which of the following? 1. Ptyalism 2. Pica 3. Lordosis 4. Melasma

2. Pica Ptyalism is an increase in saliva. Pica is a craving for and consumption of nonfood substances such as starch and clay. It can result in toxicity due to ingested substances or malnutrition from replacing nutritious foods with nonfood substances. Lordosis is abnormal anterior curvature of the lumbar spine. The body compensates for the shift in the center of gravity caused by pregnancy by developing an increased curvature of the spine. Melasma (chloasma), also referred to as mask of pregnancy, is a brownish pigmentation of the skin over the cheeks, nose, and forehead.

A client's prenatal history shows her to be a 23-year-old gravida 4, para 2. The nurse has correctly interpreted this information when she makes this statement? 1. The client has been pregnant four time and had two miscarriages. 2. The client has been pregnant four times and delivered two live-born children. 3. The client has been pregnant four times and had two cesarean deliveries. 4. The client has been pregnant four times and had two spontaneous abortions.

2. The client has been pregnant four times and delivered two live-born children. Gravida refers to the number of times a client has been pregnant; para refers to the number of viable children born. Therefore, the client who's gravida 4, para 2 has been pregnant four times and delivered two live-born children.

A woman in her third trimester advises the nurse that she wishes to breastfeed her baby, "but I don't think my nipples are right." Upon examination, the nurse notes that the client has inverted nipples. Which of the following actions should the nurse take at this time? 1. Advise the client that it is unlikely that she will be able to breastfeed. 2. Refer the client to a lactation consultant for advice. 3. Call the labor room and notify them that a client with inverted nipples will be admitted. 4. Teach the woman exercises to evert her nipples.

2. The client should be referred to a lactation consultant.

A client asks the nurse about the importance of preconception counseling. In responding, the nurse states that preconception counseling helps women lessen risky behaviors and eliminate exposure to harmful substances. Which statement made by the nurse about contraception cessation would be included in the preconception counseling? 1. "Women taking contraception up to a month before pregnancy will be better able to conceive and date the pregnancy." 2. "Women using hormonal contraception need to discontinue its use at least one menstrual period before conception." 3. "It may take several months or up to a year to conceive after discontinuing Depo-Provera." 4. "Women using an intrauterine device (IUD) will have it removed during labor."

3

A laboring woman was just assessed by the nurse and found to be 8 cm dilated. She calls the nurse back in the room, stating, "I feel pressure, and I think the baby is coming." Which nursing action has the highest priority? 1. Explain to the patient that she is not yet completely dilated, and it is normal to feel rectal pressure. 2. Call the attending provider. 3. Perform a cervical exam. 4. Assist her to the bathroom to relieve her bowels.

3

A patient has been diagnosed with intrauterine inflammation or infection (Triple I) during labor. Which assessment finding by the nurse would correlate with the Triple I diagnosis? 1. Bloody show on perineum 2. Fetal bradycardia 3. Fetal tachycardia 4. Maternal temperature 99.5 F

3

During prenatal appointments, the nurse provides teaching to the client. When providing teaching, which action would the nurse include? 1. Provide teaching about all procedures the client will need in one sitting. 2. Avoid teaching to the family to assure client privacy. 3. Assess the client's understanding of teaching. 4. Inform the client that if she has questions, they can be answered at the next visit.

3

A woman in her third trimester complains of heartburn. Which of the following recommendations should the nurse make to the patient to help prevent this condition? 1. Eating one or two large meals daily 2. Increasing intake of fluids during meals 3. Avoiding fatty or fried foods 4. Lying down for 30 to 45 minutes after eating

3. Avoiding fatty or fried foods The patient should eat small, frequent meals rather than large less-frequent ones. The patient should avoid fluid intake with meals, not increase it. The patient should avoid fatty or fried foods. The patient should remain upright for 30 to 45 minutes after eating, not lie down.

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

3. Because this baby is post-term, lanugo would likely not be present.

The nursing student is preparing to teach a prenatal class about fetal circulation. Which statement should be included in the teaching plan? 1. "One artery carries oxygenated blood from the placenta to the fetus." 2. "Two arteries carry oxygenated blood from the placenta to the fetus." 3. "Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta." 4. "Two veins carry blood that is high in carbon dioxide and other waste products away from the fetus to the placenta."

3. "Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta." Blood pumped by the embryo's heart leaves the embryo through two umbilical arteries. When oxygenated, the blood is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and the umbilical vein carries oxygenated blood and provides oxygen and nutrients to the fetus.

The result of a pregnant woman's glucose challenge test is 145 mg/dL. Which of the following information is appropriate for the nurse to give the client at this time? 1. "You will need to inject insulin at least once a day for the rest of the pregnancy" 2. "Daily oral medicines will be prescribed for you to take" 3. "You need to have a fasting glucose tolerance test as soon as possible" 4. "The results are within normal limits so no intervention is needed"

3. "You need to have a fasting glucose tolerance test as soon as possible"

A 32-week gestation client was last seen in the prenatal clinic at 28 weeks' gestation. Which of the following changes should the nurse bring to the attention of the Certified Nurse's Midwife? 1. Weight change from 128 pounds to 132 pounds 2. Pulse changes from 88 bpm to 92 bpm 3. Blood pressure changes from 110/70 to 140/90 4. Respiratory change from 16 rpm to 20 rpm

3. Blood pressure changes from 110/70 to 140/90 A blood pressure elevation to 140/90 is a sign of mild pre-eclampsia

A nurse is discussing nutrition with a primigravida. The client states that she knows that calcium is important during pregnancy but that she and her family don't consume many milk or dairy products. What advice should the nurse give? 1. "The prenatal vitamins that are recommended will satisfy all dietary requirements." 2. "You could supplement your diet with 1,800 mg of over-the-counter calcium tablets." 3. "You should consumer other nondairy foods that are high in calcium." 4. "After the first trimester, calcium isn't as important since all fetal organ structures are formed."

3. "You should consumer other nondairy foods that are high in calcium." Food is considered the ideal source of nutrients. However, milk and dairy aren't the only food sources of calcium. The client should consume other nondairy foods that are high in calcium, such as dark green leafy vegetables. While prenatal vitamins are generally recommended, they don't satisfy all requirements. The calcium requirement for pregnancy is 1,300 mg/day. Over-the-counter supplements aren't always safe and should be specifically recommended by the health care provider. While it's true that all fetal organs are formed by the end of the first trimester, development continues throughout pregnancy. Calcium requirements remain at 1,300 mg/day throughout pregnancy.

A woman with ah history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary healthcare practitioner? 1. Presence of chloasma 2. Presence of severe heartburn 3. 10-pound weight gain in a month 4. Patellar reflexes 1+

3. 10-pound weight gain in a month The weight gain may be due to fluid retention. Fluid retention occur in clients with pregnancy-induced hypertension and in clients with congestive heart failure. The physician should be notified

b) "Alter your breakfast to light foods and have small, frequent meals throughout the day" Pg. 297 Nausea peaks at 9 weeks and usually disappears by 14 weeks. A pregnant client should try to always keep something small in the stomach, opposed to a full meal, to avoid hypoglycemia which can exacerbate the nausea. Small or light and frequent meals are encouraged as they are most often able to be tolerated. Although it is good that the client is not vomiting, nausea can effect nutritional status, which is as much of a concern as electrolyte imbalance.

3. A 33-year-old multipara is 6 weeks' pregnant. The client states having always felt nauseous in the early part of pregnancy and is concerned about dietary intake at the beginning of this pregnancy because it seems the nauseous feeling is beginning earlier. How will the nurse counsel this client? a) "If you continue to feel nauseous, eat one full meal per day and sip on water as tolerated" b) "Alter your breakfast to light foods and have small, frequent meals throughout the day" c) "As long as you do not develop any vomiting, your electrolytes will be maintained" d) "Nausea peaks at 6 weeks. Symptoms are probably at their peak"

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.

A nursing student is assigned to care for a client in labor. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement is correct regarding the ductus venosus? 1. Connects the pulmonary artery to the aorta 2. Is an opening between the right and left atria 3. Connects the umbilical vein to the inferior vena cava 4. Connects the umbilical artery to the inferior vena cava

3. Connects the umbilical vein to the inferior vena cava The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.

A patient expresses concern to the nurse that her abdominal muscles appear to be separating as a result of her enlarging uterus. The nurse should explain to the woman that this condition is known as which of the following? 1. Lordosis 2. Linea nigra 3. Diastasis recti 4. Striae

3. Diastasis recti Lordosis is abnormal anterior curvature of the lumbar spine. The body compensates for the shift in the center of gravity caused by pregnancy by developing an increased curvature of the spine. Linea nigra is a type of hyperpigmentation of the skin caused by increased levels of estrogen and progesterone and characterized by a darkened line in the middle of the abdomen. Diastasis recti is the separation of the rectus abdominis muscle in the midline caused by the abdominal distention. It is a benign condition that can occur in the third trimester. Striae, or stretch marks, are streaks of pigmentation on the skin of the breasts, hips, abdomen, and buttocks resulting from stretching in these areas and the subsequent tearing of subcutaneous connective tissue and/or collagen.

