Ch 9: Nursing Care of the Growing Fetus

a) 10 Pg. 176-177 By day 10 after fertilization, the blastocyst has completely buried itself in the endometrial lining. Prior to day 10, the attachment is much looser.

1. The nurse is preparing a presentation for a health fair which will illustrate the development of a baby. The nurse should point out the fertilized egg is implanted in the endometrium by which day? a) 10 b) 8 c) 4 d) 6

b) Pre-embryonic c) Fetal d) Embryonic Pg. 175 The three stages of fetal development are the pre-embryonic, embryonic, and fetal stage. Placental and umbilical are not stages of fetal development.

26. After teaching a class on the stages of fetal development, the nurse determines that the teaching was successful when the group identifies which stages? Select all that apply. a) Placental b) Pre-embryonic c) Fetal d) Embryonic e) Umbilical

a) Physical protection Pg. 180 Amniotic fluid serves four main functions for the fetus: physical protection, temperature regulation, provision of unrestricted movement, and symmetrical growth.

5. Amniotic fluid is produced throughout the pregnancy by the fetal membranes. Amniotic fluid has four major functions. What is one of these functions? a) Physical protection b) Restriction of movement c) Medium in which to test organ maturity d) Provide fluid to keep the fetus hydrated

b) 50% Pg. 176 The ovum contains only X chromosomes and the sperm contains either X or Y-chromosomes, so the fetus can be either XX or XY, dependent upon the genetic material contained in the sperm. Thus, the odds of having a male child are 50- 50.

13. An ovum has received chromosomes for both of the parents. What are the odds of the infant being a male? a) 100% b) 50% c) 0% d) 25%

c) Mistaking implantation bleeding for last menstrual period (LMP) Pg. 177 The most common cause is implantation bleeding, which can occur as the blastocyst implants itself into the endometrium. This bleeding can be mistaken for a scanty menstrual period and can lead to miscalculation of fetal age by 2 weeks. The other choices might also contribute, especially the math miscalculation, but are not the primary reason.

38. A woman is confused after finding out the ultrasound results predict a different due date for the birth of her baby. Which factor should the nurse point out is most likely the reason for the miscalculation of the fetal age? a) Amount of weight gain of mother in early weeks of pregnancy b) Not seeking prenatal care in the beginning c) Mistaking implantation bleeding for last menstrual period (LMP) d) An error in math when calculating

a) Varicella b) Rubella e) Zika virus Pg. The Zika virus, varicella, and rubella are known as infectious teratogens. A urinary tract infection and a sinus infection would likely not alone cause fetal abnormalities.

49. The nurse is reviewing prenatal charts in the clinic and notes some clients report infections during their pregnancies. Which maternal infection(s) places the fetus at high risk for developmental abnormalities? Select all that apply. a) Varicella b) Rubella c) Urinary tract infections d) Sinus infections e) Zika virus

c) Doppler Pg. 187 Fetal heart sounds are best heard with the Doppler from the 10th week onward. They can be heard with the fetoscope by about the 18th to 20th week only. A tocodynamometer is used to record uterine contractions and not to auscultate fetal heart tones. Fetal heart tones may not be audible with an ordinary stethoscope at the 12th week.

10. A nurse is asked to auscultate the fetal heart sounds in a pregnant client. Which equipment is most appropriate when auscultating fetal heart sounds at the 12th week? a) Stethoscope b) Tocodynometer c) Doppler d) Fetoscope

c) Cell-free DNA testing Pg. 194 The nurse would anticipate performing the least invasive testing first and progressing as needed, based on test results. The client has the right to request or refuse genetic testing during her pregnancy. Cell-free DNA testing consists of testing a maternal blood specimen for DNA released by the placenta into the maternal bloodstream. This testing is done beginning at 10 weeks' gestation to test for various genetic and sex-linked disorders. An amniocentesis, which takes a sample of the amniotic fluid, can be used to determine whether the fetal lungs are mature enough to support respiration outside of the womb, as well as for genetic testing, because the fluid contains fetal cells with fetal DNA. This is typically completed between 15 to 20 weeks' gestation and is more invasive. Chorionic villus sampling (CVS) involves taking a sample of tissue from the placenta between 10 to 12 weeks' gestation to test for chromosomal and genetic abnormalities. This is also an invasive procedure with more risks than obtaining a maternal blood specimen. Rh factor testing is done to assess for potential maternal-fetal blood incompatibility by means of a maternal blood sample and can be done anytime during the pregnancy.

