Maternity Chapters 1-12

1) The client has delivered her first child at 37 weeks. The nurse would describe this to the client as what type of delivery? A) Preterm B) Postterm C) Early term D) Near term

Answer: C Explanation: A) Preterm births are those that occur between 20 weeks and 37 completed weeks. B) Postterm births are those that occur at 42 weeks and beyond. C) Early term births extend from 37 to 38 weeks' gestation. D) Near term is not terminology used to describe birth.

1) The nurse is assessing a pregnant client in the second trimester of pregnancy during a scheduled prenatal visit. Which questions are appropriate during the assessment process? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Do you feel bloated?" 2. "Do you have hemorrhoids?" 3. "Are you experiencing heartburn?" 4. "Are you experiencing constipation?" 5. "Are you experiencing nausea and vomiting?"

Answer: 1, 2, 3, 4 Explanation: Gastrointestinal symptoms that often occur during the second trimester of pregnancy include feeling bloated, the development of hemorrhoids, heartburn, and constipation. Nausea and vomiting are more common during the first trimester of pregnancy.

1) A pregnant patient's first day of her last menstrual period was 6/14. What would be this patient's estimated date of birth?

Answer: 3/21 Explanation: To determine estimated date of birth, subtract 3 months and add 7 days from the first day of the patient's last menstrual period. For this patient, this would be 6 - 3 or 3 and 14 + 7 or 21. The estimated date of birth would be 3/21.

1) A patient weighing 80 k g with a body mass index of 29.8 is 6 weeks pregnant. What should be this patient's maximum weight at the time of delivery?

Answer: 89 k g Explanation: Women who are obese are advised to limit weight gain to 5 to 9 k g (11 to 20 lb). Since the patient weighs 80 k g at 6 weeks pregnant, the maximum amount she should weigh would be 80 k g + 9 k g = 89 k g.

1) The nurse has completed a community presentation about the changes of pregnancy, and knows that the lesson was successful when a community member states that which of the following is one probable or objective change of pregnancy? A) "Enlargement of the uterus" B) "Hearing the baby's heart rate" C) "Increased urinary frequency" D) "Nausea and vomiting"

Answer: A Explanation: A) An examiner can perceive the objective (probable) changes that occur in pregnancy. Enlargement of the uterus is a probable change. B) Hearing the fetal heart rate is a diagnostic, or positive, change of pregnancy. C) Increased urinary frequency is a subjective, or presumptive, change of pregnancy. D) Nausea and vomiting are subjective, or presumptive, changes of pregnancy.

1) The nurse is explaining to a new prenatal client that the certified nurse-midwife will perform clinical pelvimetry as a part of the pelvic exam. The nurse knows that teaching has been successful when the client makes which statement about the reason for the exam? A) "It will help us know how big a baby I can deliver vaginally." B) "Doing this exam is a part of prenatal care at this clinic." C) "My sister had both of her babies by cesarean." D) "I am pregnant with my first child."

Answer: A Explanation: A) By performing a series of assessments and measurements, the examiner assesses the pelvis vaginally to determine whether the size and shape are adequate for a vaginal birth; this procedure is called clinical pelvimetry. B) Although this is a true statement, the estimation of the pelvis size is a better indication of the client's understanding. C) Stating that the client's sister had her babies by cesarean would not indicate that the client understood the teaching. D) Clinical pelvimetry is done with the first pregnancy, but the client's stating that this is her first child does not indicate that the client understood the teaching.

1) The nurse is working with a client who has experienced a fetal death in utero at 20 weeks. The client asks what her baby will look like when it is delivered. Which statement by the nurse is best? A) "Your baby will be covered in fine hair called lanugo." B) "Your child will have arm and leg buds, not fully formed limbs." C) "A white, cheesy substance called vernix caseosa will be on the skin." D) "The genitals of the baby will be ambiguous."

Answer: A Explanation: A) Downy fine hair called lanugo covers the body of a 20-week-old fetus. B) Limb buds have developed by 35 days post-fertilization. C) Vernix caseosa forms at about 24 weeks. D) Male and female external genitals appear similar until end of ninth week. At 16 weeks, sex determination is possible.

1) The nurse at the prenatal clinic has four calls to return. Which call should the nurse return first? A) Client at 32 weeks, reports headache and blurred vision. B) Client at 18 weeks, reports no fetal movement in this pregnancy. C) Client at 16 weeks, reports increased urinary frequency. D) Client at 40 weeks, reports sudden gush of fluid and contractions.

Answer: A Explanation: A) Headache and blurred vision are signs of preeclampsia, which is potentially life-threatening for both mother and fetus. This client has top priority. B) Fetal movement should be felt by 19-20 weeks. The lack of fetal movement prior to 20 weeks is considered normal. This client is a lower priority. C) Increased urinary frequency is common during pregnancy as the increased size of the uterus puts pressure on the urinary bladder. D) A full-term client who is experiencing contractions and a sudden gush of fluid is in labor. Although laboring clients should be in contact with their provider for advice on when to go to the hospital, labor at full term is an expected finding. This client is a lower priority.

1) The nurse is caring for a client pregnant with twins. Which statement indicates that the client needs additional information? A) "Because both of my twins are boys, I know that they are identical." B) "If my twins came from one fertilized egg that split, they are identical." C) "If I have one boy and one girl, I will know they came from two eggs." D) "It is rare for both twins to be within the same amniotic sac."

Answer: A Explanation: A) Not all same-sex twins are identical or monozygotic, because fraternal, or dizygotic, twins can be the same gender or different genders. B) Identical, or monozygotic, twins develop from a single fertilized ovum. They are of the same sex and have the same phenotype (appearance). C) The only way to have twins of different sexes is if they come from two separate fertilized ova. D) If the amnion has already developed approximately 8 to 12 days after fertilization, division results in two embryos with a common amniotic sac and a common chorion (monochorionic-monoamniotic placenta). This type occurs rarely.

1) The introduction of a new baby into the family is often the beginning of which of the following? A) Sibling rivalry B) Inconsistent childrearing C) Toilet training D) Weaning

Answer: A Explanation: A) Sibling rivalry results from children's fear of change in the security of their relationships with their parents, which comes with the birth of a sibling. B) Consistency is important in dealing with young children. They need reassurance that certain people, special things, and familiar places will continue to exist after the new baby arrives. C) Parents should know that the older, toilet-trained child may regress to wetting or soiling because he or she sees the new baby getting attention for such behavior. D) The older, weaned child may want to drink from the breast or bottle again after the new baby comes.

1) The nurse notes purplish stretch marks on the pregnant client's breasts during the physical assessment. Which term will the nurse use when documenting this finding in the medical record? A) Striae B) Colostrum C) Linea nigra D) Chadwick's sign

Answer: A Explanation: A) Striae is the term used to document the purplish stretch marks that may be noted on the breasts during pregnancy. B) Colostrum is not the term used to document the purplish stretch marks that may be noted on the breasts during pregnancy. C) Linea nigra is not the term used to document the purplish stretch marks that may be noted on the breasts during pregnancy. D) Chadwick's sign is not the term used to document the purplish stretch marks that may be noted on the breasts during pregnancy.

1) A client tells you that her mother was a twin, two of her sisters have twins, and several cousins either are twins or gave birth to twins. The client, too, is expecting twins. Because there is a genetic predisposition to twins in her family, there is a good chance that the client will have what type of twins? A) Dizygotic twins B) Monozygotic twins C) Identical twins D) Nonzygotic twins

Answer: A Explanation: A) Studies indicate that dizygotic twins tend to occur in certain families, perhaps because of genetic factors that result in elevated serum gonadotropin levels leading to double ovulation. B) Monozygotic twins, known also as identical twins, are not familial. C) Identical twins, known also as monozygotic twins, are not familial. D) Nonzygotic twins do not exist.

1) While completing the medical and surgical history during the initial prenatal visit, the 16-year-old primigravida interrupts with "Why are you asking me all these questions? What difference does it make?" Which statement would best answer the client's questions? A) "We ask these questions to detect anything that happened in your past that might affect the pregnancy." B) "We ask these questions to see whether you can have prenatal visits less often than most clients do." C) "We ask these questions to make sure that our paperwork and records are complete and up to date." D) "We ask these questions to look for any health problems in the past that might affect your parenting."

Answer: A Explanation: A) The course of a pregnancy depends on a number of factors, including the past pregnancy history (if this is not a first pregnancy), prepregnancy health of the woman, presence of disease/illness states, family history, emotional status, and past healthcare. B) Prenatal visits follow a set schedule for normal clients without complications. C) Paperwork is a lower priority than client care. D) The psychological history of a client, not the medical or surgical history, can indicate potential problems with parenting.

1) A pregnant client who is at 14 weeks' gestation asks the nurse why the doctor used to call her baby an embryo, and now calls it a fetus. What is the best answer to this question? A) "Fetus is the term used from the ninth week of gestation onward." B) "We call a baby a fetus when it is larger than an embryo." C) "An embryo is a baby from conception until the eighth week." D) "The official term for a baby in utero is really zygote."