A nurse is reviewing a patient's completed health history form with the patient and wants to know whether the patient's mother or father ever had a heart attack or stroke. Which component or section of the health history should the nurse consult to find this information? 1. Identifying information 2. Health status 3. Family medical 4. Self-care/lifestyle/safety behaviors

3. Family medical Identifying information includes age, gravida/para, address, race/ethnicity, religion, marital/family status, occupation, and education. Health status includes prior and present health status. Family medical includes the current health status of family members, along with genetic and other medical conditions or diseases that family members may have. Self-care/lifestyle/safety behaviors include frequency of health maintenance visits, bowel patterns, sleep patterns, stress management, nutrition, body mass index, exercise history, use and abuse of substances (tobacco, alcohol, caffeine, etc.), use of complementary and alternative medicine modalities, and safety practices (use of seat belts, sunscreen, smoke alarms, carbon monoxide detectors, and guns).

The nurse asks a patient when her last menstrual period began. The patient replies that it began about 10 days ago and ended about 5 days ago. The nurse should recognize that this patient is currently in which phase of her ovarian cycle? 1. Ovulatory 2. Luteal 3. Follicular 4. Secretory

3. Follicular The follicular phase of the ovarian cycle begins on the first day of menstruation and lasts 12 to 14 days. Thus, this patient is currently in the follicular phase. The ovulatory phase of the ovarian cycle follows the follicular phase and begins about 12 to 14 days after the first day of menstruation, when estrogen levels peak, and ends with the release of the oocyte from the mature graafian follicle. The luteal phase of the ovarian cycle begins after ovulation and lasts approximately 14 days. The secretory phase occurs in the endometrial cycle, not the ovarian cycle, and begins after ovulation and ends with the onset of menstruation.

A nurse is performing an assessment on a pregnant client. Which of the following findings would lead the nurse to report to the obstetrician that the client may be experiencing intrauterine growth restriction (IUGR)? 1. Leopold's maneuvers: Hard round object in the fundus, flat object on the left of uterus, small parts on right of uterus, soft round object above the symphysis 2. Weight gain: 6-pound increase over a 4-week period 3. Fundal height measurement: 22 cm at 26 weeks' gestation 4. Alpha-fetoprotein assessment: Level is one-half normal, accompanied by complaints of severe nausea and vomiting

3. Fundal height measurement: 22 cm at 26 weeks' gestation The fundal height at 26 weeks gestation should be approximately 26 cm. The fundal height, therefore, is below expected. This client may be experiencing intrauterine growth restriction

A pregnant client at term is in early labor. Over the past 12 hours, she has been experiencing contractions every 10-12 minutes and has not progressed. The nurse would anticipate which medication as being prescribed to help stimulate uterine contractions? 1. Estrogen 2. Fetal cortisol 3. Oxytocin 4. Progesterone

3. Oxytocin Oxytocin is the hormone responsible for stimulating uterine contractions and may be given to clients to induce or augment uterine contractions. Although estrogen has a role in uterine contractions, it isn't given to help uterine contractility. Fetal cortisol is believed to slow the production of progesterone by the placenta. Progesterone has a relaxing effect on the uterus.

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.

A nurse observes a patient, who has recently given birth, interacting with her mother, who is visiting her and the baby. The patient and her mother both share the same eye and hair color and are about the same height. The nurse knows that these traits are examples of which of the following? 1. Genotypes 2. Genomes 3. Phenotypes 4. Genetics

3. Phenotypes Genotype refers to a person's genetic makeup, not to the outward expressions of this genetic makeup. A genome is an organism's complete set of DNA. A phenotype refers to how the genes are outwardly expressed (i.e., eye color, hair color, height) Genetics is the study of heredity.

A client in her fifth month of pregnancy is having a routine clinic visit. When gathering data from the client, the nurse would be alert for which common second trimester condition? 1. Mastitis 2. Metabolic alkalosis 3. Physiologic anemia 4. Respiratory acidosis

3. Physiologic anemia Hemoglobin level and hematocrit decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production. The result is physiologic anemia. Mastitis is an infection in the breast characterized by a swollen, tender breast and flulike symptoms. This condition is most commonly seen in breast-feeding clients. Alterations in acid-base balance during pregnancy result in a state of respiratory alkalosis, compensated by mild metabolic acidosis.

A pregnant client comes to the clinic for a follow-up visit and reports swelling in her feet and ankles. Which recommendation would be most appropriate for the nurse to suggest? 1. Limit oral fluid intake. 2. Buy a good pair of walking shoes. 3. Sit and elevate the feet at least twice daily. 4. Start taking a diuretic as needed daily.

3. Sit and elevate the feet at least twice daily. Sitting down and putting the feet up at least twice daily helps to promote venous return in the pregnant client and, therefore, decreases edema. Limiting fluid intake isn't recommended unless there are additional medical complications such as heart failure. Walking shoes won't necessarily decrease edema. Diuretics aren't recommended during pregnancy because it's important to maintain an adequate circulatory volume.

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

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

3. The right atrium does contain both oxygen-rich and oxygen-poor blood.

During a vaginal examination, the nurse palpates the back of a fetus' head 2 cm below the mother's ischial spines and facing toward the right side of the mother's back. Which of the following is consistent with this assessment? 1. ROA, -2 station 2. RSP, -2 station 3. RMA, +2 station 4. ROP, +2 station

4. ROP, +2 station ROP = Right occipital posterior (the back of the baby's head is facing toward the mother's right posterior), and +2 Station - the presenting part is 2 cm below the ischial spines Incorrect ROA = Right occipital anterior (the back of the babay's head is facing toward the mother's right anterior). -2 Station - the presenting part is 2 cm above the inschial spines Incorrect RSP = Risht sacral posterior (the buttocks of the baby are facing towards the mother's right posterior). -2 Station - the presenting part is 2 cm above the ischial spines Incorrect RMA = Right mentum anterior (the face of the baby is facing toward the mother's right anterior). +2 Station - presenting part is 2 cm below the ischial spines

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 family history of cystic fibrosis should be referred to a genetic counselor.

A patient asks the nurse how she can avoid developing varicosities during her pregnancy. Which of the following should the nurse suggest to her? 1. Crossing her legs when sitting 2. Putting on support hose in the evening after being on her feet all day 3. Standing for long periods when possible 4. Dorsiflexing her feet periodically when standing or sitting

4. Dorsiflexing her feet periodically when standing or sitting The patient should avoid crossing her legs when sitting. The patient should put on support hose before rising in the morning, not in the evening after being on her feet all day. The patient should avoid prolonged standing or sitting. The patient should dorsiflex her feet periodically when standing or sitting.

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.

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.

The nurse is providing care to a pregnant client with preeclampsia. Magnesium sulfate has been ordered. The nurse understands that this drug is being given to prevent which condition? 1. Hemorrhage 2. Hypertension 3. Hypomagnesemia 4. Seizures

4. Seizures For clients with preeclampsia, magnesium sulfate is believed to depress seizure foci in the brain and peripheral neuromuscular blockage, thus preventing eclampsia. Magnesium doesn't help prevent hemorrhage in clients with preeclampsia. Antihypertensive drugs other than magnesium are preferred for sustained hypertension. Hypomagnesemia isn't a complication of preeclampsia.

The nurse is gathering information from the chart of a pregnant client. Which finding would the nurse determine does not require intervention? 1. Cardiac tamponade 2. Heart failure 3. Endocarditis 4. Systolic murmur

4. Systolic murmur Systolic murmur is heard in up to 90% of pregnant clients, and the murmur disappears soon after the birth. Cardiac tamponade, which causes effusion of fluid into the pericardial sac, isn't normal during pregnancy. Despite the increases in intravascular volume and workload of the heart associated with pregnancy, heart failure isn't normal in pregnancy. Endocarditis is most commonly associated wtih IV drug use and isn't a normal finding in pregnancy.

