EXAM #1 OB

teratogen

an agent or factor that causes malformation of an embryo.

3 shunts during fetal life:

ductus venosus: connects umbilical vein to inferior vena cava ductus arteriosus: connects main pulmonary artery to aorta foramen ovale: opening between right and left atria

fetal stage

end of the eighth week until birth. pg. 336

amnion:

inner membrane containing amniotic fluid. located in the ectoderm. umbilical cord is formed from here.

Allele

one of two or more alternative forms of a gene that arise by mutation and are found at the same place on a chromosome.

homozygous

refers to a particular gene that has identical alleles on both homologous chromosomes. pg. 348

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that which result indicates good glucose control? A) 90 mg/dL B) 100 mg/dL C) 110 mg /dL D) 120 mg/dL

A) 90 mg/dL

A couple comes to the clinic for preconception counseling and care. As part of the visit, the nurse teaches the couple about fertilization and initial development, stating that the zygote formed by the union of the ovum and sperm consists of how many chromosomes? A) 22 B) 23 C) 44 D) 46

Ans: D Feedback: With fertilization, the ovum, containing 23 chromosomes, and the sperm, containing 23 chromosomes, join, forming a zygote with a diploid number or 46 chromosomes.

heterozygous

refers to a particular gene that has different alleles on both homologous chromosomes. pg. 348

trisomy

A genetic disorder in which a person has three copies of a chromosome instead of two. ex. down syndrome

blastocyst

A thin-walled hollow structure in early embryonic development that contains a cluster of cells called the inner cell mass from which the embryo arises. pg. 336

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

A)Macrosomia

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse anticipates that the client will receive RhoGAM at which time? A) At 34 weeks' gestation and immediately before discharge B) 24 hours before delivery and 24 hours after delivery C) In the first trimester and within 2 hours of delivery D) At 28 weeks' gestation and again within 72 hours after delivery

Ans: D To prevent isoimmunization, the woman should receive RhoGAM at 28 to 32 weeks gestation and again within 72 hours after delivery.

A client's last menstrual period was April 11. Using Nagele's rule, her expected date of birth (EDB) would be: A) January 4 B) January 18 C) January 25 D) February 24

B) January 18

A nurse is working with a pregnant woman to schedule follow-up visits for her pregnancy. Which statement by the woman indicates that she understands the scheduling? A) "I need to make visits every 2 months until I'm 36 weeks pregnant." B) "Once I get to 28 weeks, I have to come twice a month." C) "From now until I'm 28 weeks, I'll be coming once a month." D) "I'll make sure to get a day off every 2 weeks to make my visits."

C) "From now until I'm 28 weeks, I'll be coming once a month."

When preparing a woman for an amniocentesis, the nurse would instruct her to do which of the following? A) Shower with an antiseptic scrub. B) Swallow the preprocedure sedative. C) Empty her bladder. D) Lie on her left side.

C) Empty her bladder.

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

D) Methotrexate

zygote

a diploid cell resulting from the fusion of two haploid gametes; a fertilized ovum. pg.337

embryonic stage

end of the second week through the eighth week. pg. 336

5 hormones of the placenta:

estrogen progesterone relaxin HPL HCG

preembryonic stage

fertilization through the second week. pg. 336

structure of umbilical cord:

formed by the amnion, and houses 1 large vein + 2 small arteries wrapped in wharton's jelly to prevent compression. @ term, average length is 22 in long + 1 in thick.

mutation

the changing of the structure of a gene, resulting in a variant form that may be transmitted to subsequent generations, caused by the alteration of single base units in DNA, or the deletion, insertion, or rearrangement of larger sections of genes or chromosomes.

monosomy

when a diploid organism has only one copy of one of its chromosomes instead of two.

A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for? A. blindness B. neonatal laryngeal papillomas C.deafness D. chicken pox

A R:A pregnant woman who contracts chlamydia is at increased risk for spontaneous abortion (miscarriage), preterm rupture of membranes, and preterm labor. The postpartum woman is at higher risk for endometritis (Fletcher & Ball, 2006). The fetus can encounter bacteria in the vagina during the birth process. If this happens, the newborn can develop pneumonia or conjunctivitis that can lead to blindness.

A nurse is preparing a teaching program for a group of pregnant women about preventing infections during pregnancy. When describing measures for preventing cytomegalovirus infection, which of the following would the nurse most likely include? A) Frequent handwashing B) Immunization C) Prenatal screening D) Antibody titer screening

A) Frequent handwashing

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia? A) Calcium gluconate B) Potassium chloride C) Ferrous sulfate D) Calcium carbonate

Ans: A The antidote for magnesium sulfate is calcium gluconate, and this should be readily available in case the woman has signs and symptoms of magnesium toxicity.

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

Ans: D Severe preeclampsia is characterized by blood pressure over 160/110 mm Hg, urine protein levels greater than 500 mg/24 hours and hyperreflexia. Mild facial edema is associated with mild preeclampsia.

identify the 3 layers of the blastocyst & what they form:

outer: ectoderm - CNS, special senses, skin, glands mid: mesoderm - skeleton, urinary, circulatoy systems + reproductive organs inner: endoderm - liver, pancreas, respiratory system, digestive system

what is amniotic fluid? also, how is it made?

- fluid serving as a cushion to fetus + umbilical cord (trauma/compression prevention). good for allowing musculoskeletal development via free-movement, + maintaining fetal temperature. composed 98% water, 2% organic materials (bilirubin, urea, uric acid, creatinine, etc) - the inner-layer amnion (from ectoderm of blastocyst) expands until it touches the outer-layer chorion (from the trophoblast)

what are the three stages of pregnancy, and when do they occur?

- preembryonic stage: fertilization - 2nd week - embryonic stage: end of 2nd week - 8th week - fetal stage - end of 8th week - birth (longest period)

morula:

- the resulting ball of cells from the mitosis of the zygote. after fertilization, the zygote makes it's way to the uterus (72 hrs), while on its way it goes through mitosis (or cleavage) x4, where it ends up a ball of 16 cells known as a morula.

A nurse is conducting a class on gestational diabetes for a group of pregnant women who are at risk for the condition. The nurse determines that additional teaching is needed when the class identifies which complication as affecting the neonate? A. hyperglycemia B. birth trauma C. hypoglycemia D. macrosomia

A R:Gestational diabetes is associated with either neonatal complications such as macrosomia, hypoglycemia, and birth trauma or maternal complications such as preeclampsia and cesarean birth.

A woman with diabetes is in labor. To reduce the likelihood of neonatal hypoglycemia, the nurse monitors the client's blood glucose level closely with the goal to maintain which level? A. below 110 mg/dL B. below 115 mg/dL C. below 105 mg/dL D. below 120 mg/dL

A R: For the laboring woman with diabetes, the blood glucose levels are monitored every 1 to 2 hours with the goal to maintain the levels below 110 mg/dL throughout the labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level.

A pregnant client with diabetes in the hospital reports waking up with shakiness and diaphoresis. Which action should the nurse prioritize after discovering the client's fasting blood sugar is 60 mg/dL? A. Provide the client some milk to drink. B. Withhold her insulin, and notify the health care provider. C. Stay with her, and ask another nurse to bring her insulin. D. Recheck her blood sugar for accuracy.

A R: The client is hypoglycemic when awakening in the morning. The nurse should provide glucose in the form of carbohydrate, such as crackers, and milk, and be prepared to reassess. The nurse should not recheck at this point, since the client is symptomatic. She does not need insulin, and she will have her morning dose adjusted after breakfast.

A pregnant woman in her second trimester tells the nurse, "I've been passing a lot of gas and feel bloated." Which of the following suggestions would be helpful for the woman? A) "Watch how much beans and onions you eat." B) "Limit the amount of fluid you drink with meals" C) "Try exercising a little more." D) "Some say that eating mints can help." E) "Cut down on your intake of cheeses."

A) "Watch how much beans and onions you eat." C) "Try exercising a little more." D) "Some say that eating mints can help."

A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? A) 9 B) 7 C) 5 D) 3

A) 9

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

A) Dried fruits B) Peanut butter C) Meats

A pregnant woman tests positive for HBV. Which of the following would the nurse expect to administer? A) HBV immune globulin B) HBV vaccine C) Acylcovir D) Valacyclovir

A) HBV immune globulin

A woman in the 34th week of pregnancy says to the nurse, "I still feel like having intercourse with my husband." The woman's pregnancy has been uneventful. The nurse responds based on the understanding that: A) It is safe to have intercourse at this time. B) Intercourse at this time is likely to cause rupture of membranes. C) There are other ways that the couple can satisfy their needs. D) Intercourse at this time is likely to result in premature labor.