Answer: A Explanation: A) The fetal stage begins in the ninth week. B) The embryonic stage ends with the eighth week, regardless of size. C) The preembryonic stage is from conception until day 15. A zygote is a fertilized ovum

1) The nurse is collecting information during the health history assessment for the client profile during the initial prenatal visit. Which question is appropriate when assessing the current pregnancy? A) "What was the date of your last menstrual period?" B) "How many times have you been pregnant?" C) "What were your children's birth weights?" D) "How many living children do you have?"

Answer: A Explanation: A) The nurse would ask the client for the date of the last menstrual period when assessing the current pregnancy as part of the client profile. B) The nurse would ask the client how many times she has been pregnant when assessing past pregnancies as part of the client profile. C) The nurse would assess the birth weights of the client's children when assessing past pregnancies as part of the client profile. D) The nurse would ask the client how many living children she has when assessing past pregnancies as part of the client profile.

1) A woman gave birth last week to a fetus at 18 weeks' gestation after her first pregnancy. She is in the clinic for follow-up, and notices that her chart states she has had one abortion. The client is upset over the use of this word. How can the nurse best explain this terminology to the client? A) "Abortion is the obstetric term for all pregnancies that end before 20 weeks." B) "Abortion is the word we use when someone has miscarried." C) "Abortion is how we label babies born in the second trimester." D) "Abortion is what we call all babies who are born dead."

Answer: A Explanation: A) The term abortion means a birth that occurs before 20 weeks' gestation or the birth of a fetus-newborn who weighs less than 500 g. An abortion may occur spontaneously, or it may be induced by medical or surgical means. B) This explanation is only partially correct. C) This explanation is only partially correct. D) This is not a true statement.

1) Which term will the nurse use when teaching a client information regarding the entire female external genitalia? A) Vulva B) Clitoris C) Mons pubis D) Perineal body

Answer: A Explanation: A) The vulva is the term the nurse will use when documenting information about the entire female external genitalia. B) The clitoris is a structure included in the female external genitalia. This term is not used when referring to the entire female external genitalia. C) The mons pubis is a structure included in the female external genitalia. This term is not used when referring to the entire female external genitalia. The perineal body is a structure included in the female external genitalia. This term is not used when referring to the entire female external genitalia

1) The nurse is seeing prenatal clients in the clinic. Which client is exhibiting expected findings? A) 12 weeks' gestation, with fetal heart tones heard by Doppler fetoscope B) 22 weeks' gestation, client reports no fetal movement felt yet C) 16 weeks' gestation, fundus three finger-breadths above umbilicus D) Marked edema

Answer: A Explanation: A) This is an expected finding because fetal heart tones should be heard by 12 weeks using a Doppler fetoscope. B) At 22 weeks, no fetal movement is an abnormal finding. Fetal movement should be felt by 20 weeks. C) This is an abnormal finding. The fundus should be three finger-breadths above umbilicus at 28 weeks. D) This is an abnormal finding. There may be some edema of hands and ankles in late pregnancy, but marked edema could indicate preeclampsia.

1) Which serum markers are assessed when conducting a quadruple screen? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Alpha-fetoprotein (A F P) B) Human chorionic gonadotropin (h C G) C) Unconjugated estriol (U E) D) Inhibin-A E) Glycated hemoglobin

Answer: A, B, C, D Explanation: A) A quadruple screen assesses for the serum marker of A F P. B) A quadruple screen assesses for the serum marker of h C G. C) A quadruple screen assesses for the serum marker of U E. D) A quadruple screen assesses the serum marker of inhibin-A. E) A quadruple screen does not assess for glycated hemoglobin.

1) What are the three functions of the fallopian tubes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Provide transport for the ovum from the ovary to the uterus B) Serve as a warm, moist, nourishing environment for the ovum or zygote C) Secrete large amounts of estrogens D) Provide a site for fertilization to occur E) Support and protect the pelvic contents

Answer: A, B, D Explanation: A) The fallopian tubes provide transport for the ovum from the ovary to the uterus. B) The fallopian tubes serve as a warm, moist, nourishing environment for the ovum or zygote. C) The ovaries, not the fallopian tubes, secrete large amounts of estrogens. D) The fallopian tubes provide a site for fertilization to occur. E) The female bony pelvis, not the fallopian tubes, supports and protects the pelvic contents.

1) The nurse educator is teaching student nurses what a fetus will look like at various weeks of development. Which descriptions would be typical of a fetus at 20 weeks' gestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The fetus has a body weight of 435-465 g. B) Nipples appear over the mammary glands. C) The kidneys begin to produce urine. D) Nails are present on fingers and toes. E) Lanugo covers the entire body.

Answer: A, B, D, E Explanation: A) A fetus at 20 weeks' gestation has a body weight of 435-465 g. B) A fetus at 20 weeks' gestation has nipples appear over the mammary glands. C) Kidneys of a fetus begin to produce urine at 12 weeks' gestation. D) A fetus at 20 weeks' gestation has nails present on fingers and toes. E) A fetus at 20 weeks' gestation has lanugo that covers the entire body.

1) The nurse is teaching the pregnant client about the symptoms of preeclampsia. Which clinical manifestations will the nurse include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Dizziness B) Blurred vision C) Abdominal pain D) Vaginal bleeding E) Severe headache

Answer: A, B, E Explanation: A) Dizziness is a clinical manifestation associated with preeclampsia. B) Blurred vision is a clinical manifestation associated with preeclampsia. C) Abdominal pain is a clinical manifestation of premature labor or abruptio placentae, not preeclampsia. D) Vaginal bleeding is a clinical manifestation of abruptio placentae or placenta previa, not preeclampsia. E) Severe headache is a clinical manifestation associated with preeclampsia.

1) Ovarian hormones include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Estrogens B) Progesterone C) Parathyroid hormone D) Luteinizing hormone E) Testosterone

Answer: A, B, E Explanation: A) Ovarian hormones include the estrogens, progesterone, and testosterone. B) Ovarian hormones include the estrogens, progesterone, and testosterone. C) Ovarian hormones do not include the parathyroid hormone. D) Ovarian hormones do not include the luteinizing hormone, although the ovary is sensitive to it. E) Ovarian hormones include the estrogens, progesterone, and testosterone.

1) The nurse is assessing a client in the third trimester of pregnancy. What physiologic changes in the client are expected? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The client's chest circumference has increased by 6 cm during the pregnancy. B) The client has a narrowed subcostal angle. C) The client is using thoracic breathing. D) The client may have epistaxis. E) The client has a productive cough.

Answer: A, C, D Explanation: A) The chest increase compensates for the elevated diaphragm. B) The diaphragm is elevated and the subcostal angle is increased as a result of pressure from the enlarging uterus. C) Breathing changes from abdominal to thoracic as pregnancy progresses. D) Epistaxis (nosebleeds) may occur and are primarily the result of estrogen-induced edema and vascular congestion of the nasal mucosa. E) A productive cough is never a normal finding.

1) The nurse is conducting an initial prenatal assessment for a pregnant client. Which screenings should the nurse prepare the client for during this visit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Complete blood count (CBC) B) Glucose tolerance test (GT T) C) A B O and Rh typing D) H I V screening E) Urinalysis

Answer: A, C, D, E Explanation: A) A C B C is drawn during the initial prenatal visit. B) A G T T is not done until the second trimester of the pregnancy. C) A B O and Rh typing are drawn during the initial prenatal visit. D) An H I V screening is drawn during the initial prenatal visit. E) A urinalysis is conducted during the initial prenatal visit and for every subsequent prenatal visit.

1) The nurse understands that a client's pregnancy is progressing normally when what physiologic changes are documented on the prenatal record of a woman at 36 weeks' gestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The joints of the pelvis have relaxed, causing a waddling gait. B) The cervix is firm and blue-purple in color. C) The uterus vasculature contains one sixth of the total maternal blood volume. D) Gastric emptying time is delayed, and the client complains of constipation and bloating. Supine hypotension

Answer: A, C, D, E Explanation: A) The sacroiliac, sacrococcygeal, and pubic joints of the pelvis relax in the later part of the pregnancy, presumably as a result of hormonal changes. This often causes a waddling gait. B) Cervical changes during pregnancy include softening and blue-purple discoloration. C) By the end of pregnancy, one sixth of the total maternal blood volume is contained within the vascular system of the uterus. D) Gastric emptying time and intestinal motility are delayed, leading to frequent complaints of bloating and constipation, which can be aggravated by the smooth muscle relaxation and increased electrolyte and water reabsorption in the large intestine. E) The enlarging uterus may exert pressure on the vena cava when the woman lies supine, causing a drop in blood pressure. This is called the vena caval syndrome, or supine hypotension.

1) Student nurses in their obstetrical rotation are learning about fertilization and implantation. The process of implantation is characterized by which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The trophoblast attaches itself to the surface of the endometrium. B) The most frequent site of attachment is the lower part of the anterior uterine wall. C) Between days 7 and 10 after fertilization, the zona pellucida disappears, and the blastocyst implants itself by burrowing into the uterine lining. D) The lining of the uterus thins below the implanted blastocyst. E) The cells of the trophoblast grow down into the uterine lining, forming the chorionic villi.