11. The nurse is caring for a client at 10 weeks' gestation who requests genetic testing for the fetus. The nurse will anticipate the health care provider prescribing which test first for this client? a) Chorionic villus sampling (CVS) b) Amniocentesis c) Cell-free DNA testing d) Rh factor testing

a) Gestational age, length, weight, and systems developed Pg. 186 Client education is a major component of maternal-child nursing. During pregnancy, nurses provide anticipatory guidance to prepare the woman and her significant other for the changes each month brings. Clients most often want to know gestational age in weeks, length, weight, and systems developed; the client is then able to visualize what the fetus looks like.

12. The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to emphasize? a) Gestational age, length, weight, and systems developed b) Length, weight, sex c) Age in weeks and systems developed d) Sex and systems developed

d) January 27 Pg. 187-188 According to Naegele rule, the nurse would determine the date of the first day of the client's LNMP (April 20), subtract 3 months (January 20) and then add 7 days (January 27) to obtain the estimated date of delivery/birth. The other options do not follow Naegele rule.

14. The nurse is determining a pregnant client's estimated date of delivery/birth (EDD) using Naegele rule. The date of the first day of the client's last normal menstrual period (LNMP) was April 20. What would be this client's EDD? a) January 20 b) December 27 c) December 25 d) January 27

c) Human chorionic gonadotropin (hCG) Pg. 178 The placenta produces hCG, which is the basis for pregnancy tests. This hormone preserves the corpus luteum and its progesterone production so that the endometrial lining is maintained. Human placental lactogen modulates fetal and maternal metabolism and participates in the development of the breasts for lactation. Estrogen causes enlargement of the woman's breasts, uterus, and external genitalia and stimulates myometrial contractility. Progesterone maintains the endometrium.

15. After teaching a pregnant woman about the hormones produced by the placenta, the nurse determines that the teaching was successful when the woman identifies which hormone produced as being the basis for pregnancy tests? a) Human placental lactogen (hPL) b) Estrogen (estriol) c) Human chorionic gonadotropin (hCG) d) Progesterone (progestin)

c) Chorion and amnion Pg. 179 The chorion and amnion are the two fetal membranes. The ectoderm, mesoderm, and endoderm are layers in the developing blastocyst.

16. A group of nursing students are preparing a presentation for a health fair illustrating the structures found during a pregnancy. Which structures should the students point out form a protective barrier around the developing fetus? a) Chorion and endoderm b) Ectoderm and amnion c) Chorion and amnion d) Amnion and mesoderm

a) Zygote Pg. 176 A fertilized ovum is known as a zygote and is the beginning of potential individual human development. The developing human organism is known as an embryo from the time it implants on the uterine wall until the eighth week after inception and as a fetus from the beginning of the ninth week after fertilization through birth. The chorion is the outermost cell layer that surrounds the embryo and fluid cavity.

17. A fertilized ovum is known as which structure? a) Zygote b) Chorion c) Embryo d) Fetus

a) Down syndrome b) Neural tube defects Pg. 196 Maternal blood is drawn between 15 and 20 weeks and is used in screening for Down syndrome and other trisomies, neural tube defects, gastroschisis, and other fetal abnormalities.

18. The client is having her blood drawn for a triple or Quad screen. For what does this test screen? Select all that apply. a) Down syndrome b) Neural tube defects c) Rubella d) Gestational diabetes e) Pre-eclampsia

d) At fertilization Pg. 185 Sex determination occurs at the time of fertilization. Meiosis refers to cell division resulting in the formation of an ovum or sperm with half the number of chromosomes. The morula develops after a series of four cleavages following the formation of the zygote. Oogenesis refers to the development of a mature ovum, which has half the number of chromosomes.

