Exam 1 NCLEX Style Questions

All major organ systems are present by the end of gestational week: a. 4 b. 8 c. 12 d. 16

b. 8 wks

A pt who is pregnant for the first time and at 12 weeks gestation is concerned that her fetus is not growing normally. She states, "I have not felt the baby move yet." Which of the following responses by the nurses is more appropriate? a. I will need to report this to your primary care provider immediately. b. Fetal movement is usually felt for the first time around the 20th week. c. It is not unusual to have no fetal movement until labor begins. d. If you have not felt the fetus move by the 22nd week, we will need to perform an amniocentesis.

b. Fetal movement is usually felt for the first time around the 20th week. *Quickening is the first maternal perception of fetal movement commonly felt as a fluttering feeling. It occurs approximately between the 16th and 20th weeks of gestation. Usually closer to 20th week.

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? a. The nurse midwife saw that the mucous plug was intact. b. The nurse midwife felt the baby rebound after being pushed. c. The nurse midwife palpated the fetal parts through the uterine wall. d. The nurse midwife assessed that the baby is head down.

b. The nurse midwife felt the baby rebound after being pushed.

A 16 yo G1P0 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? a. That is very exciting. The baby must be very healthy. b. Would you please describe what you felt for me? c. That is impossible. The baby is not big enough yet. d. Would you please let me see if I can feel the baby?

b. Would you please describe what you felt for me? *quickening occurs between 16-20 weeks gestation. At 10 weeks it would be impossible for the young woman to feel fetal movement. The nurse should elicit more information from the teen to determine what she had felt.

Which of the following developmental features would the nurse expect to be absent in a 41-week gestation fetus? a. fingernails b. eye lashes c. lanugo d. milia

c. lanugo

A pt presents to the clinic for a pregnancy test. She states that her LMP was on 12-01-18. The result of the test is positive. She has been pregnant two other times, delivered twins at term who are no 2 yo, and had one miscarriage at 8 wks. 1. When is the client's expected date of delivery? 2. Identify the client's obstetrical history using the GTPAL method.

1. 9-08-19 2. G3T1P0A1L2

Teratogens pose the greatest nongenetic risk to the fetus during the first trimester. List examples of teratogenic factors. What advice should a nurse give a pregnant client on avoiding these factors?

Examples: radiation, alcohol, tobacco, drugs, viruses, bacteria Advice: Avoid teratogens during pregnancy. Avoid exposure to large groups of people during the first trimester to decrease exposure to infections. Handwashing is an important intervention a pregnant woman can take to decrease the risk of coming in contact with infectious organisms.

The following are probably and presumptive signs of pregnancy. Match each sign nomenclature with its correct explanation. Hegar's sign a. mask of pregnancy Chadwick's sign b. slight fluttering movements of fetus felt by woman Goodell's sign c. deepened violet-bluish color of vaginal mucosa secondary to increased vascularity of the area Ballottement d. dark line of pigmentation from the umbilicus to the pubic area Braxton Hicks e. softening and compressibility of the lower uterus Quickening f. painless, irregulat contractions that are usually relieved with walking Chloasma g. softening of cervical tip Linea nigra h. stretch marks most often found on the abdomen and thighs Striae gravidarum i. rebound of inengarged fetus

Hear's sign - e Chadwick's sign - c Goodell's sign - g Ballottement - i Braxton Hicks - f Quickening - b Chloasma - a Linea nigra - d Striae gravidarum - h

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. a. amenorrhea b. breast tenderness c. quickening d. frequent urination e. uterine growth

a, b, c, d

The midwife has just palpated the fundal height at the top of the symphysis. It is likely that the client is how many weeks pregnant? a. 12 b. 20 c. 28 d. 36

a. 12 *the fundal height is assessed at every prenatal visit. The nurse should know that the top of the fundus is at the level of the symphysis at the end of the first trimester

During a prenatal visit, the primary care provider notes that the pt's cervix has a purplish-blue color. The pt questions the nurse as to why this is. Which of the following responses by the nurse is most appropriate? a. Increased vascularity of the area will occur during pregnancy. b. Decreased vascularity of the area will occur during pregnancy. c. This finding is WDL whether you are pregnant or not. d. This is an abnormal finding suggestive of pathology.

a. Increased vascularity of the area will occur during pregnancy. *During pregnancy, venous congestion occurs as a result of increased vascularity of the area. This finding is only normal during pregnancy and is not indicative of pathology. This is known as Chadwick's sign.

