Maternal and Child Nursing - Antenatal Practice Test With Answers and Rationale

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An antenatal client is informing the nurse of her When analyzing the need for health teaching of a

prenatal signs and symptoms. prenatal multigravida, the nurse


Which of the following findings would the nurse should ask which of the following questions?
determine are presumptive signs 1. “What are the ages of your children?”
of pregnancy? Select all that apply. 2. “What is your marital status?”
1. Amenorrhea. 3. “Do you ever drink alcohol?”
2. Breast tenderness. 4. “Do you have any allergies?”
3. Quickening.
3. This question is important to ask in
4. Frequent urination.
order to determine a prenatal client’s
5. Uterine growth.
health teaching needs.
1, 2, 3, and 4 are correct.
1. Amenorrhea is a presumptive sign of
pregnancy. TEST-TAKING TIP: When answering questions,
2. Breast tenderness is a presumptive it is essential that the test taker attend
sign of pregnancy. to the specific question that is being asked. All of
3. Quickening is a presumptive sign of the possible responses are
pregnancy. questions that should be asked of a pregnant
4. Frequent urination is a presumptive multigravida, but only one is related
sign of pregnancy. to the client’s needs for health teaching.
4
A woman whose prenatal weight was 105 lb
TEST-TAKING TIP: There are three classifications
weighs 109 lb at her 12-week visit.
of signs of pregnancy: presumptive,
Which of the following comments by the nurse is
probable, and positive. Signs that
appropriate at this time?
are totally subjective, or presumptive, include
1. “We expect you to gain 1 lb per week, so your
amenorrhea, breast tenderness,
weight is a little low at this time.”
quickening, and frequent urination. Signs
2. “Most women gain no weight during the first
that are objective, but not totally absolute,
trimester, so I would suggest you
are termed probable and include
eat fewer desserts for the next few weeks.”
alterations in uterine shape and size and
3. “You entered the pregnancy well underweight, so
softening of the cervix. Signs that are
we should check your diet to
absolute, or positive, include hearing
make sure you are getting the nutrients you need.”
the fetal heartbeat, detecting fetal movement,
4. “Your weight gain is exactly what we would
and ultrasound images of the fetal
expect it to be at this time.”
outline.
The weight gain is within normal for
the first trimester.
TEST-TAKING TIP: One of the assessments
that aids health care practitioners in
2
assessing the health and well-being of
The nurse is assessing the laboratory report of a
antenatal clients and their babies is
40-week gestation client. Which of
weight gain. For women who enter the
the following values would the nurse expect to find
pregnancy with a normal weight for
elevated above prepregnancy
height, the expected weight gain is: 3 to
levels?
5 lb for the entire first trimester and
1. Glucose.
approximately 1 lb per week from weeks
2. Fibrinogen.
13 to 40.
3. Hematocrit.
4. Bilirubin. 5
Because nausea and vomiting are such common
2. Fibrinogen levels will be elevated
complaints of pregnant women, the
slightly in a 40-week pregnant woman
nurse provides anticipatory guidance to a 6-week
because coagulation factors like fibrinogen
gestation client by telling her to
increase to help prevent excessive
do which of the following?
blood loss during delivery
1. Avoid eating greasy foods.
2. Drink orange juice before rising.
3. Drink 2 glasses of water with each meal.
TEST-TAKING TIP: During the latter part 4. Eat 3 large meals plus a bedtime snack.
of the third trimester, coagulation factors
increase in preparation for delivery. It is Greasy foods should be avoided
the body’s means of protecting itself
against a large loss of blood at delivery.
TEST-TAKING TIP: Although many women
3
experience nausea and vomiting or
morning sickness upon rising, many
women complain of nausea and/or vomiting but since mammograms are potentially
at other times of the day. One theory harm-producing x-rays, they are
that has been offered to explain this only ordered in emergent cases.
problem is that the body is ridding itself
8
of teratogens that could potentially harm
A 10-week gravid client is being seen in the
the fetus.
prenatal clinic. For the nurse caring for
6 this patient, providing anticipatory guidance for
A client enters the prenatal clinic. She states that which of the following should be a
she missed her period yesterday priority?
and used a home pregnancy test this morning. She 1. Pain management during labor.
states that the results were negative, 2. Methods to relieve backaches.
but “I still think I am pregnant.” Which of the 3. Breastfeeding positions.
following statements would be 4. Characteristics of the newborn.
appropriate for the nurse to make at this time?
2. It is appropriate for the nurse to provide
1. “Your period is probably just irregular.”
anticipatory guidance regarding
2. “We could do a blood test to check.”
methods to relieve back pain.
3. “Home pregnancy test results are very
accurate.”
4. “My recommendation would be to repeat the test
in one week.” TEST-TAKING TIP: This 10-week gravid
client will be entering the second
2. This response is correct. Serum pregnancy trimester in a couple of weeks. As the
tests are more sensitive than uterine body grows, the client is likely to
urine tests are. experience backaches. It is appropriate for
the nurse to provide information about
TEST-TAKING TIP: Because quantitative
this possibility and ways to relieve them.
pregnancy tests measure the exact quantity
of human chorionic gonadotropin in 9
the bloodstream, they are more accurate A client asks the nurse what was meant when the
than urine tests that simply measure physician told her she had a positive
whether or not the hormone is present Chadwick’s sign. Which of the following
in the urine. Similar to the urine tests on information about the finding would
the market, qualitative serum tests detect be appropriate for the nurse to convey at this
whether or not the hormone is present, time?
but they are still considered to be more 1. “It is a purplish stretch mark on your abdomen.”
accurate than urine tests are. 2. “It means that you are having heart palpitations.”
3. “It is a bluish coloration of your cervix and
vagina.”
7 4. “It means the doctor heard abnormal sounds
A gravida, G1 P0000, is having her first prenatal when you breathed in.”
physical examination. Which
3. A positive Chadwick’s sign means that
of the following assessments should the nurse
the client’s cervix and vagina are a
inform the client that she will have
bluish color. It is a probable sign of
that day?
pregnancy.
1. Pap smear.
2. Mammogram.
3. Glucose challenge test.
4. Biophysical profile. TEST-TAKING TIP: Chadwick’s sign is a
probable sign of pregnancy. The bluish
1. The client will have a Pap smear coloration is due to the increase in vascularization
done. of the area in response to
the high levels of circulating estrogen in
the pregnant woman’s system.
TEST-TAKING TIP: At the first prenatal
10
visit, pregnant clients will undergo complete
A client enters the prenatal clinic. She states that
obstetrical and medical physical assessments.
she believes she is pregnant.
The assessments are performed
Which of the following hormone elevations will
to provide the health care
indicate a high probability that the
practitioner with baseline data regarding
client is pregnant?
the health and well-being of the woman
1. Chorionic gonadotropin.
as well as to inform the health care practitioner
2. Oxytocin.
of any medical problems that the
3. Prolactin.
mother has that might impact the pregnancy.
4. Luteinizing hormone.
A breast exam will be performed
by the practitioner to assess for abnormalities,
1. High levels of the hormone chorionic are sad, and still others are frightened.
gonadotropin in the bloodstream and At the initial interview, it is essential that
urine of the woman is a probable sign the nurse not assume that the woman
of pregnancy. will respond in any particular way. The
nurse must ask open-ended questions in
order to elicit the woman’s feelings about
TEST-TAKING TIP: Human chorionic the pregnancy.
gonadotropin is produced by the
13
fertilized egg. Its presence in the
A client is in the 10th week of her pregnancy.
bloodstream signals the body to keep
Which of the following symptoms
the corpus luteum alive. Until the
would the nurse expect the client to exhibit?
placenta takes over the function of producing
1. Backache.
progesterone and estrogen, the
2. Dyspnea.
corpus luteum produces the hormones
3. Fatigue.
that are essential to the maintenance of
4. Diarrhea.
the pregnancy.
3. Most women complain of fatigue
11
during the first trimester.
A 16-year-old, G1 P0000, is being seen at her 10-
week gestation visit. She tells the
nurse that she felt the baby move that morning.
TEST-TAKING TIP: During the first
Which of the following responses
trimester, the body undergoes a number
by the nurse is appropriate?
of important changes. The embryo is developing,
1. “That is very exciting. The baby must be very
the hormones of the body are
healthy.”
increasing, and the maternal blood supply
2. “Would you please describe what you felt for
is increasing. To accomplish each of
me?”
the tasks, the body uses energy. The
3. “That is impossible. The baby is not big enough
mother is fatigued not only because the
yet.”
body is undergoing great change but also
4. “Would you please let me see if I can feel the
because the thyroid gland has not caught
baby?”
up with the increasing energy demands.
2. The nurse should query the young
14
woman about what she felt
The midwife has just palpated the fundal height at
the location noted on the picture
below. It is likely that the client is how many
TEST-TAKING TIP: Quickening, or subjective
weeks pregnant?
fetal movement, occurs between
1. 12.