19. The nurse is conducting a presentation for a young adult community group about fetal development and pregnancy. The nurse determines that the teaching was successful when the group identifies that the sex of offspring is determined at which time? a) When the morula forms b) During oogenesis c) During meiosis cell division d) At fertilization

c) Ultrasound Pg. 174-175, 194 The nurse would state that an ultrasound is a noninvasive test that is completely safe for both mother and child. Amniocentesis, chorionic villus sampling, and percutaneous umbilical cord sampling are invasive tests that are associated with maternal and fetal risk.

2. A 33-year-old pregnant client asks the nurse about testing for birth defects that are safe for both her and her fetus. Which test would the nurse state as being safe and noninvasive? a) Percutaneous umbilical cord sampling b) Chorionic villus sampling c) Ultrasound d) Amniocentesis

d) May Pg. 188 Naegele rule says to subtract 3 months from the first day of the last menstrual period and then add 7 days. A woman who had her last menstrual period on August 1 would subtract 3 months to reach May 1, then add 7 days to reach an estimated date of birth of May 8. To follow the client's intentions, the client would submit for her leave to begin in May. April would be beginning the leave too early. June and July are after the due date.

20. The nurse is caring for a woman at her first prenatal appointment. The woman reports her last menstrual period was August 1. The woman would like to begin her maternity leave at the beginning of the month of her due date. Which month would the nurse advise the woman to submit for her leave to begin? a) April b) July c) June d) May

a) Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy Pg. 534 The nurse should recognize that abdominal pain is not normal during pregnancy and warrants investigation since ectopic pregnancy is a distinct possibility. An abdominal ultrasound would be best practice for this complaint. Dismissing her reports as normal is not a wise choice.

21. A client comes to the clinic with concerns about her pregnancy. She is in her first trimester and is now experiencing moderate abdominal pain on the right side. What would be the nurse's first action? a) Recommend an abdominal ultrasound to the doctor since this may be ectopic pregnancy b) Obtain a detailed 24-hour intake to determine if the pain is related to what she has eaten c) Reassure the mother that this is normal as the baby is implanting into the uterus d) Encourage her to ambulate since gas pains are common in early pregnancy

c) Prepare the client for an induction of labor Pg. 177 Placental insufficiency is a serious complication where the placenta no longer works properly to provide nutrition and oxygen to the fetus, nor remove waste products from the fetus. Because this client's fetus is at full term, the nurse would anticipate an induction of labor or a cesarean birth. The client is not stable enough to be sent home for monitoring. Hypertension can be a cause of placental insufficiency; however, at this point in the pregnancy, birth is the best option. Betamethasone is a steroid given to clients to hasten preterm fetal lung development. This client is at term and does not need betamethasone.

22. A client at 38 weeks' gestation is diagnosed with placental insufficiency. Which prescription from the health care provider will the nurse anticipate? a) Discharge the client home with daily nonstress testing b) Assess the client's blood pressure every 2 hours c) Prepare the client for an induction of labor d) Administer one dose of betamethasone

a) "Exposure to certain substances during the embryonic phase may be harmful to the developing fetus" Pg. 177 Exposure to a teratogen during the embryonic stage produces the greatest damaging effects because cells are rapidly dividing and differentiating into specific body structures.

23. A pregnant client in the first trimester asks the nurse about taking medications while she is pregnant. She tells the nurse that she heard that it can be harmful to the fetus if medications are taken at certain times during pregnancy. What is the best response by the nurse? a) "Exposure to certain substances during the embryonic phase may be harmful to the developing fetus" b) "You cannot drink alcohol, but you can take some medications, such as cold preparations and over-the-counter medications" c) "As long as you are past 4 weeks of pregnancy, you should be able to take most medications" d) "There is no need for you to worry; you are not far enough along in your pregnancy for this to be a problem"

d) Obtain a signed consent form Pg. 188 Nursing responsibilities for assessment procedures include seeing a signed consent form has been obtained as needed (necessary if the procedure poses any risk to the mother or fetus that would not otherwise be present, as is the case with amniocentesis). All of the answers are nursing interventions that should be made before or during amniocentesis, but having the client sign a consent form should be completed before the others.