A pregnant client is visiting the clinic and reports tiny, blanched, slightly raised-end arterioles on her face, neck, arms, and chest. The nurse documents this finding on the medical record as which condition? 1. Epulis 2. Linea nigra 3. Striae gravidarum 4. Telangiectasis

4. Telangiectasias The dilated arterioles that occur during pregnancy are due to the elevated level of circulating estrogen and are called telangiectasias. An epulis is a red raised nodule on the gums that may develop at the end of the first trimester and continue to grow as the pregnancy progresses. The linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus during pregnancy. Striae gravidarum, or stretch marks, are slightly depressed streaks that commonly occur over the abdomen, breasts, and thighs during the second half of pregnancy.

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.

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.

D. As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy. Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. The patient should be reassured that these symptoms are within normal limits. No referral is needed at this time. Relaxation of the smooth muscles in the respiratory tract is affected by progesterone

A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider? a. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. b. These conditions are abnormal. Refer the patient to an ear, nose, and throat specialist c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds

18. As relates to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that: a. the father goes through three phases of acceptance of his own. b. the father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth. c. in the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. d. typically men remain ambivalent about fatherhood right up to the birth of their child.

ANS: A A father typically goes through three phases of development to reach acceptance of fatherhood: the announcement phase, the moratorium phase, and the focusing phase. The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy. In the last 2 months of pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant father's ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role.

14. A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: a. primipara. b. primigravida. c. multipara. d. nulligravida.

ANS: A A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind: gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.

18. A woman is at her first prenatal visit and is distressed at needing an HIV test. What response by the nurse is best? a. "We ask all women to be tested for HIV during their pregnancy." b. "This test is required by law for pregnant women." c. "Infection with HIV will make your pregnancy very high risk." d. "You could have been exposed and not know it."

ANS: A A voluntary HIV test should be conducted on all women, regardless of risk factors. This explanation is accurate and helps lessen the woman's feeling of stigma. It also lets the woman know it is voluntary. The test is not required by law. Although an HIV infection will increase the risk of complications, this explanation is too limited to be a good answer. It is true the woman may have been exposed, but that comment is demeaning and could be offensive.

A woman in her sixth month of pregnancy comes in for her first prenatal examination. She complains today of headache and abdominal pain of several months' duration. She appears somewhat hurried or nervous. What questions would the nurse ask next? a) "Do you feel safe at home?" b) "Have you been eating properly and taking a prenatal vitamin?" c) "Do you have a family history of thyroid disease?" d) "How much activity have you been able to fit into your schedule?"

"Do you feel safe at home?"

A pregnant client reports frequent urination and tells the health care provider that she has stopped drinking water during the day since she cannot take many breaks during work. Which statement by the nurse is most appropriate at this time? "Just wait until late pregnancy when the baby's head is settled into the inlet of the pelvis." "I can write you a note to give to your supervisor if that will help relieve some stress." "Maybe it would be better to stop drinking caffeinated beverages/coffee instead of water." "Fluids are necessary so your blood volume can double, which is normal in pregnancy."

"Fluids are necessary so your blood volume can double, which is normal in pregnancy." Women should not restrict their fluid intake to diminish frequency of urination because fluids are necessary to allow blood volume to double. Decreasing daily caffeine intake because of the risks caffeine poses for low birth weight may have the added benefit of reducing urinary frequency. Most importantly, a woman needs to understand that voiding more frequently is a normal pregnancy finding. The sensation of frequency will probably return after lightening (the settling of the fetal head into the inlet of the pelvis at pregnancy's end). A note for the supervisor is inappropriate in the workplace.

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman indicates a correct understanding of the discharge instructions? 1 "I will not experience mood swings since I was only at 10 weeks of gestation." 2 "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." 3 "I should eat foods that are high in iron and protein to help my body heal." 4 "I should expect the bleeding to be heavy and bright red for at least 1 week."

"I should eat foods that are high in iron and protein to help my body heal."

After teaching a pregnant woman how to count fetal movements, the nurse determines that the teaching was successful when the client states which of the following? a) "I'll do the count once a week on a morning that I'm not rushed for work." b) "I'll sit comfortably in a recliner or lie on my side when I do the counts." c) "I'll do the counts while I'm sitting and watching my son's basketball game." d) "I won't expect more than three movements to happen in an hour."

"I'll sit comfortably in a recliner or lie on my side when I do the counts."

After being rehydrated in the emergency department, a 24 year-old primipara in her 18th week of pregnancy is at home and is to rest at home for the next two days and take in small but frequent fluids and food as possible. Discharge teaching at the hospital by the nurse has been effective if the patient makes which statement? 1 "I'm going to eat five to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato." 2 "A strip of bacon and a fried egg will really taste good as long as I eat them slowly." 3 "As long as I eat small amounts and allow enough time for digestion, I can eat almost anything, like barbequed chicken or spaghetti." 4 "I'm going to stay only on clear fluids for the next 24 hours and then add dairy products like eggs and milk."

"I'm going to eat five to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato."

The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective? -"I can eat any seafood that I like because it contains phosphorus, which is a nutrient that pregnant women need." -"I will need to take iron supplementation throughout my pregnancy even if I am not anemic." -"Milk production requires higher levels of calcium; therefore, if I am going to breastfeed, I must take a calcium supplement during pregnancy." -"Because I am pregnant, I can eat anything I want and not worry about weight gain."

-"I will need to take iron supplementation throughout my pregnancy even if I am not anemic." -Iron supplementation is recommended for all pregnant women because it is almost impossible for the pregnant woman to get what is required from diet alone, especially after 20 weeks' gestation when the requirements of the fetus increase.

A pregnant client is concerned because she has noticed that she is developing brown blotches on her forehead and nose. The nurse realizes that the client understood the teaching about this problem when the client makes which statement? -"Pregnant women often develop skin problems but this should go away in the third trimester." -"These spots are from hyperpigmentation caused by the pregnancy and may be permanent." -"I will get them with every pregnancy and they will get worse every time." -"This condition is called linea nigra and the spots may fade or go away between pregnancies."

-"These spots are from hyperpigmentation caused by the pregnancy and may be permanent." The brown blotches the client is experiencing on her face is called chloasma or the "mask of pregnancy." Hyperpigmentation is one of the skin changes that pregnant women experience. This condition may be permanent or may regress between pregnancies. Linea nigra is the darkened line in the middle of the abdomen seen on some pregnant women. Chloasma does not go away in the third trimester and there is no evidence that it will get worse with each pregnancy.

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client? -Iron-deficiency anemia -Constipation -Tooth fracture -Inefficient protein metabolism

-Iron-deficiency anemia Pica is characterized by a craving for substances that have no nutritional value. Consumption of these substances can be dangerous to the client and her developing fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation of the client's compulsion to consume soil. Consumption of ice due to pica is likely to lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the client has been consuming laundry starch as a result of pica. The nurse should monitor for constipation in the client if she has been consuming clay.

The nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse? -There is not enough fiber in your diet. -The intestines are displaced by the growing fetus. -This shouldn't be happening. -hCG is delaying peristalsis.

-The intestines are displaced by the growing fetus. The growing fetus is displacing the intestines and interfering with peristalsis, delaying the passage of fecal matter and resulting in constipation. This is common and expected; however, the client should take measures to prevent hemorrhoids that can occur as the result of the pressure and straining. Progesterone, not hCG, can delay gastric emptying and decrease peristalsis.

b) Taking a B12 supplement Pg. 289 B12 is found almost exclusively in animal proteins and therefore is absent in the vegetarian diet. Fiber and dark green vegetables are needed. Vitamins A and C are not protein based and are found in a vegetarian diet.

17. The nurse educates the vegetarian client about which nutritional need during pregnancy? a) Avoiding high intake of dark green vegetables b) Taking a B12 supplement c) Limiting the intake of fiber d) Supplementing the diet with vitamins A and C

In the clinic, the nurse is discussing the recommendations for standard precaution against Zika virus infection. Which advice by the nurse will help clients avoid exposure to the virus? 1. "Sleep under mosquito nets since the Aedes albopictus mosquitos only bite at night." 2. "Avoid going to communities that have active mosquito transmission of the virus." 3. "The Zika virus may cause negative pregnancy so remember to take your vaccination by the seventh week of your pregnancy." 4. "It is unnecessary to use protection with an infected spouse."

2

The fetus of a patient in labor is in the occiput posterior position. For which manifestation should the nurse plan care for this patient? 1. Severe abdominal pain 2. Prolonged second stage of labor 3. Accelerated uterine contractions 4. Premature rupture of membranes

2

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.