16 and 20 weeks’ gestation. At 10 weeks’
2. 20.
gestation it would be impossible for the
3. 28.
young woman to feel fetal movement.
4. 36.
The nurse, therefore, should elicit more
information from the teen to determine
what she had felt.
12
A 20-year-old client states that the at-home 1. The client is likely 12 weeks pregnant.
pregnancy test that she took this morning At 12 weeks, the fundal height is at
was positive. Which of the following comments by the top of the symphysis.
the nurse is appropriate at
this time?
1. “Congratulations, you and your family must be so
TEST-TAKING TIP: The fundal height is assessed
happy.”
at every prenatal visit. It is an
2. “Have you told the baby’s father yet?”
easy, noninvasive means of assessing fetal
3. “How do you feel about the results?”
growth. The nurse should know that the
4. “Please tell me when your last menstrual period
top of the fundus is at the level of the
was.”
symphysis at the end of the first
3. It is important for the nurse to ask
trimester.
the young woman how she feels about
being pregnant. She may decide not 15
to continue with the pregnancy. When assessing the psychological adjustment of
an 8-week gravida, which of the
following would the nurse expect to see signs of?
TEST-TAKING TIP: Some pregnant women 1. Ambivalence.
are happy about their pregnancy, some 2. Depression.
3. Anxiety. The nurse takes the history of a client, G2 P1001, at
4. Ecstasy. her first prenatal visit. Which
of the following statements would indicate that the
1. It is common for women to be ambivalent
client should be referred to a
about their pregnancy during
genetic counselor?
the first trimester.
1. “My first child has cerebral palsy.”
2. “My first child has hypertension.”
TEST-TAKING TIP: Even women who stop 3. “My first child has asthma.”
taking birth control pills in order to become 4. “My first child has cystic fibrosis.”
pregnant are often startled and
4. Cystic fibrosis is an autosomal recessive
ambivalent when they actually get pregnant.
genetic disease so the client with
This is not pathological. The
a history of cystic fibrosis should be
women usually slowly accept the pregnancy
referred to a genetic counselor.
and, by 20 weeks’ gestation, are
happy and enthusiastic about the
16 TEST-TAKING TIP: Virtually all diseases,
A client makes the following statement after chronic and acute, have some genetic
finding out that her pregnancy test is component, but the ability for the genetic
positive, “This is not a good time. I am in college counselor to predict the impact of
and the baby will be due during many diseases is very poor. Those illnesses
final exams!” Which of the following responses by with clear hereditary patterns,
the nurse would be most appropriate however, do warrant referral to genetic
at this time? counselors. Cystic fibrosis has an autosomal
1. “I’m absolutely positive that everything will turn recessive inheritance pattern.
out all right.”
19
2. “I suggest that you e-mail your professors to set
The nurse has taken a health history on four
up an alternate plan.”
primigravid clients at their first prenatal
3. “It sounds like you’re feeling a little
visits. It is high priority that which of the clients
overwhelmed right now.”
receives nutrition counseling?
4. “You and the baby’s father will find a way to get
1. The woman diagnosed with phenylketonuria.
through the pregnancy.”
2. The woman who has Graves’ disease.
3. This is the best comment. It acknowledges 3. The woman with Cushing’s syndrome.
the concerns that the client is 4. The woman diagnosed with myasthenia gravis.
having.
1. The client with phenylketonuria
TEST-TAKING TIP: Nurses have two roles (PKU) must receive counseling from a
when clients express concerns to them. registered dietitian.
First, the nurse must acknowledge the
client’s concerns so that the client feels
accepted and understood. Second, the TEST-TAKING TIP: PKU is a genetic disease
nurse must help the client to problem that is characterized by the absence
solve the situation. It is very important, of the enzyme needed to metabolize
however, that the acceptance precede the phenylalanine, an essential amino acid.
period of problem solving. When patients with PKU consume
phenylalanine, a metabolite that affects
17
cognitive centers in the brain is created
The nurse notes each of the following findings in a
in the body. If a pregnant woman who
12-week gestation client. Which of
has PKU were to eat foods high in
the findings would enable the nurse to tell the
phenylalanine, her baby would develop
client that she is positively pregnant?
severe mental retardation in utero.
1. Fetal heart rate via Doppler.
2. Positive pregnancy test. 20
3. Positive Chadwick’s sign. Which of the following findings in an 8-week
4. Montgomery gland enlargements. gestation client, G2 P1001, should
the nurse highlight for the nurse midwife?
1. Hearing a fetal heart rate is a positive
1. Body mass index of 17.
sign of pregnancy.
2. Blood pressure of 100/60.
TEST-TAKING TIP: Positive signs of pregnancy 3. Hematocrit of 36%.
are signs that irrefutably show that 4. Hemoglobin of 13.2.
a fetus is in utero. An ultrasound of a 20. 1. The BMI of 17 is of concern. This
fetus is one positive sign and the fetal client is entering her pregnancy underweight.
heartbeat is another positive sign.
18
TEST-TAKING TIP: Women who enter their fundal height at the level of the
pregnancies underweight are encouraged umbilicus is expected at 20 weeks’
to gain slightly more—35 to 45 lb—during their
pregnancies than are women
of normal weight who are encouraged to TEST-TAKING TIP: It is important for
gain 25 to 35 lb. the test taker to know the timing of key
pregnancy changes. The mother should
21
feel fetal movement by 20 weeks’ gestation.
A woman, 6 weeks pregnant, is having a vaginal
Primigravidas often feel fetal
examination. Which of the following
movement later than multigravidas.
would the practitioner expect to find?
Specific fundal height measurements
1. Thin cervical muscle.
2. An enlarged ovary. are also expected at key times in the
3. Thick cervical mucus. pregnancy.
4. Pale pink vaginal wall.
24
2. The practitioner would expect to The following four changes occur during
palpate an enlarged ovary. pregnancy. Which of them usually increases
the father’s interest and involvement in the
TEST-TAKING TIP: The cervix is long and
pregnancy?
thick in order to retain the pregnancy in
1. Learning the results of the pregnancy test.
the uterine cavity. The cervical mucus is
2. Attending childbirth education classes.
thin and the vaginal wall is bluish in
3. Hearing the fetal heartbeat.
color as a result of elevated estrogen
4. Meeting the obstetrician or midwife.
levels. The ovary is enlarged because the
corpus luteum is still functioning. 3. Hearing the fetal heart beat often
increases fathers’ interests in their
22
partners’ pregnancies.
A pregnant woman must have a glucose challenge
test (GCT). Which of the following
should be included in the preprocedure teaching?
1. Fast for 12 hours before the test. TEST-TAKING TIP: Women who are in the
2. Bring a urine specimen to the laboratory on the first few weeks of pregnancy often experience
day of the test. a number of physical complaints—
3. Be prepared to have 4 blood specimens taken on nausea and vomiting, fatigue, breast tenderness,
the day of the test. and urinary frequency.
4. The test should take one hour to complete. Prospective fathers whose partners’ experience
these complaints are often not
4. The test does take about 1 hour to very interested in the pregnancies. When
complete. the baby becomes “real,” with a positive
TEST-TAKING TIP: The GCT is done at heartbeat or fetal movement, the fathers
approximately 24 weeks’ gestation to assess often become very excited.
the client’s ability to metabolize glucose.
It is a 1-hour, nonfasting screening 25
test. One hour after a client consumes The nurse midwife tells a client that the baby is
50 grams of a concentrated glucose solution, growing and that ballottement was
a serum glucose level is done. If the evident during the vaginal examination. How
value is 130 mg/dL or higher, the client should the nurse explain what the
is referred for a 3-hour glucose tolerance nurse midwife means by ballottement?
test to determine whether or not she has 1. The nurse midwife saw that the mucus plug was
gestational diabetes. intact.
2. The nurse midwife felt the baby rebound after
23 being pushed.
The nurse working in an outpatient obstetric office 3. The nurse midwife palpated the fetal parts
assesses four primigravid through the uterine wall.
clients. Which of the client findings would the 4. The nurse midwife assessed that the baby is
nurse highlight for the physician? head down.
1. 17 weeks’ gestation; denies feeling fetal
movement. 2. This is the definition of ballottement.
2. 24 weeks’ gestation; fundal height at the TEST-TAKING TIP: Although this question
umbilicus. discusses nurse-patient interaction, it is
3. 27 weeks’ gestation; complains of excess simply a definition question. The test
salivation. taker is being asked to identify the definition
4. 34 weeks’ gestation; complains of hemorrhoidal of the word ballottement.
pain.