Answer: A, C, E Explanation: A) During implantation, the trophoblast attaches itself to the surface of the endometrium for further nourishment. B) The most frequent site of attachment is the upper part of the posterior uterine wall. C) Between days 7 and 10 after fertilization, the zona pellucida disappears, and the blastocyst implants itself by burrowing into the uterine lining and penetrating down toward the maternal capillaries until it is completely covered. D) The lining of the uterus thickens, not thins. E) The cells of the trophoblast grow down into the thickened lining, forming the chorionic villi.

1) A nurse examining a prenatal client recognizes that a lag in progression of measurements of fundal height from week to week and month to month could signal what condition? A) Twin pregnancy B) Intrauterine growth restriction C) Hydramnios D) Breech position

Answer: B Explanation: A) A sudden increase in fundal height could indicate twins. B) A lag in progression of measurements of fundal height from month to month could signal intrauterine growth restriction (I U G R). C) A sudden increase in fundal height could indicate hydramnios. D) A fetus in breech position would still have a normal fundal height measurement.

1) The adolescent client reports to the clinic nurse that her period is late, but her home pregnancy test is negative. What should the nurse explain that these findings most likely indicate? A) "This means you are not pregnant." B) "You might be pregnant, but it might be too early for your home test to be accurate." C) "We don't trust home tests. Come to the clinic for a blood test." D) "Most people don't use the tests correctly. Did you read the instructions?"

Answer: B Explanation: A) Although it might be true that she is not pregnant, this is not the best statement because the pregnancy might be too early for a urine pregnancy test to detect. B) This is a true statement. Most home pregnancy tests have low false-positive rates, but the false-negative rate is slightly higher. Repeating the test in a week is recommended. C) This statement is not worded therapeutically. A clinic pregnancy test is usually a urine test. D) Although this statement gets at the need to read the instructions for the test, it is not worded therapeutically.

1) The nurse is assessing a primiparous client who indicates that her religion is Judaism. Why is this information pertinent for the nurse to assess? A) Religious and cultural background can impact what a client eats during pregnancy. B) It provides a baseline from which to ask questions about the client's religious and cultural background. C) Knowing the client's beliefs and behaviors regarding pregnancy is not important. D) Clients sometimes encounter problems in their pregnancies based on what religion they practice.

Answer: B Explanation: A) Although this can be true, much more than diet is impacted by religious and cultural background. B) Nurses have an obligation to be aware of other cultures and develop a culturally sensitive plan of care to meet the needs of the childbearing woman and her family. C) It is especially helpful if the nurse is familiar with common practices of various religious and cultural groups who reside in the community. D) How a client observes her religion occasionally will cause problems with pregnancy, but this is not the most important reason for obtaining this information.

1) The true moment of fertilization occurs when what happens? A) Cortical reaction occurs B) Nuclei unite C) Spermatozoa propel themselves up the female tract D) Sperm surrounding the ovum release their enzymes

Answer: B Explanation: A) At the moment of penetration by a fertilizing sperm, the zona pellucida undergoes a reaction that prevents additional sperm from entering a single ovum, known as the block to polyspermy. This cellular change is mediated by release of materials from the cortical granules, organelles found just below the ovum's surface, and is called the cortical reaction. B) The true moment of fertilization occurs as the nuclei unite. Their individual nuclear membranes disappear, and their chromosomes pair up to produce the diploid zygote. C) Fertilization has not yet occurred when the spermatozoa are still in the female reproductive tract. This is part of the acrosomal reaction and occurs prior to fertilization

1) The female and male reproductive organs are homologous, which means what? A) They are believed to cause vasoconstriction and muscular contraction B) They are fundamentally similar in function and structure C) They are rich in sebaceous glands D) They are target organs for estrogenic hormones

Answer: B Explanation: A) Efferent sympathetic motor nerves are believed to cause vasoconstriction and muscular contraction. B) The female and male reproductive organs are homologous; that is, they are fundamentally similar in function and structure. C) The labia minora are rich in sebaceous glands. D) The female internal reproductive organs are target organs for estrogenic hormones.

1) A pregnant woman tells the nurse-midwife, "I've heard that if I eat certain foods during my pregnancy, the baby will be a boy." The nurse-midwife should explain that this is a myth, and that the sex of the baby is determined at what time? A) At the time of ejaculation B) At the time of fertilization C) At the time of implantation D) At the time of differentiation

Answer: B Explanation: A) Ejaculation is the release of sperm from the male, and does not necessarily cause a pregnancy. B) Fertilization is the point at which the sex of the zygote is determined. C) Implantation is when the fertilized ovum is implanted in the uterine endometrium. The sex of the zygote has already been determined at this stage. D) Differentiation refers to a cell division process.

1) A nurse teaches newly pregnant clients that if an ovum is fertilized and implants in the endometrium, the hormone the fertilized egg begins to secrete is which of the following? A) Estrogen B) Human chorionic gonadotropin (h C G) C) Progesterone D) Luteinizing hormone

Answer: B Explanation: A) Estrogen and progesterone are ovarian hormones. B) If the ovum is fertilized and implants in the endometrium, the fertilized egg begins to secrete human chorionic gonadotropin (h C G), which is needed to maintain the corpus luteum. C) Estrogen and progesterone are ovarian hormones. D) Luteinizing hormone is excreted by the anterior pituitary gland.

1) A woman has been unable to complete a full-term pregnancy because the fertilized ovum failed to implant in the uterus. This is most likely due to a lack of which hormone? A) Estrogen B) Progesterone C) F S H D) L H

Answer: B Explanation: A) Estrogens are associated with characteristics contributing to femaleness. B) Progesterone is often called the hormone of pregnancy because it inhibits uterine contractions and relaxes smooth muscle to cause vasodilation, allowing pregnancy to be maintained. C) F S H is a hormone secreted by the pituitary gland, and its lack would not affect the ability of the uterus to be prepared for implantation of the fertilized ovum. D) L H is a hormone secreted by the pituitary gland, and its lack would not affect the ability of the uterus to be prepared for implantation of the fertilized ovum.

1) The pregnant client at 14 weeks' gestation is in the clinic for a regular prenatal visit. Her mother also is present. The grandmother-to-be states that she is quite uncertain about how she can be a good grandmother to this baby because she works full time. Her own grandmother was retired, and was always available when needed by a grandchild. What is the nurse's best response to this concern? A) "Don't worry. You'll be a wonderful grandmother. It will all work out fine." B) "What are your thoughts on what your role as grandmother will include?" C) "As long as there is another grandmother available, you don't have to worry." "Grandmothers are supposed to be available. You should retire from your job

Answer: B Explanation: A) It is important to avoid clichés in order to promote effective therapeutic communication. B) Although relationships with parents can be very complex, the expectant grandparents often become increasingly supportive of the expectant couple, even if conflicts previously existed. But it can be difficult for even sensitive grandparents to know how deeply to become involved in the childrearing process. In some areas, classes for grandparents provide information about changes in birthing and parenting practices. C) It is important to avoid placing guilt on clients in order to promote effective therapeutic communication. D) It is important to avoid placing guilt on clients in order to promote effective therapeutic communication.

1) The nurse is preparing to assess the pregnant client's fundal height during a routine prenatal visit. Which nursing action is appropriate in this situation? A) Telling the client not to eat or drink for one hour after the procedure B) Asking the client to empty her bladder prior to the procedure C) Obtaining informed consent for the procedure D) Assessing blood pressure after the procedure

Answer: B Explanation: A) It is not necessary for the client to abstain from eating or drinking for one hour after the procedure. This action might be appropriate for a client who is having a glucose tolerance test, not for one undergoing assessment of fundal height. B) It is appropriate for the nurse to ask the client to empty her bladder prior to assessing fundal height. A full bladder may impact the accuracy of the measurement. C) Informed consent is not needed, as assessing fundal height is not an invasive procedure. D) There is no reason to assess the client's blood pressure after measuring fundal height.

1) The nurse is conducting an initial prenatal appointment for a client who believes she is pregnant. Which is considered a positive sign of pregnancy? A) Linea nigra B) Fetal heartbeat C) Breast tenderness D) Urinary frequency

Answer: B Explanation: A) Linea nigra is a probable, not positive, sign of pregnancy. B) A fetal heartbeat is a positive sign of pregnancy. C) Breast tenderness is a probable, not positive, sign of pregnancy. D) Urinary frequency is a probable, not positive, sign of pregnancy.

1) The nurse is preparing a class on reproduction. What is the cell division process called that results in two identical cells, each with the same number of chromosomes as the original cell? A) Meiosis B) Mitosis C) Oogenesis D) Gametogenesis

Answer: B Explanation: A) Meiosis is a process of cell division that leads to the development of ova and sperm. B) Mitosis results in the production of diploid body (somatic) cells, which are exact copies of the original cell. C) Oogenesis is the process that produces the female gamete, called an ovum (egg). D) Gametogenesis is the process by which germ cells, or gametes (ova and sperm), are produced.