Which of the following can be identified by performing an amniocentesis? (select all that apply) A.Meconium in th eamniotic fluid. B. Neural tubed efects. C. Alphafetoprotein level for fetal abmornalities. D. A future pregnancy will have a chromosomal anomaly.

A.Meconium in the amniotic fluid. B. Neural tube defects. C. Alpha fetoprotein level for fetal abmornalities.

A woman is at her first prenatal visit and is distressed at needing an HIV test. What response by the nurse is best? a. "We ask all women to be tested for HIV during their pregnancy." b. "This test is required by law for pregnant women." c. "Infection with HIV will make your pregnancy very high risk." d. "You could have been exposed and not know it."

ANS: A A voluntary HIV test should be conducted on all women, regardless of risk factors. This explanation is accurate and helps lessen the woman's feeling of stigma. It also lets the woman know it is voluntary. The test is not required by law. Although an HIV infection will increase the risk of complications, this explanation is too limited to be a good answer. It is true the woman may have been exposed, but that comment is demeaning and could be offensive.

12. A nurse is assessing a woman receiving magnesium sulfate. The nurse assesses her deep tendon reflexes at 0 and 1+. What action by the nurse is best? a. Hold the magnesium sulfate. b. Ask the provider to order a 24-hour UA. c. Assess the woman's temperature. d. Take the woman's blood pressure.

ANS: A Absent or hypoactive deep tendon reflexes are indicative of magnesium sulfate toxicity. The nurse should hold the magnesium and notify the provider. There is no need for a 24- hour UA at this point. Temperature changes are not related to magnesium. Blood pressure can be assessed, but that is not the priority. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 542 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment

7. A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be: a. negative. b. positive. c. satisfactory. d. unsatisfactory.

ANS: A Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative. A positive CST indicates the presence of repetitive later FHR decelerations. Satisfactory and unsatisfactory are not applicable terms.

Which comment by a woman in her first trimester indicates ambivalent feelings? a. "I wanted to become pregnant, but I'm scared about being a mother." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "My body is changing so quickly."

ANS: A Ambivalence refers to conflicting feelings. This woman is demonstrating this conflict. The other statements do not indicate ambivalence.

2. A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have: a. amenorrhea. b. positive pregnancy test. c. Chadwick's sign. d. Hegar's sign.

ANS: A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are felt by the woman. A positive pregnancy test, the presence of Chadwick's sign, and the presence of Hegar's sign are all probable signs of pregnancy.

3. The nursing student learns that spontaneous termination of a pregnancy is considered to be an abortion if a. the pregnancy is less than 20 weeks. b. the fetus weighs less than 1000 g. c. the products of conception are passed intact. d. no evidence exists of intrauterine infection.

ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of a fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 523 OBJ: Integrated Process: Teaching-Learning MSC: Client Needs: Health Promotion and Maintenance

6. A patient asks her nurse, "My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?" The best response by the nurse is: a. "Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby." b. "Your placenta isn't working properly, and your baby is in danger." c. "This means that we will need to perform an amniocentesis to detect if you have any placental damage." d. "Don't worry about it. Everything is fine."

ANS: A An accurate and appropriate response is, "Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby." Although "Your placenta isn't working properly, and your baby is in danger" may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the patient. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. The response "Don't worry about it. Everything is fine" is not appropriate and discredits the patient's concerns.

7. The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to a. assess fetal heart rate (FHR) and maternal vital signs. b. perform a venipuncture for hemoglobin and hematocrit levels. c. place clean disposable pads to collect any drainage. d. monitor uterine contractions.

ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The blood levels can be obtained later. It is important to assess future bleeding and provide for comfort, but the top priority is mother/fetal well-being. Monitoring uterine contractions is important but not the top priority. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 530 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

1. A pregnant woman's mother is worried that her daughter is not "big enough" at 20 weeks. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. What should the nurse report to the woman and her mother? a. "The body of the uterus is at the belly button level, just where it should be at this time." b. "You're right. We'll inform the practitioner immediately." c. "When you come for next month's appointment, we'll check you again to make sure that the baby is growing." d. "Lightening has occurred, so the fundal height is lower than expected."

ANS: A At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks of gestation is located at the level of the umbilicus. There is no need to inform the practitioner. The nurse should reassure both mother and patient that the findings are normal. The descent of the fetal head (lightening) occurs in late pregnancy.

24. With regard to medications, herbs, shots, and other substances normally encountered by pregnant women, the maternity nurse should be aware that: a. both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. b. the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. c. killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. d. no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

ANS: A Both prescription and OTC drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of after birth care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

12. Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment: a. has no known contraindications. b. has fewer false-positive results. c. is more sensitive in detecting fetal compromise. d. is slightly more expensive.

ANS: A CST has several contraindications. NST has a high rate of false-positive results, is less sensitive than the CST, and is relatively inexpensive.

22. A patient at 32 weeks of gestation reports that she has severe lower back pain. The nurse's assessment should include a. observation of posture and body mechanics. b. palpation of the lumbar spine. c. exercise pattern and duration. d. ability to sleep for at least 6 hours uninterrupted.

ANS: A Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis. Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in the pregnancy. Exercise and sleep are not as important to assess as are posture and body mechanics, which can contribute to the pain.

7. A student nurse reads a patient's chart and sees the term "striae gravidarum," The student asks the registered nurse what this means. What response by the nurse is accurate? a. Stretch marks on the abdomen and breasts b. Dark pigmentation on the woman's face c. Bluish-purple discoloration of the vagina and labia d. Reddened bleeding gums in a pregnant woman

ANS: A Stretch marks occurring on the abdomen and/or breasts of a pregnant woman are called striae gravidarum. Dark pigmentation on the face is known as melisma, chloasma, or the mask of pregnancy. The bluish tint to the vagina and labia is known as Chadwick's sign. Reddened and bleeding gums are known as gingivitis in both pregnant and non-pregnant women.

A student nurse reads a patient's chart and sees the term "striae gravidarum," The student asks the registered nurse what this means. What response by the nurse is accurate? a. Stretch marks on the abdomen and breasts b. Dark pigmentation on the woman's face c. Bluish-purple discoloration of the vagina and labia d. Reddened bleeding gums in a pregnant woman

ANS: A Stretch marks occurring on the abdomen and/or breasts of a pregnant woman are called striae gravidarum. Dark pigmentation on the face is known as melisma, chloasma, or the mask of pregnancy. The bluish tint to the vagina and labia is known as Chadwick's sign. Reddened and bleeding gums are known as gingivitis in both pregnant and non-pregnant women.

2. Prenatal testing for human immunodeficiency virus (HIV) is recommended for: a. all women, regardless of risk factors. b. a woman who has had more than one sexual partner. c. a woman who has had a sexually transmitted infection. d. a woman who is monogamous with her partner.

ANS: A Testing for the antibody to HIV is strongly recommended for all pregnant women. A HIV test is recommended for all women, regardless of risk factors. Women who test positive for HIV can be treated, reducing the risk of transmission to the fetus.

13. Appendicitis may be difficult to diagnose in pregnancy because the appendix is: a. displaced upward and laterally, high and to the right. b. displaced upward and laterally, high and to the left. c. deep at McBurney point. d. displaced downward and laterally, low and to the right.

ANS: A The appendix is displaced high and to the right, beyond McBurney point.

21. While teaching the expectant mother about personal hygiene during pregnancy, maternity nurses should be aware that: a. tub bathing is permitted even in late pregnancy unless membranes have ruptured. b. the perineum should be wiped from back to front. c. bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath. d. expectant mothers should use specially treated soap to cleanse the nipples.

ANS: A The main danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

4. The nursing faculty explains that the fetus can survive in a low-oxygen environment due to which of the following? (Select all that apply.) a. Fetal hemoglobin carries more oxygen than an adult's. b. The fetus has higher average hemoglobin and hematocrit. c. Hemoglobin carries more oxygen at low partial pressures of carbon dioxide. d. Fetal blood is more acidic than the maternal blood. e. The fetus does not need gas exchange while in utero.

ANS: A, B, C The fetus can survive in low oxygen environments due to its hemoglobin being able to carry more oxygen that the mom, having a higher level of hemoglobin and hematocrit, and the fact that hemoglobin can carry more oxygen at low partial pressures of carbon dioxide. Fetal blood is alkaline. The fetus does need gas exchange in utero.

1. Signs and symptoms that a woman should report immediately to her health care provider include: (Select all that apply.) a. vaginal bleeding. b. rupture of membranes. c. heartburn accompanied by severe headache. d. decreased libido. e. Urinary frequency.