24. A woman at 15 weeks' gestation is about to undergo amniocentesis. Which nursing intervention should be made first? a) Observe the fetal heart rate monitor b) Place the client in supine position c) Have the client void d) Obtain a signed consent form

c) Fetal femur measurement of 30 mm d) Fetal implantation in the uterine fundus e) Fetal heart beat present Pg. 194 Many providers perform a fetal survey by ultrasound at 20 weeks' gestation. The fetus is now large enough at this point for all major organs to be visible on ultrasound. Measurements of bones can be compared to the expected size (29 to 31 mm at 20 weeks). Basic characteristics of the organs can identify anomalies. The fetal heart should be beating and valve functioning is identified. Down syndrome characteristics are not fully visible and an amniocentesis best confirms the chromosomal structure. The procedure also can indicate placental placement in the fundus. At this point of gestation, typically the fetal head is not showing engagement in the pelvis. This occurs closer to the end of the pregnancy.

25. A client is at 20 weeks' gestation and is scheduled for a fetal survey with ultrasound. To confirm normal development thus far in pregnancy, which result(s) are expected? Select all that apply. a) Down syndrome (trisomy 21) in the fetus b) Fetal head engagement in the pelvis c) Fetal femur measurement of 30 mm d) Fetal implantation in the uterine fundus e) Fetal heart beat present

d) Trisomy numeric abnormality Pg. 167 Down syndrome is an example of a chromosomal abnormality involving the number of chromosomes (trisomy numeric abnormality), in particular chromosome 21, in which the individual has three copies of that chromosome. Multifactorial inheritance gives rise to disorders such as cleft lip, congenital heart disease, neural tube defects, and pyloric stenosis. X-linked recessive inheritance is associated with disorders such as hemophilia. Chromosomal deletion is involved with disorders such as cri-du-chat syndrome.

27. While talking with a pregnant client who has undergone genetic testing, the client informs the nurse that the baby will be born with Down syndrome. The nurse understands that Down syndrome is an example of a: a) X-linked recessive inheritance b) Chromosomal deletion c) Multifactorial inheritance d) Trisomy numeric abnormality

a) It supplies oxygen and nutrients to the fetus b) It produces hormones that help maintain the pregnancy c) It carries waste away for excretion by the mother Pg. 177-179 The placenta supplies the developing organism with food and oxygen, carries waste away for excretion by the mother, slows the maternal immune response so that the mother's body does not reject the fetal tissues, and produces hormones that help maintain the pregnancy. Wharton's jelly protects the umbilical cord and the foramen ovale permits most of the blood to bypass the right ventricle. The amniotic fluid cushions the fetus against injury.

28. A nurse is describing the development of the fetus to a group of pregnant women. When describing the function of the placenta, which information would the nurse most likely include? Select all that apply. a) It supplies oxygen and nutrients to the fetus b) It produces hormones that help maintain the pregnancy c) It carries waste away for excretion by the mother d) It cushions the fetus against injury e) It permits blood to bypass the right ventricle f) It protects the umbilical cord

d) From fertilization to the end of the second week after fertilization Pg. 175 The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. The fetal stage begins at 9 weeks after fertilization and ends at birth. There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period.

29. A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage? a) Approximately 6 weeks after fertilization to the end of 8 weeks b) Approximately 2 weeks after fertilization to the end of the eighth week c) Approximately 9 weeks after fertilization to birth d) From fertilization to the end of the second week after fertilization

b) Down syndrome Pg. 196 The nurse is correct to interpret the lab results and develop a teaching plan. The nurse would teach the client that since the serum level is elevated above 2 MoM, there is a significant risk of Down syndrome. Instruction would then indicate further testing and considerations if the diagnosis is confirmed. Pregnancies found to have a fetus with Edwards syndrome have AFP, uE3, and hCG with lower MoM. The MSAFP test does not provide information about the risk for Tay-Sachs disease or hemophilia A.

3. The nurse is reporting a maternal serum alpha-fetoprotein (MSAFP) level of 2.5 MoM on shift hand-off. The oncoming nurse would be correct to initiate a teaching plan related to the fetus being at higher risk for which condition? a) Hemophilia A b) Down syndrome c) Tay-Sachs disease d) Edwards syndrome

c) Prevent alveoli from collapsing on expiration Pg. 183 Surfactant is a phospholipid that reduces surface tension; it prevents alveoli from collapsing on expiration. Resistance to airflow is an effect of tissue elasticity and airway size. Immunologic competence is provided by antibodies in the mucus layer. Fully matured alveoli contain squamous cells as well as type II surfactant cells.

