Maternity by Lowdermilk Chapters 12, 13, 14, 15

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? ___________________ G = # of pregnancy T = after 37 to 42 weeks P = between 20 to before 37 weeks A = before 20 weeks L = # of living children

ANS: 3-1-0-1-0 G: Total number of times the woman has been pregnant (she is pregnant for the third time) T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term) P: Number of pregnancies that resulted in a preterm birth (none) A: Abortions or miscarriages before the period of viability (she has had one) L: Number of children born who are currently living (she has no living children)

Which information regarding amniotic fluid is important for the nurse to understand? a.Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus. b.Volume of the amniotic fluid remains approximately the same throughout the term of a healthy pregnancy. c.The study of fetal cells in amniotic fluid yields little information. d.A volume of more than 2 L of amniotic fluid is associated with fetal renal abnormalities.

ANS: A Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, cushions the fetus, and helps maintain a constant body temperature. The volume of amniotic fluid constantly changes. The study of amniotic fluid yields information regarding the sex of the fetus and the number of chromosomes. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

What kind of fetal anomalies are most often associated with oligohydramnios? a.Renal b.Cardiac c.Gastrointestinal d.Neurologic

ANS: A An amniotic fluid volume of less than 300 ml (oligohydramnios) is often associated with fetal renal anomalies. The amniotic fluid volume has no bearing on the fetal cardiovascular system. Gastrointestinal anomalies are associated with hydramnios or an amniotic fluid volume greater than 2 L. The amniotic fluid volume has no bearing on the fetal neurologic system.

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

ANS: A An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. It is too early in the pregnancy to perform an MSAFP screening; it is performed at 16 to 18 weeks of gestation. An amniocentesis is performed if the MSAFP levels are abnormal or if fetal/maternal anomalies are detected. This procedure is not performed until 16 to 18 weeks of gestation. An NST is performed to assess fetal well-being in the third trimester.

A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where the baby makes the meconium. What is the correct response by the nurse? a.Fetal intestines b.Fetal kidneys c.Amniotic fluid d.Placenta

ANS: A As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. Meconium is not produced by the fetal kidneys nor should it be present in the amniotic fluid, which may be an indication of fetal compromise. The placenta does not produce meconium.

Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus? a. Moderate coffee consumption b. Moderate alcohol consumption c. Cigarette smoke d. Emotional distress

ANS: A Birth defects in humans have not been related to caffeine consumption. Pregnant women who consume more than 300 mg of caffeine daily may be at increased risk for miscarriage or intrauterine growth restriction (IUGR). Although the exact effects of alcohol in pregnancy have not been quantified, it exerts adverse effects on the fetus including fetal alcohol syndrome, fetal alcohol effects, learning disabilities, and hyperactivity. A strong, consistent, causal relation has been established between maternal smoking and reduced birth weight. Childbearing triggers profound and complex physiologic and psychologic changes. Evidence suggests a relationship between emotional distress and birth complications.

A pregnant woman tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal change, commonly called the mask of pregnancy or, scientifically: a. Chloasma b. Linea nigra c. Striae gravidarum d. Palmar erythema

ANS: A Chloasma, the mask of pregnancy, usually fades after birth. Linea nigra is a pigmented line that runs vertically up the abdomen. Striae gravidarum are also known as stretch marks. Palmar erythema is signified by pinkish red blotches on the hands.

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

ANS: A Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in lower extremities. Domestic violence cannot be determined based on the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings. Cocaine use cannot be determined based on the sparse facts provided.

A woman asks the nurse, "What protects my baby's umbilical cord from being squashed while the baby's inside of me?" What is the nurse's best response? a."Your baby's umbilical cord is surrounded by connective tissue called Wharton's jelly, which prevents compression of the blood vessels." b."Your baby's umbilical cord floats around in blood and amniotic fluid." c."You don't need to be worrying about things like that." d."The umbilical cord is a group of blood vessels that are very well protected by the placenta."

ANS: A Explaining the structure and function of the umbilical cord is the most appropriate response. Connective tissue called Wharton's jelly surrounds the umbilical cord, prevents compression of the blood vessels, and ensures continued nourishment of the embryo or fetus. The umbilical cord does not float around in blood or fluid. Telling the client not to worry negates her need for information and discounts her feelings. The placenta does not protect the umbilical cord.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. Which recommendation would the nurse make for this particular client after a tennis match? a.Drink several glasses of fluid. b.Eat extra protein sources such as peanut butter. c.Enjoy salty foods to replace lost sodium. d.Consume easily digested sources of carbohydrate.

