RLE 107 Module 1c FETAL GROWTH AND DEVELOPMENT AND ASSESSMENT
When is the most accurate time to determine gestational age through ultrasound? * A. First trimester B. Second trimester C. Third trimester D. No difference in accuracy among the trimesters
A. First trimester
The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determine fetal lung maturity. What is the ratio that reflects fetal maturity of the lung?
2:1
25. 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."
A. "Your baby's umbilical cord is surrounded by connective tissue called Wharton's jelly, which prevents compression of the blood vessels."
29. 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.
A. Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus.
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.
A. Because both of my twins are boys, I know that they are identical.
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.
A. Cardiovascular system is the first organ system to function in the developing human.
A nurse is discussing fetal development with a pregnant woman. The woman is 12 weeks pregnant and asks, "What is happening with my baby?" Which of the following would the nurse integrate into the response? Select all that apply. * A. Continued sexual differentiation B. Eyebrows forming C. Startle reflex present D. Spinal cord is formed and fused at the midpoint E. Lanugo present on the head
A. Continued sexual differentiation B. Eyebrows forming D. Spinal cord is formed and fused at the midpoint
17. A nurse is conducting prenatal education classes for a group of parents. Which purposes should the nurse explain thatare performed by the amniotic fluid? Select all that apply. A. Cushions the fetus B. Protects the skin of the fetus C. Provides nourishment for the fetus D. Allows for buoyancy for fetal movement E. Maintains a stable temperature for the fetus
A. Cushions the fetus D. Allows for buoyancy for fetal movement E. Maintains a stable temperature for the fetus
26. 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
A. Decidua basalis
11. The nurse is conducting a staff in-service on multifetal pregnancy. Which statement about dizygotic twin developmentshould the nurse include in the teaching session? A. Dizygotic twins arise from two fertilized ova and are the same sex. B. Dizygotic twins arise from a single fertilized ovum and are always of the same sex. C. Dizygotic twins arise from two fertilized ova and may be the same sex or different sexes. D. Dizygotic twins arise from a single fertilized ovum and may be the same sex or different sexes.
A. Dizygotic twins arise from two fertilized ova and are the same sex.
The nurse's role in diagnostic testing is to provide which of the following? * A. Advice to the couple B. Information about the tests C. Reassurance about fetal safety D. Assistance with decision making
B. Information about the tests
24. A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where thebaby makes the meconium. What is the correct response by the nurse? A. Fetal intestines B. Fetal kidneys C. Amniotic fluid D. Placenta
A. Fetal intestines
A newly pregnant patient tells the nurse that she has irregular periods and is unsure of when she got pregnant. Scheduling an ultrasound is a standing prescription for the patient's health care provider. When is the best time for the nurse to schedule the patient's ultrasound? * A. Immediately B. In 2 weeks C. In 4 weeks D. In 6 weeks
A. Immediately
7. Which best describes what occurs during the fetal period of development? A. Maturation of organ systems B. Development of basic organ systems C. Resistance of organs to damage from external agents D. Development of placental oxygen-carbon dioxide exchange
A. Maturation of organ systems
21. What does a score of 9 on a biophysical profile signify? A. Normal B. Abnormal C. Equivocal D. Nonreactive
A. Normal
10. An expectant client, diagnosed with oligohydramnios, asks the nurse about what this condition means for the baby.Which statement should the nurse give to the client? A. Oligohydramnios can cause poor fetal lung development. B. Oligohydramnios means that the fetus is excreting excessive urine. C. Oligohydramnios could mean that the fetus has a gastrointestinal blockage. D. Oligohydramnios is associated with fetal central nervous system abnormalities.
A. Oligohydramnios can cause poor fetal lung development.
An expectant client, diagnosed with oligohydramnios, asks the nurse about what this condition means for the baby. Which statement should the nurse give to the client? * A. Oligohydramnios can cause poor fetal lung development. B. Oligohydramnios means that the fetus is excreting excessive urine. C. Oligohydramnios could mean that the fetus has a gastrointestinal blockage. D. Oligohydramnios is associated with fetal central nervous system abnormalities.
A. Oligohydramnios can cause poor fetal lung development.
A woman just delivered a healthy term newborn. Upon assessing the umbilical cord, the nurse would identify which of the following as normal? Select all that apply. * A. One vein B. Two veins C. One artery D. Two arteries E. One ligament
A. One vein D. Two arteries
30. 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.
A. Optimal fetal circulation is achieved when I am in the side-lying position.
13. A pregnant client asks the nurse how her baby gets oxygen to breathe. What is the nurse's best response? A. Oxygen-rich blood is delivered through the umbilical vein to the baby. B. Take lots of deep breaths because the baby gets all of its oxygen from you C. You don't need to be concerned about your baby getting enough oxygen. D. The baby's lungs are not mature enough to actually breathe, so don't worry.