30. Assessment for surfactant level via lecithin/sphingomyelin (L/S) ratio in the amniotic fluid is a primary estimation of fetal maturity. The purpose of surfactant is to: a) Encourage immunologic competence of lung tissue b) Promote maturation of lung alveoli c) Prevent alveoli from collapsing on expiration d) Increase lung resistance on inspiration

d) November 15 Pg. To calculate the date of delivery by Naegele rule, the nurse will count backward 3 calendar months from the first day of a client's last menstrual period and add 7 days. For this client, the first day of the last menstrual period was February 8. Counting back 3 months would be November; then adding 7 days, the estimated date of delivery will be November 15.

31. A nurse is calculating the estimated date of birth for a client who has just found out about being pregnant. The client's last menstrual period started on February 8 and lasted for 6 days. Using Naegele rule, which date does the nurse determine as the estimated date of delivery? a) December 1 b) October 8 c) May 1 d) November 15

a) "Based on your results, your baby is doing well" Pg. Biophysical profiles may be done as often as daily during a high-risk pregnancy. A score of 8 to 10 means the fetus is considered to be doing well. A score of 6 is considered suspicious and a score of 4 denotes a fetus potentially in jeopardy. A score of 9 does not indicate the need for additional testing, a greater risk for preterm labor, or a fetus in jeopardy.

32. A client has had a biophysical profile done and receives a score of 9. The client asks the nurse, "What does this mean?" Which response by the nurse would be appropriate? a) "Based on your results, your baby is doing well" b) "We'll have to watch you closely because your baby may be in jeopardy" c) "Your score is a little low so we need to do more testing" d) "Your score means that you are likely to go into preterm labor"

d) "I forgot to tell you at my first prenatal appointment that I take phenytoin for seizures" Pg. 273 Phenytoin is a teratogen and the provider would consider an alternate seizure medication if indicated. Ideally, the client would have alerted the health care provider as early as possible. Acetaminophen is not considered a teratogen when taken as directed and heparin does not cross the placental barrier and is considered safe during pregnancy. Smoking during pregnancy can cause intrauterine growth restriction, but this client stopped smoking before the pregnancy.

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

d) Continues progesterone production by corpus luteum Pg. 177, 179 The corpus luteum is responsible for producing progesterone until this function is assumed by the placenta. hCG is a fail-safe mechanism to prolong the life of the corpus luteum and ensure progesterone production. Estrogen is responsible for providing a rich blood supply to the decidua. Progesterone helps maintain a nutrient-rich decidua.

34. The nursing instructor is preparing a class presentation covering the various hormones and their functions during pregnancy. The instructor determines the class is successful when the class correctly matches which function with hCG? a) Sustains life of placenta b) Maintains nutrient-rich decidua c) Provides rich blood supply to decidua d) Continues progesterone production by corpus luteum

b) The end of the second trimester Pg. 187 During the second trimester, fetal growth is significant. The fetus begins this trimester 3 inches long and weighing less than 1 oz (0.8 gm). By the end of the second trimester, the fetus is about 15 inches long and weighs more than 2 lbs (1000 gm). Major organs develop to the point that the fetus may survive (with help) outside the womb. The fetus would not be able to survive at the end of the first trimester. The end of the third trimester is the expected time of deliver. The fourth trimester involves the time after delivery.

35. A multigravida client is concerned that she may deliver early. When asking the nurse what is the earliest her baby can be delivered and survive, which time frame would the nurse point out? a) The end of the first trimester b) The end of the second trimester c) The end of the fourth trimester d) The end of the third trimester

b) Ovum d) Zygote c) Embryo a) Fetus Pg. Fetal growth begins with the ovum (from ovulation to fertilization) and then continues as follows: zygote (fertilization to implantation), embryo (implantation from 5 to 8 weeks) and fetus (from 5 to 8 weeks to term).

36. A nurse is describing fetal growth to a group of newly pregnant clients. Place the structures below in the order from ovulation to term. Use all options. a) Fetus b) Ovum c) Embryo d) Zygote

b) Estriol c) Relaxin d) Progestin e) Human chorionic somatomammotropin Pg. 177-179 Estriol, relaxin, progestin, and human chorionic somatomammotropin are secreted by the placenta. Prolactin is secreted after delivery for breastfeeding.