ANS: A, B, C Vaginal bleeding, rupture of membranes, and severe headaches all are signs of potential complications in pregnancy. Patients should be advised to report these signs to the health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

1. The nurse assesses pregnant women for exposure to human teratogens, including which of the following? (Select all that apply.) a. Infections b. Radiation c. Maternal conditions d. Drugs e. Chemicals

ANS: A, B, C, D Exposure to radiation and a number of infections may result in profound congenital deformities. These include varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and PKU may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities. Coffee is not considered a teratogen.

2. A pregnant woman reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. Which vaccines could this patient receive? (Select all that apply.) a. Tetanus b. Hepatitis A and B c. Measles, mumps, rubella (MMR) d. Influenza e. Varicella

ANS: A, B, D Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer for women who have a risk for contracting or developing the disease. Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus.

A pregnant woman reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. Which vaccines could this patient receive? (Select all that apply.) a. Tetanus b. Hepatitis A and B c. Measles, mumps, rubella (MMR) d. Influenza e. Varicella

ANS: A, B, D Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer for women who have a risk for contracting or developing the disease. Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus.

2. A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? (Select all that apply.) a. Tetanus b. Diphtheria c. Chickenpox d. Rubella e. Hepatitis B

ANS: A, B, E Immunization with live or attenuated live viruses is contraindicated during pregnancy because of potential teratogenicity. Vaccines consisting of killed viruses may be used. Immunizations that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines. Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps.

2. The nursing faculty teaches that the placenta produces many hormones necessary for normal pregnancy. These include (Select all that apply.) a. human chorionic gonadotropin (hCG). b. insulin. c. estrogen. d. progesterone. e. testosterone.

ANS: A, C, D The placenta produces hCG, estrogen, and progesterone. It does not produce insulin or testosterone.

1. The nurse is caring for a woman who had infibulation performed on her as a child. Which of the following actions by the perinatal nursing staff are appropriate for this patient? (Select all that apply.) a. Obtaining frequent urinalysis collections b. Providing larger equipment for exams c. Astute assessments for pain during procedures d. Monitoring for infections e. Draping the woman maximally

ANS: A, C, D, E Female genital mutilation, cutting, or circumcision, also called infibulation, involves removal of some or all of the external female genitalia. The labia majora are often stitched together over the vaginal and urethral opening as part of this practice. The woman is at risk for many issues including urinary tract and other genital infections and pain. Often the woman will not give any verbal or nonverbal signs of pain so the nurse must be astute in assessing for it. Draping the woman should be done as completely as possible. The equipment for exams must be smaller, such as a pediatric speculum.

The nurse is caring for a woman who had infibulation performed on her as a child. Which of the following actions by the perinatal nursing staff are appropriate for this patient? (Select all that apply.) a. Obtaining frequent urinalysis collections b. Providing larger equipment for exams c. Astute assessments for pain during procedures d. Monitoring for infections e. Draping the woman maximally

ANS: A, C, D, E Female genital mutilation, cutting, or circumcision, also called infibulation, involves removal of some or all of the external female genitalia. The labia majora are often stitched together over the vaginal and urethral opening as part of this practice. The woman is at risk for many issues including urinary tract and other genital infections and pain. Often the woman will not give any verbal or nonverbal signs of pain so the nurse must be astute in assessing for it. Draping the woman should be done as completely as possible. The equipment for exams must be smaller, such as a pediatric speculum.

A pregnant woman asks the nursing student what to do about her frequent heartburn. What suggestions can the student make that are appropriate? (Select all that apply.) a. Try chewing gum during the day. b. Take Alka-Seltzer or other antacid. c. Drink a small sip of cream before meals. d. Eat small amounts of dry crackers. e. Wear loose-fitting clothing.

ANS: A, C, E Chewing gum, a small sip of cream before meals, and wearing loose clothing all can help relieve heartburn. The patient can take antacids recommended by the provider, but Alka-Seltzer has too much sodium. Dry crackers help with morning sickness.

During pregnancy there are a number of changes that occur as a direct result of the presence of the fetus. Which of these adaptations meet these criteria? (Select all that apply.) a. Leukorrhea b. Development of a mucous plug c. Quickening d. Ballottement e. Lightening

ANS: A, C, E Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements, or "feeling life." Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descent into the pelvis. This occurs 2 weeks before labor in the nullipara and at the start of labor in the multipara. Mucus fills the cervical canal, creating a plug that acts as a barrier against bacterial invasion during pregnancy. Passive movement of the unengaged fetus is referred to as ballottement

A nurse is caring for patients in the prenatal clinical who are all 35 weeks along. Which patient should the nurse see first? a. Shortness of breath when climbing stairs b. Abdominal pain c. Ankle edema in the afternoon d. Backache with prolonged standing

ANS: B Abdominal pain may indicate preterm labor or placental abruption so this patient should be seen first. Shortness of breath climbing stairs, afternoon ankle edema, and backache are all normal findings at this stage of pregnancy.

32. A woman who is 8 months pregnant is brought to the emergency department after a serious motor vehicle crash. Although she has no apparent injuries, she is admitted to the hospital. Her partner is upset and wants to know why she just can't come home. What response by the nurse is best? a. "This is standard procedure for all pregnant crash victims." b. "She needs to be monitored for some potential complications." c. "We may have to deliver the baby at any time now." d. "We are giving her medicine to keep her from laboring."

ANS: B After serious trauma, a woman may be admitted and observed because an abruptio placentae may take up to 24 hours to become apparent. Not all motor vehicle crash patients will need to be admitted. The baby may or may not need to be delivered at any time, but this statement will frighten the partner. There is no indication the patient is in labor. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 532 | Safety Alert Box OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

14. Which statement related to oogenesis is correct? a. Two million primary oocytes will mature. b. At birth, all ova are contained in the female's ovaries. c. The oocytes complete their division during fetal life. d. Monthly, at least two oocytes mature.

ANS: B All of the cells that may undergo meiosis in a woman's lifetime are contained in the ovaries at birth. Only 400 to 500 ova will mature during the approximately 35 years of a woman's reproductive life. The primary oocytes begin their first meiotic division during fetal life but remain suspended until puberty. Every month, one primary oocyte matures and completes meiotic division yielding two unequal cells.

10. A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" The best answer is a. "A baby's sex is determined as soon as conception occurs, and the differences are apparent." b. "The baby has developed enough that we can determine the sex by examining the genitals through ultrasound." c. "Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different." d. "It might be possible to determine your baby's sex, but the external organs look very similar right now."

ANS: B Although gender is determined at conception, the external genitalia of males and females look similar through the 9th week. By the 12th week, the external genitalia are distinguishable as male or female.

8. The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change? a. Her center of gravity will shift backward. b. She will have increased lordosis. c. She will have increased abdominal muscle tone. d. She will notice decreased mobility of her pelvic joints.

ANS: B An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help the woman maintain her balance. The center of gravity shifts forward. She will have decreased muscle tone. She will notice increased mobility of her pelvic joints.

A student nurse is teaching a pregnant woman ways to manage constipation. Which instruction by the student causes the nurse to provide a correction? a. Drink at least 8 glasses of liquids a day. b. The fat in cheese helps lubricate the bowels. c. You do need to continue your iron pills. d. Add extra fiber, which can be found in fruit.

ANS: B Cheese tends to cause constipation, so this statement by the student needs correction by the nurse. The other statements are all correct.

10. In the first trimester, ultrasonography can be used to gain information on: a. amniotic fluid volume. b. location of gestational sacs. c. placental location and maturity. d. cervical length.

ANS: B During the first trimester, ultrasound examination is performed to obtain information regarding the number, size, and location of gestational sacs; the presence or absence of fetal cardiac and body movements; the presences or absence of uterine abnormalities (e.g., bicornuate uterus or fibroids) or adnexal masses (e.g., ovarian cysts or an ectopic pregnancy); and pregnancy dating.

15. Which time-based description of a stage of development in pregnancy is accurate? a. Viability—22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight >500 g). b. Full Term—Pregnancy from the beginning of week 39 of gestation to the end of week 40. c. Preterm—Pregnancy from 20 to 28 weeks. d. Postdate—Pregnancy that extends beyond 38 weeks.

ANS: B Full Term is 39 to 40 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since LMP. Preterm is 20 to 37 weeks of gestation. Postdate or postterm is a pregnancy that extends beyond 42 weeks or what is considered the limit of full term.

16. A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. Anxiety due to hospitalization b. Worsening disease and impending seizure c. Effects of magnesium sulfate d. Gastrointestinal upset

ANS: B Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a seizure is imminent. These sign are not due to anxiety or magnesium sulfate or related to gastrointestinal upset. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 538 | Table 25.3 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

29. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves a. corticosteroids to reduce inflammation. b. IV therapy to correct fluid and electrolyte imbalances. c. an antiemetic, such as pyridoxine, to control nausea and vomiting. d. enteral nutrition to correct nutritional deficits.