A) It is safe to have intercourse at this time.

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

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

A pregnant woman is scheduled to undergo percutaneous umbilical blood sampling. When discussing this test with the woman, the nurse reviews what can be evaluated with the specimens collected. Which of the following would the nurse include? (Select all that apply.) A) Rh incompatibility B) Fetal acid-base status C) Sex-linked disorders D) Enzyme deficiencies E) Coagulation studies

A) Rh incompatibility B) Fetal acid-base status E) Coagulation studies

After teaching a group of students about the discomforts of pregnancy, the students demonstrate understanding of the information when they identify which as common during the first trimester? (Select all that apply.) A) Urinary frequency B) Breast tenderness C) Cravings D) Backache E) Leg cramps

A) Urinary frequency B) Breast tenderness C) Cravings

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

A)Congenital anomalies

When teaching a class of pregnant women about the effects of substance abuse during pregnancy, which of the following would the nurse most likely include? A)Low-birth-weight infants B)Excessive weight gain C)Higher pain tolerance D)Longer gestational periods

A)Low-birth-weight infants

After teaching a group of students about the use of antiretroviral agents in pregnant women who are HIV- positive, the instructor determines that the teaching was successful when the group identifies which of the following as the underlying rationale? A)Reduction in viral loads in the blood B)Treatment of opportunistic infections C)Adjunct therapy to radiation and chemotherapy D)Can cure acute HIV/AIDS infections

A)Reduction in viral loads in the blood

The nurse is teaching a pregnant woman about how to prevent contracting cytomegalovirus (CMV) during pregnancy. What tips would the nurse share with this client? Select all that apply. A. Do not share food or drinks with young children, especially if they are in daycare. B. If you develop any flu-like symptoms, notify your physician immediately to be evaluated for CMV. C. Wash your hands thoroughly with soap and water after touching saliva or urine. D. If you have CMV, it is suggested that you not breast-feed your infant. E. If you contract CMV, your doctor will give you some oral medicine to treat it.

A,B,C R: Cytomegalovirus (CMV) is a mild infection and women may not know they have contracted it. The problem arises when a pregnant woman contracts it during the first 20 weeks of gestation. Prevention is the key, so the nurse would reinforce handwashing, not eating or drinking from a container after a small child has done so, and notifying the physician if the client develops mild flu-like symptoms so she can be tested to rule out CMV.

A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply. A. Plan periods of rest into the workday. B. Receive pneumococcal and influenza vaccines. Continue taking the scheduled warfarin. C. Let the physician know if you become short of breath or have a nighttime cough. D. Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus.

A,B,C R: Women with known heart conditions need to be closely followed by both the obstetrician and a cardiologist. Recommendations would include rest periods, reduction of stress, getting immunizations, and monitoring for heart failure as demonstrated by a nighttime cough and shortness of breath. Consuming more sodium in the diet is not recommended due of the potential of developing hypertension. Warfarin is contraindicated during pregnancy since it crosses the placental barrier and can cause spontaneous abortion, stillbirth or preterm birth.

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. A. previous large for gestational age (LGA) infant B. hypertension C. maternal age less than 18 years D. obesity E. genitourinary tract abnormalities

A,B,D R: Obesity, hypertension, and a previous infant weighing more than 9 lb (4 kg) are risk factors for developing gestational diabetes. Maternal age less than 18 years and genitourinary tract abnormalities do not increase the risk of developing gestational diabetes.

The nurse is caring for a pregnant client who indicates that she is fond of meat, works with children, and has a pet cat. Which instructions should the nurse give this client to prevent toxoplasmosis? Select all that apply. A. Eat meat cooked to 160° F (71° C). B. Avoid cleaning the cat's litter box. C. Avoid contact with children when they have a cold. D. Avoid outdoor activities such as gardening. E. Keep the cat outdoors at all times.

A,B,D R:To minimize risk of toxoplasmosis, the nurse should instruct the client to eat meat that has been cooked to an internal temperature of 160° F (71° C) throughout and to avoid cleaning the cat's litter box or performing activities such as gardening. Avoiding children with colds is unreasonable when working with children, and contact with children with colds is not a cause of toxoplasmosis. The cat should be kept indoors to prevent it from hunting and eating birds or rodents.

The nurse is educating a client with type 1 diabetes about the complications associated with diabetes and pregnancy. Which problems would the nurse include in her teaching? Select all that apply. A. Decreased birth weight B. Polyhydramnios C. Increased risk of spontaneous abortion D. Hypertension E. Cystic fibrosis

A,B,D R:Women with pregestational diabetes, which is type 1 diabetes, are at a higher risk of having an infant with complications during the pregnancy and at delivery. Spontaneous abortion is higher in women who have pregestational diabetes. Also, they run a higher risk of having a pregnancy with polyhydramnios, and of developing maternal hypertension. The birth weight of an infant born to a mother with diabetes is increased, not decreased. Cystic fibrosis is not associated with maternal diabetes.

A woman who immigrated here from a third world country presents to the clinic to find out if she is pregnant. Which signs and/or symptoms would the nurse assess as possible indicators that she might have an active case of tuberculosis as well? Select all that apply. A. anorexia B. hemoptysis C. weight gain D. night sweats E. fatigue

A,B,D,E Women emigrating from developing countries are at high risk for tuberculosis. Clinical manifestations include fatigue, fever or night sweats, nonproductive cough, weakness, slow weight loss, anemia, hemoptysis, and anorexia.

A nurse is caring for a client with cardiovascular disease who has just given birth. What nursing interventions should the nurse perform when caring for this client? Select all that apply. A. Assess for shortness of breath. B. Assess for edema and note any pitting. C. Monitor the client's hemoglobin and hematocrit. D. Auscultate heart sounds for abnormalities. E. Assess for a moist cough.

A,B,D,E R: The nurse should assess for possible fluid overload in a client with cardiovascular disease who has just given birth. Signs of fluid overload in the client who has just labored include cough, progressive dyspnea, edema, palpitations, and crackles in the lung bases. Hemoglobin and hematocrit levels are not affected by laboring of the client with cardiovascular disease.

A nurse is assessing a newborn and suspects that the mother may have abused alcohol during her pregnancy. The nurse suspect this based on which newborn findings? Select all that apply. A. small head circumference B. thin upper lip C. large inset eyes D. macrocephaly E. limb abnormality

A,B,E R: Characteristics of FASD include craniofacial dysmorphia (thin upper lip, small head circumference, and small eyes), IUGR, microcephaly, and congenital anomalies such as limb abnormalities and cardiac defects.

A nurse is conducting a class for a group of pregnant women about the risk of substance use during pregnancy. When discussing the effects of nicotine on a pregnancy, which complications would the nurse include? Select all that apply. A. premature rupture of membranes B. ectopic pregnancy C. macrosomia D. placenta previa E. spontaneous abortion

A,D,E R: Smoking increases the risk of spontaneous abortion, tubal ectopic pregnancy, preterm labor and birth, fetal growth restriction, stillbirth, premature rupture of membranes, low fetal iron stores, maternal hypertension, placenta previa, and abruptio placentae.

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

Ans: A A family history of gestational hypertension, such as a mother or sister, is considered a risk factor for the client. Having a twin sister or having a sister-in-law with gestational hypertension would not increase the client's risk. If the client had a history of preeclampsia in her first pregnancy, then she would be at risk in her second pregnancy.

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

Ans: A After evacuation of a hydatidiform mole, long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for 1 year and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow-up after evacuation of a hydatidiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided.

When assessing a woman in her first trimester, which emotional response would the nurse most likely expect to find? A) Ambivalence B) Introversion C) Acceptance D) Emotional lability

Ans: A During the first trimester, the pregnant woman commonly experiences ambivalence, with conflicting feelings at the same time. Introversion heightens during the first and third trimesters when the woman's focus is on behaviors that will ensure a safe and healthy pregnancy outcome. Acceptance usually occurs during the second trimester. Emotional lability (mood swings) is characteristic throughout a woman's pregnancy.

Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which of the following? A) Linea nigra B) Striae gravidarum C) Melasma D) Vascular spiders

Ans: A Linea nigra refers to the darkened line of pigmentation down the middle of the abdomen in pregnant women. Striae gravidarum refers to stretch marks, irregular reddish streaks on the abdomen, breasts, and buttocks. Melasma refers to the increased pigmentation on the face, also known as the mask of pregnancy. Vascular spiders are small, spiderlike blood vessels that appear usually above the waist and on the neck, thorax, face, and arms.