26
2. The fundal height at 24 weeks should A multigravid client is 22 weeks pregnant. Which of
be 4 cm above the umbilicus. The the following symptoms would
the nurse expect the client to exhibit? avoided. All medications are assigned a
1. Nausea. pregnancy category from “A”—research
2. Dyspnea. has shown they are safe to be consumed
3. Urinary frequency. throughout pregnancy—to “X”—a teratogenic
4. Leg cramping. agent. Category “B” medications
are considered safe because of anecdotal
4. Leg cramping is often a complaint of
evidence, although controlled
clients in the second trimester.
research has not been conducted to confirm
that evidence. Teratogens are agents
that have definitely been shown to cause
TEST-TAKING TIP: Although clients in the fetal damage.
second trimester do experience some
physical discomfort, such as leg cramps 29
A 20-week gestation client is being seen in the
and backaches, most women feel well. prenatal clinic. Place an “X” on the
They no longer are fatigued, nauseous, place on the abdomen where the nurse would
and so on as in the first trimester, but expect the fundal height to be felt.
the baby is not so large as to cause significant
complaints like dyspnea or the
recurrence of urinary frequency.
27
The glucose challenge screening test is performed TEST-TAKING TIP: At 20 weeks’ gestation,
at or after 24 weeks’ gestation to the fundal height should be felt at the
assess for the maternal physiological response to umbilicus. About 8 weeks later, it is felt
which of the following pregnancy between the umbilicus and xiphoid
hormones? process and at the xiphoid process at
1. Estrogen. 36 weeks.
2. Progesterone.
3. Human placental lactogen.
4. Human chorionic gonadotropin.
3. Human placental lactogen (hPL) is an
insulin antagonist. 30
TEST-TAKING TIP: hPL is produced by the A client who was seen in the prenatal clinic at 20
placenta. As the placenta grows, the weeks’ gestation weighed 128 lb
hormone levels rise. At approximately at that time. Approximately how many pounds
24 weeks’ gestation, the levels are high would the nurse expect the client to
enough to impact glucose metabolism. weigh at her next visit at 24 weeks’ gestation?
If performed earlier, the GCT test may 1. 129 lb.
result in a false-negative result. 2. 130 lb.
3. 131 lb.
28 4. 132 lb.
A client is 15 weeks pregnant. She calls the
obstetric office to request a medication 4. The woman would be expected to
for a headache. The nurse answers the telephone. weigh about 132 lb. At this stage of
Which of the following is the pregnancy, the woman is expected to
nurse’s best response? gain about 1 lb a week.
1. “Because the organ systems in the baby are TEST-TAKING TIP: The incremental weight
developing right now, it is risky to gain of a client is an important means of
take medicine.” assessing the growth and development of
2. “You can take any of the over-the-counter the fetus. The nurse would expect that,
medications because they are all safe during the second and third trimesters,
in pregnancy.” the woman should gain approximately
3. “The physician will prescribe a category “X” 1 lb per week.
medication for you.” 31
4. “You can take acetaminophen because it is a An 18-week gestation client telephones the
category “B” medicine.” obstetrician’s office stating, “I’m really
4. Category “B” medications have been scared. I think I have breast cancer. My breasts
shown to be safe to take throughout are filled with tumors.” The nurse
pregnancy. should base the response on which of the
TEST-TAKING TIP: It is important for following?
pregnant women to contact their health 1. Breast cancer is often triggered by pregnancy.
care practitioners to find out which medications 2. Nodular breast tissue is normal during
are safe to take during pregnancy pregnancy.
and which medications must be 3. The woman is exhibiting signs of a psychotic
break. while also improving the muscle tone
4. Anxiety attacks are especially common in the of the lower back.
second trimester.
34
2. Nodular breast tissue is normal in A woman in her third trimester advises the nurse
pregnancy. that she wishes to breastfeed her
baby, “but I don’t think my nipples are right.” Upon
TEST-TAKING TIP: The high levels of
examination, the nurse notes
estrogen seen in pregnancy result in a
that the client has inverted nipples. Which of the
number of changes. The hypertrophy
following actions should the
and hyperplasia of the breast tissue, in
nurse take at this time?
preparation for neonatal lactation, are
1. Advise the client that it is unlikely that she will
two of the changes.
be able to breastfeed.
32 2. Refer the client to a lactation consultant for
A woman states that she frequently awakens with advice.
“painful leg cramps” during the 3. Call the labor room and notify them that a client
night. Which of the following assessments should with inverted nipples will be
the nurse make? admitted.
1. Dietary evaluation. 4. Teach the woman exercises in order to evert her
2. Goodell’s sign. nipples.
3. Hegar’s sign.
2. The client should be referred to a lactation
4. Posture evaluation.
consultant.
32. 1. A dietary evaluation is indicated since
painful leg cramps can be caused by
consuming too little calcium or too TEST-TAKING TIP: Research on eversion
much phosphorus. exercises has shown that they are not effective
plus breast manipulation can
bring on contractions since oxytocin production
TEST-TAKING TIP: Leg cramps can occur is stimulated. Lactation consultants
as a result of low calcium and/or high are breastfeeding specialists. A lactation
phosphorus since they are often related consultant would probably
to a poor calcium/phosphorus ratio. A dietary recommend that the client wear breast
assessment should be done to determine shields in her bra. The shields are made
whether or not the client is consuming of hard plastic and have a small hole
enough calcium, primarily found through which the nipple everts.
in dairy products, or large quantities of
35
phosphorus, found in carbonated beverages
Which of the following vital sign changes should
and processed sandwich meats.
the nurse highlight for a pregnant
33 woman’s obstetrician?
Which of the following exercises should be taught 1. Prepregnancy blood pressure (BP) 100/60 and
to a pregnant woman who complains third trimester BP 140/90.
of backaches? 2. Prepregnancy respiratory rate (RR) 16 rpm and
1. Kegeling. third trimester RR 22 rpm.
2. Pelvic tilting. 3. Prepregnancy heart rate (HR) 76 bpm and third
3. Leg lifting. trimester HR 88 bpm.
4. Crunching. 4. Prepregnancy temperature (T) 98.6ºF and third
trimester T 99.2ºF.
2. The pelvic tilt is an exercise that can
reduce backache pain. 1. The blood pressure should not elevate
during pregnancy. This change
should be reported to the health care
TEST-TAKING TIP: Pelvic tilt exercises help practitioner.
to reduce backache pain. The client is
taught to get into an optimal position—
on the hands and knees is often best. She TEST-TAKING TIP: The basal metabolic
is then taught to force her back out while rate of the woman increases during pregnancy.
tucking her head and buttocks under and As a result the nurse would expect
holding that position for a few seconds, to observe a respiratory rate of 20 to 24
followed by holding the alternate position rpm. High levels of progesterone in the
for a few seconds—arching her back body result in a decrease in the contractility
while lifting her head and her buttocks of the smooth musculature
toward the ceiling. These positions should be throughout the body. This results in an
alternated repeatedly for about increase in the pulse rate. In addition,
5 minutes. The exercises are very relaxing progesterone is thermogenic, resulting in
a slight rise in the woman’s core body 4. Reassure the mother that this is normal in the
temperature. third trimester.
36 4. It is normal for colostrum to be
A nurse midwife has advised a 39-week gestation expressed late in pregnancy.
gravid to take evening primrose TEST-TAKING TIP: Even though colostrum
oil 2500 mg daily as a complementary therapy. This is present in the breasts in the latter part
suggestion was made because of the third trimester, it is important for
evening primrose has been shown to perform women not to pump their breasts.
which of the following actions? Oxytocin, the hormone that promotes
1. Relieve back strain. the ejection of milk during lactation, is
2. Improve development of colostrum. the hormone of labor. Pumping of the
3. Ripen the cervix. breasts, therefore, could stimulate the
4. Reduce the incidence of hemorrhoids. uterus to contract.
3. Evening primrose converts to a 39
prostaglandin substance in the body. A 36-week gestation gravid client is complaining of
Prostaglandins are responsible for dyspnea when lying flat. Which
readying the cervix for dilation. of the following is the likely clinical reason for this
complaint?
TEST-TAKING TIP: Nurse midwives often
1. Maternal hypertension.
recommend complementary therapies
2. Fundal height.
during pregnancy as well as during labor
3. Hydramnios.
and delivery. Nurse midwives usually believe
4. Congestive heart failure
in promoting natural means for
maintaining a healthy pregnancy and for 2. The fundal height is the likely cause
stimulating labor. Evening primrose is of the woman’s dyspnea.
one of those interventions.
37
TEST-TAKING TIP: As the uterus enlarges,
A 38-week gestation client, Bishop score 1, is
the woman’s organs are impacted. At 36
advised by her nurse midwife to take
weeks, the fundus is at the level of the
evening primrose daily. The office nurse advises
xiphoid process. The diaphragm is elevated
the client to report which of the
and the lungs are displaced. When
following side effects that has been attributed to
a client lies flat she has difficulty breathing.
the oil?
Most women use multiple pillows at
1. Skin rash.
night for sleep. Whenever caring for a
2. Pedal edema.
pregnant woman, the nurse should elevate
3. Blurred vision.
the head of the bed.