ANS: B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids are not the expected treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 535 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

Which situation best describes a man "trying on" fathering behaviors? a. Spending more time with his siblings b. Taking a nephew to the park to play c. Reading books on newborn care d. Exhibiting physical symptoms related to pregnancy

ANS: B Interacting with children and assuming the behavior and role of a father best describe a man "trying on" being a father. The man normally will seek closer ties with his father during this time, not his siblings. While some fathers do everything they can to learn about infant care, others are not ready to learn when the information is presented, so the nurse should provide the information again after the baby is born and it is more relevant. Exhibiting symptoms related to pregnancy is called couvade

11. During the first trimester, a woman can expect which of the following changes in her sexual desire? a. An increase, because of enlarging breasts b. A decrease, because of nausea and fatigue c. No change d. An increase, because of increased levels of female hormones

ANS: B Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy, the breasts may become enlarged and tender; this tends to interfere with coitus, decreasing the desire to engage in sexual activity.

27. Which of the following behaviors by a pregnant woman would be an example of mimicry? a. Babysitting for a neighbor's children b. Wearing maternity clothes before they are needed c. Daydreaming about the newborn d. Imagining oneself as a good mother

ANS: B Mimicry refers to observing and copying the behaviors of others, in this case, other pregnant women. Wearing maternity clothes before they are needed helps the expectant mother "feel" what it's like to be obviously pregnant. Babysitting other children is a form of role playing where the woman practices the expected role of motherhood. Daydreaming is a type of fantasy where the woman "tries on" a variety of behaviors in preparation for motherhood. Imagining herself as a good mother is the woman's effort to look for a good role fit. She observes behavior of other mothers and compares them with her own expectations.

Which of the following behaviors by a pregnant woman would be an example of mimicry? a. Babysitting for a neighbor's children b. Wearing maternity clothes before they are needed c. Daydreaming about the newborn d. Imagining oneself as a good mother

ANS: B Mimicry refers to observing and copying the behaviors of others, in this case, other pregnant women. Wearing maternity clothes before they are needed helps the expectant mother "feel" what it's like to be obviously pregnant. Babysitting other children is a form of role playing where the woman practices the expected role of motherhood. Daydreaming is a type of fantasy where the woman "tries on" a variety of behaviors in preparation for motherhood. Imagining herself as a good mother is the woman's effort to look for a good role fit. She observes behavior of other mothers and compares them with her own expectations.

A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

ANS: B Nausea and vomiting are believed to be caused by increased levels of hormones and decreased gastric motility. Glucose levels decrease in the first trimester. Hypoglycemia, if experienced, can also lead to nausea. Gastric secretions do decrease, but this is not the main cause of nausea and vomiting.

Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria d. Ketonuria

ANS: B Small amounts of glucose may indicate "physiologic spilling," which occurs because the filtered load exceeds the renal tubules' ability to absorb them. The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

25. Which statement about multifetal pregnancy is inaccurate? a. The expectant mother often develops anemia because the fetuses have a greater demand for iron. b. Twin pregnancies come to term with the same frequency as single pregnancies. c. The mother should be counseled to increase her nutritional intake and gain more weight. d. Backache and varicose veins often are more pronounced.

ANS: B Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions.

6. The student nurse is assessing a woman with abruptio placentae. The student reports to the registered nurse "I can't really palpate her abdomen, it's as hard as a board." What action by the nurse is the priority? a. Tell the student to document the findings. b. Have the student teach the woman relaxation techniques. c. Assess the woman's fundal height and vital signs. d. Administer a dose of opioid pain medication.

ANS: C A hard, board-like abdomen in this setting is characteristic of concealed hemorrhage. The nurse assesses the woman's fundal height (which will rise with bleeding) and vital signs to detect shock. Documentation occurs after interventions are complete. Relaxation techniques may help the woman cope with the situation, but anxiety is not the reason for the findings. The woman may or may not need pain medication, and if she is going to need surgery, she should not get opioids until consents are signed. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 532 | Safety Alert Box OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment

31. A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old married daughter is expecting her first child. What is a major factor in determining how the woman will respond to becoming a grandmother? a. Her career b. Being divorced c. Her age d. Age of the daughter

ANS: C Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. Career responsibilities may have demands that make the grandparents not as accessible, but it is not a major factor in determining the woman's response to becoming a grandmother. Being divorced is not a major factor that determines adaptation of grandparents. The age of the daughter is not a major factor that determines adaptation of grandparents. The age of the grandparent is a major factor.

A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old married daughter is expecting her first child. What is a major factor in determining how the woman will respond to becoming a grandmother? a. Her career b. Being divorced c. Her age d. Age of the daughter

ANS: C Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. Career responsibilities may have demands that make the grandparents not as accessible, but it is not a major factor in determining the woman's response to becoming a grandmother. Being divorced is not a major factor that determines adaptation of grandparents. The age of the daughter is not a major factor that determines adaptation of grandparents. The age of the grandparent is a major factor.

19. To relieve a leg cramp, the patient should be instructed to a. massage the affected muscle. b. stretch and point the toe. c. dorsiflex the foot. d. apply a warm pack.

ANS: C Dorsiflexion of the foot stretches the leg muscle and relieves the painful muscle contraction. Since she is prone to blood clots in the legs, massaging the affected leg muscle is contraindicated. Pointing the toes will contract the muscle and not relieve the pain. Warm packs can be used to relax the muscle, but more immediate relief is necessary, such as dorsiflexion of the foot.

To relieve a leg cramp, the patient should be instructed to a. massage the affected muscle. b. stretch and point the toe. c. dorsiflex the foot. d. apply a warm pack.

ANS: C Dorsiflexion of the foot stretches the leg muscle and relieves the painful muscle contraction. Since she is prone to blood clots in the legs, massaging the affected leg muscle is contraindicated. Pointing the toes will contract the muscle and not relieve the pain. Warm packs can be used to relax the muscle, but more immediate relief is necessary, such as dorsiflexion of the foot.

8. During a pregnancy group meeting, the nurse teaches patients that the fetal period is best described as one of a. development of basic organ systems. b. resistance of organs to damage from external agents. c. maturation of organ systems. d. development of placental oxygen-carbon dioxide exchange.

ANS: C During the fetal period, the body systems grow in size and mature in function to allow independent existence after birth. Basic organ systems are developed during the embryonic period. The organs are always at risk for damage from external sources; however, the older the fetus, the more resistant the organs will be. The greatest risk is when the organs are developing. The placental system is complete by week 12, but that is not the best description of the fetal period.

16. The nurse teaches a pregnant woman that one of the most effective methods for preventing venous stasis is to a. wear elastic stockings in the afternoons. b. sleep with the foot of the bed elevated. c. rest often with the feet elevated. d. sit with the legs crossed.

ANS: C Elevating the feet and legs improves venous return and prevents venous stasis. Elastic stockings should be applied before lowering the legs in the morning. Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis.

8. A pregnant woman has been diagnosed with gestational hypertension and is crying. She asks the nurse if this means she has to take blood pressure medicine for the rest of her life. What answer by the nurse is best? a. "Yes, you will have hypertension for the rest of your life." b. "No, this always goes away after you deliver." c. "Maybe, we have to wait and see at your 6-week postpartum checkup." d. "I don't know. But if you need medicine you should take it."

ANS: C Gestational hypertension can last after delivery. If it has not resolved by postpartum week 6, it is considered chronic, and the woman will probably have to take medication. It may or may not resolve, but the nurse should not provide false reassurance or state that he or she does not know without finding more information. Telling the woman to take medicine if she needs it belittles her concerns. PTS: 1 DIF: Cognitive Level: Application/Applying REF: p. 536 | Table 25.1 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

27. In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement would accurately apply to the centering model of care? a. Group sessions begin with the first prenatal visit. b. At each visit, blood pressure, weight, and urine dipsticks are obtained by the nurse. c. Eight to twelve women are placed in gestational-age cohort groups. d. Outcomes are similar to those of traditional prenatal care.

ANS: C Gestational-age cohorts comprise the groups with approximately 8 to 12 women in each group. This group remains intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. Group sessions begin at 12 to 16 weeks of gestation and end with an early after birth visit. Before group sessions the patient has an individual assessment, physical examination, and history. At the beginning of each group meeting, patients measure their own blood pressure, weight, and urine dips and enter these in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. Results evaluating this approach have been very promising. In a study of adolescent patients, there was a decrease in low-birth-weight infants and an increase in breastfeeding rates.