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? a. Surfactant is formed in the fetal lungs. b. Eyes begin to open and close. c. Respiratory movements begin. d. Spinal column is completely formed.

a. Surfactant is formed in the fetal lungs

An 18 yo G1P0 pt is upset about recent body changes that have occurred since she last visited her primary care provider. She has gained a total of 16 kg (35 lb), her face has dark pigmentation, and she has a dark line extending down from her umbilicus. She tells the nurse she is going on a diet because the baby is not due for another month and she does not want to be fat the rest of her life. 1. What could the nurse say to provide emotional support to this pt? 2. What are some possible causes of the body image changes she is experiencing?

1. Dieting while pregnant is not a good idea. Walking may help with the pts mood. Hyperpigmentation of the face (cholasma) is normal with pregnancy and will fade. The line down her abdomen (linea nigra) is also normal during pregnancy and is likely to fade. 2. Weight gain is mainly due to the fetus, placenta, and amniotic fluid. Some overeating may contribute, but it is likely not a big factor. Dieting now is not necessary, as her body will change after delivery.

A woman in her 8th week of pregnancy comes to the clinic for her first prenatal visit. She states that she has experienced no problems and has decided not to come for care unless she needs it. Which of the following responses by the nurse best emphasizes the importance of first trimester prenatal care? a. The first 3 months of pregnancy is the most critical time in fetal development. b. We recommend that all clients come in for prenatal visits as often as medical insurance will cover it. c. Your primary care provider needs to meet you at least twice prior to admitting you for l & d. d. Most clients do not realize they are pregnant until about the 28th week.

a. The first 3 months of pregnancy is the most critical time in fetal development. * During this time, internal organs are developing and the fetus is at an increased risk from teratogens that can cause fetal anomalies.

A nurse understands that a pt is demonstrating probable signs of pregnancy when which of the following signs are observed by a primary care provider? Select all that apply. a. cholasma b. Goodell's sign c. Ballottement d. Chadwick's sign e. quickening

b, c, d *Cholasma and quickening are presumptive signs of pregnancy

A breastfeeding mom should increase her calories per day by: a. 100-300 b. 300-500 c. 500-700 d. 700-900

b. 300-500

It is discovered that a pregnant woman practices pica. Which of the following complications is most often associated with this behavior? a. hypothyroidism b. iron deficiency anemia c. hypercalcemia d. overexposure to zinc

b. iron deficiency anemia

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 correctly portrays her GTPAL? a) G4T2P1A2L1 b) G4T2P1A1L2 c) G5T1P1A2L2 d) G5T2P2A1L1

c) G5T1P1A2L2

The parent of a newborn angrily asks the nurse, "Why would the doctor want to give my baby the vaccination for hepatitis B. It's a sexually transmitted disease, you know!" Which of the following is the best response by the nurse? a. The hep B vaccine is given to all babies, It is given because many babies get infected from their mothers during pregnancy. b. It is important for your baby to get the vaccine in the hospital because the shot may not be available when your child gets older. c. Hep B can be a life-threatening infection that is contracted by contact with blood as well as sexually. d. Most parents want to protect their children from as many serious diseases as possible. Hep B is one of those diseases.

c. Hep B can be a life-threatening infection that is contracted by contact with blood as well as sexually. * Hep B is a very serious disease that can be transmitted sexually or via contact with blood and blood products. The vaccine is given in infancy to prevent future infections.

A nurse determines a pt who is pregnant needs further instructions about an amniocentesis when the pt states: a. I must report cramping or signs of infection to the physician b. I should drink lots of fluids and rest for the next 24 hr c. I need to have a full bladder for the procedure to be done d. The amniotic fluid can be used to detect genetic abnormalities

c. I need to have a full bladder for the procedure to be done *Amniocentesis requires an empty bladder to prevent an inadvertent puncture from occurring.

