Antepartum

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

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

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

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

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

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

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

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

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

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

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

The midwife has just palpated the fundal height at the location noted on the picture below. It is likely that the client is how many weeks pregnant? 1. 12. 2. 20. 3. 28. 4. 36.

1

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 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

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

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, 4

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, 4

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, 5

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, 5

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, 4

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, 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, 5

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, 5

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. Leg cramps can occur as a result of low calcium and/or high phosphorus since they are often related to a poor calcium/phosphorus ratio. A dietary assessment should be done to determine whether or not the client is consuming enough calcium, primarily found in dairy products, or large quantities of phosphorus, found in carbonated beverages and processed sandwich meats.

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

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. Ptyalism is related to the increase in vascular congestion of the mucous membranes from increased estrogen production. Women with increased salivation often also experience gingivitis, which is also related to estrogen production. In addition, ptyalism is seen in women with nausea and vomiting. Because of the caustic effects of gastric juices on the enamel of the teeth, the inflammation seen in the gums, and the increased salivation, it is essential that the pregnant woman take special care of her teeth during pregnancy, including regular visits to the dentist and/or the dental hygienist.

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.

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 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

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

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

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

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

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

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

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

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

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

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

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

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

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 1 1/2 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, 8oz skim milk, 4 oz cream cheese, and 1 1/2 cup cottage cheese.

2

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

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

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

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

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, 4

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, 5

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, 4

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, 5

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, 5

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. A lactation consultant would probably recommend that the client wear breast shields in her bra. The shields are made of hard plastic and have a small hole through which the nipple everts.

A 36-week gestation gravid 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. Because the weight of the gravid uterus compresses the great vessels, the nurse would expect the client to complain of dizziness when lying supine. The blood supply to the head and other parts of the body is diminished when the great vessels are compressed.

The 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. At the end of the third trimester and through to the early postpartum period, a normal leukocytosis, or rise in white blood cell count, is seen. This is a natural physiological change that protects the woman's body from the invasion of pathogens during the birth process. The nurse should rely on a temperature elevation to determine whether or not the woman has an infection.

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.

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

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. Although the nurse might prefer that a client completely stop a behavior that the nurse deems unsafe or inappropriate, the client may disagree. The nurse, therefore, must attempt to provide a substitute for the client's behavior. Pica is a behavior that should be discouraged because of its potentially detrimental effects. If the client wishes to consume ice, an excellent alternative is ice pops, Italian ices, or iced fruit juice.

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. The water-soluble vitamins, if consumed in large quantities, have not been shown to be harmful dur- ing pregnancy. The body eliminates the excess quantities through the urine and stool. However, the fat-soluble vitamins— vitamins A, D, E, and K—can build up in the body. Vitamins A and D have been shown to be teratogenic to the fetus in megadoses.

A 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

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 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

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

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

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, at39 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

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 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

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

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

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

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. Lanugo is a fine hair that covers the body of the fetus. It begins to disappear at about 38 weeks and very likely has completely vanished by 41 weeks' gestation.

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. There are a number of old wives' tales that pregnant women believe in and live by. One of the common tales relates to the ingestion of strawberries: Women who eat strawberries have babies with strawberry marks on their bodies. Unless belief in old wives' tales has the potential to affect the health of the baby and/or mother, it is ill-advised and unnecessary to argue with the mother about her beliefs.

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. Vaginal and rectal cultures are done to assess for the presence of group B streptococcal (GBS) bacteria in the woman's vagina and rectum. If the woman has GBS as part of her normal flora, she will be given IV antibiotics during labor to prevent vertical transmission to her baby at birth. GBS is often called "the baby killer."

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

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

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

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

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

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

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

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

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

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

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

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. Because of the growth of the uterus, it is very difficult for women in the third trimester to breathe in the supine position. During the prenatal visit, the baby's heartbeat will be monitored and the fundal height will be assessed. Both of these procedures can safely be performed in the semi-Fowler's position.

A client is 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. It is important for pregnant women to contact their healthcare practitioners to find out which medications are safe to take during pregnancy and which medications must be avoided. All medications are assigned a pregnancy category from "A"—research has shown they are safe to be consumed throughout pregnancy—to "X"—a teratogenic agent. Category "B" medications are considered safe because of anecdotal evidence, although controlled research has not been conducted to confirm that evidence. Teratogens are agents that have definitely been shown to cause fetal damage.

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.

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.

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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.

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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."

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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.

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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, 3 This question is asking the test taker to differentiate between complaints that are expected during the third trimester and those that are abnormal. Heartburn and backaches are expected complaints. In addition, once lightening has occurred, frequent urination also returns. In each of the 3 cases, the signs do not indicate pathology. Both persistent headache and blurred vision, however, are signs that the woman may have developed a complication of pregnancy. If they should develop, the client should be advised to report them to the health care practitioner.

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.

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, 4

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. There is no contraindication to intercourse or to orgasm during pregnancy unless it has been determined that a client is at high risk for preterm labor. Until late in pregnancy, there are very few oxytocin receptor sites in the uterine body. The woman will, therefore, not go into labor as a result of orgasm during sexual relations.

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.

3, 1, 2, 4

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. hPL is produced by the placenta. As the placenta grows, the hormone levels rise. At approximately 24 weeks' gestation, the levels are high enough to affect glucose metabolism. If performed earlier, the GCT test may result in a false-negative result.

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. Clients who engage in pica eat large quantities of nonfood items like ice, laundry starch, soap, and dirt. There are a number of problems related to pica, including teratogenesis related to eating foods harmful to the fetus. More commonly, the women fill up on items like ice instead of eating high-quality foods. This practice is often culturally related.

A 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. Labor contractions often begin in a woman's back, feeling much like a backache. The difference is that labor contractions are intermittent and rhythmic. The client should be advised to attend to any pains that come and go and time them. She may be beginning the labor process.

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. Pelvic tilt exercises help to reduce backache pain. The client is taught to get into an optimal position—on the hands and knees is often best. She is then taught to force her back out while tucking her head and buttocks under and holding that position for a few seconds, followed by holding the alternate position for a few seconds—arching her back while lifting her head and her buttocks toward the ceiling. These positions should be alternated repeatedly for about 5 minutes. The exercises are very relaxing while also improving the muscle tone of the lower back.

A 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

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 moderately active women of childbearing age consume the equivalent of 2 cups of fruit per day. Approximately 8 oz of fruit juice equals 1 cup of fruit. Fruit juices, however, are rarely made of 100% juice and almost always contain added sugar. In addition, the client is not receiving the benefit of the fiber that is contained in the whole fruit. The nurse should compliment the client on her fruit intake but encourage her to consume whole fruits rather than large quantities of juice (see http://health.gov/dietaryguidelines/dga 2010/DietaryGuidelines2010.pdf).

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.

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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."

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