37. During a prenatal class for a group of new mothers, the nurse is describing the hormones produced by the placenta. What hormones would the nurse include? Select all that apply. a) Prolactin b) Estriol c) Relaxin d) Progestin e) Human chorionic somatomammotropin

b) Protects the fetus from changes in temperature e) Shields the fetus against pressure or a blow to the mother's abdomen Pg. 180 The most important purpose of amniotic fluid is to shield the fetus against pressure or a blow to the mother's abdomen. Because liquid changes temperature more slowly than air, it also protects the fetus from changes in temperature. And yet another function, it aids in muscular development, as amniotic fluid allows the fetus freedom to move. Finally, it protects the umbilical cord from pressure, protecting the fetal oxygen supply. It is progesterone that maintains the endometrial lining of the uterus. It is estrogen that contributes to mammary gland development in preparation for lactation and stimulates uterine growth to accommodate the developing fetus.

39. A young mother in a prenatal class asks the nurse why there is amniotic fluid in the uterus with her baby. Which functions of the amniotic fluid should the nurse point out to the client? Select all that apply. a) Contributes to mammary gland development in preparation for lactation b) Protects the fetus from changes in temperature c) Maintains the endometrial lining of the uterus d) Stimulates uterine growth to accommodate the developing fetus e) Shields the fetus against pressure or a blow to the mother's abdomen

b) It is going to be close but you may still be pregnant at the wedding Pg. 187-188 To answer the client's question, the nurse would determine the client's estimated date of delivery/birth. The formula for Naegele rule says to subtract 3 months from the first day of the last normal menstrual period (August 1) and add 7 days to the result. This client has an EDD of May 8. Because the wedding is on May 1, the dates are too close to be certain if the infant will be born before or after the wedding date. It is most accurate for the nurse to state that there is the possibility that the client will be pregnant at the wedding. The client would not have "weeks of pregnancy" remaining nor be postpartum for weeks when the wedding occurs. The wedding is not just past the due date.

4. A pregnant client asks the nurse about the estimated date of delivery/birth, because the client is in a wedding and wants to know if the infant will be born before the wedding date. The client reports that the last normal menstrual period was on August 1. The wedding is May 1. Using Naegele rule to determine the estimated date of delivery/birth, which response is accurate? a) You will just pass your due date so chances are that the infant will be born b) It is going to be close but you may still be pregnant at the wedding c) There is no problem, you still have several weeks until you reach your estimated date of delivery d) The infant will be 4 weeks old when the wedding occurs

b) Ectopic pregnancy Pg. 534 An ectopic pregnancy or tubal pregnancy can result when there is blockage or scarring of the fallopian tubes due to infection (PID) or trauma (tubal ligation reversal). Ectopic pregnancy may present with vague signs and symptoms but is the leading cause of maternal death in the first trimester and should be given priority when determining the cause of abdominal complaints. The other choices would be ruled out after the ectopic pregnancy is ruled out.

40. The nurse is assessing a young female who just found out she is pregnant. She is now reporting vague abdominal discomfort. After noting the client has a history of PID, the nurse predicts the health care provider will give priority to ruling out which situation? a) Repeat PID b) Ectopic pregnancy c) Endometriosis d) UTI

b) Level of fetal surfactants Pg. 197 Amniocentesis is done to check the lung surfactant ratio of the fetus, which will determine if the lungs are matured enough for delivery. Amniocentesis can be used to determine fetal renal and alimentary output, but these factors are not critical to birth. Maternal blood work will reveal information about the mother and not the lung maturity of the fetus.

41. The nurse is preparing a pregnant client with severe hypertension for an emergent amniocentesis for possible early delivery of the fetus. The nurse will explain to the client that the health care provider is evaluating which parameter? a) Fetal alimentary output b) Level of fetal surfactants c) Maternal blood makeup d) Fetal renal output

d) The amount gradually fluctuates during pregnancy Pg. 179 Amniotic fluid is alkaline. Amniotic fluid is composed of 98% water and 2% organic matter. Amniotic fluid volume gradually fluctuates throughout pregnancy. Sufficient amounts promote fetal movement to enhance musculoskeletal development.