1) The nurse teaching a high school class explains that during the menstrual cycle, the endometrial glands begin to enlarge under the influence of estrogen and cervical mucosal changes occur; the changes peak at ovulation. In which phase of the menstrual cycle does this occur? A) Menstrual B) Proliferative C) Secretory D) Ischemic

Answer: B Explanation: A) Menstruation occurs during the menstrual phase. B) The proliferative phase begins when the endometrial glands begin to enlarge under the influence of estrogen and cervical mucosal changes occur; the changes peak at ovulation. C) The secretory phase occurs after ovulation. The ischemic phase occurs if fertilization does not occur

1) The nurse receives a phone call from a client who claims she is pregnant. The client reports that she has regular menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What would the client's estimated date of delivery (E D D) be if she is pregnant? A) Nov. 13 B) Jan. 17 C) Jan. 10 D) Dec. 3

Answer: B Explanation: A) Nov. 13 is not correct according to Nagele's rule. B) The due date is Jan. 17. Nagele's rule is to add 7 days to the last menstrual period and subtract 3 months. The last menstrual period is April 10, therefore Jan. 17 is the E D D. C) Jan. 10 is not correct according to Nagele's rule. D) Dec. 3 is not correct according to Nagele's rule.

1) A client who is in the second trimester of pregnancy tells the nurse that she has developed a darkening of the line in the midline of her abdomen from the symphysis pubis to the umbilicus. What other expected changes during pregnancy might she also notice? A) Lightening of the nipples and areolas B) Reddish streaks called striae on her abdomen C) A decrease in hair thickness D) Small purplish dots on her face and arms

Answer: B Explanation: A) Pigmentation of the skin increases in areas already hyperpigmented: areolae, nipples, vulva, perianal area, and linea alba. B) Striae, or stretch marks, are reddish, wavy, depressed streaks that may occur over the abdomen, breasts, and thighs as pregnancy progresses. C) A greater percentage of hair follicles go into the dormant phase, resulting in less hair shedding, which is perceived as thickening of the hair. D) Although bright-red elevations on the skin (vascular spider nevi) are a normal finding, petechiae are not

1) Couples at risk for having a detectable single gene or chromosomal anomaly may wish to undergo which procedure? A) Preimplantation genetic screening (P G S) B) Preimplantation genetic diagnosis (P G D) C) Intracytoplasmic sperm injection (I C S I) D) Gamete intrafallopian transfer (G I F T)

Answer: B Explanation: A) Preimplantation genetic screening (P G S) is a term used when the embryos are screened for aneuploidy for the purpose of increasing the likelihood of a viable pregnancy with normal chromosomes. B) Preimplantation genetic diagnosis (P G D) is a term used when one or both genetic parents carry a gene mutation and testing is performed to determine whether that mutation or unbalanced chromosomal compliment has been passed to the oocyte or embryo. C) Intracytoplasmic sperm injection (I C S I) is a microscopic procedure to inject a single sperm into the outer layer of an ovum so that fertilization will occur. D) Gamete intrafallopian transfer (G I F T) involves the retrieval of oocytes by laparoscopy.

1) A prenatal educator is asking a partner about normal psychologic adjustment of an expectant mother during the second trimester of pregnancy. Which answer by the partner would indicate a typical expectant mother's response to pregnancy? A) "She is very body-conscious, and hates every little change." B) "She daydreams about what kind of parent she is going to be." C) "I haven't noticed anything. I just found out she was pregnant." D) "She has been having dreams at night about misplacing the baby."

Answer: B Explanation: A) Psychologic adjustment to pregnancy is as significant as the physiologic changes. B) The second trimester brings increased introspection and consideration of how she will parent. She might begin to get furniture and clothing as concrete preparation, and may feel movement and be aware of the fetus as she begins to incorporate it into her identity. C) In the first trimester, pregnant women usually tell their partners of the pregnancy. This answer is incorrect. D) Psychologic adjustment to pregnancy is as significant as the physiologic changes. In the third trimester, dreams of misplacing the baby or being unable to get to the baby are common.

1) The nurse begins a prenatal assessment on a 25-year-old primigravida at 20 weeks' gestation and immediately contacts the healthcare provider because of which finding? A) Pulse 88/minute B) Respirations 30/minute C) Temperature 37.4°C (99.3°F) D) Blood pressure 118/82 m m H g

Answer: B Explanation: A) Pulse rate may increase 10-15 beats per minute during pregnancy, with an average of 60-100 beats per minute. B) Tachypnea is not a normal finding and requires medical care. C) A slightly higher temperature is an expected finding during pregnancy, ranging from 36.2°C-37.6°C (97°F-99.6°F). A blood pressure of less than or equal to 120/80 mmHg is considered normal

1) The prenatal clinic nurse is designing a new prenatal intake information form for pregnant clients. Which question is best to include on this form? A) Where was the father of the baby born? B) Do genetic diseases run in the family of the baby's father? C) What is the name of the baby's father? D) Are you married to the father of the baby?

Answer: B Explanation: A) The father's place of birth is not important information to include about the pregnancy. B) This question has the highest priority because it gets at the physiologic issue of inheritable genetic diseases that might directly impact the baby. C) Although it is helpful for the nurse to know the name of the baby's father to include him in the prenatal care, this is psychosocial information. D) Although the marital status of the client might have cultural significance, this is psychosocial information.

1) The nurse is presenting a class to pregnant clients. The nurse asks, "The fetal brain is developing rapidly, and the nervous system is complete enough to provide some regulation of body function on its own, at which fetal development stage?" It is clear that education has been effective when a participant makes which response? A) "The 17th-20th week" B) "The 25th-28th week" C) "The 29th-32nd week" D) "The 33rd-36th week"

Answer: B Explanation: A) The nervous system function is not developed between the 17th and 20th weeks of gestation. B) Between the 25th and 28th week, the brain is developing rapidly, and the nervous system is complete enough to provide some degree of regulation of body functions. C) The complexity of the nervous system develops long before the 29th-32nd week. D) The complexity of the nervous system develops long before the 33rd-36th week.

1) Nurses who are interacting with expectant families from a different culture or ethnic group can provide more effective, culturally sensitive nursing care by doing what? A) Recognizing that ultimately it is the family's right to make a woman's healthcare choices. B) Obtaining a medical interpreter of the language the client speaks. C) Evaluating whether the client's healthcare beliefs have any positive consequences for her health. D) Accepting personal biases, attitudes, stereotypes, and prejudices.

Answer: B Explanation: A) The nurse should recognize that ultimately it is the woman's right to make her own healthcare choices. B) The nurse should provide for the services of an interpreter if language barriers exist. C) The nurse should evaluate whether the client's healthcare beliefs have any potential negative consequences for her health. D) The nurse should identify personal biases, attitudes, stereotypes, and prejudices.

1) A client at 16 weeks' gestation has a hematocrit of 35%. Her prepregnancy hematocrit was 40%. Which statement by the nurse best explains this change? A) "Because of your pregnancy, you're not making enough red blood cells." B) "Because your blood volume has increased, your hematocrit count is lower." C) "This change could indicate a serious problem that might harm your baby." D) "You're not eating enough iron-rich foods like meat."

Answer: B Explanation: A) The pregnancy would not cause a decrease in the production of red blood cells. B) Hemoglobin and hematocrit levels drop in early to mid-pregnancy as a result of pregnancy-associated hemodilution. Because the plasma volume increase (50%) is greater than the erythrocyte increase (25%), the hematocrit decreases slightly. C) This change is referred to as physiologic anemia of pregnancy, and is not harmful to the fetus. D) The decreased hematocrit does not mean that the woman is not eating enough iron-rich foods. It is recommended that an iron supplement during pregnancy of 27 milligrams of iron be taken daily, and iron can be found in most prenatal supplements.

1) A 25-year-old primigravida is at 20 weeks' gestation. The nurse takes her vital signs and notifies the healthcare provider immediately because of which finding? A) Pulse 88/minute B) Rhonchi in both bases C) Temperature 37.4°C (99.3°F) D) Blood pressure 122/78 m m H g

Answer: B Explanation: A) The pulse will increase 10-15 beats/minute during pregnancy, with 60-90 beats/minute being the normal range. B) Any abnormal breath sounds should be reported to the healthcare provider. C) Temperature norms in pregnancy are slightly higher due to fetal metabolism: 36.2-37.6°C (97-99.6°F). D) A blood pressure less than or equal to 120/80 m m H g considered normal.

1) The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take based on these findings? A) Document the findings on the prenatal chart. B) Have the physician see the client today. C) Instruct the client to avoid direct sunlight. D) Analyze previous thyroid hormone lab results.

Answer: B Explanation: A) While all of these findings should be documented on the prenatal chart, additional action is indicated. B) Mottling of the skin is indicative of possible anemia. These abnormalities must be reported to the healthcare provider immediately. C) Instructing the client to avoid direct sunlight is not necessary; rather, additional action is indicated. D) The thyroid gland increases in size during pregnancy due to hyperplasia. Additional action is indicated.