4. Tinnitus.
40
1. Evening primrose has been shown to
The nurse is providing anticipatory guidance to a
cause skin rash in some women.
woman in her second trimester
regarding signs/symptoms that she might
experience in the coming weeks. Which
TEST-TAKING TIP: Even though evening
of the following comments by the client indicates
primrose is a “natural” substance, it can
that further teaching is needed?
cause side effects in some clients. The
1. “During the third trimester I may experience
most common side effect seen from the
frequent urination.”
oil is a skin rash. Headaches and nausea
2. “During the third trimester I may experience
have also been seen.
heartburn.”
38 3. “During the third trimester I may experience
A 37-week gravid client states that she noticed a back pain.”
“white liquid” leaking from her 4. “During the third trimester I may experience
breasts during a recent shower. Which of the persistent headache.”
following nursing responses is appropriate
4. Persistent headache should not be
at this time?
seen in pregnant women.
1. Advise the woman that she may have a
TEST-TAKING TIP: This question is asking
galactocele.
the test taker to determine which complaint
2. Encourage the woman to pump her breasts to
is not expected during the third
stimulate an adequate milk
trimester. The nurse, therefore, must
supply.
know which symptoms are normal during
3. Assess the liquid because a breast discharge is
the third trimester in order to know
diagnostic of a mammary
which symptoms are not normal during
infection.
that period. Persistent headache can indicate
that the woman has developed a 3. Sims’.
complication of pregnancy 4. Semi-Fowler’s.
41 4. The client should be placed in a semi-
A client, in her third trimester, is concerned that Fowler’s position.
she will not know the difference TEST-TAKING TIP: Because of the growth
between labor contractions and normal aches and of the uterus, it is very difficult for
pains of pregnancy. How should women in the third trimester to breathe
the nurse respond? in the supine position. During the prenatal
1. “Don’t worry. You’ll know the difference when the visit, the baby’s heartbeat will be
contractions start.” monitored and the fundal height will be
2. “The contractions may feel just like a backache, assessed. Both of these procedures can
but they will come and go.” safely be performed in the semi-Fowler’s
3. “Contractions are a lot worse than your position.
pregnancy aches and pains.” 44. 2, 3, and 4 ar
4. “I understand. You don’t want to come to the
44
hospital before you are in labor.”
A third-trimester client is being seen for routine
2. This is a true statement prenatal care. Which of the following
assessments will the nurse perform during the
visit? Select all that apply.
TEST-TAKING TIP: Labor contractions often 1. Blood glucose.
begin in a woman’s back, feeling 2. Blood pressure.
much like a backache. The difference is 3. Fetal heart rate.
that labor contractions are intermittent 4. Urine protein.
and rhythmic. The client should be advised 5. Pelvic ultrasound.
to attend to any pains that come
Study These Flashcards
and go and time them. She may be beginning
2, 3, and 4 are correct.
the labor process.
42
Which finding would the nurse view as normal 2. The blood pressure is assessed at
when evaluating the laboratory each prenatal visit.
reports of a 34-week gestation client? 3. The fetal heart rate is assessed at
1. Anemia. each prenatal visit. Depending on
2. Thrombocytopenia. the equipment available, it will be
3. Polycythemia. assessed mechanically via Doppler
4. Hyperbilirubinemia. or manually via fetoscope. The fetal
heart is audible via Doppler many weeks before it
1. Anemia is an expected finding.
is audible via
fetoscope.
4. Urine protein is performed at each
TEST-TAKING TIP: By the end of the second prenatal visit
trimester, the blood supply of the
woman increases by approximately 50%.
This increase is necessary in order for
TEST-TAKING TIP: The test taker must
the client to be able to perfuse the placenta.
read the question carefully. Although
There is a concurrent increase in
urine glucose assessments are done at
red blood cell production, but the vast
each visit, blood glucoses are assessed
majority of women are unable to produce
only intermittently during the pregnancy.
the red blood cells in sufficient numbers
Similarly, although ultrasound assessments
to keep pace with the increase in blood
may be ordered intermittently
volume. As a result, clients develop what
during a pregnancy, they are certainly
is commonly called “physiological anemia
not done at every prenatal visit. As a
of pregnancy.” A hematocrit of 32% is
matter of fact, there is no absolute
considered normal for a pregnant
mandate that a sonogram must be done
woman.
at all during a pregnancy.
43
45
The nurse asks a 31-week gestation client to lie on
A nurse is working in the prenatal clinic. Which of
the examining table during a
the following findings seen in
prenatal examination. In which of the following
third-trimester pregnant women would the nurse
positions should the client be
consider to be within normal
placed?
limits? Select all that apply.
1. Orthopneic.
1. Leg cramps.
2. Lateral-recumbent.
2. Varicose veins.
3. Hemorrhoids. Study These Flashcards
4. Fainting spells. 2. It is inappropriate to ask the Muslim
5. Lordosis. client about the name for the baby.
Study These Flashcards
1, 2, 3, and 5 are correct.
TEST-TAKING TIP: Traditional Muslim
1. Leg cramps are normal, although the
couples will not tell anyone the baby’s
client’s diet should be assessed.
name until he or she has gone through
2. Varicose veins are normal, although
the official naming ceremony, called
client teaching may be needed.
“aqiqah.” Babies are rarely named before
3. Hemorrhoids are normal, although
a week of age. The parents need time to
client teaching may be needed.
get to know their baby and decide on an
appropriate name for him or her.
5. Lordosis, or change in the curvature 48
of the spine, is normal, although patient A woman is 36-weeks’ gestation. Which of the
teaching may be needed. following tests will be done during
TEST-TAKING TIP: There are a number of her prenatal visit?
physical complaints that are “normal” 1. Glucose challenge test.
during pregnancy. There are interventions, 2. Amniotic fluid volume assessment.
however, that can be taught to 3. Vaginal and rectal cultures.
help to alleviate some of the discomforts. 4. Karyotype analysis.
The test taker should be familiar with
Study These Flashcards
patient education information that
3. Vaginal and rectal cultures are done at
should be conveyed regarding the physical
approximately 36 weeks’ gestation.
complaints of pregnancy. For example,
clients who complain of hemorrhoids
should be encouraged to eat high-fiber
foods and drink fluids in order to produce TEST-TAKING TIP: Vaginal and rectal cultures
softer stools. The softer stools are done to assess for the presence
should decrease the irritation of the of group B streptococcal (GBS) bacteria
hemorrhoids. in the woman’s vagina and rectum. If the
woman has GBS as part of her normal
flora, she will be given IV antibiotics
during labor to prevent vertical transmission
to her baby at birth. GBS is often
46 called, “the baby killer.”
A 36-week gestation gravid lies flat on her back.
49
Which of the following maternal
A 34-week gestation woman calls the obstetric
signs/symptoms would the nurse expect to
office stating, “Since last night
observe?
I have had three nosebleeds.” Which of the
1. Hypertension.
following responses by the nurse is
2. Dizziness.
appropriate?
3. Rales.
1. “You should see the doctor to make sure you are
4. Chloasma.
not becoming severely anemic.”
Study These Flashcards 2. “Do you have a temperature?”
2. Dizziness is an expected finding 3. “One of the hormones of pregnancy makes the
nasal passages prone to bleeds.”
TEST-TAKING TIP: Because the weight of
4. “Do you use any inhaled drugs?”
the gravid uterus compresses the great vessels,
the nurse would expect the client Study These Flashcards
to complain of dizziness when lying 3. This is an accurate statement. Hormonal
supine. The blood supply to the head changes in pregnancy make the
and other parts of the body is diminished nasal passages prone to bleeds.
when the great vessels are compressed.
47
TEST-TAKING TIP: Estrogen, one of the
The nurse is interviewing a 38-week gestation
important hormones of pregnancy,
Muslim woman. Which of the following
promotes vasocongestion of the mucous
questions would be inappropriate for the nurse to
membranes of the body. Increased vascular
ask?
perfusion of the mucous membranes
1. “Do you plan to breastfeed your baby?”
of the gynecological system is essential
2. “What do you plan to name the baby?”
for the developing fetus to survive. The
3. “Which pediatrician do you plan to use?”
vasocongestion occurs in all of the mucous
4. “How do you feel about having an episiotomy?”
membranes of the body, however,
leading to many complaints including A client is 35 weeks’ gestation. Which of the
nosebleeds and gingival bleeding. following findings would the nurse expect
to see?
50
1. Nausea and vomiting.
The nurse asks a woman about how the woman’s
2. Maternal ambivalence.
husband is dealing with the pregnancy.
3. Fundal height 10 cm above the umbilicus.
The nurse concludes that counseling is needed
4. Use of three pillows for sleep comfort.
when the woman makes
which of the following statements? Study These Flashcards
1. “My husband is ready for the pregnancy to end so 4. The use of three pillows for sleep
that we can have sex again.” comfort is often seen in clients who
2. “My husband has gained quite a bit of weight are 35 weeks’ gestation.
during this pregnancy.” TEST-TAKING TIP: It is essential that the
3. “My husband seems more worried about our test taker differentiate between normal
finances now than before the and abnormal findings at various points
pregnancy.” during the pregnancy—for example, nausea
4. “My husband plays his favorite music for my and vomiting are normal during the
belly so the baby will learn to like it.” first trimester but not during the second
or third trimesters. The fundal height
Study These Flashcards
measurement is also important to remember.