ANS: A If no medical or obstetric problems contraindicate physical activity, then pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise because dehydration can trigger premature labor. The woman's caloric intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

An expectant couple attending childbirth classes have questions regarding multiple births since twins "run in the family." What information regarding multiple births is important for the nurse to share? a.Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. b.Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. c.Identical twins are more common in Caucasian families. d.Fraternal twins are the same gender, usually male.

ANS: A If the parents-to-be are older and have taken fertility drugs, then they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; that is, they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference, and fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender, and identical twins are the same gender.

The nurse caring for a pregnant client is evaluating his or her health teaching regarding fetal circulation. Which statement from the client reassures the nurse that his or her teaching has been effective? a."Optimal fetal circulation is achieved when I am in the side-lying position." b."Optimal fetal circulation is achieved when I am on my back with a pillow under my knees." c."Optimal fetal circulation is achieved when the head of the bed is elevated." d."Optimal fetal circulation is achieved when I am on my abdomen."

ANS: A Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously, it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, then blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compressing the vena cava. Many women find lying on their abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.

Appendicitis may be difficult to diagnose in pregnancy because the appendix is: a. Displaced upward and laterally, high and to the right. b. Displaced upward and laterally, high and to the left. c. Deep at McBurney point. d. Displaced downward and laterally, low and to the right.

ANS: A The appendix is displaced laterally, high to the right, and beyond McBurney point.

The various systems and organs of the fetus develop at different stages. Which statement is most accurate? a.Cardiovascular system is the first organ system to function in the developing human. b.Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks of gestation. c.Body changes from straight to C-shape occurs at 8 weeks of gestation. d.Gastrointestinal system is mature at 32 weeks of gestation.

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

The mucous plug that forms in the endocervical canal is called the: a. Operculum b. Leukorrhea c. Funic souffle d. Ballottement

ANS: A The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have: a. Amenorrhea. b. Positive pregnancy test. c. Chadwick's sign. d. Hegar's sign.

ANS: A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are felt by the woman. A positive pregnancy test, the presence of Chadwick's sign, and the presence of Hegar's sign all are probable signs of pregnancy.

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

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

Prenatal testing for human immunodeficiency virus (HIV) is recommended for: a. All women, regardless of risk factors. b. A woman who has had more than one sexual partner. c. A woman who has had a sexually transmitted infection. d. A woman who is monogamous with her partner.

ANS: A Testing for the antibody to HIV is strongly recommended for all pregnant women. A HIV test is recommended for all women, regardless of risk factors. Women who test positive for HIV can be treated, reducing the risk of transmission to the fetus.

While teaching the expectant mother about personal hygiene during pregnancy, maternity nurses should be aware that: a. Tub bathing is permitted even in late pregnancy unless membranes have ruptured. b. The perineum should be wiped from back to front. c. Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath. d. Expectant mothers should use specially treated soap to cleanse the nipples.

ANS: A The main danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

Signs and symptoms that a woman should report immediately to her health care provider include: (Select all that apply) a. Vaginal bleeding. b. Rupture of membranes. c. Heartburn accompanied by severe headache. d. Decreased libido. e. Urinary frequency.

ANS: A, B, C Vaginal bleeding, rupture of membranes, and severe headaches all are signs of potential complications in pregnancy. Clients should be advised to report these signs to the health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, he or she should be knowledgeable regarding known human teratogens, which include: (Select all that apply) a. Infections b. Radiation c. Maternal conditions d. Drugs e. Chemicals

ANS: A, B, C, D, E Exposure to radiation and a number of infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, cytomegalovirus (CMV), and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria (PKU) may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics as well as chemicals including lead, mercury, tobacco, and alcohol also may result in structural and functional abnormalities.

1. Intrauterine growth restriction (IUGR) is associated with what pregnancy-related risk factors? a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension d. Premature rupture of membranes e. Smoking

ANS: A, B, C, E Poor nutrition, maternal collagen disease, gestational hypertension, and smoking are risk factors associated with the occurrence of IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR.