1) What signs would indicate that a pregnant client's urinalysis culture was abnormal? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) p H 4.6-8 B) Alkaline urine C) Cloudy appearance D) Negative for protein and red blood cells E) Hemoglobinuria

Answer: B, C, E Explanation: A) Urine p H of 4.6-8 is within a normal, healthy range. B) Alkaline urine could indicate metabolic alkalemia, Proteus infection, or an old specimen. C) A cloudy appearance could indicate an infection. D) Positive findings could indicate contaminated specimen, U T I, or kidney disease. Hemoglobinuria would be indicated by an abnormal urine color

A couple is at the clinic for preconceptual counseling. Both parents are 40 years old. The nurse knows that the education session has been successful when the wife makes which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "We are at low risk for having a baby with Down syndrome." B) "Our children are more likely to have genetic defects." C) "Children born to parents our age have sex-linked disorders." D) "The tests for genetic defects can be done early in pregnancy." E) "It will be almost impossible for us to conceive a child."

Answer: B, D Explanation: A) The risk for trisomy 21 (Down syndrome) is 1 in 385. B) Women 35 or older are at greater risk for having children with chromosome abnormalities. C) Sex-linked disorders are not related to the age of either parent. D) Genetic testing such as amniocentesis and chorionic villus sampling are done in the first trimester. E) Fertility decreases somewhat after age 35, but being over 35 does not mean that conception is impossible.

1) What are the three functions of cervical mucosa? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Form the relatively fixed axis of the birth passage B) Provide lubrication for the vaginal canal C) Provide nourishment and protective maternal antibodies to infants D) Provide an alkaline environment to shelter deposited sperm from the acidic vaginal secretions E) Act as a bacteriostatic agent

Answer: B, D, E Explanation: A) The female boney pelvis forms the relatively fixed axis of the birth passage. B) The cervical mucosa provides lubrication for the vaginal canal. C) The breasts provide nourishment and protective maternal antibodies to infants. D) The cervical mucosa provides an alkaline environment to shelter deposited sperm from the acidic vaginal secretions. E) The cervical mucosa acts as a bacteriostatic agent.

1) The nurse is providing care to a pregnant client diagnosed with a urinary tract infection (U T I) during a routine prenatal visit. What will the nurse educate the client about based on this data? A) Gestational hypertension B) Gestational diabetes mellitus C) Preterm labor D) Anemia

Answer: C Explanation: A) A diagnosis of a U T I during pregnancy does not increase the risk for gestational hypertension. B) A diagnosis of a U T I during pregnancy does not increase the risk for gestational diabetes mellitus. C) The nurse would provide teaching to the client regarding signs and symptoms associated with preterm labor, as the diagnosis of a U T I increases the risk for developing this complication of pregnancy. A diagnosis of a UTI during pregnancy does not increase the risk for anemia

1) The nurse has received a phone call from a multigravida who is 21 weeks pregnant and has not felt fetal movement yet. What is the best action for the nurse to take? A) Reassure the client that this is a normal finding in multigravidas. B) Suggest that she should feel for movement with her fingertips. C) Schedule an appointment for her with her physician for that same day. D) Tell her gently that her fetus is probably dead.

Answer: C Explanation: A) A lack of fetal movement is unusual at 21 weeks, and should be checked. B) Fetal movement can be actively palpated by the client's physician or a trained examiner, but is unlikely to be self-detected by the mother at this stage. C) Quickening, or the mother's perception of fetal movement, occurs about 18 to 20 weeks after the L M P in a primigravida (a woman who is pregnant for the first time) but may occur as early as 16 weeks in a multigravida (a woman who has been pregnant more than once). D) The fetus may or may not have died after or about the 20th week of pregnancy; however, telling the client that the fetus might have died in utero without confirmation of this fact is nontherapeutic.

1) A woman is experiencing mittelschmerz and increased vaginal discharge. Her temperature has increased by 0.6°C (1.0°F) over the past 36 hours. This most likely indicates what? A) Menstruation is about to begin. B) Ovulation will occur soon. C) Ovulation has occurred. D) She is pregnant, and will not menstruate.

Answer: C Explanation: A) A temperature increase does not occur when menstruation is about to begin. B) A temperature increase does not occur before ovulation has occurred. C) In some women, ovulation is accompanied by mid-cycle pain, known as mittelschmerz. This pain may be caused by a thick tunica albuginea or by a local peritoneal reaction to the expelling of the follicular contents. Body temperature increases about 0.3°C to 0.6°C (0.5°F to 1°F) 24 to 48 hours after the time of ovulation. D) Pregnancy can be detected through the presence of human chorionic gonadotropin hormone.

1) The nurse is reviewing preconception questionnaires in charts. Which couple are the most likely candidates for preconceptual genetic counseling? A) Wife is 30 years old, husband is 31 years old B) Wife and husband are both 29 years old, first baby for husband, wife has a normal 4-year-old C) Wife's family has a history of hemophilia D) Single 32-year-old woman is using donor sperm

Answer: C Explanation: A) An age under 35 is not a risk factor for genetic abnormalities. B) An age under 35 is not a risk factor for genetic abnormalities. C) For families in which the woman is a known or possible carrier of an X-linked disorder, such as hemophilia, the risk of having an affected male fetus is 25%. D) Sperm donors are screened for genetic disorders, and men with a possible genetic problem are not accepted for sperm donation.

1) The nurse is providing prenatal care to an obese client who asks, "How much weight should I gain during my pregnancy?" Which response by the nurse is appropriate? A) "You should gain 15 to 25 pounds." B) "You should gain 25 to 35 pounds." C) "You should gain 11 to 20 pounds." D) "You should gain 28 to 40 pounds."

Answer: C Explanation: A) An overweight client should gain 15 to 25 pounds during pregnancy. B) A pregnant client who has a normal weight before pregnancy should gain 25 to 35 pounds during pregnancy. C) An obese client who becomes pregnant should gain 11 to 20 pounds during pregnancy. D) An underweight client should gain 28 to 40 pounds during pregnancy.

1) Which statement regarding cervical mucus is accurate during ovulation and appropriate to include in an educational session with the client? A) Cervical mucus is thicker during ovulation. B) Cervical mucus is opaque during ovulation. C) Cervical mucus is clearer during ovulation. D) Cervical mucus is acidic during ovulation.

Answer: C Explanation: A) Cervical mucus is thinner, not thicker, during ovulation. B) Cervical mucus is clearer, not opaque, during ovulation. C) Cervical mucus is clearer during ovulation. D) Cervical mucus is alkaline, not acidic, during ovulation.

1) Which statement by a pregnant client to the nurse would indicate that the client understood the nurse's teaching? A) "Because of their birth relationship, fraternal twins are more similar to each other than if they had been born singly." B) "Identical twins can be the same or different sex." C) "Congenital abnormalities are more prevalent in identical twins." D) "Identical twins occur more frequently than fraternal twins."

Answer: C Explanation: A) Fraternal twins are not more similar to each other than if they had been born singly. B) Identical, or monozygotic twins, have identical chromosomal structures, and, therefore, are always the same sex. C) Monozygotic twinning is considered a random event and occurs in approximately 3 to 4 per 1000 live births. Congenital anomalies are more prevalent and both twins may have the same malformation. D) Dizygotic, or fraternal, twins occur more frequently than do monozygotic twins.

1) The nurse is listening to the fetal heart tones of a client at 37 weeks' gestation while the client is in a supine position. The client states, "I'm getting lightheaded and dizzy." What is the nurse's best action? A) Assist the client to sit up. B) Remind the client that she needs to lie still to hear the baby. C) Help the client turn onto her left side. Check the client's blood pressure

Answer: C Explanation: A) Having the client sit up will not offer the best and fastest relief. B) Having the client lie still will not improve the situation, and is not therapeutic. C) During pregnancy the enlarging uterus may put pressure on the vena cava when the woman is supine, resulting in supine hypotensive syndrome. This pressure interferes with returning blood flow and produces a marked decrease in blood pressure with accompanying dizziness, pallor, and clamminess, which can be corrected by having the woman lie on her left side. D) The client is hypotensive because she is at the end of pregnancy and lying supine. Checking her blood pressure will not relieve the situation.

1) A client who is experiencing her first pregnancy has just completed the initial prenatal examination with a certified nurse-midwife. Which statement indicates that the client needs additional information? A) "Because we heard the baby's heartbeat, I am undoubtedly pregnant." B) "Because I have had a positive pregnancy test, I am undoubtedly pregnant." C) "My last period was 2 months ago, which means I'm 2 months along." D) "The increased size of my uterus means that I am finally pregnant."

Answer: C Explanation: A) Hearing the fetal heart rate is a positive, or diagnostic, change of pregnancy, so this statement would not indicate the need for further teaching. B) A positive pregnancy test is a positive, or diagnostic, indication of pregnancy. This statement would not indicate the need for further teaching. C) Amenorrhea is a subjective, or presumptive, change of pregnancy, and is not a reliable indicator of pregnancy in the early months. This statement requires additional teaching. D) Increased uterine size is an objective, or probable, change of pregnancy.