In a client's seventh month of pregnancy, she reports feeling ìdizzy, like I'm going to pass out, when I lie down flat on my back.î The nurse integrates which of the following in to the explanation? A) Pressure of the gravid uterus on the vena cava B) A 50% increase in blood volume C) Physiologic anemia due to hemoglobin decrease D) Pressure of the presenting fetal part on the diaphragm

Ans: A The client is describing symptoms of supine hypotension syndrome, which occurs when the heavy gravid uterus falls back against the superior vena cava in the supine position. The vena cava is compressed, reducing venous return, cardiac output, and blood pressure, with increased orthostasis. The increased blood volume and physiologic anemia are unrelated to the client's symptoms. Pressure on the diaphragm would lead to dyspnea.

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

Ans: A With a ruptured ectopic pregnancy, the woman is at high risk for hemorrhage. Jaundice, edema, and infection are not associated with a ruptured ectopic pregnancy.

A pregnant woman undergoes maternal serum alpha-fetoprotein (MSAFP) testing at 16 to 18 weeks' gestation. Which of the following would the nurse suspect if the woman's level is decreased? A) Down syndrome B) Sickle-cell anemia C) Cardiac defects D) Open neural tube defect

Ans: A Feedback: Decreased levels might indicate Down syndrome or trisomy 18. Sickle cell anemia may be identified by chorionic villus sampling. MSAFP levels would be increased with cardiac defects, such as tetralogy of Fallot. A triple marker test would be used to determine an open neural tube defect.

A nurse is describing advances in genetics to a group of students. Which of the following would the nurse least likely include? A) Genetic diagnosis is now available as early as the second trimester. B) Genetic testing can identify presymptomatic conditions in children. C) Gene therapy can be used to repair missing genes with normal ones. D) Genetic agents may be used in the future to replace drugs.

Ans: A Feedback: Genetic diagnosis is now possible very early in pregnancy (see Evidence-Based Practice 10.1). Genetic testing can now identify presymptomatic conditions in children and adults. Gene therapy can be used to replace or repair defective or missing genes with normal ones. Gene therapy has been used for a variety of disorders, including cystic fibrosis, melanoma, diabetes, HIV, and hepatitis (Tamura, Kamuma, Nakazato, et al. 2010). The potential exists for creation of increased intelligence and size through genetic intervention. Recent research using gene therapy shows promise for the generation of insulin-producing cells to cure diabetes (Calne, Gan, & Lee 2010). In the future, genetic agents may replace drugs, general surgery may be replaced by gene surgery, and genetic intervention may replace radiation.

When describing genetic disorders to a group of childbearing couples, the nurse would identify which as an example of an autosomal dominant inheritance disorder? A) Huntington's disease B) Sickle cell disease C) Phenylketonuria D) Cystic fibrosis

Ans: A Feedback: Huntington's disease is an example of an autosomal dominant inheritance disorder. Sickle cell disease, phenylketonuria, and cystic fibrosis are examples of autosomal recessive inheritance disorders.

After teaching a group of students about fetal development, the instructor determines that the teaching was successful when the students identify which of the following as providing the barrier to other sperm after fertilization? A) Zona pellucida B) Zygote C) Cleavage D) Morula

Ans: A Feedback: The zona pellucida is the clear protein layer that acts as a barrier to other sperm once one sperm enters the ovum for fertilization. The zygote refers to the union of the nuclei of the ovum and sperm resulting in the diploid number of chromosomes. Cleavage is another term for mitosis. The morula is the result of four cleavages leading to 16 cells that appear as a solid ball of cells. The morula reaches the uterine cavity about 72 hours after fertilization.

A group of students are reviewing the signs of pregnancy. The students demonstrate understanding of the information when they identify which as presumptive signs? (Select all that apply. A) Amenorrhea B) Nausea C) Abdominal enlargement D) Braxton-Hicks contractions E) Fetal heart sounds

Ans: A, B Presumptive signs include amenorrhea, nausea, breast tenderness, urinary frequency and fatigue. Abdominal enlargement and Braxton-Hicks contractions are probable signs of pregnancy. Fetal heart sounds are a positive sign of pregnancy.

A group of students are reviewing information about genetic inheritance. The students demonstrate understanding of the information when they identify which of the following as an example of an autosomal recessive disorder? (Select all that apply.) A) Cystic fibrosis B) Phenylketonuria C) Tay-Sachs disease D) Polycystic kidney disease E) Achondroplasia

Ans: A, B, C Feedback: Examples of autosomal recessive disorders include cystic fibrosis, phenylketonuria, and Tay-Sachs disease. Polycystic kidney disease and achondroplasia are examples of autosomal dominant diseases.

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios based on which of the following? (Select all that apply.) A) History of diabetes B) Complaints of shortness of breath C) Identifiable fetal parts on abdominal palpation D) Difficulty obtaining fetal heart rate E) Fundal height below that for expected gestational age

Ans: A, B, D Factors such as maternal diabetes or multiple gestations place the woman at risk for hydramnios. In addition, there is a discrepancy between fundal height and gestational age, such that a rapid growth of the uterus is noted. Shortness of breath may result from overstretching of the uterus due to the increased amount of amniotic fluid. Often, fetal parts are difficult to palpate and fetal heart rate is difficult to obtain because of the excess fluid present.

A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman's gastrointestinal tract, which of the following would the nurse expect to find? (Select all that apply. A) Hyperemic gums B) Increased peristalsis C) Complaints of bloating D) Heartburn E) Nausea

Ans: A, C, D, E Gastrointestinal system changes include hyperemic gums due to estrogen and increased proliferation of blood vessels and circulation to the mouth; slowed peristalsis; acid indigestion and heartburn; bloating and nausea and vomiting.

A nurse is discussing fetal development with a pregnant woman. The woman is 12 weeks pregnant and asks, "What's happening with my baby?" Which of the following would the nurse integrate into the response? (Select all that apply.) A) Continued sexual differentiation B) Eyebrows forming C) Startle reflex present D) Digestive system becoming active E) Lanugo present on the head

Ans: A, D Feedback: At 12 weeks, sexual differentiation continues and the digestive system shows activity. Eyebrows form and startle reflex is present between weeks 21 and 24. Lanugo on the head appears about weeks 13-16.

A woman just delivered a healthy term newborn. Upon assessing the umbilical cord, the nurse would identify which of the following as normal? (Select all that apply.) A) One vein B) Two veins C) One artery D) Two arteries E) One ligament F) Two ligaments

Ans: A, D Feedback: The normal umbilical cord contains one large vein and two small arteries.

A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.) A) Dark red vaginal bleeding B) Insidious onset C) Absence of pain D) Rigid uterus E) Absent fetal heart tones

Ans: A, D, E Feedback: Assessment findings associated with abruption placenta include a sudden onset, with concealed or visible bleeding, dark red bleeding, constant pain or uterine tenderness on palpation, firm to rigid uterine tone, and fetal distress or absent fetal heart tones.

A woman comes to the prenatal clinic suspecting that she is pregnant, and assessment reveals probable signs of pregnancy. Which of the following would be included as part of this assessment? (Select all that apply A) Positive pregnancy test B) Ultrasound visualization of the fetus C) Auscultation of a fetal heart beat D) Ballottement E) Absence of menstruation F) Softening of the cervix

Ans: A, D, F Probable signs of pregnancy include a positive pregnancy test, ballottement, and softening of the cervix (Goodell's sign). Ultrasound visualization of the fetus, auscultation of a fetal heart beat, and palpation of fetal movements are considered positive signs of pregnancy. Absence of menstruation is a presumptive sign of pregnancy.

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic? A) 3.3 mEq/L B) 6.1 mEq/L C) 8.4 mEq/L D) 10.8 mEq/L

Ans: B Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 7 mEq/L are considered therapeutic, whereas levels more than 8 mEq/dL are generally considered toxic.

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

Ans: B As with any seizure, the priority is to clear the airway and maintain adequate oxygenation both to the mother and the fetus. Fluids and control of hypertension are addressed once the airway and oxygenation are maintained. Delivery of fetus is determined once the seizures are controlled and the woman is stable.

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

Ans: B Having a toddler and preschooler at home needing attention suggest that the woman would have difficulty maintaining bed rest at home. Therefore, expectant management at home may not be appropriate. Expectant management is appropriate if the mother and fetus are both stable, there is no active bleeding, the client has readily available access to reliable transportation, and can comprehend instructions.