Relating to the fetal circulatory system, which special characteristics allow the fetus to obtain sufficient oxygen from the maternal blood? (Select all that apply) a.Fetal hemoglobin (Hb) carries 20% to 30% more oxygen than maternal Hb. b.Fetal Hb carries 40% to 50% more oxygen than maternal Hb. c.Hb concentration is 50% higher than that of the mother. d.Fetal heart rate is 110 to 160 beats per minute. e.Fetal heart rate is 160 to 200 beats per minute.

ANS: A, C, D The following three special characteristics enable the fetus to obtain sufficient oxygen from maternal blood: (1) the fetal Hb carries 20% to 30% more oxygen; (2) the concentration is 50% higher than that of the mother; and (3) the fetal heart rate is 110 to 160 beats per minute, a cardiac output that is higher than that of an adult.

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

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

Assessment of a woman's nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. Which finding might require consultation to a higher level of care? a. Oral contraceptive use may interfere with the absorption of iron. b. Illnesses that have created nutritional deficits, such as PKU, may require nutritional care before conception. c. The woman's socioeconomic status and educational level are not relevant to her examination; they are the province of the social worker. d. Testing for diabetes is the only nutrition-related laboratory test most pregnant women need.

ANS: B A registered dietitian can help with therapeutic diets. Oral contraceptive use may interfere with the absorption of folic acid. Iron deficiency can appear if placement of an intrauterine device (IUD) results in blood loss. A woman's finances can affect her access to good nutrition; her education (or lack thereof) can influence the nurse's teaching decisions. The nutrition-related laboratory test that pregnant women usually need is a screen for anemia.

A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" What is the best answer? a."A baby's sex is determined as soon as conception occurs." b."The baby has developed enough to enable us to determine the sex by examining the genitals through an ultrasound scan." c."Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different." d."It might be possible to determine your baby's sex, but the external organs look very similar right now."

ANS: B Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.

The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change? a. Her center of gravity will shift backward. b. She will have increased lordosis. c. She will have increased abdominal muscle tone. d. She will notice decreased mobility of her pelvic joints.

ANS: B An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain her balance. The center of gravity shifts forward. She will have decreased muscle tone. She will notice increased mobility of her pelvic joints.

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

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

Which statement regarding the structure and function of the placenta is correct? a.Produces nutrients for fetal nutrition b.Secretes both estrogen and progesterone c.Forms a protective, impenetrable barrier to microorganisms such as bacteria and viruses d.Excretes prolactin and insulin

ANS: B As one of its early functions, the placenta acts as an endocrine gland, producing four hormones necessary to maintain the pregnancy and to support the embryo or fetus: human chorionic gonadotropin (hCG), human placental lactogen (hPL), estrogen, and progesterone. The placenta does not produce nutrients. It functions as a means of metabolic exchange between the maternal and fetal blood supplies. Many bacteria and viruses can cross the placental membrane.

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

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

Which statement concerning neurologic and sensory development in the fetus is correct? a.Brain waves have been recorded on an electroencephalogram as early as the end of the first trimester (12 weeks of gestation). b.Fetuses respond to sound by 24 weeks of gestation and can be soothed by the sound of the mother's voice. c.Eyes are first receptive to light at 34 to 36 weeks of gestation. d.At term, the fetal brain is at least one third the size of an adult brain.

ANS: B Hearing develops early and is fully developed at birth. Brain waves have been recorded at week 8. Eyes are receptive to light at 28 weeks of gestation. The fetal brain is approximately one fourth the size of an adult brain.

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

ANS: B In normal pregnancies the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy. As the uterus grows it may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy. At 14 weeks the uterus is not yet at the level of the umbilicus. The fundus is not palpable above the umbilicus until 22 to 24 weeks of gestation.

A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. What is the nurse's best answer? a."You should have felt the baby move by now." b."Within the next month, you should start to feel fluttering sensations." c."The baby is moving; however, you can't feel it yet." d."Some babies are quiet, and you don't feel them move."

ANS: B Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating, "you should have felt the baby move by now" is incorrect and may be an alarming statement to the client. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, then further assessment is necessary.