1. The woman implies that she and her
From 20 weeks’ gestation,
husband are not having sex. There is
when the fundal height is usually at the
no need to refrain from sexual intercourse
same height as the umbilicus, to 36
during a normal pregnancy—
weeks’ gestation, when the final height is
so the woman and her husband need
at the xiphoid process, the height measures
further counseling.
are approximately the same number
TEST-TAKING TIP: Couvade is the term of centimeters above the symphysis
given to a father’s physiological responses as the number of weeks of fetal gestation.
to his partner’s pregnancy. For example, at 24 weeks’ gestation,
Men have been seen to exhibit a number the height is usually 24 cm above the
of physical complaints/changes that symphysis or 4 cm above the umbilicus,
simulate their partner’s physical and at 35 weeks’ gestation, the height is
complaints/changes—for example, indigestion, usually 35 cm above the symphysis, or
weight gain, urinary frequency, 15 cm above the umbilicus.
and backache.
53
51 A woman, 26-weeks’ gestation, calls the triage
The blood of a pregnant client was initially nurse stating, “I’m really scared. I tried
assessed at 10 weeks’ gestation and reassessed not to but I had an orgasm when we were making
at 38 weeks’ gestation. Which of the following love. I just know that I will go into
results would the nurse expect preterm labor now.” Which of the following
to see? responses by the nurse is appropriate?
1. Rise in hematocrit from 34% to 38%. 1. “Lie down and drink a quart of water. If you feel
2. Rise in white blood cells from 5,000 cells/mm3 any back pressure at all call me
to 15,000 cells/mm3. back right away.”
3. Rise in potassium from 3.9 mEq/ L to 5.2 mEq/ L. 2. “Although oxytocin was responsible for your
4. Rise in sodium from 137 mEq/ L to 150 mEq/ L. orgasm, it is very unlikely that it
will stimulate preterm labor.”
Study These Flashcards 3. “I will inform the doctor for you. What I want you
2. The nurse would expect to see an to do is to come to the hospital
elevated white blood cell count. right now to be checked.”
4. “The best thing for you to do right now is to take
a warm shower, and then do a
TEST-TAKING TIP: At the end of the third fetal kick count assessment.”
trimester and through to the early postpartum
period, a normal leukocytosis, or Study These Flashcards
rise in white blood cell count, is seen. 2. This is an accurate statement.
This is a natural physiological change
that protects the woman’s body from the
invasion of pathogens during the birth TEST-TAKING TIP: There is no contraindication
process. The nurse should rely on a temperature to intercourse or to orgasm
elevation to determine whether during pregnancy, unless it has been
or not the woman has an infection determined that a client is high risk for
preterm labor. Until late in pregnancy,
52 there are very few oxytocin receptor sites
on the uterine body. The woman will,
therefore, not go into labor as a result of nursing staff in order to facilitate the
an orgasm during sexual relations. communication during that transition.
54 56
A couple is preparing to interview obstetric The nurse is assisting a couple to develop
primary care providers in order to determine decisions for their birth plan. Which of
who they will go to for care during their pregnancy the following decisions should be considered
and delivery. In order to nonnegotiable by the parents?
make the best choice, which of the following 1. Whether or not the father will be present during
actions should the couple perform first? labor.
1. Take a tour of hospital delivery areas. 2. Whether or not the woman will have an
2. Develop a preliminary birth plan. episiotomy.
3. Make appointments with three or four obstetric 3. Whether or not the woman will be able to have
care providers. an epidural.
4. Search the internet for the malpractice histories 4. Whether or not the father will be able to take
of the providers. pictures of the delivery.
Study These Flashcards Study These Flashcards
2. It is best that a couple first develop a 1. The presence of the father at delivery
birth plan. should be nonnegotiable.

TEST-TAKING TIP: It is important for a TEST-TAKING TIP: Even though the birth
couple’s needs and wants to match their plan should include issues like the use or
obstetrical care practitioner’s philosophy nonuse of episiotomies, emergent issues
of care. If, for example, the couple is during the delivery may lead to a sudden
interested in the possibility of having a change in plans. For example, if a cesarean
water birth, it is important that the is needed for malpresentation, the
health care provider be willing to perform issue of episiotomy is moot and the
a water birth. If, however, the client will definitely need anesthesia.
woman wants to be “completely pain However, there are some issues that
free,” the health care provider must be should be nonnegotiable. If the father
willing to order pain medications wishes to be in the delivery room no
throughout the labor and delivery. A matter the type of delivery or whether or
birth plan will list the couples’ many not an emergent situation is occurring,
wishes. that should be stated in the plan and
accepted by the health care provider.
55
During a preconception counseling session, the 57
nurse encourages a couple to prepare During a prenatal visit, a gravid client is
a birth plan. Which of the following is the most complaining of ptyalism. Which of the
important goal for this action? following nursing interventions is appropriate?
1. Promote communication between the couple and 1. Encourage the woman to brush her teeth
health care professionals. carefully.
2. Enable the couple to learn about the types of 2. Advise the woman to have her blood pressure
medicine used in labor. checked regularly.
3. Provide the couple with a list of items that they 3. Encourage the woman to wear supportive
should put in a bag for labor. hosiery.
4. Give the high-risk couple a sense of control over 4. Advise the woman to avoid eating rare meat.
having to have a cesarean.
Study These Flashcards
Study These Flashcards 1. Clients who experience ptyalism have
1. Birth plans help to facilitate communication an excess of saliva. They should be
between couples and their advised to be vigilant in the care for
health care providers. their teeth and gums. Ptyalism is often
accompanied by gingivitis and
TEST-TAKING TIP: The earlier a birth plan
nausea and vomiting.
is developed, the better. A pregnant
woman and her partner must feel comfortable
with the communication methods,
TEST-TAKING TIP: Ptyalism is related to
physical care, and health care
the increase in vascular congestion of
philosophies of their obstetrical health
the mucous membranes from increased
care provider. The birth plan is a means
estrogen production. Women with increased
for everyone to clearly understand each
salivation often also experience
step of the birthing process. When the
gingivitis, which is also related to estrogen
client enters the hospital for delivery, the
production. In addition, ptyalism is
birth plan should be presented to the
seen in women with nausea and vomiting. solder. Lead, when consumed either
Because of the caustic affects of gastric through the respiratory tract or the
juices on the enamel of the teeth, the GI tract, can cause permanent damage to
inflammation seen in the gums and the the central nervous system of the unborn
increased salivation, it is essential that child. It is very important, therefore, that
the pregnant woman take special care of the woman not breathe in the air in
her teeth during pregnancy, including rooms that have recently been sanded.
regular visits to the dentist or the dental The paint aerosolizes and the lead can
hygienist. be inhaled. In addition, lead leaches into
hot water more readily than into cold
58
so water from the cold tap should be
A gravid woman who recently emigrated from
consumed—but only after the water has
mainland China is being seen at her
run through the pipes for a minimum of
first prenatal visit. She was never vaccinated in
2 minutes.
her home country. An injection to
prevent which of the following communicable 60
diseases should be administered to After nutrition counseling, a woman, G3 P1101,
the woman during her pregnancy? proclaims that she certainly can’t
1. Influenza. eat any strawberries during her pregnancy. Which
2. Mumps. of the following is the likely
3. Rubella. reason for this statement?
4. Varicella. 1. The woman is allergic to strawberries.
2. Strawberries have been shown to cause birth
Study These Flashcards
defects.
1. The woman should receive the influenza
3. The woman believes in old wives’ tales.
injection. The nasal spray,
4. The premature baby died because the woman
however, should not be administered
ate strawberries
to a pregnant woman
Study These Flashcards
3. The woman believes in old wives’
TEST-TAKING TIP: It is very important for tales.
pregnant women to be protected from the flu by
receiving the inactivated influenza
injection. The fetus will not be TEST-TAKING TIP: There are a number of
injured from the shot and the woman old wives’ tales that pregnant women believe
will be protected from the many sequelae in and live by. One of the common
that can develop from the flu. However, tales relates to the ingestion of strawberries:
the live nasal flu spray should not be Women who eat strawberries have
administered to pregnant women. It is babies with strawberry marks on their
contraindicated to vaccinate pregnant
bodies. Unless old-wives’ tales have the
women with many other vaccines, including
potential to impact the health of the baby
the measles-mumps-rubella
and/or mother, it is ill advised and unnecessary
(MMR) and the varicella vaccines.
to argue with the mother
See http://www.acog.org/from_home/
about her beliefs.
publications/misc/bco282.pdf
61
59
A woman is planning to become pregnant. Which of
A gravid woman and her husband inform the nurse
the following actions should
that they have just moved into a
she be counseled to take before stopping birth
three-story home that was built in the 1930s.
control? Select all that apply.