42. When describing the characteristics of the amniotic fluid to a pregnant woman, the nurse would include which information? a) It is usually an acidic fluid b) It is composed primarily of organic substances c) It limits fetal movement in utero d) The amount gradually fluctuates during pregnancy

a) When the umbilical cord is clamped, the newborn no longer requires the placenta for oxygenation Pg. When the umbilical cord is clamped, the newborn begins breathing oxygen on one's own rather than getting oxygenated blood from the placenta. Crowning is when the fetal head is visible in the birth canal, and the placenta is still providing oxygenation at this time. The cord may be clamped at different times after the birth, so it is not the birth itself that causes the newborn to not require oxygenated blood from the placenta. Surfactant is produced during the 22- to 28-week stage of development, but that time frame is not when the fetus supplies one's own oxygen.

43. The nurse is conducting prenatal education with a group of women. One participant asks the nurse when the fetus's blood will no longer require the placenta for oxygenation. How will the nurse respond? a) When the umbilical cord is clamped, the newborn no longer requires the placenta for oxygenation b) When the birth occurs, the placenta is no longer required to provide the newborn with oxygen c) When the fetal head is crowning or "presenting" the fetal blood moves away from the placenta d) When the fetal lungs produce surfactant, around 22 to 28 weeks' gestation, the placenta no longer supplies oxygen

c) Taking "natural" medications d) Taking over-the-counter herbs e) Receiving immunizations Pg. 273 The pregnant woman is taught to consider that substances she takes into her body may pass to the fetus. These include immunizations, over-the-counter herbs, and all medications, even the ones labeled as "natural." The woman should verify with her health care provider before any of those things are taken. Eating spicy food and drinking specific brands of bottled water would not need to be cleared with the provider unless the woman experienced gastrointestinal symptoms following ingestion.

44. The nurse is providing prenatal education in the community. The nurse advises the pregnant women to check with their health care provider before what activity(ies)? Select all that apply. a) Eating spicy foods b) Drinking bottled water c) Taking "natural" medications d) Taking over-the-counter herbs e) Receiving immunizations

b) Maintains the endometrial lining of the uterus during pregnancy Pg. 179 Progesterone is necessary to maintain the endometrial lining of the uterus during pregnancy. It is human chorionic gonadotropin (hCG) that acts to ensure the corpus luteum of the ovary continues to produce estrogen and progesterone. Estrogen contributes to mammary gland development, and human placental lactogen regulates maternal glucose, protein, and fat levels.

45. A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough of it naturally. She asks the nurse what function this hormone has in her pregnancy. What should the nurse explain is the primary function of progesterone? a) Regulates maternal glucose, protein, and fat levels b) Maintains the endometrial lining of the uterus during pregnancy c) Contributes to mammary gland development d) Ensures the corpus luteum of the ovary continues to produce estrogen

d) Placental insufficiency Pg. 185 A deficiency of amniotic fluid, oligohydramnios, is associated with uteroplacental insufficiency and fetal renal abnormalities. Excess amniotic fluid is associated with maternal diabetes, neural tube defects, and malformations of the gastrointestinal tract and central nervous system.

46. Assessment of a pregnant woman reveals oligohydramnios. The nurse would be alert for the development of which condition? a) Fetal gastrointestinal malformations b) Maternal diabetes c) Neural tube defects d) Placental insufficiency

a) From fertilization to the end of the second week after fertilization Pg. 175 The pre-embryonic stage begins at fertilization and lasts through the end of the second week after fertilization. The embryonic stage begins approximately 2 weeks after fertilization and ends at the conclusion of the eighth week after fertilization. The fetal stage begins at 9 weeks after fertilization and ends at birth. There is no distinct stage recognized approximately 6 to 8 weeks after fertilization. This is part of the embryonic stage period.