A nurse strongly encourages a pregnant client to avoid eating swordfish and tilefish because these fish contain which of the following? A) Excess folic acid, which could increase the risk for neural tube defects B) Mercury, which could harm the developing fetus if eaten in large amounts C) Lactose, which leads to abdominal discomfort, gas, and diarrhea D) Low-quality protein that does not meet the woman's requirements

Ans: B Nearly all fish and shellfish contain traces of mercury and some contain higher levels of mercury that may harm the developing fetus if ingested by pregnant women in large amounts. Among these fish are shark, swordfish, king mackerel, and tilefish. Folic acid is found in dark green vegetables, baked beans, black-eyed peas, citrus fruits, peanuts, and liver. Folic acid supplements are needed to prevent neural tube defects. Women who are lactose intolerant experience abdominal discomfort, gas, and diarrhea if they ingest foods containing lactose. Fish and shellfish are an important part of a healthy diet because they contain high-quality proteins, are low in saturated fat, and contain omega-3 fatty acids.

Assessment of a pregnant woman reveals that she compulsively craves ice. The nurse documents this finding as which of the following? A) Quickening B) Pica C) Ballottement D) Linea nigra

Ans: B Pica refers to the compulsive ingestion of nonfood substances such as ice. Quickening refers to the mother's sensation of fetal movement. Ballottement refers to the feeling of rebound from a floating fetus when an examiner pushes against the woman's cervix during a pelvic examination. Linea nigra refers to the pigmented line that develops in the middle of the woman's abdomen.

A primiparous client is being seen in the clinic for her first prenatal visit. It is determined that she is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what she will most likely experience during this period. Which of the following would the nurse include? A) Ankle edema B) Urinary frequency C) Backache D) Hemorrhoids

Ans: B The client is in her first trimester and would most likely experience urinary frequency as the growing uterus presses on the bladder. Ankle edema, backache, and hemorrhoids would be more common during the later stages of pregnancy.

A pregnant woman comes to the clinic and tells the nurse that she has been having a whitish vaginal discharge. The nurse suspects vulvovaginal candidiasis, based on which assessment finding? A) Fever B) Vaginal itching C) Urinary frequency D) Incontinence

Ans: B Vaginal secretions become more acidic, white, and thick during pregnancy. Most women experience an increase in a whitish vaginal discharge, called leukorrhea. This is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Fever would suggest a more serious infection. Urinary frequency occurs commonly in the first trimester, disappears during the second trimester, and reappears during the third trimester. Incontinence would not be associated with a vulvovaginal candidiasis. Incontinence would require additional evaluation.

The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman's increased risk? A) Oligohydramnios B) Preeclampsia C) Post-term labor D) Chorioamnionitis

Ans: B Women with multiple gestations are at high risk for preeclampsia, preterm labor, hydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.

The nurse is discussing the insulin needs of a primiparous client with diabetes who has been using insulin for the past few years. The nurse informs the client that her insulin needs will increase during pregnancy based on the nurse's understanding that the placenta produces: A) hCG, which increases maternal glucose levels B) hPL, which deceases the effectiveness of insulin C) Estriol, which interferes with insulin crossing the placenta D) Relaxin, which decreases the amount of insulin produced

Ans: B hPL acts as an antagonist to insulin, so the mother must produce more insulin to overcome this resistance. If the mother has diabetes, then her insulin need would most likely increase to meet this demand. hCG does not affect insulin and glucose level. Estrogen, not estriol, is believed to oppose insulin. In addition, insulin does not cross the placenta. Relaxin is not associated with insulin resistance.

Assessment of a pregnant woman reveals oligohydramnios. The nurse would be alert for the development of which of the following? A) Maternal diabetes B) Placental insufficiency C) Neural tube defects D) Fetal gastrointestinal malformations

Ans: B Feedback: 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.

After teaching a group of students about fetal development, the instructor determines that the teaching was successful when the students identify which of the following as essential for fetal lung development? A) Umbilical cord B) Amniotic fluid C) Placenta D) Trophoblasts

Ans: B Feedback: Amniotic fluid is essential for fetal growth and development, especially fetal lung development. The umbilical cord is the lifeline from the mother to the growing embryo. The placenta serves as the interface between the mother and developing fetus. It secretes hormones and supplies the fetus with nutrients and oxygen needed for growth. The trophoblasts differentiate into all the cells that form that placenta.

After the nurse describes fetal circulation to a pregnant woman, the woman asks why her fetus has a different circulation pattern than hers. In planning a response, the nurse integrates understanding of which of the following? A) Fetal blood is thicker than that of adults and needs different pathways. B) Fetal circulation carries highly oxygenated blood to vital areas first. C) Fetal blood has a higher oxygen saturation and circulates more slowly. D) Fetal heart rates are rapid and circulation time is double that of adults.

Ans: B Feedback: Fetal circulation functions to carry highly oxygenated blood to vital areas first while shunting it away from less vital ones. Fetal blood is not thicker than that of adults. Large volumes of oxygenated blood are not needed because the placenta essentially takes over the functions of the lung and liver during fetal life. Although fetal heart rates normally range from 120 to 160 beats per minute, circulation time is not doubled.

A woman is scheduled to undergo fetal nuchal translucency testing. Which of the following would the nurse include when describing this test? A) "A needle will be inserted directly into the fetus's umbilical vessel." B) "You'll have an intravaginal ultrasound to measure fluid in the fetus." C) "The doctor will take a sample of fluid from your bag of waters." D) "A small piece of tissue from the fetal part of the placenta is taken."

Ans: B Feedback: Fetal nuchal translucency testing involves an intravaginal ultrasound that measures fluid collection in the subcutaneous space between the skin and cervical spine of the fetus. Insertion of a needle into the fetus's umbilical vessel describes percutaneous umbilical blood sampling. Taking a sample of fluid from the amniotic sac (bag of waters) describes an amniocentesis. Obtaining a small tissue specimen from the fetal part of the placenta describes chorionic villus sampling.

A nursing instructor is preparing a teaching plan for a group of nursing students about the potential for misuse of genetic discoveries and advances. Which the following would the instructor most likely include? A) Gene replacement therapy for defective genes B) Individual risk profiling and confidentiality C) Greater emphasis on the causes of diseases D) Slower diagnosis of specific diseases

Ans: B Feedback: Individual risk profiling based on an individual's genetic makeup can raise issues related to privacy and confidentiality. Gene replacement therapy for defective genes and a greater emphasis on looking at the causes of disease are considered benefits associated with genetic advances. Rapid, more specific diagnosis of diseases would be possible.

A nurse is teaching a class on X-linked recessive disorders. Which of the following statements would the nurse most likely include? A) Males are typically carriers of the disorders. B) No male-to-male transmission occurs. C) Daughters are more commonly affected with the disorder. D) Both sons and daughters have a 50% risk of the disorder.

Ans: B Feedback: Most X-linked disorders demonstrate a recessive pattern of inheritance. Males are more affected than females. A male has only one X chromosome and all the genes on his X chromosome will be expressed, whereas a female will usually need both X chromosomes to carry the disease. There is no male-to-male transmission (since no X chromosome from the male is transmitted to male offspring), but any man who is affected will have carrier daughters. If a woman is a carrier, there is a 50% chance that her sons will be affected and a 50% chance that her daughters will be carriers.

The nurse is developing a presentation for a community group of young adults discussing fetal development and pregnancy. The nurse would identify that the sex of offspring is determined at the time of: A) Meiosis B) Fertilization C) Formation of morula D) Oogenesis

Ans: B Feedback: 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.

When describing the structures involved in fetal circulation, the nursing instructor describes which structure as the opening between the right and left atrium? A) Ductus venosus B) Foramen ovale C) Ductus arteriosus D) Umbilical artery

Ans: B Feedback: The foramen ovale is the opening between the right and left atrium. The ductus venosus connects the umbilical vein to the inferior vena cava. The ductus arteriosus connects the main pulmonary artery to the aorta. The umbilical artery carries blood to the placenta.

During a prenatal class for a group of new mothers, the nurse is describing the hormones produced by the placenta. Which of the following would the nurse include? (Select all that apply.) A) Prolactin B) Estriol C) Relaxin D) Progestin E) Human chorionic somatomammotropin

Ans: B, C, D, E Feedback: Estriol, relaxin, progestin, and human chorionic somatomammotropin are secreted by the placenta. Prolactin is secreted after delivery for breast-feeding.

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

Ans: B, C, E High-risk factors associated with preterm PROM include low socioeconomic status, multiple gestation, low body mass index, tobacco use, preterm labor history, placenta previa, abruptio placenta, urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis.

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

Ans: B, C, E Possible signs of infection associated with premature rupture of membranes include elevation of maternal temperature and pulse rate, abdominal/uterine tenderness, fetal tachycardia over 160 bpm, elevated white blood cell count and C-reactive protein levels, and cloudy, foul-smelling amniotic fluid.