Which of the following is critical for
1. Take a daily multivitamin.
the nurse to advise the woman in order to protect
2. See a medical doctor.
the unborn child?
3. Drink beer instead of vodka.
1. Stay out of any rooms that are being renovated.
4. Stop all over-the-counter medications.
2. Drink water only from the hot water tap.
5. Stop smoking cigarettes.
3. Refrain from entering the basement.
4. Climb the stairs only once per day. Study These Flashcards
1, 2, and 5 are correct.
Study These Flashcards
1. It is very important that women, before
1. The woman should stay out of rooms
attempting to become pregnant,
that are being renovated.
begin taking daily multivitamin
tablets.
2. Women who wish to become pregnant
TEST-TAKING TIP: Antique houses often
should first see a medical doctor
contain lead-based paint and water
for a complete check-up
piping that has been soldered with leadbased
5. Women who wish to become pregnant TEST-TAKING TIP: There are many skin
should be counseled to stop changes that occur normally during
smoking. pregnancy. Most of the changes—such
TEST-TAKING TIP: Because the embryo is as linea nigra, melasma, and hyperpigmentation
very sensitive during the first trimester of the areolae—are related
of pregnancy, women should be advised to an increase in the melanin-producing
to be vigilant about their health even before bodies of the skin as a result of
becoming pregnant. For example, stimulation by the female hormones,
folic acid, a vitamin in multivitamin estrogen and progesterone. The
tablets, helps to prevent neural tube defects. presence of petechiae is usually related
Women of childbearing age often to a pathological condition, such as
fail to go for complete physical examinations. thrombocytopenia.
It is important to discover the
64
presence of any medical illnesses before
A pregnant woman informs the nurse that her last
the pregnancy begins, however, so
normal menstrual period was on
women should be counseled to have a
September 20, 2006. Using Nagele’s rule, the nurse
complete physical before stopping birth
calculates the client’s estimated
control methods.
date of delivery as:
62 1. May 30, 2007.
The nurse discusses sexual intimacy with a 2. June 20, 2007.
pregnant couple. Which of the following 3. June 27, 2007.
should be included in the teaching plan? 4. July 3, 2007.
1. Vaginal intercourse should cease by the
Study These Flashcards
beginning of the third trimester.
3. The estimated date of delivery is June
2. Breast fondling should be discouraged because
27, 2007
of the potential for preterm labor.
3. The couple may find it necessary to experiment
with alternate positions.
4. Vaginal lubricant should be used sparingly TEST-TAKING TIP: Nagele’s rule is a simple
throughout the pregnancy. method used to calculate a client’s
estimated date of confinement (EDC) or
Study These Flashcards estimated date of delivery (EDD) from
3. With increasing size of the uterine the last normal menstrual period (LMP).
body, the couple may need counseling The nurse learns the date of the last
regarding alternate options for sexual menstrual period from the client. He or
intimacy. she then subtracts 3 months from the
date, adds 7 days to the date, and adjusts
TEST-TAKING TIP: Pregnancy lasts 10
lunar months. It is essential that the
nurse counsel clients on ways to maintain
health and well-being in the many the year, if needed. For the example
facets of their lives. Sexual intimacy is given:
one of the important aspects of a married Last normal menstrual
couple’s life together. The couple period—September 20, 2006 = 9 - 20 - 2006
can be counseled to use alternate positions, 37
engage in mutual masturbation, 6 27
or other means to satisfy their needs for adjust the year 6 - 27 - 2007
sexual expression during the pregnancy June 27, 2007
period. 65
63 A father experiencing couvade syndrome is likely
Which of the following skin changes should the to exhibit which of the following
nurse highlight for a pregnant symptoms/behaviors?
woman’s health care practitioner? 1. Heartburn.
1. Linea nigra. 2. Promiscuity.
2. Melasma. 3. Hypertension.
3. Petechiae. 4. Indifference.
4. Spider nevi. Study These Flashcards
Study These Flashcards 1. Heartburn is a common symptom
3. Petechiae are pinpoint red or purple
spots on the skin. They are seen in
hemorrhagic conditions. TEST-TAKING TIP: Heartburn is a subjective
complaint that fathers often experience
during their partners’ pregnancies.
Fathers who are experiencing couvade
symptoms are exhibiting a strong affiliation
between themselves and their partners.
TEST-TAKING TIP: Gravidity refers to
It is inappropriate for prospective
pregnancy and parity refers to delivery.
fathers to engage in illicit relationships
Every time a woman is pregnant, it is
and/or indifference toward their partners’
counted as one gravida (G). The results
pregnancies. They should be fully
of each pregnancy are then documented
engaged in the process. Hypertension, an
as a para (P) in the following order. The
objective sign, should be investigated
first number refers to full-term births or
further. The father may have developed a
births ≥ 38 weeks’ gestation; the second
pathologic condition.
number refers to preterm births or
66 births between 20 and 37 weeks’ gestation;
A nurse is advising a pregnant woman about the the third number refers to abortions,
danger signs of pregnancy. whether spontaneous or therapeutic;
The nurse should teach the mother that she should and the fourth number refers to the
notify the physician immediately number of living children. The client has
if she experiences which of the following been pregnant 5 times (G5); she birthed
signs/symptoms? Select all that 1 son, 1 daughter, had 1 miscarriage, had
apply. 1 first trimester abortion, and is currently
1. Convulsions. pregnant. Her parity (P1122) accurately
2. Double vision. reflects her obstetrical history:
3. Epigastric pain. 1 full-term delivery (daughter at
4. Persistent vomiting. 39 weeks), 1 preterm delivery (son at
5. Polyuria. 28 weeks), 2 abortions (1 miscarriage,
1 first-trimester abortion), and,
Study These Flashcards
1, 2, 3, and 4 are correct. 68
1. Convulsions are a danger sign of The partner of a gravida accompanies her to her
pregnancy. prenatal appointment. The nurse
2. Double vision is a danger sign of notes that the father of the baby has gained weight
pregnancy. since she last saw him. Which of
3. Epigastric pain is a danger sign of the following comments is most appropriate for
pregnancy. the nurse to make to the father?
4. Persistent vomiting is a danger sign of 1. “I see that you are gaining weight right along
pregnancy. with your partner.”
2. “You and your partner will be able to go on a diet
together after the baby is born.”
TEST-TAKING TIP: The danger signs of 3. “I can see that you are a bad influence on your
pregnancy are signs or symptoms that can partner’s eating habits.”
occur in an otherwise healthy pregnancy 4. “I am so glad to see that you are taking so much
that are likely due to serious pregnancy interest in your partner’s
complications. For example, double vision, pregnancy.”
epigastric pain, and blurred vision are
Study These Flashcards
symptoms of the hypertensive illnesses of
4. This is an appropriate comment to
pregnancy, and persistent vomiting is a
make at this time.
symptom of hyperemesis gravidarum.
TEST-TAKING TIP: This father is exhibiting
67 a sign of couvade; i.e., weight gain. This
A woman provides the nurse with the following is a positive response since it shows that
obstetrical history: Delivered a son, he is exhibiting a sympathetic response to
now 7 years old, at 28 weeks’ gestation; delivered his partner’s pregnancy. In addition, this
a daughter, now 5 years old, at father is accompanying his partner to the
39 weeks’ gestation; had a miscarriage 3 years prenatal visit, another positive sign.
ago, and had a first-trimester
69
abortion 2 years ago. She is currently pregnant.
The nurse is caring for a pregnant client who is a
Which of the following portrays
vegan. Which of the following
an accurate picture of this woman’s gravidity and
foods should the nurse suggest the client consume
parity?
as substitutes for restricted
1. G4 P2121.
foods?
2. G4 P1212.
1. Tofu, legumes, broccoli.
3. G5 P1122.
2. Corn, yams, green beans.
4. G5 P2211.
3. Potatoes, parsnips, turnips.
Study These Flashcards 4. Cheese, yogurt, fish.
3. This accurately reflects this woman’s
Study These Flashcards
gravidity and parity—G5P1122.
1. Tofu, legumes, and broccoli are excellent 2. Vitamin D supplementation can be
substitutes for the restricted harmful during pregnancy.
foods.

TEST-TAKING TIP: The water-soluble


TEST-TAKING TIP: Vegans are vegetarians vitamins, if consumed in large quantities,
who eat absolutely no animal products. have not been shown to be harmful
Since animal products are most clients’ during pregnancy. The body eliminates
sources of protein and iron, it is necessary the excess quantities through the urine
for vegans to be very careful to meet their and stool. However, the fat-soluble
increased needs by eating excellent vitamins—vitamins A, D, E, and K—can
sources of these nutrients. It is recommended build up in the body. Vitamins A and
that vegans meet with a registered D have been shown to be teratogenic to
dietitian early in their pregnancies the fetus in megadoses.
to discuss diet choices.