47. A nursing instructor is explaining the stages of fetal development to a group of nursing students. The instructor determines the session is successful after the students correctly choose which time period as representing the pre-embryonic stage? a) From fertilization to the end of the second week after fertilization b) Approximately 6 weeks after fertilization to the end of 8 weeks c) Approximately 9 weeks after fertilization to birth d) Approximately 2 weeks after fertilization to the end of the eighth week

b) "We will have to wait until the baby is 16 weeks' gestation to determine what the sex is" Pg. 187 The sex of the baby can be determined by ultrasound at 16 weeks' gestation. An ultrasound at 6 and 8 weeks would be too early to determine the sex. An ultrasound at 20 weeks should confirm what was found at 16 weeks.

48. The pregnant client at 6 weeks' gestation asks the nurse if an ultrasound will reveal the sex of the fetus yet. What is the best response by the nurse? a) "We will have to wait until the baby is 20 weeks' gestation to determine the sex of the baby" b) "We will have to wait until the baby is 16 weeks' gestation to determine what the sex is" c) "We will be able to determine the sex of the baby today with transvaginal ultrasound" d) "We will have to wait until the baby is 8 weeks' gestation to be able to determine what the sex is"

d) More definitive evaluations to conclude anything Pg. 196 Increased maternal serum alpha-fetoprotein levels may indicate a neural tube defect, Turner syndrome, tetralogy of Fallot, multiple gestation, omphalocele, gastroschisis, or hydrocephaly. Therefore, additional information and more specific determinations need to be done before any conclusion can be made. Down syndrome is associated with decreased maternal serum alpha-fetoprotein levels. This type of testing provides no information about the acid-base status of the fetus. Immediate termination is not warranted; more information is needed.

6. Prenatal testing is used to assess for genetic risks and to identify genetic disorders. In explaining to a couple about an elevated maternal serum alpha-fetoprotein screening test result, the nurse would discuss the need for: a) A more specific determination of the acid-base status b) Special care needed for a Down syndrome infant c) Immediate termination of the pregnancy based on results d) More definitive evaluations to conclude anything

d) "Amniotic fluid cushions your baby to prevent injury" Pg. 180 The amniotic fluid, kept inside the amnion, cushions the fetus against injury, regulates temperature, and allows the fetus to move freely inside it, which allows normal musculoskeletal development of the fetus. The woman's blood supplies food to—and carries wastes away from—the fetus. The placenta supplies the developing organism with food and oxygen; then the umbilical cord connects the fetal blood vessels contained in the villi of the placenta with those found within the fetal body.

7. A pregnant woman undergoing amniocentesis asks her nurse why the baby needs this fluid. What would be an accurate response from the nurse? a) "Amniotic fluid supplies the food your baby needs to grow" b) "Amniotic fluid provides fetal blood circulation" c) "Amniotic fluid keeps the fetus from moving freely inside it to prevent injury" d) "Amniotic fluid cushions your baby to prevent injury"

b) Intrauterine infection of the fetus e) Maternal smoking Pg. 190 There are a number of contributory causes for IUGR in a fetus, including maternal smoking or drug/alcohol use, infections such as cytomegalovirus and rubella, maternal hypertension, and chronic maternal diseases such as sickle cell disease or renal disease. Maternal heartburn is a normal maternal complaint and does not affect the fetal well-being. Small parents could cause a fetus to be small, but would not cause IUGR. Maternal exercise does not cause IUGR.

8. An infant was born at term but has intrauterine growth restriction (IUGR). What findings in the infant's history would contribute to this problem? Select all that apply. a) Parents small in stature b) Intrauterine infection of the fetus c) Maternal heartburn d) Daily maternal exercise e) Maternal smoking

c) Umbilical arteries Pg. 177 The placenta is a flat, round structure which forms on the decidua and attaches to the fetus by the umbilical cord. The placenta is the organ responsible for supplying nutrients and oxygenated blood to the fetus. The amniotic fluid surrounds the fetus and provides protection, temperature regulation, allows movement, and symmetric growth. It collects urine and other waste products from the fetus. The decidua is the name given to the endometrium after the pregnancy starts. The umbilical arteries carry waste products away from the fetus to the placenta, where they are filtered out into the maternal body for proper disposal.

9. A nurse is discussing the importance of good nutrition to a young pregnant client. The nurse would point out that the growing fetus is getting nutrition from the mother via which structure? a) Amniotic fluid b) Placenta c) Umbilical arteries d) Decidua