33. What comment by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult, and I don't have time to deal with him." c. "My husband will stay with the baby so I can take our son to the park." d. "When we brought the baby home, we made our son stop sleeping in the crib."

ANS: C It is important for a mother to seek time alone with her toddler to reassure him that he is loved. Toddlers can feel jealous and resentful having to share the mother's attention. It is normal for a child to regress when a new sibling is introduced into the home. As difficult as it is, the mother must make time to spend with the toddler. Changes in sleeping arrangements should be made several weeks before the birth so that the child does not feel displaced by the new baby.

What comment by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult, and I don't have time to deal with him." c. "My husband will stay with the baby so I can take our son to the park." d. "When we brought the baby home, we made our son stop sleeping in the crib."

ANS: C It is important for a mother to seek time alone with her toddler to reassure him that he is loved. Toddlers can feel jealous and resentful having to share the mother's attention. It is normal for a child to regress when a new sibling is introduced into the home. As difficult as it is, the mother must make time to spend with the toddler. Changes in sleeping arrangements should be made several weeks before the birth so that the child does not feel displaced by the new baby.

20. To reassure and educate pregnant patients about changes in their breasts, nurses should be aware that: a. the visibility of blood vessels that form an intertwining blue network indicates full function of Montgomery's tubercles and possibly infection of the tubercles. b. the mammary glands do not develop until 2 weeks before labor. c. lactation is inhibited until the estrogen level declines after birth. d. colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

ANS: C Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by midpregnancy. Colostrum is a creamy, white-to-yellow premilk fluid that can be expressed from the nipples before birth.

A woman is currently pregnant; she has a 5-year-old son and a 3-year-old daughter born at full term. She had one other pregnancy that terminated at 8 weeks. Her gravida and para are a. gravida 3 para 2. b. gravida 4 para 3. c. gravida 4 para 2. d. gravida 3 para 3.

ANS: C She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion, which is not included in the gravida-para classification

10. The nurse should be aware that the partner's main role in pregnancy is to: a. provide financial support. b. protect the pregnant woman from "old wives' tales." c. support and nurture the pregnant woman. d. make sure the pregnant woman keeps prenatal appointments.

ANS: C The partner's main role in pregnancy is to nurture the pregnant woman and to respond her feelings of vulnerability. In older societies, the man enacted the ritual couvade. Changing cultural and professional attitudes have encouraged fathers' participation in the birth experience over the past 30 years.

22. To provide the patient with accurate information about dental care during pregnancy, maternity nurses should be aware that: a. dental care can be dropped from the priority list because the woman has enough to worry about and is getting a lot of calcium anyway. b. dental surgery, in particular, is contraindicated because of the psychologic stress it engenders. c. if dental treatment is necessary, the woman will be most comfortable with it in the second trimester. d. dental care interferes with the expectant mother's need to practice conscious relaxation.

ANS: C The second trimester is best for dental treatment because that is when the woman will be able to sit most comfortably in the dental chair. Dental care such as brushing with fluoride toothpaste is especially important during pregnancy because nausea during pregnancy may lead to poor oral hygiene. Emergency dental surgery is permissible, but the mother must clearly understand the risks and benefits. Conscious relaxation is useful, and it may even help the woman get through any dental appointments; it is not a reason to avoid them.

21. What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Many women have nausea in the first trimester. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. The history of bleeding is normally described as being brownish. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 528 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

20. With regard to follow-up visits for women receiving prenatal care, nurses should be aware that: a. the interview portions become more intensive as the visits become more frequent over the course of the pregnancy. b. monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. c. during the abdominal examination, the nurse should be alert for supine hypotension. d. for pregnant women, a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive.

ANS: C The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in blood pressure and a feeling of faintness. The interview portion of follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women hypertension is defined as a systolic BP of 140 or greater and a diastolic BP of 90 or greater.

24. A couple ask the prenatal nurse to explain centering pregnancy. Which statement accurately applies to this model of care? a. A way to control labor pain and remain centered during the process b. A philosophy of making the pregnancy the center of the family's life c. Education and support sessions are provided to small cohorts of women d. Labor practice where the woman is surrounded by an extensive network of people

ANS: C This method involves ten 1.5- to 2-hour sessions with small groups of women and health care providers beginning at 12 to 16 weeks of pregnancy and ending in early postpartum. Sessions include assessment, education, and social support. It is not a way to control labor pain, a philosophy of making the pregnancy the center of the family's life, or the use of a large network of people during labor.

A couple ask the prenatal nurse to explain centering pregnancy. Which statement accurately applies to this model of care? a. A way to control labor pain and remain centered during the process b. A philosophy of making the pregnancy the center of the family's life c. Education and support sessions are provided to small cohorts of women d. Labor practice where the woman is surrounded by an extensive network of people

ANS: C This method involves ten 1.5- to 2-hour sessions with small groups of women and health care providers beginning at 12 to 16 weeks of pregnancy and ending in early postpartum. Sessions include assessment, education, and social support. It is not a way to control labor pain, a philosophy of making the pregnancy the center of the family's life, or the use of a large network of people during labor.

A nurse is encouraging a patient to attend an early pregnancy class for the second trimester. What topic would be inconsistent with the nurse's knowledge of topics presented in this class? a. Fetal development b. Body mechanics c. Childbirth choices d. Managing morning sickness

ANS: D Managing morning sickness would be taught in a first trimester early pregnancy class. The other topics are appropriate for second trimester classes.

23. A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would require further discussion with the nurse? a. "My husband and I have agreed that my sister will be my coach." b. "We plan to use Lamaze to reduce the pain during labor." c. "We want the labor and birth to take place in a birthing room with our son present. d. "We will not use the fetal monitor during labor."

ANS: D A birth plan consists of what the woman and partner wish to have happen during labor and delivery. Intermittent or continuous fetal monitoring is one aspect of care for consideration; however, it is unrealistic to state that monitoring will not be used. The nurse should explain the purpose to ensure the couple is making an informed decision. The woman can refuse this procedure but would need to understand how this might negatively impact her child. The couple also need to understand that the entire plan is tentative depending on what events actually occur. The other statements are appropriate for a birth plan.

3. A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. What action by the nurse is best? a. Refer the patient to an ear, nose, and throat specialist. b. Explain that nasal stuffiness and nosebleeds are caused by a decrease in progesterone. c. Attach the woman to a cardiac monitor, and draw blood for hemoglobin and hematocrit. d. Teach that the increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

ANS: D As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy. No referral is needed. The patient does not need to be attached to a cardiac monitor or have lab drawn. The patient should be taught that estrogen causes these changes, not progesterone.

22. To reassure and educate their pregnant patients about changes in their blood pressure, maternity nurses should be aware that: a. a blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. b. shifting the patient's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. c. the systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. d. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.

ANS: D Compression of the iliac veins and inferior vena cava also leads to varicose veins in the legs and vulva. The tightness of a cuff that is too small produces a reading that is too high; similarly the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first decreases and then gradually increases.

29. The maternal task that begins in the first trimester and continues throughout the neonatal period is called a. seeking safe passage for herself and her baby. b. securing acceptance of the baby by others. c. learning to give of herself. d. developing attachment with the baby.

ANS: D Developing attachment (strong ties of affection) to the unborn baby begins in early pregnancy when the woman accepts that she is pregnant. By the second trimester, the baby becomes real, and feelings of love and attachment surge. Seeing safe passage is a task that ends with delivery. During this task the woman seeks health care and cultural practices. Securing acceptance continues throughout pregnancy as the woman reworks relationships. Learning to give of herself occurs during pregnancy and is sometimes noticed as the woman gives to others in the form of food or presents.

13. When explaining twin conception, the nurse points out that dizygotic twins develop from a. a single fertilized ovum and are always of the same sex. b. a single fertilized ovum and may be the same sex or different sexes. c. two fertilized ova and are the same sex. d. two fertilized ova and may be the same sex or different sexes.

ANS: D Dizygotic twins are two different zygotes, each conceived from a single ovum and a single sperm. They may be both male, both female, or one male and one female. A single fertilized ovum that produces twins is called monozygotic. Monozygotic twins are always the same sex. Dizygotic twins are from two fertilized ova and may or may not be the same sex.

1. A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category? a. Blood pressure, age, and BMI b. Drug/alcohol use, age, and family history c. Family history, blood pressure, and BMI d. Family history, BMI, and drug/alcohol abuse

ANS: D Her family history of NTD, low BMI, and substance abuse all are high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which would be a high risk. The woman's drug/alcohol use and family history put her in a high risk category, but her age does not. The woman's family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal.