A nurse is assessing a child with Klinefelter's syndrome. Which of the following would the nurse expect to assess? (Select all that apply.) A) Gross mental retardation B) Long arms C) Profuse body hair D) Gynecomastia E) Enlarged testicles

Ans: B, D Feedback: Manifestations of Klinefelter's syndrome include mild mental retardation, small testicles, infertility, long arms and legs, gynecomastia, scant facial and body hair, and decreased libido.

A nurse is developing a teaching plan about nutrition for a group of pregnant women. Which of the following would the nurse include in the discussion? (Select all that apply. A) Keep weight gain to 15 lb B) Eat three meals with snacking C) Limit the use of salt in cooking D) Avoid using diuretics E) Participate in physical activity

Ans: B, D, E To promote optimal nutrition, the nurse would recommend gradual and steady weight gain based on the client's prepregnant weight, eating three meals with one or two snacks daily, not restricting the use of salt unless instructed to do so by the health care provider, avoiding the use of diuretics, and participating in reasonable physical activity daily.

After teaching a class on the stages of fetal development, the instructor determines that the teaching was successful when the students identify which of the following as a stage? (Select all that apply.) A) Placental B) Preembryonic C) Umbilical D) Embryonic E) Fetal

Ans: B, D, E Feedback: The three stages of fetal development are the preembryonic, embryonic, and fetal stage. Placental and umbilical are not stages of fetal development.

A gravida 2 para 1 client in the 10th week of her pregnancy says to the nurse, ìI've never urinated as often as I have for the past three weeks.î Which response would be most appropriate for the nurse to make? A) ìHaving to urinate so often is annoying. I suggest that you watch how much fluid you are drinking and limit it.î B) ìYou shouldn't be urinating this frequently now; it usually stops by the time you're eight weeks pregnant. Is there anything else bothering you?î C) ìBy the time you are 12 weeks pregnant, this frequent urination should no longer be a problem, but it is likely to return toward the end of your pregnancy.î D) ìWomen having their second child generally don't have frequent urination. Are you experiencing any burning sensations?î

Ans: C As the uterus grows, it presses on the urinary bladder, causing the increased frequency of urination during the first trimester. This complaint lessens during the second trimester only to reappear in the third trimester as the fetus begins to descend into the pelvis, causing pressure on the bladder.

A woman in her second trimester comes for a follow-up visit and says to the nurse, ìI feel like I'm on an emotional roller-coaster.î Which response by the nurse would be most appropriate? A) How often has this been happening to you? B) Maybe you need some medication to level things out. C) Mood swings are completely normal during pregnancy. D) Have you been experiencing any thoughts of harming yourself?

Ans: C Emotional lability is characteristic throughout most pregnancies. One moment a woman can feel great joy, and within a short time she can feel shock and disbelief. Frequently, pregnant women will start to cry without any apparent cause. Some women feel as though they are riding an emotional roller-coaster. These extremes in emotion can make it difficult for partners and family members to communicate with the pregnant woman without placing blame on themselves for their mood changes. Clear explanations about how common mood swings are during pregnancy are essential.

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

Ans: C Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision, or sweating. Magnesium sulfate may cause sweating.

Which of the following data on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy? A) Use of oral contraceptives for 5 years B) Ovarian cyst 2 years ago C) Recurrent pelvic infections D) Heavy, irregular menses

Ans: C In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy.

The nurse is assessing a pregnant woman in the second trimester. Which of the following tasks would indicate to the nurse that the client is incorporating the maternal role into her personality? A) The woman demonstrates concern for herself and her fetus as a unit. B) The client identifies what she must give up to assume her new role. C) The woman acknowledges the fetus as a separate entity within her. D) The client demonstrates unconditional acceptance without rejection.

Ans: C Incorporation of the maternal role into her personality indicates acceptance by the pregnant woman. In doing so, the woman becomes able to identify the fetus as a separate individual. Demonstrating concern for herself and her fetus as a unit is associated with introversion and more commonly occurs during the third trimester. Identification of what the mother must give up to assume the new role occurs during the first trimester. Demonstrating unconditional acceptance without rejection occurs during the third trimester.

A woman suspecting she is pregnant asks the nurse about which signs would confirm her pregnancy. The nurse would explain that which of the following would confirm the pregnancy? A) Absence of menstrual period B) Abdominal enlargement C) Palpable fetal movement D) Morning sickness

Ans: C Only positive signs of pregnancy would confirm a pregnancy. The positive signs of pregnancy confirm that a fetus is growing in the uterus. Visualizing the fetus by ultrasound, palpating for fetal movements, and hearing a fetal heartbeat are all signs that make the pregnancy a certainty. Absence of menstrual period and morning sickness are presumptive signs, which can be due to conditions other than pregnancy. Abdominal enlargement is a probable sign.

A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make? A) "Make sure that anything around your waist is quite snug." B) "Try to eat three large meals a day with less snacking." C) "Drink fluids in between meals rather than with meals." D) "Lie down for about an hour after you eat"

Ans: C Suggestions to minimize nausea and vomiting include avoiding tight waistbands to minimize pressure on the abdomen, eating small frequent meals throughout the day, separating fluids from solids by consuming fluids in between meals; and avoiding lying down or reclining for at least 2 hours after eating.

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate? A) "Why are you crying?" B) "Will a pill help your pain?" C) "I'm sorry you lost your baby." D) "A baby still wasn't formed in your uterus."

Ans: C Telling the client that the nurse is sorry for the loss acknowledges the loss to the woman, validates her feelings, and brings the loss into reality. Asking why the client is crying is ineffective at this time. Offering a pill for the pain ignores the client's feelings. Telling the client that the baby wasn't formed is inappropriate and discounts any feelings or beliefs that the client has.

After teaching a group of nursing students about the possible causes of spontaneous abortion, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of first trimester abortions? A) Maternal disease B) Cervical insufficiency C) Fetal genetic abnormalities D) Uterine fibroids

Ans: C The causes of spontaneous abortion are varied and often unknown. The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother. Chromosomal abnormalities are more likely causes in first trimester and maternal disease is more likely in the second trimester. Those occurring during the second trimester are more likely related to maternal conditions, such as cervical insufficiency, congenital or acquired anomaly of the uterine cavity (uterine septum or fibroids), hypothyroidism, diabetes mellitus, chronic nephritis, use of crack cocaine, inherited and acquired thrombophilias, lupus, polycystic ovary syndrome, severe hypertension and acute infection such as rubella virus, cytomegalovirus, herpes simplex virus, bacterial vaginosis, and toxoplasmosis.

A woman is at 20 weeks' gestation. The nurse would expect to find the fundus at which of the following? A) Just above the symphysis pubis B) Mid-way between the pubis and umbilicus C) At the level of the umbilicus D) Mid-way between the umbilicus and xiphoid process

Ans: C The uterus, which starts as a pear-shaped organ, becomes ovoid as length increases over width. By 20 weeks' gestation, the fundus, or top of the uterus, is at the level of the umbilicus and measures 20 cm. A monthly measurement of the height of the top of the uterus in centimeters, which corresponds to the number of gestational weeks, is commonly used to date the pregnancy.

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the client's plan of care? A) Clear liquid diet B) Total parenteral nutrition C) Nothing by mouth D) Administration of labetalol

Ans: C Typically, on admission, the woman with hyperemesis has oral food and fluids withheld for the first 24 to 36 hours to rest the gut and receives parenteral fluids to rehydrate and reduce the symptoms. Once the condition stabilizes, oral intake is gradually increased. Total parenteral nutrition may be used if the client's condition does not improve with several days of bed rest, gut rest, IV fluids, and antiemetics. Labetalol is an antihypertensive agent that may be used to treat gestational hypertension, not hyperemesis.

The health care provider orders PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which of the following would be most important for the nurse to do? A) Use clean technique to administer the drug. B) Keep the gel cool until ready to use. C) Maintain the client for 1/2 hour after administration. D) Administer intramuscularly into the deltoid area.

Ans: C When PGE2 is ordered, the gel should come to room temperature before administering it. Sterile technique should be used and the client should remain supine for 30 minutes after administration. RhoGAM is administered intramuscularly into the deltoid area.

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

Ans: C With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity.

Which of the following changes in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy? A) Ligament tightening B) Decreased swayback C) Increased lordosis D) Joint contraction

Ans: C With pregnancy, the woman's center of gravity shifts forward, requiring a realignment of the spinal curvatures. There is an increase in the normal lumbosacral curve (lordosis). Ligaments of the sacroiliac joints and pubis symphysis soften and stretch. Increased swayback and an upper spine extension to compensate for the enlarging abdomen occur. Joint relaxation and increased mobility occur due to the influence of the hormones relaxin and progesterone.