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? a. It is a purplish stretch mark on your abdomen. b. It means that you are having heart palpitations c. It is a bluish coloration of your cervix and vagina d. It means the doctor heard abnormal sounds when you breathed in

c. It is a bluish coloration of your cervix and vagina

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? a. "We expect you to gain about 1 lb per week, so your weight is a little low at this time." b. "Most women gain no weight during the first trimester, so I would suggest you eat fewer desserts for the next few weeks." c. "You entered the pregnancy well underweight, so we should check your diet to make sure you are getting the nutrients you need." d. "Your weight gain is exactly what we would expect it to be at this time."

d. "Your weight gain is exactly what we would expect it to be at this time."

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? a. chorionic gonadotropin b. oxytocin c. prolactin d. luteininzing hormone

a. chorionic gonadotropin * high levels of human chorionic gonadotropin in the bloodstream and urine of the woman is a probable sign of pregnancy

A nurse working in a prenatal clinic is providing education to a pt who is pregnant. The pt does not like milk. What is a good source of calcium that the nurse can recommend? a. dark green leafy vegetables b. deep red or orange vegetables c. citrus fruits and juices d. meat, poultry, and fish

a. dark green leafy vegetables

The nurse notes each of the following findings in a 12-week gestation client. Which of the findings would enable the nurse to tell the client that she is positively pregnant? a. fetal heart rate via Doppler b. positive pregnancy test c. positive Chadwick's sign d. Montgomery gland enlargements

a. fetal heart rate via Doppler *Remember your 3 positive signs of pregnancy!! Fetal heart rate, visualization of fetus on US, fetal movement felt by examiner

The amniotic fluid surrounding the fetus in utero functions to: a. maintain a constant body temperature of the fetus b. promote adherence of the placenta to the uterus c. reduce excessive fetal movement in the uterus d. allow exchange of oxygen, nutrients, and waste

a. maintain a constant body temperature of the fetus

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? a. fetal heart begins to beat b. lanugo covers the fetal body c. kidneys secrete urine d. fingernails begin to form

b. lanugo covers the fetal body

A 36-week gestation gravid lies flat on her back. Which of the following maternal signs/symptoms would the nurse expect to observe? a. hypertension b. dizziness c. rales d. chloasma

b. dizziness *the weight of the gravid uterus compresses the great vessels, the nurse would expect the client to complain of dizziness when lying supine

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 preprgnancy levels? a. glucose b. fibrinogen c. hematorcrit d. bilirubin

b. fibrinogen * Fibrinogen levels will be elevated slightly in a 40-week pregnant woman because coagulation factors like fibrinogen increase to help prevent excessive blood loss during delivery

The shunt that allows most of the blood that enters the right atrium to flow directly into the left atrium is referred to as the: a. ductus arteriosus b. foramen ovale c. pulmonary artery d. ductus venosus

b. foramen ovale *The ductus arteriosus connects the pulmonary artery with the aorta allowing blood to bypass the lungs. The pulmonary artery is not a shunt. The ductus venosus shunts blood from the umbilical vein to the inferior vena cava allowing most of the blood to bypass the liver.

A pt who is in preterm labor is scheduled to undergo an amniocentesis. She is also scheduled for a fetal lung maturity test to determine if her fetus can adapt to extrauterine life or will develop respiratory distress. Which of the following is a test for fetal lung maturity? a. alpha fetoprotein b. lecithin/sphingomyelin ratio c. Kleihauser-Betke test d. indirect Coombs' test

b. lecithin/sphingomyelin ratio *L/S ratio of 2:1 indicates fetal lung maturity (L/S ratio 3:! for a diabetic pt). Alpha-fetoprotein is used to assess for neural tube defects or chromosomal disorders. Kleihauer-Betke test is used to ensure blood is obtained from the fetus during PUBS. Indirect Coombs' test is used to detect Rh antibodies in the mother's blood.