1) What is the increased vascularization causing the softening of the cervix known as? A) Hegar sign B) Chadwick sign C) Goodell sign D) McDonald sign

Answer: C Explanation: A) Hegar sign is a softening of the isthmus of the uterus. B) Increased vascularization causes blue-purple discoloration of the cervix known as Chadwick sign. C) Increased vascularization causes the softening of the cervix known as Goodell sign. D) McDonald sign is an ease in flexing the body of the uterus against the cervix.

1) During her first months of pregnancy, a client tells the nurse, "It seems like I have to go to the bathroom every 5 minutes." The nurse explains to the client that this is because of which of the following? A) The client probably has a urinary tract infection. B) Bladder capacity increases throughout pregnancy. C) The growing uterus puts pressure on the bladder. D) Some women are very sensitive to body function changes.

Answer: C Explanation: A) Increased frequency of urination in the first trimester of pregnancy does not indicate a urinary tract infection. B) Bladder capacity does not increase throughout pregnancy. C) During the first trimester, the growing uterus puts pressure on the bladder, producing urinary frequency until the second trimester, when the uterus becomes an abdominal organ. Near term, when the presenting part engages in the pelvis, pressure is again exerted on the bladder. D) Sensitivity is not the cause of an increased frequency of urination in the first trimester.

1) The nurse is creating a handout on reproduction for teen clients. Which piece of information should the nurse include in this handout? A) The fertilized ovum is called a gamete. B) Prior to fertilization, the sperm are zygotes. C) Ova survive 12-24 hours in the fallopian tube if not fertilized. Sperm survive in the female reproductive tract up to a week

Answer: C Explanation: A) Ova and sperm are gametes; a fertilized ovum is a zygote. B) Sperm are gametes (as are ova); a zygote is a fertilized ovum. C) Ova are considered fertile for about 12 to 24 hours after ovulation. Sperm can survive in the female reproductive tract for 48 to 72 hours but are believed to be healthy and highly fertile for only about the first 24 hours

1) What would the nurse include as part of a routine physical assessment for a second-trimester primiparous patient whose prenatal care began in the first trimester and is ongoing? A) Pap smear B) Hepatitis B screening (H Bs A g) C) Fundal height measurement D) Complete blood count

Answer: C Explanation: A) Pap smear is usually done at the initial prenatal appointment. B) Hepatitis B screening is done at the initial prenatal appointment. C) At each prenatal visit, the blood pressure, pulse, and weight are assessed, and the size of the fundus is measured. Fundal height should be increasing with each prenatal visit. D) Complete blood count is done at the initial prenatal appointment.

1) The nurse is assessing a pregnant client who reports nasal stuffiness and congestion. Which term will the nurse use to document this data in the medical record? A) Rales B) Epistaxis C) Rhinitis of pregnancy D) Pregnancy-induced asthma

Answer: C Explanation: A) Rales is not the term the nurse uses to document nasal stuffiness and congestion that occurs during pregnancy. B) Epistaxis is not the term the nurse uses to document nasal stuffiness and congestion that occurs during pregnancy. C) Rhinitis of pregnancy is the term that the nurse will use when documenting nasal stuffiness and congestion that often occurs during pregnancy. D) Pregnancy-induced asthma is not the term the nurse uses to document nasal stuffiness and congestion that occurs during pregnancy.

1) Screening for gestational diabetes mellitus (G D M) is typically completed between which of the following weeks of gestation? A) 36 and 40 weeks B) Before 20 weeks C) 24 and 28 weeks D) 30 and 34 weeks

Answer: C Explanation: A) Screening for gestational diabetes mellitus (G D M) is not completed between 36 and 40 weeks' gestation. B) Screening for gestational diabetes mellitus (G D M) is not completed before 20 weeks' gestation. C) Screening for gestational diabetes mellitus (G D M) is typically completed between 24 and 28 weeks' gestation. D) Screening for gestational diabetes mellitus (G D M) is not completed between 30 and 34 weeks' gestation.

1) The student nurse encounters a 15-year-old girl who reports that she has no pubic or axillary hair and has not yet experienced growth of her breasts. The student asks the nurse about the physiology of this occurrence. The nurse explains that the client probably lacks which hormone? A) Testosterone B) Progesterone C) Estrogen D) Prolactin

Answer: C Explanation: A) Testosterone is responsible for the development of secondary sex characteristics in males. B) Progesterone and prolactin do not accomplish this change. C) Estrogens influence the development of secondary sex characteristics in females. Progesterone and prolactin do not accomplish this change

1) The nurse is providing care to a pregnant client who is experiencing an increase in white, thick, and "cottage-cheese-like" vaginal discharge. Based on this data, which diagnosis does the nurse anticipate for this client? A) Syphilis B) Gonorrhea C) Moniliasis D) Chlamydia

Answer: C Explanation: A) The assessment data does not support the diagnosis of syphilis. B) The assessment data does not support the diagnosis of gonorrhea. C) Vaginal secretions during pregnancy are often thick, white and acidic which increase the client's risk for moniliasis, a common yeast infection during pregnancy. D) The assessment data does not support the diagnosis of chlamydia.

1) It is 1 week before a pregnant client's due date. The nurse notes on the chart that the client's pulse rate was 74-80 before pregnancy. Today, the client's pulse rate at rest is 90. What action should the nurse should take? A) Chart the findings. B) Notify the physician of tachycardia. C) Prepare the client for an electrocardiogram (E K G). Prepare the client for transport to the hospital

Answer: C Explanation: A) The pulse rate frequently increases during pregnancy, although the amount varies from almost no increase to an increase of 10 to 15 beats per minute. This is a normal response, and does not indicate a need for emergency measures or treatment. B) This pulse rate in a near-term client is not considered to be tachycardia. C) This pulse rate in a near-term client does not indicate a need for emergency measures or treatment. D) This client does not need to go to the hospital.

1) A client with a normal prepregnancy weight asks why she has been told to gain 25-35 pounds during her pregnancy while her underweight friend was told to gain more weight. What should the nurse tell the client the recommended weight gain is during pregnancy? A) 25-35 pounds, regardless of a client's prepregnant weight B) More than 25-35 pounds for an overweight woman C) Up to 40 pounds for an underweight woman D) The same for a normal weight woman as for an overweight woman

Answer: C Explanation: A) The recommended total weight gain during pregnancy for a woman of normal weight before pregnancy is 25 to 35 pounds. B) For women who were overweight before becoming pregnant, the recommended gain is 15 to 25 pounds. C) Prepregnant weight determines the recommended weight gain during pregnancy. Underweight women are advised to gain 28-40 pounds. D) Women of normal weight should gain 25-35 pounds during pregnancy, whereas overweight women should limit their weight gain to 15-25 pounds during pregnancy.

1) The nurse is preparing a presentation on the menstrual cycle for a group of high school students. Which statement should the nurse include in this presentation? A) "The menstrual cycle has five distinct phases that occur during the month." B) "One hormone controls the phases of the menstrual cycle." C) "The secretory phase occurs when a woman is most fertile." D) "Menstrual cycle phases vary in order from one woman to another."

Answer: C Explanation: A) There are four phases of the menstrual cycle. B) Four hormones control ovulation and, therefore, the menstrual cycle. C) During the secretory phase, the vascularity of the entire uterus increases greatly, providing a nourishing bed for implantation. Although the length of the menstrual cycle might vary, the phases of the menstrual cycle always occur in the same order

1) The nurse is creating a poster for pregnant mothers. Which description of fetal development should the nurse include? A) Four primary germ layers form from the blastocyst. B) After fertilization, the cells only become larger for several weeks. C) Most organs are formed by 8 weeks after fertilization. The embryonic stage is from fertilization until 5 months

Answer: C Explanation: A) Three primary germ layers form from the blastocyst: ectoderm, mesoderm, and endoderm. B) After fertilization, the cells reproduce by mitosis, resulting in more cells, not larger cells. C) Most organs are formed during the embryonic stage, which lasts from the 15th day after fertilization until the end of the 8th week after conception. D) The embryonic stage ends before the fifth month.

1) The client is at 6 weeks' gestation, and is spotting. The client had an ectopic pregnancy 1 year ago, so the nurse anticipates that the physician will order which intervention? A) A urine pregnancy test B) The client to be seen next week for a full examination C) An antiserum pregnancy test D) An ultrasound

Answer: C Explanation: A) Urine pregnancy tests are not quantifiable. B) It is not appropriate to wait until next week to see the client. C) A β-Subunit radioimmunoassay (R I A) uses an antiserum with specificity for the β-subunit of h C G in blood plasma. This test may not only detect pregnancy but also detect an ectopic pregnancy or trophoblastic disease. D) An ultrasound may be used to diagnose an ectopic pregnancy, but would not be needed now.

1) The nurse is assessing an obese pregnant client during a routine prenatal visit. Which is the priority assessment for this client? A) Complete blood count (C B C) B) Basic metabolic panel (B M P) C) Blood pressure D) Fetal heart rate

Answer: C Explanation: A) While it is important to monitor the client's C B C to assess for anemia, this is not the priority assessment for this client. B) The B M P is not commonly monitored during pregnancy. A blood glucose level may be monitored, as the client's weight places her at risk for gestational diabetes mellitus. C) The blood pressure would be monitored closely at each prenatal visit due to the client's weight. Obese clients have a greater risk for gestational hypertension. This is the priority assessment for this client. D) While it is important to monitor the fetal heart rate during every prenatal visit, this is not the priority for this client.