A newly married couple plans to use the natural family planning method of contraception. Understanding how long an ovum can live after ovulation is important to them. The nurse knows that his or her teaching was effective when the couple responds that an ovum is considered fertile for which period of time? a.6 to 8 hours b.24 hours c.2 to 3 days d.1 week

ANS: B Most ova remain fertile for approximately 24 hours after ovulation, much longer than 6 to 8 hours. However, ova do not remain fertile for 2 to 3 days or are viable for 1 week. If unfertilized by a sperm after 24 hours, the ovum degenerates and is reabsorbed.

Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy. Why is this the case? a.Maternal nutritional status is extremely difficult to adjust because of an individual's ingrained eating habits. b.Adequate nutrition is an important preventive measure for a variety of problems. c.Women love obsessing about their weight and diets. d.A woman's preconception weight becomes irrelevant.

ANS: B Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach. Pregnancy is a time when many women are motivated to learn about adequate nutrition and make changes to their diet that will benefit their baby. Pregnancy is not the time to begin a weight loss diet. Clients and their caregivers should still be concerned with appropriate weight gain.

Probable signs of pregnancy are: a. Determined by ultrasound b. Observed by the health care provider c. Reported by the client d. Diagnostic tests

ANS: B Probable signs are those detected through trained examination. Fetal visualization is a positive sign of pregnancy. Presumptive signs are those reported by the client. The term diagnostic tests is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy.

A nurse should advise which women about continued condom use during pregnancy? a. Unmarried pregnant women b. Women at risk for acquiring or transmitting sexually transmitted infections (STIs) c. All pregnant women d. Women at risk for candidiasis

ANS: B The objective of "safer sex" is to provide prophylaxis against the acquisition and transmission of STIs. Because these diseases may be transmitted to the woman and her fetus, condom use is recommended throughout pregnancy if the woman is at risk for acquiring an STI. Pregnant women are encouraged to practice "safer sex" behaviors. An unmarried pregnant woman may be in a monogamous relationship and not require the use of a condom. All pregnant women are encouraged to practice "safer sex" behaviors. The client should be educated as to what may place both herself and the fetus at risk. Any pregnant woman might develop candidiasis. This is not related to condom use.

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

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

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

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

In the first trimester, ultrasonography can be used to gain information on: a. Amniotic fluid volume b. The presence of maternal abnormalities c. Placental location and maturity d. Cervical length

ANS: B Ultrasonography can detect certain uterine abnormalities such as bicornuate uterus, fibroids, and ovarian cysts. Amniotic fluid volume is not available via ultrasonography until the second or third trimester. Placental location and maturity are not available via ultrasonography until the second or third trimester. Cervical length is not available via ultrasonography until the second or third trimester.

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

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

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

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

During the first trimester, a woman can expect which of the following changes in her sexual desire? a. An increase, because of enlarging breasts b. A decrease, because of nausea and fatigue c. No change d. An increase, because of increased levels of female hormones

ANS: B Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy, the breasts may become enlarged and tender; this tends to interfere with coitus, decreasing the desire to engage in sexual activity.

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

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

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

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

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

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

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

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

Which time-based description of a stage of development in pregnancy is accurate? a. Viability—22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight >500 g) b. Term—pregnancy from the beginning of week 38 of gestation to the end of week 42 c. Preterm—pregnancy from 20 to 28 weeks d. Postdate—pregnancy that extends beyond 38 weeks

ANS: B Term is 38 to 42 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since LMP. Preterm is 20 to 37 weeks of gestation. Postdate or postterm is a pregnancy that extends beyond 42 weeks or what is considered the limit of full term.

Obstetric hx: pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation Twins were born at 34 weeks of gestation Another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a. 3-1-1-1-3 b. 4-1-2-0-4 c. 3-0-3-0-3 d. 4-2-1-0-3

ANS: B The correct calculation of this woman's gravidity and parity is 4-1-2-0-4. G: total number of times the woman has been pregnant; she is pregnant for the fourth time. T: number of pregnancies carried to term (surpassing 37 week); One was born at 39 weeks of gestation P: This is the number of pregnancies that resulted in a preterm birth (between 20 weeks and before 37 weeks); the woman has had two pregnancies in which she delivered preterm (34 weeks for her twins and 35 weeks of gestation for another child) A: number of spontaneous miscarriages or elective terminations occurring before 20 weeks (prior to viability) L: This number signifies the number of children born that currently are living; the woman has four children -> her children from previous pregnancies are living

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

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

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

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

Physiologic anemia often occurs during pregnancy as a result of: a. Inadequate intake of iron. b. Dilution of hemoglobin concentration. c. The fetus establishing iron stores. d. Decreased production of erythrocytes.