A woman is carrying dizygotic twins. She asks the nurse about the babies. Which of the following explanations is accurate? a. during a period of rapid growth, the fertilized egg divided completely b. when the woman ovulated, she expelled two mature ova c. the babies share one placenta and a common chorion d. the babies will definitely be the same sex and have the same blood type

b. when the woman ovulated, she expelled two mature ova

A pregnant woman informs the nurse that her LMP was on September 20, 2006. Using Nagele's rule, the nurse calculates the woman's EDD as a. May 30, 2007 b. June 20, 2007 c. June 27, 2007 d. July 3, 2007

c. June 27, 2007

A nursing student is assisting the nurse in caring for infants in the nursery. The nurse questions the student about vitamin K (Aqua MEPHYTON). Which response by the student indicates an understanding of the purpose for administering this drug? a. The purpose of this drug is to prevent hypoglycemia in the newborn. b. Vitamin K is a fat-soluble vitamin and provides a positive nutritional status. c. This drug is given to the newborn to prevent and/or treat hemorrhagic diseases. d. Vitamin K is produced and stored in the liver, which is immature in the infant.

c. This drug is given to the newborn to prevent and/or treat hemorrhagic diseases.

Which of the following pts should the nurse be concerned about regarding weight gain? a. a pt who has gained 1.8 kg (4 lb) and is in her first trimester b. a pt who has gained 11.3 kg (25 lb) and is in her third trimester c. a pt who has gained 6.8 kg (15 lb) and is in her first trimester d. a pt who has gained 9.1 kg (20 lb) and is in her second trimester

c. a pt who has gained 6.8 kg (15 lb) and is in her first trimester *The general rule is that pts should gain 3-4 lb during the first trimester and after that a weight gain of 1 lb per week for the last two trimesters.

What explanation should a nurse give to a pt who asks why it is important for her to stay off of her back when the fetus is being monitored with electronic fetal monitoring? a. the monitor is applied to the maternal back and this would limit access b. it is an uncomfortable position for how long the procedure takes c. it causes a drop in blood pressure decreasing fetal oxygenation d. the fetus is more likely to fall asleep in this position, impairing results

c. it causes a drop in blood pressure decreasing fetal oxygenation

The umbilical cord contains which of the following blood vessels? a. one artery and one vein b. two arteries and two veins c. one vein and two arteries d. two veins and one artery

c. one vein and two arteries *Two umbilical arteries carry deoxygenated blood from the fetus to the placenta and one umbilical vein that supplies the embryo with oxygen and nutrients from the placenta.

Identical twins or a monozygotic pregnancy... a. are contained in a single amniotic sac b. may be of the same or different genders c. result from fertilization of one ovum d. are commonly due to the use of fertility medications

c. result from fertilization of one ovum *There can be one or two amniotic sacs. Monozygotic twins are the same gender. Multifetal pregnancies (3+) are due to the use of fertility medications and in vitro fertilization.

A woman is 36-weeks gestation. Which of the following tests will be done during her prenatal visit? a. glucose challenge test b. amniotic fluid volume assessment c. vaginal and rectal cultures d. karyotype analysis

c. vaginal and rectal cultures *done to assess for presence of group B streptococcal (GBS) bacteria. If the woman has GBS, she will be given IV antibiotics when labor begins to prevent transmission to her baby at birth

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? a. 129 lb b. 130 lb c. 131 lb d. 132 lb

d. 132 lb * at this stage of pregnancy, the woman is expected to gain about 1 lb per week

A prenatal nurse recommends folic acid supplements to a pregnant pt. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency? a. iron deficiency anemia b. poor bone formation c. macrosomic fetus d. neural tube defect

d. neural tube defect *EBP research has proven that an inadequate intake of folic acid has been associated with neural tube defects. Excellent food sources of FA are: fresh green leafy vegetables, liver, peanuts, cereals, and whole-grain breads

A pt who is pregnant is diagnosed with iron deficiency anemia and has been prescribed iron supplements. The nurse should advise the pt to take the iron supplements with which of the following? a. ice water b. low-fat or whole milk c. tea or coffee d. orange juice

d. orange juice *Orange juice contains vitamin C which aids in the absorption of iron. Milk and caffeine actually interfere with iron absorption.