1) The nurse is explaining the difference between meiosis and mitosis. Which statements would be best? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Meiosis is the division of a cell into two exact copies of the original cell. B) Mitosis is splitting one cell into two, each with half the chromosomes of the original cell. C) Meiosis is a type of cell division by which gametes, or the sperm and ova, reproduce. D) Mitosis occurs in only a few cells of the body. Meiotic division leads to cells that halve the original genetic material

Answer: C, E Explanation: A) Meiosis creates two cells that have half of the chromosomes of the original cell. B) Mitosis creates two cells that are exact copies of the original cell. C) Meiosis is a special type of cell division by which diploid cells give rise to gametes (sperm and ova). D) Mitosis makes growth and development possible. In mature individuals it is the process by which our body cells continue to divide and replace themselves. E) Meiosis creates two cells that contain half the genetic material of the parent cell.

1) The clinic nurse is compiling data for a yearly report. Which client would be classified as a primigravida? A) A client at 18 weeks' gestation who had a spontaneous loss at 12 weeks B) A client at 13 weeks' gestation who had an ectopic pregnancy at 8 weeks C) A client at 14 weeks' gestation who has a 3-year-old daughter at home D) A client at 15 weeks' gestation who has never been pregnant before

Answer: D Explanation: A) A pregnant woman who has been pregnant before is called a multigravida. B) A pregnant woman who has been pregnant before is called a multigravida. C) A pregnant woman who has been pregnant before is called a multigravida. D) Primigravida means a woman who is pregnant for the first time.

1) Which of the following is common in many non-Western cultures and is on the increase in the United States? A) Ceremonial rituals and rites B) Cultural assessment C) Cultural values D) Co-sleeping

Answer: D Explanation: A) A universal tendency exists to create ceremonial rituals and rites around important life events. B) Healthcare professionals are becoming increasingly aware of the importance of addressing cultural, physiologic, and psychologic needs in the prenatal assessment in order to provide culture-specific healthcare during pregnancy. C) Identification of cultural values is useful in planning and providing culturally sensitive care. D) Some parents advocate cosleeping or bed sharing (one or both parents sleeping with their baby or young child). Cosleeping, which is common in many non-Western cultures, is on the increase in the United States.

1) The nurse is assessing a newly pregnant client. Which finding does the nurse note as a normal psychosocial adjustment in this client's first trimester? A) An unlisted telephone number B) Reluctance to tell the partner of the pregnancy C) Parental disapproval of the woman's partner D) Ambivalence about the pregnancy

Answer: D Explanation: A) An unlisted telephone number does not indicate psychosocial adjustment. B) Reluctance to tell the partner about the pregnancy might indicate that the client anticipates disapproval, and is not a normal psychosocial adjustment. C) Parental disapproval of the client's partner does not indicate psychosocial adjustment. D) Ambivalence toward a pregnancy is a common psychosocial adjustment in early pregnancy.

1) The primigravida at 22 weeks' gestation has a fundal height palpated slightly below the umbilicus. Which of the following statements would best describe to the client why she needs to be seen by a physician today? A) "Your baby is growing too much and getting too big." B) "Your uterus might have an abnormal shape." C) "The position of your baby can't be felt." D) "Your baby might not be growing enough."

Answer: D Explanation: A) At 22 weeks' gestation, the fundal height should be at about 22 c m. B) Uterine shape can be assessed only with diagnostic imaging techniques such as ultrasound or C T scan. C) The position of the baby is not noted until 36 weeks' gestation. D) The fundal height at 20-22 weeks should be about even with the umbilicus. At 22 weeks' gestation, a fundal height below the umbilicus and a uterine size that is inconsistent with length of gestation could indicate fetal demise.

1) The nurse is presenting a community education session on female hormones. Which statement from a participant indicates the need for further information? A) "Estrogen is what causes females to look female." B) "The presence of some hormones causes other to be secreted." C) "Progesterone is present at the end of the menstrual cycle." D) "Prostaglandin is responsible for achieving conception."

Answer: D Explanation: A) Estrogens are associated with characteristics contributing to femaleness, including breast alveolar lobule growth and duct development. B) It is true that the presence of some hormones causes other to be secreted. .X X C C) It is true that the proportions of progesterone and estrogen control the events of both ovarian and menstrual cycles. D) Prostaglandin is not related to conception. Prostaglandin production increases during follicular maturation and has basic regulatory functions in cells.

1) The nurse is preparing a handout on the ovarian cycle to a group of middle school girls. Which information should the nurse include? A) The hormone human chorionic gonadotropin stimulates ovulation. B) Irregular menstrual cycles have varying lengths of the luteal phase. C) The ovum leaves its follicle during the follicular phase. D) There are two phases of the ovarian cycle: luteal and follicular.

Answer: D Explanation: A) Human chorionic gonadotropin (h C G) is secreted by a fertilized ovum, and does not stimulate ovulation. B) In women whose menstrual cycles vary, usually it is only the length of the follicular phase that varies, while the luteal phase is of fixed length. C) The luteal phase begins when the ovum leaves its follicle. D) The ovarian cycle has two phases: the follicular phase (days 1 to 14) and the luteal phase (days 15 to 28 in a 28-day cycle).

1) The nurse teaching the phases of the menstrual cycle should include that the corpus luteum begins to degenerate, estrogen and progesterone levels fall, and extensive vascular changes occur in which phase? A) Menstrual phase B) Proliferative phase C) Secretory phase D) Ischemic phase

Answer: D Explanation: A) In the menstrual phase, estrogen levels are low, cervical mucus is scant, viscous, and opaque, and endometrium is shed. B) In the proliferative phase, endometrium and myometrium thickness increases and estrogen peaks just before ovulation. C) In the secretory phase, estrogen drops sharply, and progesterone dominates; vascularity of the entire uterus increases; and tissue glycogen increases, making the uterus ready for implantation. D) In the ischemic phase, the corpus luteum begins to degenerate, and as a result, both estrogen and progesterone levels fall. Small blood vessels rupture, and the spiral arteries constrict and retract, causing a deficiency of blood in the endometrium, which becomes pale.

1) A newborn has been diagnosed with a disorder that occurs through an autosomal recessive inheritance pattern. The parents ask the nurse, "Which of us passed on the gene that caused the disorder?" What should the nurse tell them? A) The female B) The male C) Neither D) Both

Answer: D Explanation: A) It is not a sex-linked disorder or an abnormal chromosome disorder. B) It is not a sex-linked abnormality. C) In an autosomal recessive inherited disorder, both parents are carriers of the abnormal gene. D) An affected individual can have clinically normal parents, but both parents are generally carriers of the abnormal gene.

1) The nurse is preparing a handout for female adolescents on the menstrual cycle. What phase of the cycle occurs if fertilization does not take place? A) Menstrual B) Proliferative C) Secretory D) Ischemic

Answer: D Explanation: A) Menstruation occurs during the menstrual phase. Some endometrial areas are shed, whereas others remain. B) The proliferative phase begins when the endometrial glands enlarge, the blood vessels become prominent and dilated, and the endometrium increases in thickness. C) The secretory phase follows ovulation. D) The ischemic phase occurs if fertilization does not occur.

1) The nurse is teaching a pregnant client the clinical manifestations associated with preterm labor. Which client statement indicates the need for further education? A) "Menstrual-like cramps are a sign of preterm labor." B) "A dull low backache is a sign of preterm labor." C) "Diarrhea is a sign of preterm labor." D) "Vomiting is a sign of preterm labor."

Answer: D Explanation: A) Painful menstrual-like cramps are a sign of preterm labor. This statement indicates appropriate understanding of the information presented. B) A dull low backache is a sign of preterm labor. This statement indicates appropriate understanding of the information presented. C) Diarrhea is a sign of preterm labor. This statement indicates appropriate understanding of the information presented. D) Vomiting is not a clinical manifestation associated with preterm labor. This statement indicates the need for further education.

1) The nurse explains to a preconception class that if only a small volume of sperm is discharged into the vagina, an insufficient quantity of enzymes might be released when they encounter the ovum. In that case, pregnancy would probably not result, because of which of the following? A) Peristalsis of the fallopian tube would decrease, making it difficult for the ovum to enter the uterus. B) The block to polyspermy (cortical reaction) would not occur. C) The fertilized ovum would be unable to implant in the uterus. Sperm would be unable to penetrate the zona pellucida of the ovum

Answer: D Explanation: A) Peristalsis of the fallopian tube is not a factor in this stage of fertilization. B) A block to polyspermy would indicate that the ovum had already been penetrated by a fertilizing sperm, which would occur later in the fertilization process. C) The ovum has not yet been fertilized in this example. D) About a thousand acrosomes must rupture to clear enough hyaluronic acid for even a single sperm to penetrate the ovum's zona pellucida successfully. If only a small amount of sperm were released, there most likely would be an insufficient quantity of acrosomes to penetrate the zona pellucida of the ovum and allow fertilization.