72
70 A vegan is being counseled regarding vitamin
When assessing the fruit intake of a pregnant intake. It is essential that this woman
client, the nurse notes that the client supplement which of the following B vitamins?
usually eats 1 piece of fruit per day and drinks 7 to 1. B1 (thiamine).
8 servings of fruit juice per day. 2. B2 (niacin).
Which of the following is the most important 3. B6 (pyridoxine).
communication for the nurse to make? 4. B12 (cobalamin).
1. “You are effectively meeting your daily fruit
Study These Flashcards
requirements.”
4. Vitamin B12 (cobalamin) should be
2. “Fruit juices are excellent sources of folic acid.”
supplemented.
3. “It would be even better if you were to consume
more whole fruits and less fruit
juice.”
4. “Your fruit intake far exceeds the recommended TEST-TAKING TIP: Vitamin B12 (cobalamin)
daily fruit intake.” is found almost exclusively in animal
products—meat, dairy, eggs. Since vegans
Study These Flashcards do not consume animal products, and
3. It is recommended that pregnant the vitamin is not in most nonanimal
clients eat whole fruits rather than sources, it is strongly recommended that
consume large quantities of fruit vegans supplement that vitamin. Those
juice. This is the most important who take in too little of the vitamin are
statement for the nurse to make. susceptible to anemia and nervous system
disorders. In addition, the vitamin is
especially important during pregnancy
TEST-TAKING TIP: Approximately 6 oz since it is essential for DNA synthesis.
of fruit juice equals 1 serving from the
73
fruit group. Fruit juices, however, are
foods would be best for the nurse to recommend
usually much higher in sugar than are
to the client?
whole fruits. In addition, the client is not
1. Bananas.
receiving the benefit of the fiber that is
2. Rice.
contained in the whole fruit. The nurse
3. Yogurt.
should compliment the client on her
4. Celery.
fruit intake but encourage her to
consume whole fruits rather than large Study These Flashcards
quantities of juice. 4. Celery is an excellent food to reverse
constipation.
71
TEST-TAKING TIP: Most women complain
A client states that she is a strong believer in
of constipation during pregnancy. Progesterone,
vitamin supplements to maintain her
a muscle-relaxant, is responsible
health. The nurse advises the woman that it is
for a slowing of the digestive system.
recommended to refrain from consuming
It is important, therefore, to recommend
excess quantities of which of the following
foods to pregnant clients that will help to
vitamins during pregnancy?
alleviate the problem. Foods high in fiber,
1. Vitamin C.
like celery, are excellent suggestions.
2. Vitamin D.
3. Vitamin B2 (niacin). 74
4. Vitamin B12 (cobalamin). A pregnant client is lactose intolerant. Which of the
following alternative calciumrich
Study These Flashcards
foods could this woman consume?
1. Turnip greens.
2. Green beans. 2. This client consumed 32⁄3 servings:
3. Cantaloupe. 1 cup yogurt 1 serving, 8 oz chocolate
4. Nectarines. milk 1 serving; 1 cup cottage
cheese 2⁄3 serving; and 11⁄2 oz hard
Study These Flashcards
cheese 1 serving.
1. Turnip greens are calcium-rich.

TEST-TAKING TIP: It is essential that the


TEST-TAKING TIP: There are a number of
test taker know which foods are placed in
women who, for one reason or another,
which food groups and the equivalent
do not consume large quantities of dairy
quantity of food that meets one serving
products. The nurse must be prepared to
size. For example, 1 cup of any type
suggest alternate sources since dairy
of milk—whole, skim, butter, or even
products are the best sources for calcium
chocolate—is equal to one dairy serving
intake. Any of the dark green leafy vegetables,
while 11⁄2 oz of hard cheese is equal to
like kale, spinach, collards, and
one serving.
turnip greens, are excellent sources, as
are small fish that are eaten with the 77
bones, like sardines. Which of the following choices can the nurse teach
a prenatal client is equivalent to
75
one 2-oz meat serving?
A nurse, who is providing nutrition counseling to a
1. 4 tbsp peanut butter.
new gravid client, advises the
2. 2 eggs.
woman that a serving of meat is approximately
3. 1 cup cooked lima beans.
equal in size to which of the
4. 2 ounces mixed nuts.
following items?
1. Deck of cards. Study These Flashcards
2. VCR tape. 2. 2 eggs 1 meat serving
3. CD case.
4. Video camera.
Study These Flashcards TEST-TAKING TIP: The test taker should
1. This is an accurate statement. A serving refer to the US Dietary Association information
of meat is approximately equal to at http://www.health.gov/
a deck of cards. dietaryguidelines for up-to-date dietary
recommendations. As more research
information is forthcoming, dietary
recommendations change.
TEST-TAKING TIP: The dietary recommendation
of the meat group for pregnant 78
clients is: 3 servings of meat per day. A nurse is discussing the serving sizes in the grain
food group with a new prenatal
Each serving is defined as 2 to 3 oz of
client. Which of the following foods equals 1
meat, fish, or poultry. The average
serving size from the grain group?
American diet well exceeds the recommended
Select all that apply.
meat intake since most
1. 1 bagel.
Americans consider a serving of meat to
2. 1 slice of bread.
be larger than a deck of cards.
3. 1 cup cooked pasta.
76 4. 1 tortilla.
The nurse is evaluating the 24-hour dairy intake of 5. 1 cup dry cereal.
four gravid clients. Which of
Study These Flashcards
the following clients consumed the highest
2, 4, and 5 are correct.
number of dairy servings during 1 day?
The client who consumed:
1. 4 oz whole milk, 2 oz hard cheese, 1 cup of
pudding made with milk and 2 oz 2. 1 slice bread 1 serving.
cream cheese.
2. 1 cup yogurt, 8 oz chocolate milk, 1 cup cottage
cheese, and 11⁄2 oz hard cheese. 4. 1 tortilla 1 serving.
3. 1⁄2 cup cottage cheese, 8 oz whole milk, 1 cup of 5. 1 cup dry cereal 1 serving.
buttermilk, and 1⁄2 oz hard TEST-TAKING TIP: The test taker should
cheese. note that pregnant women are recommended
4. 1⁄2 cup frozen yogurt, 8 oz skim milk, 4 oz cream to consume 7 to 11 servings of
cheese, and 11⁄2 cup of cottage grain. However, 1 sandwich equals 2
cheese. servings since each piece of bread equals
1 serving. Also, it is important to counsel
Study These Flashcards women to eat whole grain foods rather
than processed grains. More nutrients as A nurse has identified the following nursing
well as more fiber are obtained from diagnosis for a prenatal client: Altered
whole grain foods. nutrition: less than body requirements related to
poor folic acid intake. Which of
79
the following foods should the nurse suggest the
A woman asks the nurse about consuming herbal
client consume?
supplements during pregnancy.
1. Potatoes and grapes.
Which of the following responses is appropriate?
2. Cranberries and squash.
1. Herbals are natural substances, so they are
3. Apples and corn.
safely ingested during pregnancy.
4. Oranges and spinach.
2. It is safe to take licorice and cat’s claw, but no
other herbs are safe. Study These Flashcards
3. A federal commission has established the safety 4. Oranges and spinach are excellent
of herbals during pregnancy. folic acid sources.
4. The woman should discuss everything she eats TEST-TAKING TIP: The intake of folic acid
with a health care practitioner. is especially important during the first
trimester of pregnancy to help to prevent
Study These Flashcards
structural defects, including spina bifida
4. Every woman should advise her health
and gastroschisis. The best sources of
care practitioner of what she is consuming,
folic acid are liver and green leafy vegetables.
including food, medicines,
Oranges and orange juice are
herbals, and all other substances.
also good sources.
TEST-TAKING TIP: Herbals are not regulated
by the Food and Drug Administration 82
(FDA). There is some information A nurse is discussing diet with a pregnant woman.
on selected herbals at the National Institute Which of the following foods
of Health web site—http://nccam. should the nurse advise the client to avoid
nih.gov/health—but because research on consuming during her pregnancy?
pregnant women is particularly sensitive 1. Bologna.
there is very little definitive information 2. Cantaloupe.
on the safety of many herbals in pregnancy. 3. Asparagus.
No matter what is consumed by 4. Popcorn.
the mother, however, the health care
Study These Flashcards
practitioner should be consulted.
82. 1. Bologna should not be consumed
80 during pregnancy unless it is thoroughly
A Chinese immigrant is being seen in the prenatal cooked.
clinic. When providing nutrition
TEST-TAKING TIP: Because pregnant
counseling, which of the following factors should
women are slightly immunocompromised,
the nurse keep in mind?
they are especially susceptible to
1. Many Chinese eat very little protein.
certain diseases. Deli meats, unless
2. Many Chinese believe pregnant women should
heated to steaming hot, can cause listeriosis.
eat cold foods.