A. Oxygen-rich blood is delivered through the umbilical vein to the baby.
3. Which is the purpose of the ovums zona pellucida? A. Prevents multiple sperm from fertilizing the ovum B. Stimulates the ovum to begin mitotic cell division C. Allows the 46 chromosomes from each gamete to merge D. Makes a pathway for more than one sperm to reach the ovum
A. Prevents multiple sperm from fertilizing the ovum
20. On which aspect of fetal diagnostic testing do parents usually place the most importance? A. Safety of the fetus B. Duration of the test C. Cost of the procedure D. Physical discomfort caused by the procedure
A. Safety of the fetus
A pregnant client's biophysical profile score is 8. She asks the nurse to explain the results. What is the nurses best response? * A. The test results are within normal limits. B. Immediate birth by cesarean birth is being considered. C. Further testing will be performed to determine the meaning of this score. D. An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding birth.
A. The test results are within normal limits.
When describing amniotic fluid to a pregnant woman, the nurse would include which of the following? * A. This fluid acts as transport mechanism for oxygen and nutrients. B. The fluid is mostly protein to provide nourishment to your baby. C. This fluid acts as a cushion to help to protect your baby from injury. D. The amount of fluid remains fairly constant throughout the pregnancy.
A. This fluid acts as transport mechanism for oxygen and nutrients.
The nurse is instructing a client on how to perform kick counts. Which information should the nurse include in the teaching session? Select all that apply. * A. Use a clock or timer when performing kick counts. B. Your bladder should be full before performing kick counts. C. Notify your health care provider if you have not felt movement in 24 hours. D. Protocols can provide a structured timetable for concentrating on fetal movements. E. You should lie on your side, place your hands on the largest part of the abdomen, and concentrate on the number of movements felt.
A. Use a clock or timer when performing kick counts. D. Protocols can provide a structured timetable for concentrating on fetal movements. E. You should lie on your side, place your hands on the largest part of the abdomen, and concentrate on the number of movements felt.
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.
A. Your baby will be covered in fine hair called lanugo.
2. After teaching a group of students about fetal development, the instructor determines that the teaching was successfulwhen the students identify which of the following as providing the barrier to other sperm after fertilization? A. Zona pellucida B. Zygote C. Cleavage D. Morula
A. Zona pellucida
After teaching a group of students about fetal development, the instructor determines that the teaching was successful when the students identify which of the following as providing the barrier to other sperm after fertilization? * A. Zona pellucida B. Zygote C. Cleavage D. Morula
A. Zona pellucida
After the nurse describes fetal circulation to a pregnant woman, the woman asks why her fetus has a different circulation pattern than hers. In planning a response, the nurse integrates understanding of which of the following? * A. Fetal blood is thicker than that of adults and needs different pathways. B. Fetal circulation carries highly oxygenated blood to vital areas first. C. Fetal blood has a higher oxygen saturation and circulates more slowly. D. Fetal heart rates are rapid and circulation time is double that of adults.
B. Fetal circulation carries highly oxygenated blood to vital areas first.
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
A.Dizygotic twins
The clinic nurse is obtaining a health history on a newly pregnant client. Which is an indication for fetal diagnostic procedures if present in the health history? * A.Maternal diabetes B. Weight gain of 25 lb C. Maternal age older than 30 (30 and above) D. Previous infant weighing more than 3000 g at birth
A.Maternal diabetes
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 mothers 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.
B. Fetuses respond to sound by 24 weeks of gestation and can be soothed by the sound of the mothers voice.
A biophysical profile is performed on a pregnant client. The following assessments are noted: nonreactive stress test (NST), three episodes of fetal breathing movements (FBMs), limited gross movements, opening and closing of hang indicating the presence of fetal tone, and adequate amniotic fluid index (AFI) meeting criteria. What would be the correct interpretation of this test result? * A. A score of 10 would indicate that the results are equivocal. B. A score of 8 would indicate normal results. C. A score of 6 would indicate that birth should be considered as a possible treatment option. D. A score of 9 would indicate reassurance.
B. A score of 8 would indicate normal results.
After teaching a group of students about fetal development, the instructor determines that the teaching was successful when the students identify which of the following as essential for fetal lung development? * A. Umbilical cord B. Amniotic fluid C. Placenta D. Trophoblasts
B. Amniotic fluid
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.