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

Which statement regarding the development of the respiratory system is a high priority for the nurse to understand? a.The respiratory system does not begin developing until after the embryonic stage. b.The infant's lungs are considered mature when the L/S ratio is 1:1, at approximately 32 weeks of gestation. c.Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. d.Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks of gestation. Alternative: With regard to the development of the respiratory system, maternity nurses should be aware that:

ANS: C A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and thus accelerates lung maturity. The development of the respiratory system begins during the embryonic phase and continues into childhood. The infant's lungs are considered mature when the L/S ratio is 2:1, at approximately 35 weeks of gestation. Lung movements have been visualized on ultrasound scans at 11 weeks of gestation.

A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a."That must have been a coincidence; babies can't respond like that." b."The fetus is demonstrating the aural reflex." c."Babies respond to sound starting at approximately 24 weeks of gestation." d."Let me know if it happens again; we need to report that to your midwife."

ANS: C Babies respond to external sound starting at approximately 24 weeks of gestation. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The last statement is inappropriate and may cause undue psychologic alarm to the client.

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

ANS: C Estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. Estrogen levels increase, not decrease. The diaphragm is displaced. However, the key is that estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. The volume of blood is increased. However, the key here is that estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing.

In order to reassure and educate pregnant clients about changes in their breasts, nurses should be aware that: a. The visibility of blood vessels that form an intertwining blue network indicates full function of Montgomery's tubercles and possibly infection of the tubercles b. The mammary glands do not develop until 2 weeks before labor c. Lactation is inhibited until the estrogen level declines after birth d. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding

ANS: C Lactation is inhibited until the estrogen level declines after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by midpregnancy. Colostrum is a creamy white-to-yellow premilk fluid that can be expressed from the nipples before birth.

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

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

A nurse providing care to a pregnant woman should know that all are normal gastrointestinal changes in pregnancy except: a. Ptyalism b. Pyrosis c. Pica d. Decreased peristalsis

ANS: C Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Ptyalism (excessive salivation) is a normal finding. Pyrosis (heartburn) is a normal finding. Decreased peristalsis is a normal finding.

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? a."We don't really know when such defects occur." b."It depends on what caused the defect." c."Defects occur between the third and fifth weeks of development." d."They usually occur in the first 2 weeks of development."

ANS: C The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. "We don't really know when such defects occur" is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development—in the third to fifth weeks; therefore, the statement, "They usually occur in the first 2 weeks of development" is inaccurate.

A client arrives for her initial prenatal examination. This is her first child. She asks the nurse, "How does my baby get air inside my uterus?" What is the correct response by the nurse? a."The baby's lungs work in utero to exchange oxygen and carbon dioxide." b."The baby absorbs oxygen from your blood system." c."The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream." d."The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen." Alternative: Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), "How does my baby get air inside my uterus?" The correct response is:

ANS: C The placenta delivers oxygen-rich blood through the umbilical vein, not the artery, to the fetus and excretes carbon dioxide into the maternal bloodstream. The fetal lungs do not function as respiratory gas exchange in utero. The baby does not simply absorb oxygen from a woman's blood system; rather, blood and gas transport occur through the placenta.

At a routine prenatal visit, the nurse explains the development of the fetus to her client. At approximately ____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. The client is how many weeks of gestation at today's visit? a.20 b.24 c.28 d.30

ANS: C These milestones in human development occur at 28 weeks of gestation. These milestones have not occurred by 20 or 24 weeks of gestation but have been reached before 30 weeks of gestation.

A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2011. Her expected date of birth (EDB) is: a. September 17, 2011 b. November 7, 2011 c. November 21, 2011 d. December 17, 2011

ANS: C Using Nägele's rule, the EDB is calculated by subtracting 3 months from the month of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2011, her due date is November 21, 2011. September 17, 2011, is too short a period to complete a normal pregnancy. Using Nägele's rule, an EDB of November 7, 2011 is 2 weeks early. December 17, 2011, is almost a month past the correct EDB.

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

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

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

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

The nurse should be aware that the partner's main role in pregnancy is to: a. Provide financial support. b. Protect the pregnant woman from "old wives' tales." c. Support and nurture the pregnant woman. d. Make sure the pregnant woman keeps prenatal appointments.