1) The nurse is explaining "quickening" to a client who is pregnant for the first time. Which client indicates the need for further education on this topic? A) "It will feel like butterflies in my stomach." B) "It might feel like I have gas." C) "It should occur during the second trimester of my pregnancy." D) "It is an indication that I am experiencing preterm labor."

Answer: D Explanation: A) Quickening is often described as if there are butterflies in the stomach. This statement indicates appropriate understanding of the information presented. B) Quickening is often mistaken for gas. This statement indicates appropriate understanding of the information presented. C) Quickening often occurs during the second trimester of pregnancy, between 16 and 22 weeks' gestation. This statement indicates appropriate understanding of the information presented. Quickening is not an indication of preterm labor, but an expected finding during pregnancy. This statement indicates the need for further education

1) The couple at 12 weeks' gestation has been told that their fetus has sickle cell disease. Which statement by the couple indicates that they are adequately coping? A) "We knew we were both carriers of sickle cell disease. We shouldn't have tried to have a baby." B) "If we had been healthier when we conceived, our baby wouldn't have this disease now." C) "Taking vitamins before we got pregnant would have prevented this from happening." D) "The doctor told us there was a 25% chance that our baby would have sickle cell disease."

Answer: D Explanation: A) Self-blame and judgment do not indicate adequate coping. B) Preconception health and nutrition do not affect transmission of an autosomal recessive trait. Self-blame and judgment do not indicate adequate coping. C) Preconception health and nutrition do not affect transmission of an autosomal recessive trait. D) A true statement indicates adequate coping. When both parents are carriers of an autosomal recessive disease, there is a 25% risk for each pregnancy that the fetus will be affected.

1) The client at 30 weeks' gestation with her first child is upset. She tells the prenatal clinic nurse that she is excited to become a mother, and has been thinking about what kind of parent she will be. But her mother has told her that she doesn't want to be a grandmother because she doesn't feel old enough, while her husband has said that the pregnancy doesn't feel real to him yet, and he will become excited when the baby is actually here. What is the most likely explanation for what is happening within this family? A) Her husband will not attach with this child and will not be a good father. B) Her mother is rejecting the role of grandparent, and will not help out. C) The client is not progressing through the developmental tasks of pregnancy. D) The family members are adjusting to the role change at their own paces.

Answer: D Explanation: A) The expectant father must first deal with the reality of the pregnancy and then struggle to gain recognition as a parent from his partner, family, friends, coworkers, society-and from his baby as well. B) Younger grandparents leading active lives may not demonstrate as much interest as the young couple would like. C) This is a false statement. The client is at the stage of seeking acceptance of this child by others, which first will be her partner and other family members. D) This is a true statement. With each pregnancy, routines and family dynamics are altered, requiring readjustment and realignment.

1) A woman calls the clinic and tells a nurse that she thinks she might be pregnant. She wants to use a home pregnancy test before going to the clinic, and asks the nurse how to use it correctly. What information should the nurse give? A) The false-positive rate of these tests is quite high. B) If the results are negative, the woman should repeat the test in 2 weeks if she has not started her menstrual period. C) A negative result merely indicates growing trophoblastic tissue and not necessarily a uterine pregnancy. D) The client should follow up with a healthcare provider after taking the home pregnancy test.

Answer: D Explanation: A) The false-positive rate of these tests is quite low. B) If the results are negative, the woman should repeat the test in 1 week if she has not started her menstrual period. C) A positive result merely indicates growing trophoblastic tissue and not necessarily a uterine pregnancy. D) It is important that clients remember that the tests are not always accurate and they should follow up with a healthcare provider.

1) What is the function of the scrotum? A) Produce testosterone, the primary male sex hormone B) Deposit sperm in the female vagina during sexual intercourse so that fertilization of the ovum can occur C) Provide a reservoir where spermatozoa can survive for a long period D) Protect the testes and the sperm by maintaining a temperature lower than that of the body

Answer: D Explanation: A) The interstitial cells produce testosterone, the primary male sex hormone. B) The primary reproductive function of the penis is to deposit sperm in the female vagina during sexual intercourse so that fertilization of the ovum can occur. C) The epididymis provides a reservoir where spermatozoa can survive for a long period. D) The function of the scrotum is to protect the testes and the sperm by maintaining a temperature lower than that of the body.

1) The nurse is providing care to a client who is entering the second trimester of pregnancy. Which client statement does the nurse anticipate when assessing this client? A) "We picked out a name for a boy and for a girl." B) "We bought the baby's crib and car seat this past weekend." C) "I am so uncomfortable all the time and I can't seem to sleep at night." D) "I am angry with my husband for not showing more interest in my pregnancy."

Answer: D Explanation: A) The nurse would expect this client statement during the third, not second, trimester of pregnancy. B) The nurse would expect this client statement during the third, not second, trimester of pregnancy. C) The nurse would expect this client statement during the third, not second, trimester of pregnancy. The nurse would expect this statement during the second trimester of pregnancy

1) The nurse is assessing a pregnant client during a scheduled prenatal visit who reports dizziness and clamminess when lying in bed each morning. Which statement by the nurse is appropriate based on this data? A) "The doctor may order an amniocentesis to determine if the fetus is healthy." B) "This information indicates that you are developing gestational hypertension." C) "Be sure to sit up slowly and stay sitting for several minutes prior to getting up." "Try lying on your left side to enhance blood flow, which will help your symptoms

Answer: D Explanation: A) This data does not warrant an amniocentesis. B) This data does not support the diagnosis of gestational hypertension. C) This statement is appropriate for a client who is experiencing orthostatic hypotension and is not appropriate for the data assessed. The data suggests that the client is experiencing supine hypotension, which is often corrected by having the client lie on her left side

1) The partner of a client at 16 weeks' gestation accompanies her to the clinic. The partner tells the nurse that the baby just doesn't seem real to him, and he is having a hard time relating to his partner's fatigue and food aversions. Which statement would be best for the nurse to make? A) "If you would concentrate harder, you'd be aware of the reality of this pregnancy." B) "My husband had no problem with this. What was your childhood like?" C) "You might need professional psychological counseling. Ask your physician." D) "Many men feel this way. Feeling the baby move in a few weeks will help make it real to you."

Answer: D Explanation: A) This is inappropriate for the nurse say. B) This is an inappropriate comment for the nurse to make. C) The partner's feelings are not indicative of psychological pathology. D) Initially, expectant fathers may have ambivalent feelings. The extent of ambivalence depends on many factors, including the father's relationship with his partner, his previous experience with pregnancy, his age, his economic stability, and whether the pregnancy was planned. The expectant father must first deal with the reality of the pregnancy and then struggle to gain recognition as a parent from his partner, family, friends, coworkers, society-and from his baby as well.

1) If a woman has the pre-existing condition of diabetes, the nurse knows that she would be prone to what high-risk factor when pregnant? A) Vasospasm B) Postpartum hemorrhage C) Episodes of hypoglycemia and hyperglycemia D) Cerebrovascular accident (C V A)

Answer: D Explanation: A) Vasospasm would be a high-risk factor for a client with pre-existing cardiac disease. B) Postpartum hemorrhage would be a high-risk factor for a client with pre-existing hyperthyroidism. C) Episodes of hypoglycemia and hyperglycemia would be a high-risk factor for a client with pre-existing diabetes. D) Cerebrovascular accident (C V A) would be a high-risk factor for a client with pre-existing hypertension.

1) The client in the prenatal clinic tells the nurse that she is sure she is pregnant because she has not had a menstrual cycle for 3 months, and her breasts are getting bigger. What response by the nurse is best? A) "Lack of menses and breast enlargement are presumptive signs of pregnancy." B) "The changes you are describing are definitely indicators that you are pregnant." C) "Lack of menses can be caused by many things. We need to do a pregnancy test." D) "You're probably not pregnant, but we can check it out if you like."

swer: C Explanation: A) Although a lack of menses and breast enlargement are presumptive signs of pregnancy, the nurse should not state this without explaining that these symptoms also can be caused by other conditions. B) This statement is false because amenorrhea and breast enlargement can be caused by other conditions. C) This is a true statement, and addresses that these changes could be caused by conditions other than pregnancy. D) While lack of menses and breast enlargement might not be caused by pregnancy, they likely are the result of pregnancy, and it is inappropriate for the nurse to suggest the client is not pregnant.

1) Which third-trimester client would the nurse suspect might be having difficulty with psychological adjustments to her pregnancy? A) A woman who says, "Either a boy or a girl will be fine with me" B) A woman who puts her feet up and listens to some music for 15 minutes when she is feeling too stressed C) A woman who was a smoker but who has quit at least for the duration of her pregnancy D) A woman who has not investigated the kind of clothing or feeding methods the baby will need

swer: D Explanation: A) Acceptance of gender is indicative of healthy adaptation to pregnancy. B) Using stress reduction techniques are indicative of healthy adaptation to pregnancy. C) Quitting smoking is indicative of healthy adaptation to pregnancy. D) By the third trimester, the client should be planning and preparing for the baby (for example, living arrangements, clothing, feeding methods).