During a vaginal exam, the nurse notes that the cervix has a bluish color. The nurse documents this finding as: A) Hegar's sign B) Goodell's sign C) Chadwick's sign D) Ortolani's sign

Ans: C Bluish coloration of the cervix is termed Chadwick's sign. Hegar's sign refers to the softening of the lower uterine segment or isthmus. Goodell's sign refers to the softening of the cervix. Ortolani's sign is a maneuver done to identify developmental dysplasia of the hip in infants.

When describing amniotic fluid to a pregnant woman, the nurse would include which of the following? A) "This fluid acts as transport mechanism for oxygen and nutrients." B) "The fluid is mostly protein to provide nourishment to your baby." C) "This fluid acts as a cushion to help to protect your baby from injury." D) "The amount of fluid remains fairly constant throughout the pregnancy."

Ans: C Feedback: Amniotic fluid protects the floating embryo and cushions the fetus from trauma. The placenta acts as a transport mechanism for oxygen and nutrients. Amniotic fluid is primarily water with some organic matter. Throughout pregnancy, amniotic fluid volume fluctuates.

While talking with a pregnant woman who has undergone genetic testing, the woman informs the nurse that her baby will be born with Down syndrome. The nurse understands that Down syndrome is an example of: A) Multifactorial inheritance B) X-linked recessive inheritance C) Trisomy numeric abnormality D) Chromosomal deletion

Ans: C Feedback: 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.

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

Ans: C Feedback: 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.

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

Ans: C Feedback: The woman with preterm premature rupture of membranes should monitor her baby's activity by performing fetal kick counts daily, check her temperature and report any increases to the health care provider, not insert anything into her vagina or vaginal area, such as tampons or vaginal intercourse, and avoid sitting in a tub bath.

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

Ans: D A foul odor of the amniotic fluid indicates infection. Yellow-green fluid would suggest meconium. A blue color on Nitrazine testing and ferning indicate the presence of amniotic fluid.

The nurse is teaching a pregnant woman about recommended weight gain. The woman has a prepregnancy body mass index of 26. The nurse determines that the teaching was successful when the woman states that she should gain no more than which amount during pregnancy? A) 35 to 40 pounds B) 25 to 35 pounds C) 28 to 40 pounds D) 15 to 25 pounds

Ans: D A woman with a body mass index of 26 is considered overweight and should gain no more than 15 to 25 pounds during pregnancy. Women with a body mass index of 18.5 to 24.9 (considered healthy weight) should gain 25 to 35 pounds. A woman with a body mass index less than 18.5 should gain 28 to 40 pounds.

Which of the following findings on a prenatal visit at 10 weeks might lead the nurse to suspect a hydatidiform mole? A) Complaint of frequent mild nausea B) Blood pressure of 120/84 mm Hg C) History of bright red spotting 6 weeks ago D) Fundal height measurement of 18 cm

Ans: D Findings with a hydatidiform mole may include uterine size larger than expected. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion.

Which of the following findings would the nurse interpret as suggesting a diagnosis of gestational trophoblastic disease? A) Elevated hCG levels, enlarged abdomen, quickening B) Vaginal bleeding, absence of FHR, decreased hPL levels C) Visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen D) Gestational hypertension, hyperemesis gravidarum, absence of FHR

Ans: D Gestational trophoblastic disease may be manifested by early development of preeclampsia (gestational hypertension), severe morning sickness due to high hCG levels, and absence of fetal heart rate or activity. There is no fetus, so quickening and evidence of a fetal skeleton would not be seen. The abdominal enlargement is greater than expected for pregnancy dates, but hCG, not hPL, levels are increased.

The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome? A) Hyperglycemia B) Elevated platelet count C) Leukocytosis D) Elevated liver enzymes

Ans: D HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia or leukocytosis is not a part of this syndrome.

While talking with a woman in her third trimester, which behavior indicates to the nurse that the woman is learning to give of oneself? A) Showing concern for self and fetus as a unit B) Unconditionally accepting the pregnancy without rejection C) Longing to hold infant D) Questioning ability to become a good mother

Ans: D Learning to give of oneself would be demonstrated when the woman questions her ability to become a good mother to the infant. Showing concern for herself and fetus as a unit reflects the task of ensuring safe passage throughout pregnancy and birth. Unconditionally accepting the pregnancy reflects the task of seeking acceptance of the infant by others. Longing to hold the infant reflects the task of seeking acceptance of self in the maternal role to the infant.

The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. The mother will most likely experience which of the following at that time? A) Dysuria B) Dyspnea C) Constipation D) Urinary frequency

Ans: D Lightening refers to the descent of the fetal head into the pelvis and engagement. With this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection. Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to lightening.

A nursing instructor is teaching a class to a group of students about pregnancy, insulin, and glucose. Which of the following would the instructor least likely include as opposing insulin? A) Prolactin B) Estrogen C) Progesterone D) Cortisol

Ans: D Prolactin, estrogen, and progesterone are all thought to oppose insulin. As a result, glucose is less likely to enter the mother's cells and is more likely to cross over the placenta to the fetus. After the first trimester, hPL from the placenta and steroids (cortisol) from the adrenal cortex act against insulin. hPL acts as an antagonist against maternal insulin, and thus more insulin must be secreted to counteract the increasing levels of hPL and cortisol during the last half of pregnancy.

A pregnant client in her second trimester has a hemoglobin level of 11 g/dL. The nurse interprets this as indicating which of the following? A) Iron-deficiency anemia B) A multiple gestation pregnancy C) Greater-than-expected weight gain D) Hemodilution of pregnancy

Ans: D Feedback: During pregnancy, the red blood cell count increases along with an increase in plasma volume. However, there is a greater increase in the plasma volume as a result of hormonal factors and sodium and water retention. Thus, the plasma increase exceeds the increase in RBCs, resulting in hemodilution of pregnancy, which is also called physiologic anemia of pregnancy. Changes in maternal iron levels would be more indicative of an iron-deficiency anemia. Although anemia may be present with a multiple gestation, an ultrasound would be a more reliable method of identifying it. Weight gain does not correlate with hemoglobin levels.

When teaching a pregnant client about the physiologic changes of pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which of the following would the nurse include as the underlying reason for the effect? A) Pancreatic function is affected by pregnancy. B) Glucose is utilized more rapidly during a pregnancy. C) The pregnant woman increases her dietary intake. D) Glucose moves through the placenta to assist the fetus.

Ans: D Feedback: The growing fetus has large needs for glucose, amino acids, and lipids, placing demands on maternal glucose stores. During the first half of pregnancy, much of the maternal glucose is diverted to the growing fetus. The pancreas continues to function during pregnancy. However, the placental hormones can affect maternal insulin levels. The demand for glucose by the fetus during pregnancy is high, but it is not necessarily used more rapidly. Placental hormones, not the woman's dietary intake, play a major role in glucose metabolism during pregnancy.

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) Progesterone (progestin) D) Human chorionic gonadotropin (hCG)

Ans: D Feedback: 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.

The nurse is providing care to a neonate whose mother abuses heroin. Which finding would the nurse expect to assess? A. easy consolability B. sneezing C. vigorous sucking D. hypotonicity

B

What criteria would the physician base his decision on to begin insulin therapy for a gestational diabetic mother? A. Urine is 2+ for glucose and serum blood glucose is 120. B. A 2-hour postprandial glucose level cannot be kept below 120 mg/dL. C. Weight gain is over 30 pounds (13.6 kg) and blood sugars are fluctuating between 95 and 130 throughout the day. D. Client cannot keep fasting blood sugar lower than 90 mg/dL.

B R:A physician usually recommends beginning a woman with gestational diabetes on insulin therapy when exercise and diet are ineffective and if she is unable to keep her fasting blood sugar levels below 95 mg/dL or her 2-hour postprandial glucose levels below 120 mg/dL.

A woman with diabetes is in labor. To reduce the likelihood of neonatal hypoglycemia, the nurse monitors the client's blood glucose level closely with the goal to maintain which level? A. below 105 mg/dL B. below 110 mg/dL C. below 120 mg/dL D. below 115 mg/dL

B R: For the laboring woman with diabetes, the blood glucose levels are monitored every 1 to 2 hours with the goal to maintain the levels below 110 mg/dL throughout the labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level.

Which of the following would the nurse include when teaching a pregnant woman about chorionic villus sampling? A) "The results should be available in about a week." B) "You'll have an ultrasound first and then the test." C) "Afterwards, you can resume your exercise program." D) "This test is very helpful for identifying spinal defects."