ANS: C The partner's main role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability. In older societies, the man enacted the ritual couvade. Changing cultural and professional attitudes have encouraged fathers' participation in the birth experience over the past 30 years.

With regard to follow-up visits for women receiving prenatal care, nurses should be aware that: a. The interview portions become more intensive as the visits become more frequent over the course of the pregnancy. b. Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. c. During the abdominal examination, the nurse should be alert for supine hypotension. d. For pregnant women, a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive.

ANS: C The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in blood pressure and a feeling of faintness. The interview portion of follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women hypertension is defined as a systolic BP of 140 or greater and a diastolic BP of 90 or greater.

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

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

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

ANS: C, D, E c. Quickening d. Ballottement e. Lightening Quickening is the first recognition of fetal movements or "feeling life." Passive movement of the unengaged fetus is referred to as ballottement. Lightening occurs when the fetus begins to descend into the pelvis. This occurs 2 weeks before labor in the nullipara and at the start of labor in the multipara. Leukorrhea & Development of the operculum occur with pregnancy, but are not a direct result of the fetus

What is the most basic information that a nurse should be able to share with a client who asks about the process of conception? a.Ova are considered fertile 48 to 72 hours after ovulation. b.Sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours. c.Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d.Implantation in the endometrium occurs 6 to 10 days after conception. Alternative: The most basic information a maternity nurse should have concerning conception is:

ANS: D After implantation, the endometrium is called the decidua. Ova are considered fertile for approximately 24 hours after ovulation. Sperm remain viable in the woman's reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse? a. "My husband and I have agreed that my sister will be my coach because he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is okay." b. "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." c. "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." d. "We do not want the fetal monitor used during labor because it will interfere with movement and doing effleurage."

ANS: D Because monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low risk pregnancy and as long as labor is progressing normally. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative. Having the woman's sister as her coach with her husband nearby is an acceptable request for a laboring woman. Using breathing techniques to alleviate pain is a realistic part of a birth plan. Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation.

Which structure is responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream? a.Decidua basalis b.Blastocyst c.Germ layer d.Chorionic villi

ANS: D Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula; implantation occurs at this stage. The germ layer is a layer of the blastocyst.

A woman in the 34th week of pregnancy reports that she is very uncomfortable because of heartburn. Which recommendation would be appropriate for this client? a.Substitute other calcium sources for milk in her diet. b.Lie down after each meal. c.Reduce the amount of fiber she consumes. d.Eat five small meals daily.

ANS: D Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women and do not alleviate heartburn.

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category? a. Blood pressure, age, BMI b. Drug/alcohol use, age, family history c. Family history, blood pressure (BP), BMI d. Family history, BMI, drug/alcohol abuse

ANS: D Her family history of NTD, low BMI, and substance abuse are high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which is a high risk. The woman's drug/alcohol (ETOH) use and family history put her in a high risk category, but her age does not. The woman's family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which is high risk. Her BP is normal.

With regard to maternal, fetal, and neonatal health problems, nurses should be aware that: a. Infection has replaced pulmonary embolism as one of the three top causes of maternal death attributable to pregnancy b. The leading cause of death in the neonatal period is disorders related to short gestation and low birth weight c. Factors related to the maternal death rate include age and marital status but not race d. Antepartum fetal deaths can best be prevented by better recognizing and responding to abnormalities of pregnancy and labor

ANS: D Medical teams need to be alert to signs of trouble. Race is a factor. African-American maternal mortality rates are more than three times higher than those for Caucasian women. Infection used to be an important cause of maternal death; it has been replaced by pulmonary embolism. The leading cause of death in the neonatal period is congenital anomalies. Race is a factor. African-American maternal mortality rates are more than three times higher than those for Caucasian women.