18. The most basic information a maternity nurse should have concerning conception is a. ova are considered fertile 48 to 72 hours after ovulation. b. sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours. c. conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d. implantation in the endometrium occurs 6 to 10 days after conception.

ANS: D Implantation occurs 6 to 10 days after conception and is complete after 10 days. Ova are considered fertile for approximately 24 hours after ovulation. Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.

23. When discussing work and travel during pregnancy with a pregnant patient, nurses should instruct them that: a. women should sit for as long as possible and cross their legs at the knees from time to time for exercise. b. women should avoid seat belts and shoulder restraints in the car because they press on the fetus. c. metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. d. while working or traveling in a car or on a plane, women should arrange to walk around at least every 2 hours or so.

ANS: D Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

9. A new mother is distresses over the "white substance" covering her infant because it "looks ugly." What action by the nurse is most appropriate? a. Scrub the substance off of the baby. b. Reassure the mom that it will go away. c. Report the findings to the provider. d. Explain that the vernix caseosa protects fetal skin from amniotic fluid.

ANS: D Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. This can be washed off gently, when the baby gets the first bath. Although it will not remain, this statement does not explain the purpose of the substance. This does not need to be reported.

26. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that a. bed rest and analgesics are the recommended treatment. b. she will be unable to conceive in the future. c. a D&C will be performed to remove the products of conception. d. hemorrhage is the major concern.

ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before hemorrhaging. If the tube must be removed, her fertility will decrease but she will not be infertile. A D&C is done on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes. PTS: 1 DIF: Cognitive Level: Comprehension/Understanding REF: p. 527 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

3. Which symptom is considered a warning sign and should be reported immediately by the pregnant woman to her health care provider? a. Nausea with occasional vomiting b. Fatigue c. Urinary frequency d. Vaginal bleeding

ANS: D Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of potential complications of the pregnancy. Nausea with occasional vomiting, fatigue, and urinary frequency are normal first-trimester complaints. Although they may be worrisome or annoying to the mother, they usually are not indications of pregnancy problems.

11. Which clinical sign is not included in the symptoms of preeclampsia? a. Hypertension b. Edema c. Proteinuria d. Glycosuria

ANS: D Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia. Hypertension is usually the first sign noted. Edema occurs but is considered a non-specific sign. Edema can lead to rapid weight gain. Proteinuria should be assessed through a 24- hour UA. PTS: 1 DIF: Cognitive Level: Knowledge/Remembering REF: p. 537 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

6. The student nurse learns that some of the embryo's intestines remain within the umbilical cord during the embryonic period because the a. umbilical cord is much larger at this time than it will be at the end of pregnancy. b. intestines begin their development within the umbilical cord. c. nutrient content of the blood is higher in this location. d. abdomen is too small to contain all the organs while they are developing.

ANS: D The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks, the abdomen is large enough to contain them. The intestines remain within the umbilical cord only until approximately week 10. Intestines begin their development within the umbilical cord but only because the liver and kidneys occupy most of the abdominal cavity. All the intestines are within the abdominal cavity around week 10.

4. While teaching an early pregnancy class, the nurse explains that the morula is a a. fertilized ovum before mitosis begins. b. flattened disk-shaped layer of cells within a fluid-filled sphere. c. double layer of cells that becomes the placenta. d. solid ball composed of the first cells formed after fertilization.

ANS: D The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that develops after fertilization. The fertilized ovum is called the zygote. This is the embryonic disk. It will develop into the baby. The placenta is formed from two layers of cells: the trophoblast, which is the other portion of the fertilized ovum, and the decidua, which is the portion of the uterus where implantation occurs.

28. A step in maternal role attainment that relates to the woman giving up certain aspects of her previous life is termed a. looking for a fit. b. role playing. c. fantasy. d. grief work.

ANS: D The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back. Looking for a fit is when the woman observes the behaviors of mothers and compares them with her own expectations. Role playing involves searching for opportunities to provide care for infants in the presence of another person. Fantasies allow the woman to try on a variety of behaviors. This usually deals with how the child will look and the characteristics of the child.

39. The nurse in the OB triage area has four patients to see. Which patient should the nurse see first? a. First trimester, vomiting for an hour b. Second trimester, fingers swollen c. Third trimester, painful urination d. Third trimester, painful vaginal bleeding

ANS: D This patient may have a placenta previa or abruptio placentae or might be having a spontaneous abortion. The nurse needs to see this patient first. The other patients may have normal vomiting of the first trimester. Swollen fingers indicate edema that needs to be investigated. Painful urination probably indicates a urinary tract infection. The priority patient is the one with bleeding.

A blunt abdominal trauma causes fetal hemorrhage in a pregnant patient. The nurse finds that the patient is Rh negative. What action does the nurse take? 1 Initiate magnesium sulfate per protocol. 2 Administer oxytocin (pitocin). 3 Administer prescribed Rho (D) immunoglobulin. 4 Prepare the patient for magnetic resonance imaging (MRI).

Administer prescribed Rho (D) immunoglobulin.

Which is a priority nursing action when a pregnant patient with severe gestational hypertension is admitted to the health care facility? 1 Prepare the patient for cesarean delivery. 2 Administer intravenous (I.V.) and oral fluids. 3 Provide diversionary activities during bed rest. 4 Administer the prescribed magnesium sulfate.

Administer the prescribed magnesium sulfate.

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic? A) 3.3 mEq/L B) 6.1 mEq/L C) 8.4 mEq/L D) 10.8 mEq/L

B) 6.1 mEq/L

A nurse is researching the topic of edema during pregnancy. Which physiologic mechanism contributes to fluid retention? a. Decreased nitrogen retention. b. Increased level of steroid sex hormones. c. Decreased intracapillary pressure and permeability. d. Increased serum protein.

B. Increased level of steroid sex hormones. Rationale: Increased water retention, a basic alteration of pregnancy, is caused by several interrelated factors. The increased level of steroid sex hormones affects sodium and fluid retention. The lowered serum protein also influences fluid balance, as do increased intracapillary pressure and permeability. Nitrogen retention does not influence fluid balance.

A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history? a) G2 P0020 b) G3 P0021 c) G3 P0020 d) G2 P1020

G3 P0020 Gravida (G) is the total number of pregnancies she has had, including the present one. Para (P), the outcome of her pregnancies, is further classified by the FPAL system as follows: F = Full term: number of babies born at 37 or more weeks of gestation, which is 0 and not 1 in this case. P = Preterm: number of babies born between 20 and 37 weeks of gestation, which is 0 in this case. A = Abortions: total number of spontaneous and elective abortions, which is 2 in this case. L = Living children, as of today.

A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records? G3 T2 P2 A0 L1 G3 T0 P1 A1 L2 G2 T2 P1 A0 L2 G2 T1 P1 A1 L1

G3 T0 P1 A1 L2 G indicates the total number of pregnancies (2 prior, now pregnant = 3); T indicates term deliveries at or beyond 38 weeks' gestation (none = 0); P is for preterm deliveries (at 20 to 37 weeks = 1; multiple fetus delivery are scored as 1); A is for abortions or pregnancies ending before 20 weeks' gestation (1); and L refers to living children which is 2. Thus, G3 T0 P1 A1 L2 is what the nurse should note in the client's record.

A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history? G3, T1, P0, A2, L1 G2, T0, P1, A1, L1 G3, T0, P1, A1, L1 G2, T1, P2, A1, L2

G3, T0, P1, A1, L1 The woman's obstetric history would be documented as G3, T0, P1, A1, L1. G (gravida) = 3 (past and current pregnancy), T (term pregnancies) = 0, P (number of preterm pregnancies) = 1, A (number of pregnancies ending before 20 weeks viability to include miscarriage) = 1, and L (number of living children) = 1.

A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal? Decrease protein in urine Prevent maternal seizures Reverse edema Decrease blood pressure

Prevent maternal seizures

The nurse is counseling a young woman who has just entered her second trimester. The patient had an uneventful first trimester, with no symptoms of morning sickness. She tells the nurse, "It still doesn't seem real. It's just hard to believe that I will really have a baby." From experience, the nurse knows that which of the following are likely to help the woman accept the fact that she is having a baby? (Select all that apply.) a) Seeing an ultrasound image of the baby b) Giving up alcohol c) Receiving a positive result on a pregnancy test d) Feeling the baby kick e) Taking prenatal vitamins f) Setting up a crib for the baby

• Feeling the baby kick • Seeing an ultrasound image of the baby • Setting up a crib for the baby