B. As one of its early functions, the placenta acts as an endocrine gland.
The nurse is reviewing the procedure for alpha-fetoprotein (AFP) screening with a patient at 16 weeks gestation. The nurse determines that the patient understands the teaching when she mentions that which fluid will be collected for the initial screening process? * A. Urine B. Blood C. Saliva D. Amniotic
B. Blood
14. Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normalpregnancy, including which of the following? (Select all that apply.) A. Insulin B. Estrogen C. Progesterone D. Testosterone E. Human chorionic gonadotropin (hCG)
B. Estrogen C. Progesterone E. Human chorionic gonadotropin (hCG)
8. The nurse is developing a presentation for a community group of young adults discussing fetal development andpregnancy. The nurse would identify that the sex of offspring is determined at the time of: A. Meiosis B. Fertilization C. Formation of morula D. Oogenesis
B. Fertilization
When describing the structures involved in fetal circulation, the nursing instructor describes which structure as the opening between the right and left atrium? * A. Ductus venosus B. Foramen ovale C. Ductus arteriosus D. Umbilical artery
B. Foramen ovale
9. An expectant parent says to the nurse, When my sisters baby was born, it was covered in a cheese-like coating. Whatis the purpose of this coating? The correct response by the nurse is to explain that the purpose of vernix caseosa is to: A. Regulate fetal temperature. B. Makes the fetal skin lubricated and prevent maceration utero C. Promote normal peripheral nervous system development. D. Allow the transport of oxygen and nutrients across the amnion.
B. Makes the fetal skin lubricated and prevent maceration utero
Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? * A. Biophysical profile B. Multiple-marker screening C. Lecithin-to-sphingomyelin ratio D. Blood type and crossmatch of maternal and fetal serum (rh incompatibility
B. Multiple-marker screening
In preparing a pregnant client for a nonstress test (NST), which of the following should be included in the plan of care? * A. Maintain NPO status prior to testing. B. Position the client for comfort, adjusting the tocotransducer belt to locate fetal heart rate. C. Have an infusion pump prepared with oxytocin per protocol for evaluation.
B. Position the client for comfort, adjusting the tocotransducer belt to locate fetal heart rate.
23. 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
B. Secretes both estrogen and progesterone
15. The nurse is planning a prenatal class on fetal development. Which characteristics of prenatal development should thenurse include for a fetus of 24 weeks, based on fertilization age? Select all that apply. A. Ear cartilage firm B. Skin wrinkled and red C. Surfactant production nears mature levels D. Fetal movement becoming progressively more noticeable
B. Skin wrinkled and red D. Fetal movement becoming progressively more noticeable
16. The nurse is explaining fetal circulation to a group of nursing students. Which should be included in the teachingsession? Select all that apply. A. After birth the ductus venosus remains open, but the other shunts close. B. The foramen ovale shunts blood from the right atrium to the left atrium C. The ductus venosus shunts blood from the liver to the inferior vena cava. D. The ductus arteriosus shunts blood from the right ventricle to the left ventricle.
B. The foramen ovale shunts blood from the right atrium to the left atrium C. The ductus venosus shunts blood from the liver to the inferior vena cava.
A woman who is 36 weeks pregnant asks the nurse to explain the vibroacoustic stimulator (VAS) test. Which should the nurse include in the response? Select all that apply. * A. The test is invasive. B. The test uses sound to elicit fetal movements. C. The test may confirm nonreactive nonstress test results. D. The test can only be performed if contractions are present.
B. The test uses sound to elicit fetal movements. C. The test may confirm nonreactive nonstress test results.
A woman pregnant with twins asks the nurse about differences between identical and fraternal twins. The nurse explains that since it has been determined that she is having a boy and a girl, they are fraternal, and will have with of the following? * A.One placenta, two amnions, and two chorions B. Two placentas, two amnions, and two chorions C. Two placentas, one amnion, and two chorions D. Two placentas, two amnions, one chorion
B. Two placentas, two amnions, and two chorions
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."
C. "The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream."
19. When is the earliest that chorionic villus sampling can be performed during pregnancy? A. 4 weeks B. 8 weeks C. 10 weeks D. 12 weeks
C. 10 weeks
During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an electronic Doppler device. When this instrument is used, fetal heart tones can be detected as early as: A. 4 weeks B. 8 weeks C. 10 weeks D. 14 weeks
C. 10 weeks
22. At a routine prenatal visit, the nurse explains the development of the fetus to her client. At approximately ____ weeksof gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27cm 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
C. 28
28. The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determinefetal lung maturity. Which ratio reflects fetal maturity of the lungs? A. 1.4:1 B. 1.8:1 C. 2:1 D. 1:1
C. 2:1
18. The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetushas which? A. Hemophilia B. Sickle cell anemia C. A neural tube defect
C. A neural tube defect
5. Some of the embryos intestines remain within the umbilical cord during the embryonic period because the: A. Intestines need this time to grow until week 15. B. Nutrient content of the blood is higher in this location. C. Abdomen is too small to contain all the organs while they are developing. D. Umbilical cord is much larger at this time than it will be at the end of pregnancy
C. Abdomen is too small to contain all the organs while they are developing.
Some of the embryos intestines remain within the umbilical cord during the embryonic period because the: * A. Intestines need this time to grow until week 15. B. Nutrient content of the blood is higher in this location. C. Abdomen is too small to contain all the organs while they are developing. D. Umbilical cord is much larger at this time than it will be at the end of pregnancy.