Nutrition is an alterable and important preventive measure for a variety of potential problems such as low birth weight and prematurity. While completing the physical assessment of the pregnant client, the nurse is able to evaluate the client's nutritional status by observing a number of physical signs. Which physical sign indicates to the nurse that the client has unmet nutritional needs? a.Normal heart rate, rhythm, and blood pressure b.Bright, clear, and shiny eyes c.Alert and responsive with good endurance d.Edema, tender calves, and tingling

ANS: D The physiologic changes of pregnancy may complicate the interpretation of physical findings. Lower extremity edema often occurs when caloric and protein deficiencies are present; however, edema in the lower extremities may also be a common physical finding during the third trimester. Completing a thorough health history and physical assessment and requesting further laboratory testing, if indicated, are essential for the nurse. The malnourished pregnant client may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure. A client receiving adequate nutrition will have bright, shiny eyes with no sores and moist, pink membranes. Pale or red membranes, dryness, infection, dull appearance of the cornea, or blue sclerae are signs of poor nutrition. A client who is alert and responsive with good endurance is well nourished. A listless, cachectic, easily fatigued, and tired presentation would be an indication of a poor nutritional status.

In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their clients that: a. Both require the woman to have a full bladder b. The abdominal examination is more useful in the first trimester c. Initially the transvaginal examination can be painful d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail

ANS: D The transvaginal examination also allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty one. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither method should be painful, although with the transvaginal examination the woman will feel pressure as the probe is moved.

A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. In order to reassure the client regarding fetal well-being it is best for the nurse to: a. Assess the fetal heart tones with a Doppler stethoscope b. Measure the girth of the woman's abdomen c. Complete an ultrasound examination (sonogram) d. Offer the woman and her family the opportunity to listen to the fetal heart tones

ANS: D To provide the parents with the greatest sense of reassurance, the nurse should offer to have the client and her spouse the chance to listen to their baby's heartbeat. Fetal heart tones can be heard with a fetoscope in the first trimester; by the second trimester, the fetal heart rate can be heard with the Doppler stethoscope. This should be performed as part of routine fetal assessment. Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an important measure that should be determined with precision, with the same technique and positioning of the client used consistently. This should be completed at every prenatal visit. Routine ultrasound examinations are recommended in early pregnancy; they date the pregnancy and provide useful information about the health of the fetus. They are not necessary at each prenatal visit.

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

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

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

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

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

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

When discussing work and travel during pregnancy with a pregnant patient, nurses should instruct them that: a. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise. b. Women should avoid seat belts and shoulder restraints in the car because they press on the fetus. c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. d. While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so

ANS: D Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

The nurse caring for the pregnant client must understand that the hormone essential for maintaining pregnancy is: a. Estrogen. b. Human chorionic gonadotropin (hCG). c. Oxytocin. d. Progesterone.

ANS: D Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels increase at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider? a. Nausea with occasional vomiting b. Fatigue c. Urinary frequency d. Vaginal bleeding

ANS: D Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of potential complications of the pregnancy. Nausea with occasional vomiting, fatigue, and urinary frequency are normal first-trimester complaints. Although they may be worrisome or annoying to the mother, they usually are not indications of pregnancy problems.

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

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

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

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

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

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

For what reason would breastfeeding be contraindicated? a. Hepatitis B b. Everted nipples c. History of breast cancer 3 years ago d. Human immunodeficiency virus (HIV) positive

ANS: D Women who are HIV positive are discouraged from breastfeeding. Although hepatitis B antigen has not been shown to be transmitted through breast milk, as an added precaution infants born to HBsAg-positive women should receive the hepatitis B vaccine and immune globulin immediately after birth. Everted nipples are functional for breastfeeding. Newly diagnosed breast cancer would be a contraindication to breastfeeding

A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? (Select all that apply) A. The fetal alarm signal is reached when there are no fetal movements noted for 5 hours. B. The patient can monitor fetal activity once daily for a 60-minute period and note activity. C. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. D. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted.

B, C, D The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours.

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? a. Biophysical profile b. Amniocentesis c. Maternal serum alpha-fetoprotein (MSAFP) d. Transvaginal ultrasound

D. Transvaginal ultrasound An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women, whose thick abdominal layers cannot be penetrated adequately with the abdominal approach. A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).

When would the best timeframe be to establish gestational age based on ultrasound? a. At term b. 8 weeks c. Between 14 and 22 weeks d. 36 weeks

c. Between 14 and 22 weeks Rationale: Ultrasound determination of gestational age dating is best done between 14 and 22 weeks. It is less reliable after that period because of variability in fetal size. Standard sets of measurements relative to gestational age are noted around 10 to after 12 weeks and include crown-rump length (after 10), biparietal diameter (after 12), femur length, and head and abdominal circumferences.