B) "You'll have an ultrasound first and then the test."

When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which of the following would be most appropriate? A) Monthly visits until 32 weeks, then bi-monthly visits B) Bi-monthly visits until 28 weeks, then weekly visits C) Monthly visits until 20 weeks, then bi-monthly visits D) Bi-monthly visits until 36 weeks, then weekly visits

B) Bi-monthly visits until 28 weeks, then weekly visits

A group of nursing students are preparing a presentation for their class about measures to prevent toxoplasmosis. Which of the following would the students be least likely to include? Select all that apply. A) Washing raw fruits and vegetables before eating them B) Cooking all meat to an internal temperature of 140 F C) Wearing gardening gloves when working in the soil D) Avoiding contact with a cats litter box.

B) Cooking all meat to an internal temperature of 140 F

A group of students are reviewing information about sexually transmitted infections and their effect on pregnancy. The students demonstrate understanding of the information when they identify which infection as being responsible for ophthalmia neonatorum? A) Syphilis B) Gonorrhea C) Chlamydia D) HPV

B) Gonorrhea

A neonate born to a mother who was abusing heroin is exhibiting signs and symptoms of withdrawal. Which of the following would the nurse assess? (Select all that apply.) A) Low whimpering cry B) Hypertonicity C) Lethargy D) Excessive sneezing E) Overly vigorous sucking F) Tremors

B) Hypertonicity C) Lethargy D) Excessive sneezing

During a routine prenatal visit, a client, 36 weeks pregnant, states she has difficulty breathing and feels like her pulse rate is really fast. The nurse finds her pulse to be 100 beats per minute (increased from baseline readings of 70 to 74 beats per minute) and irregular, with bilateral crackles in the lower lung bases. Which nursing diagnosis would be the priority for this client? A) Ineffective tissue perfusion related to supine hypotensive syndrome B) Impaired gas exchange related to pulmonary congestion C) Activity intolerance related to increased metabolic requirements D) Anxiety related to fear of pregnancy outcome

B) Impaired gas exchange related to pulmonary congestion

A client's maternal serum alpha-fetoprotein (MSAFP) level was unusually elevated at 17 weeks. The nurse suspects which of the following? A) Fetal hypoxia B) Open spinal defects C) Down syndrome D) Maternal hypertension

B) Open spinal defects

After teaching a group of students about the different perinatal education methods, the instructor determines that the teaching was successful when the students identify which of the following as the Bradley method? A) Psychoprophylactic method B) Partner-coached method C) Natural childbirth method D) Mind prevention method

B) Partner-coached method

A nurse is reviewing the medical record of a pregnant woman and notes that she is gravid II. The nurse interprets this to indicate the number of: A) Deliveries B) Pregnancies C) Spontaneous abortions D) Pre-term births

B) Pregnancies

When describing perinatal education to a pregnant woman and her partner, the nurse emphasizes that the primary goal of these classes is to: A) Equip a couple with the knowledge to experience a pain-free childbirth B) Provide knowledge and skills to actively participate in birth and parenting C) Eliminate anxiety so that they can have an uncomplicated birth D) Empower the couple to totally control the birth process

B) Provide knowledge and skills to actively participate in birth and parenting

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

B) Thin upper lip

A nurse is developing a program for pregnant women with diabetes about reducing complications. Which factor would the nurse identify as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes? A)Stability of the woman's emotional and psychological status B)Degree of glycemic control achieved during the pregnancy C)Evaluation of retinopathy by an ophthalmologist D)Blood urea nitrogen level (BUN. within normal limits

B)Degree of glycemic control achieved during the pregnancy

The nurse is teaching a pregnant woman with iron deficiency anemia about foods high in iron. Which foods if selected by the woman indicate a successful teaching program? Select all that apply. A. potatoes B. broccoli C. peanut butter D. corn E. yogurt F. raisins

B,C,F R:Foods high in iron include dried fruits such as raisins, whole grains, green leafy vegetables such as broccoli and spinach, peanut butter, and iron-fortified cereals. Potatoes and corn are high in carbohydrates. Yogurt is a good source of calcium.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? A. Hemoglobin of 13 or lower B. Heart rate of 84 C. Hematocrit of 32% or less D. Blood pressure of 100/68

C R:Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dL. Tachycardia, hypotension and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria.

A pregnant woman is flying across the country to visit her family. After teaching the woman about traveling during pregnancy, which statement indicates that the teaching was successful? A) "I'll sit in a window seat so I can focus on the sky to help relax me." B) "I won't drink too much fluid so I don't have to urinate so often." C) "I'll get up and walk around the airplane about every 2 hours." D) "I'll do some upper arm stretches while sitting in my seat."

C) "I'll get up and walk around the airplane about every 2 hours."

A pregnant woman in the 36th week of gestation complains that her feet are quite swollen at the end of the day. After careful assessment, the nurse determines that this is an expected finding at this stage of pregnancy. Which intervention would be most appropriate for the nurse to suggest? A) "Limit your intake of fluids." B) "Eliminate salt from your diet." C) "Try elevating your legs when you sit." D) "Wear Spandex-type full-length pants."

C) "Try elevating your legs when you sit."

A nurse measures a pregnant woman's fundal height and finds it to be 28 cm. The nurse interprets this to indicate which of the following? A) 14 weeks' gestation B) 20 weeks' gestation C) 28 weeks' gestation D) 36 weeks' gestation

C) 28 weeks' gestation

A client who is 4 months pregnant is at the prenatal clinic for her initial visit. Her history reveals she has 7-year-old twins who were born at 34 weeks gestation, a 2-year old son born at 39 weeks gestation, and a spontaneous abortion 1 year ago at 6 weeks gestation. Using the GTPAL method, the nurse would document her obstetric history as: A) 3 2 1 0 3 B) 3 1 2 2 3 C) 4 1 1 1 3 D) 4 2 1 3 1

C) 4 1 1 1 3

On the first prenatal visit, examination of the woman's internal genitalia reveals a bluish coloration of the cervix and vaginal mucosa. The nurse records this finding as: A) Hegar's sign B) Goodell's sign C) Chadwick's sign D) Homans' sign

C) Chadwick's sign

A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? A) Rubella B) Hepatitis B C) Cytomegalovirus D) Parvovirus B19

C) Cytomegalovirus

After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching? A) I should take my iron with milk. B) I should avoid drinking orange juice. C) I need to eat foods high in fiber. D) I'll call the doctor if my stool is black and tarry.

C) I need to eat foods high in fiber.

A pregnant woman has a rubella titer drawn on her first prenatal visit. The nurse explains that this test measures which of the following? A) Platelet level B) Rh status C) Immunity to German measles D) Red blood cell count

C) Immunity to German measles

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

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

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurses teaching was successful? A)I'll basically follow the same diet that I was following before I became pregnant. B)Because I need extra protein, I'll have to increase my intake of milk and meat. C)Pregnancy affects insulin production, so I'll need to make adjustments in my diet. D)I'll adjust my diet and insulin based on the results of my urine tests for glucose.

C)Pregnancy affects insulin production, so I'll need to make adjustments in my diet.

The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply. A. Since fortified cereals are a poor source of iron, eat eggs or pancakes for breakfast. B. Limit intake of dried fruits, eating only fresh fruit. C. Drink orange juice with the iron supplement. D. Cook food in an iron skillet, if possible. E. Increase intake of dried beans and green leafy vegetables.

C,D,E R:Dried fruits, fortified grains and cereals, and animal protein are all good sources of iron for a pregnant woman. Cooking in an iron skillet also will increase the amount of iron ingested. Vitamin C, like what is found in orange juice, enhances absorption of iron and is recommended to drink when taking iron supplements. Folate also increases the effectiveness of iron supplements; foods high in folate include green leafy vegetables, fortified grains and dried beans.

During a routine prenatal check up, the nurse interviews a pregnant client to identify possible risk factors for developing gestational diabetes. Which factor would the nurse identify as increasing the woman's risk? Select all that apply. A. younger maternal age at pregnancy B. previous birth of small for gestational age baby C. maternal obesity with body mass index more than 35 D. client of African-American lineage E. previous history of spontaneous abortion

C,E R:The risk factors for gestational diabetes include previous history of spontaneous abortion, maternal obesity with body mass index (BMI) more than 35, and client of a high-risk ethnic group such as Native American, Hispanic, Asian. The other risk factors for gestational diabetes are previous history of stillbirth, birth of large for gestational age infant, and advancing maternal age.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? A. Blood pressure of 100/68 B. Heart rate of 84 C.Hemoglobin of 13 or lower D. Hematocrit of 32% or less

D R: Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dL. Tachycardia, hypotension and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria.