C. Abdomen is too small to contain all the organs while they are developing.
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.
C. Babies respond to sound starting at approximately 24 weeks of gestation.
When preparing a woman for an amniocentesis, the nurse would instruct her to do which of the following? * A. Shower with an antiseptic scrub. B. Swallow the pre-procedure sedative. C. Empty her bladder. D. Lie on her left side.
C. Empty her bladder.
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.
C. Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity.
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. D. The embryonic stage is from fertilization until 5 months
C. Most organs are formed by 8 weeks after fertilization.
What is the term for a nonstress test in which there are two or more fetal heart rate accelerations of 15 or more bpm with fetal movement in a 20-minute period? * A. Positive B. Negative C. Reactive D. Nonreactive
C. Reactive
1. One of the assessments performed in the birth room is checking the umbilical cord for blood vessels. Which finding isconsidered to be within normal limits? A. One artery and one vein B. Two veins and one artery C. Two arteries and one vein D. Two arteries and two veins
C. Two arteries and one vein
Which response by the nurse is most appropriate to the statement, "This test isn't my idea, but my husband insists?" A. "It's your decision." B. "Don't worry. Everything will be fine." C. "Why don't you want to have this test?" D. "You're concerned about having this test?"
D. "You're concerned about having this test?"
27. A woman who is 8 months pregnant asks the nurse, "Does my baby have any antibodies to fight infection?" What is themost appropriate response by the nurse? A. "Your baby has all the immunoglobulins necessary: immunoglobulin G (IgG), immunoglobulin M (IgM), andimmunoglobulin A (IgA)." B. "Your baby won't receive any antibodies until he is born and you breastfeed him." C. "Your baby does not have any antibodies to fight infection." D. "Your baby has IgG and IgM."
D. "Your baby has IgG and IgM."
A woman who is 8 months pregnant asks the nurse, "Does my baby have any antibodies to fight infection?" What is the most appropriate response by the nurse? * A. "Your baby has all the immunoglobulins necessary: immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA)." B. "Your baby won't receive any antibodies until he is born and you breastfeed him." C. "Your baby does not have any antibodies to fight infection." D. "Your baby has IgG and IgM."
D. "Your baby has IgG and IgM."
A couple comes to the clinic for preconception counseling and care. As part of the visit, the nurse teaches the couple about fertilization and initial development, stating that the zygote formed by the union of the ovum and sperm consists of how many chromosomes? * A. 22 B. 23 C. 44 D. 46
D. 46
Which nursing intervention is necessary prior to a second-trimester transabdominal ultrasound? * A. Perform an abdominal preparation B. Administer a soap suds enema. C. Ensure the client is NPO for 12 hours. D. Instruct the client to drink 1 to 2 quarts of water.
D. Instruct the client to drink 1 to 2 quarts of water.
In a routine prenatal visit the nurse examines a client who is 37 weeks pregnant and notices that the fetal heart rate has dropped to 120 beats/min from a rate of 160 beats/min earlier in the pregnancy. The nurse should: * A. Ask if the client has taken a sedative B. Notify the physician C. Turn the client to her right side D. Record rate as a normal finding
D. Record rate as a normal finding
4. The nurse is explaining the process of cell division during the pre-embryonic period to a group of nursing students.Which describes the morula? A. Fertilized ovum before mitosis begins B. Double layer of cells that becomes the placenta C. Flattened, disk-shaped layer of cells within a fluid-filled sphere D. Solid ball composed of the first cells formed after fertilization
D. Solid ball composed of the first cells formed after fertilization
The nurse is explaining the process of cell division during the pre-embryonic period to a group of nursing students. Which describes the morula? * A. Fertilized ovum before mitosis begins B. Double layer of cells that becomes the placenta C. Flattened, disk-shaped layer of cells within a fluid-filled sphere D. Solid ball composed of the first cells formed after fertilization
D. Solid ball composed of the first cells formed after fertilization
12. The nurse is explaining the function of the placenta to a pregnant client. Which statement indicates to the nurse theneed for further client teaching? A. My baby gets oxygen from the placenta. B. The placenta functions to help excrete waste products. C. The nourishment that I take in passes through the placenta. D. The placenta helps maintain a stable temperature for my baby.
D. The placenta helps maintain a stable temperature for my baby.
6. A client who is 16 weeks pregnant with her first baby asks how long it will be before she feels the baby move. Which isthe nurse's best answer? A. You should have felt the baby move by now. B. The baby is moving, but you can't feel it yet. C. Some babies are quiet and you don't feel them move. D. Within the next month you should start to feel fluttering sensations.
D. Within the next month you should start to feel fluttering sensations.