A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor? A. are usually suggested primarily for women who develop gestational diabetes. B. can be taken until the degeneration of the placenta occurs. C. can be used as long as they control serum glucose levels. D. have been shown to be effective and safe in recent short term studies.

D R: Recent studies have examined the use of oral hypoglycemic medications in pregnancy with much success. Several studies have used glyburide with promising results. Many health care providers are using glyburide and metformin as an alternative to insulin therapy because they do not cross the placenta and therefore do not cause fetal/neonatal hypoglycemia. Some oral hypoglycemic medications are considered safe and may be used if nutrition and exercise are not adequate alone. Maternal and newborn outcomes are similar to those seen in women who are treated with insulin. Oral hypoglycemic agents, however, must be further investigated to determine their safety with confidence and provide better treatment options for diabetes in pregnancy. Currently, there is a growing acceptance of glyburide use as a primary therapy for gestational diabetes. Glyburide and metformin have also been found to be safe, effective, and economical for the treatment of gestational diabetes, although neither drug has been approved by the FDA for use in pregnancy.

The health care provider of a newly pregnant client determines the woman also has mitral stenosis and will need appropriate therapy. Which medication should the nurse prepare to teach this client to provide her with the best possible care? A. warfarin B. digoxin C. aspirin D. heparin

D This client has an increased risk for developing blood clots. If an anticoagulant is required, heparin is the drug of choice as it does not cross the placenta barrier. Warfarin crosses the placenta and may have teratogenic effects. Aspirin is not recommended in this situation. If digoxin is not used to prevent blood clots.

When assessing a pregnant woman in her last trimester, which question would be most appropriate to use to gather information about weight gain and fluid retention? A) "What's your usual dietary intake for a typical day?" B) "What size maternity clothes are you wearing now?" C) "How puffy does your face look by the end of a day?" D) "How swollen do your ankles appear before you go to bed?

D) "How swollen do your ankles appear before you go to bed?

10.When assessing a pregnant woman with heart disease throughout the antepartal period, the nurse would be especially alert for signs and symptoms of cardiac decompensation at which time? A) 16 to 20 weeks gestation B) 20 to 24 weeks gestation C) 24 to 28 weeks gestation D) 28 to 32 weeks gestation

D) 28 to 32 weeks gestation

A nurse is providing care to several pregnant women at the clinic. The nurse would screen for group B streptococcus infection in a client at: A) 16 weeks gestation B) 28 week gestation C) 32 weeks gestation D) 36 weeks gestation

D) 36 weeks gestation

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which of the following to be performed? A) Hemoglobin and hematocrit B) Urine for culture C) Fetal ultrasound D) Fundal height measurement

D) Fundal height measurement

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

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

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

D) Oral prednisone

During a nonstress test, when monitoring the fetal heart rate, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline. The nurse interprets this as: A) Variable decelerations B) Fetal tachycardia C) A nonreactive pattern D) Reactive pattern

D) Reactive pattern

A nursing instructor is describing the various childbirth methods. Which of the following would the instructor include as part of the Lamaze method? A) Focus on the pleasurable sensations of childbirth B) Concentration on sensations while turning on to own bodies C) Interruption of the fear-tension-pain cycle D) Use of specific breathing and relaxation techniques

D) Use of specific breathing and relaxation techniques

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

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

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

D)Cocaine

A woman with diabetes is considering becoming pregnant. She asks the nurse whether she will be able to take oral hypoglycemics when she is pregnant. The nurses response is based on the understanding that oral hypoglycemics: A)Can be used as long as they control serum glucose levels B)Can be taken until the degeneration of the placenta occurs C)Are usually suggested primarily for women who develop gestational diabetes D)Show promising results but more studies are needed to confirm their effectiveness

D)Show promising results but more studies are needed to confirm their effectiveness

placenta

a flattened circular organ in the uterus of pregnant eutherian mammals, nourishing and maintaining the fetus through the umbilical cord. pg.336

umbilical cord

a flexible cordlike structure containing blood vessels and attaching a human or other mammalian fetus to the placenta during gestation.

trophoblast

a layer of tissue on the outside of a mammalian blastula, supplying the embryo with nourishment and later forming the major part of the placenta. pg. 336

morula

a solid ball of cells resulting from division of a fertilized ovum, and from which a blastula is formed. pg. 337

genes

a unit of heredity that is transferred from a parent to offspring and determines some characteristic of the offspring.

cleavage (aka mitosis):

after the sperm meets the egg, in the fallopian tube, the mix (zygote) travels towards the uterus via tubal muscular, movements. during travel, the zygote goes through cleavage x 4, where it becomes a a ball of 16 cells known as a morula.

what happens to the lungs + the foramen ovale, after baby's first breath?

baby breathes = inflation of lungs. this causes increased blood flow to lungs via RV, which then cause pressure to increase in LA. the increased pressure in the LA causes septum primum, a flap that closes to the ductus arteriosus, to snap shut (now the atria are seperated by a wall). the foramen ovale functionally closes w/in 1-2 hrs. physiologically closed by 1 mo d/t deposits of fibrin. permanently closed by 6th month of life.

chorion + chorionic villi:

chorion, made by the trophoblast, consist of the trophoblast cells and a mesodermal lining. it has finger-like projections called chorionic villi which form the fetal portion of the placenta.

genotype

genes inherited from parents. Genetic makeup of an individual, usually in the form of DNA, is the internally coded inheritable information. pg.348

how does newborn circulation work?

it's all a closed system now. unoxygenated blood enters heart through superior/inferior vena cava, enters RA & is pumped in RV. from RV, blood is pumped through pulmonary arteries into lungs, where it's oxygenated. blood travels back via pulmonary veins into LA, then is pumped in LV. from the LV, blood is pumped to all extremities and organs.

what is the blastocyst? also, how is it formed?

once the morula enters the uterus, uterine fluid enters it, turning it into a fluid-filled ball of cells. these cells will continue to divide in specialized cells that will turn into fetal structures. the fluid filled ball of cells is the blastocyst, which will form the embryo & the amnion.

how does blood circulate w/in a fetus?

oxygenated blood is arrives from placenta, half goes through capillaries in liver, while the other half enters inferior vena cava via ductus venosus. from the inferior vena cava, blood [oxygenated] travels to right atrium, then is shunted into the left atrium via foramen ovale, then to the left ventricle. from there, the majority of the blood is pushed to the parts that need it most. the brain & the heart, while a little bit is sent to the lungs to keep them nourished. the blood enters the descending aorta, where it makes its way back to the placenta, via the umbilical arteries.

genetic counseling

process by which the patients or relatives at risk of an inherited disorder are advised of the consequences and nature of the disorder, the probability of developing or transmitting it, and the options open to them in management and family planning.

fertilization

process occurs in about an hour. When one spermatozoon penetrates the ovum's thick outer membrane. pg. 336

genomics

the branch of molecular biology concerned with the structure, function, evolution, and mapping of genomes.

genome

the complete set of genes or genetic material present in a cell or organism.

what happens to the ductus venosus & the ductus arteriosus after birth?

the ductus venosus usually closes w/ inhibition of blood flow secondary to cutting of umbilical cord. the ductus arteriosus closes w/ the increased oxygenation of arterial blood levels. its closure prevents mixing of blood from aorta and pulmonary artery.

what is fertilization? also, when does it occur

the meeting of sperm & egg. it occurs around 2 weeks after the last normal menstrual period in a 28-day cycle.

karyotype

the number and visual appearance of the chromosomes in the cell nuclei of an organism.

trophoblast:

the outer layer of cells surrounding the blastocyst cavity. it develops into the chorion + helps form the placenta.

phenotype

the physical expression, or characteristics, of a trait.

implantation:

the process of attachment (of the blastocyst?) to the endometrium of the uterus. occurs 7-8 days after fertilization

mosaicism

the property or state of being composed of cells of two genetically different types.

genetics

the study of heredity and the variation of inherited characteristics.

zona pellucida

the thick transparent membrane surrounding a mammalian ovum before implantation. pg. 337

oligohydramnios:

too little amniotic fluid (<500 ml @ term). - associates w/: uteroplacental insufficiencies, fetal renal abnormalities, and higher risk for surgical birth (c-section) &/or low-birth weight baby.

polyhydramnios:

too much amniotic fluid ( >2000 ml @ term) - associated w/: maternal diabetes, neural tube defects, chromosomal deviations, malformations of CNS &/or GI tract that prevent normal swallowing of amniotic fluid by fetus. - risk for premature rupture of membranes d/t overdistention.