Pregnant women should avoid
3. Many Chinese are prone to anemia.
these foods. Other foods that contain
4. Many Chinese believe strawberries can cause
Listeria monocytogenes that should be
birth defects.
avoided are unpasteurized milk, soft
Study These Flashcards cheese, and undercooked meats. See
2. Many Chinese women do believe in http://www.cfsan.fda.gov/~pregnant/
the “hot and cold” theory of life. ataglanc.html and http://www.health.
gov/dietaryguidelines/dga2005/
document/html/chapter10.htm
TEST-TAKING TIP: Whenever a question
specifies that a client belongs to a specific
cultural or ethnic group, the test 83
taker should attend carefully to that information. A 12-week gestation client tells the nurse that she
It is very likely that the and her husband eat sushi at least
question is asking the test taker to discern once per week. She states, “I know that fish is
cultural/ethnic differences in order good for me, so I make sure we eat it
to discern the test taker’s cultural regularly.” Which of the following responses by the
competence. Pregnancy is believed by nurse is appropriate?
many Chinese to be a “hot period.” In 1. “You are correct. Fish is very healthy for you.”
order to maintain the equilibrium of the 2. “You can eat fish, but sushi is too salty to eat
body, therefore, pregnant women consume during pregnancy.”
“cold” foods and drinks. 3. “Sushi is raw. Raw fish is especially high in
mercury.”
81
4. “It is recommended that fish be cooked to 86
destroy harmful bacteria.” A woman confides in the nurse that she practices
pica. Which of the following
Study These Flashcards
alternatives could the nurse suggest to the
4. This is correct. It is recommended
woman?
that during pregnancy the client eat
1. Replace laundry starch with salt.
only well-cooked fish.
2. Replace ice with frozen fruit juice.
TEST-TAKING TIP: Fish is an excellent
3. Replace soap with cream cheese.
source of omega-3 oil and protein.
4. Replace soil with uncooked pie crust.
During pregnancy fish should be eaten
well-cooked to avoid ingestion of Study These Flashcards
pathogens. The pregnant woman should 2. This is an excellent suggestion. Fruit
limit her intake to 12 oz per week or less juice, although high in sugar, does
to reduce the potential of her consuming contain vitamins.
toxic levels of methylmercury. See
http://www.cfsan.fda.gov/~pregnant/
safemea.html TEST-TAKING TIP: Although the nurse
might prefer that a client completely stop
84
a behavior that the nurse deems unsafe or
The nurse is caring for a prenatal client who states
inappropriate, the client may disagree.
she is prone to developing anemia.
The nurse, therefore, must attempt to
Which of the following foods should the nurse
provide a substitute for the client’s behavior.
advise the gravida is the best
Pica is a behavior that should be
source of iron?
discouraged because of its potentially
1. Raisins.
detrimental effects. If the client wishes to
2. Hamburger.
consume ice, an excellent alternative is
3. Broccoli.
ice pops, Italian ices, or iced fruit juice.
4. Molasses.
87
Study These Flashcards
A mother is experiencing nausea and vomiting
2. Hamburger contains the most iron
every afternoon. The ingestion of
which of the following spices has been shown to
be a safe complementary therapy
TEST-TAKING TIP: Iron is present in most
for this complaint?
animal sources—seafood, meats, eggs—
1. Ginger.
although it is not present in milk. There
2. Sage.
also is iron in vegetable sources, although
3. Cloves.
not in the same concentration as
4. Nutmeg.
in animal products. If the nurse is caring
for a pregnant vegetarian, the nurse must Study These Flashcards
counsel the client regarding good nonanimal 1. Ginger has been shown to be a safe
sources of all nutrients. antiemetic agent for pregnant women.
85
It is discovered that a pregnant woman practices
TEST-TAKING TIP: Morning sickness and
pica. Which of the following complications
daytime nausea and vomiting are common
is most often associated with this behavior?
complaints of pregnant women during the
1. Hypothyroidism.
first trimester. Ginger, consumed as ginger
2. Iron deficiency anemia.
tea, ginger ale, or the like, has been
3. Hypercalcemia.
shown to be a safe and an effective antinausea
4. Overexposure to zinc.
agent for many pregnant women.
Study These Flashcards
88
2. Iron deficiency anemia is often seen
A woman tells the nurse that she would like
in clients who engage in pica.
suggestions for alternate vitamin C
sources because she isn’t very fond of citrus fruits.
Which of the following suggestions
TEST-TAKING TIP: Clients who engage in
is appropriate?
pica eat large quantities of nonfood items
1. Barley and brown rice.
like ice, laundry starch, soap, and dirt.
2. Strawberries and potatoes.
There are a number of problems related
3. Buckwheat and lentils.
to pica, including teratogenesis related to
4. Wheat flour and figs.
eating foods harmful to the fetus. More
commonly, the women fill up on items Study These Flashcards
like ice instead of eating high-quality 2. Strawberries and potatoes are
foods. This practice is often culturally excellent sources of vitamin C, as are
related.
zucchini, blueberries, kiwi, green Why is it essential that women of childbearing age
beans, green peas, and the like. be counseled to plan their
pregnancies?
TEST-TAKING TIP: The test taker must be
1. Much of the organogenesis occurs before the
prepared to answer basic nutrition questions
missed menstrual period.
related to the health of the pregnant
2. Insurance companies must preapprove many
woman. Even though citrus fruits
prenatal care expenditures.
are commonly thought of as the primary
3. It is recommended that women be pregnant no
sources of vitamin C, the test taker
more than 3 times during their
should realize that virtually all fruits and
lifetime.
vegetables contain the vitamin, while
4. The cardiovascular system is stressed when
grains do not.
pregnancies are less than 2 years apart.
Study These Flashcards
89 1. This statement is true. Organogenesis
A nurse is providing diet counseling to a new begins prior to the missed menstrual
prenatal client. Which of the following period.
dairy products should the client be advised to
avoid eating during the pregnancy?
1. Vanilla yogurt. TEST-TAKING TIP: The test taker may be
2. Parmesan cheese. unfamiliar with the term organogenesis.
3. Gorgonzola cheese. To answer the question correctly, however, it is
4. Chocolate milk. essential that the test taker
be able to decipher the definition. It is
Study These Flashcards
important that the nurse break the word
3. The intake of gorgonzola cheese
down into its parts in order to deduce
should be discouraged during pregnancy.
the meaning. Organo means “organ” and
genesis means “origin.” The definition of
the term, therefore, is origin, or development,
TEST-TAKING TIP: Gorgonzola cheese is a of the organ systems.
soft cheese. Soft cheeses harbor Listeria
monocytogenes, the organism that causes 92
listeriosis. Pregnant women are at high A woman has just completed her first trimester.
risk of developing this infection because Which of the following fetal structures
they are slightly immunosuppressed. The can the nurse tell the woman are well formed at
adult disease can assume many forms, including this time? Select all that apply.
meningitis, pneumonia, and sepsis. 1. Genitals.
Pregnant women who develop the 2. Heart.
disease often deliver stillborn babies or 3. Fingers.
babies who are at risk of dying postdelivery 4. Alveoli.
from fulminant disease. 5. Kidneys.

90 Study These Flashcards


A woman asks the nurse about the function of 1, 2, 3, and 5 are correct.
amniotic fluid. Which of the following 1. The genitalia are formed by the end
statements by the woman indicates that additional of the first trimester.
teaching is needed? 2. The heart is formed by the end of the
1. The fluid provides fetal nutrition. first trimester.
2. The fluid cushions the fetus from injury. 3. The fingers are formed by the end of
3. The fluid enables the fetus to grow. the first trimester.
4. The fluid provides a stable thermal environment
Study These Flashcards
5. The kidneys are formed by the end of
90. 1. The umbilical cord, not the amniotic
the first trimester.
fluid, delivers nutrition to the developing
TEST-TAKING TIP: The test taker should
fetus.
be familiar with the basic developmental
changes that occur during the three
trimesters. In addition, the test taker
TEST-TAKING TIP: The amniotic fluid is should be able to develop a basic timeline
produced primarily by the fetus as fetal of developmental milestones that
urine. In addition to the functions noted occur during the pregnancy. By the
above, the baby practices “breathing” the conclusion of the first trimester, all
amniotic fluid in and out of the lungs in major organs are completely formed.
preparation for breathing air in the extrauterine The maturation of the organ systems
environment. must, however, still occur.
91
93 chorion.
An ultrasound of a fetus’ heart shows that normal 4. The babies will definitely be the same sex and
fetal circulation is occurring. have the same blood type.
Which of the following statements should the
Study These Flashcards
nurse interpret as correct in relation
2. This is a true statement. Dizygotic
to the fetal circulation?
twins result from two mature ova that
1. The foramen ovale is a hole between the
are fertilized.
ventricles.
2. The umbilical vein contains oxygen-poor blood. TEST-TAKING TIP: The best way for the
3. The right atrium contains both oxygen-rich and test taker to differentiate between
oxygen-poor blood. monozygotic twinning and dizygotic
4. The ductus venosus lies between the aorta and twinning is to remember the meaning of
pulmonary artery. the prefixes to the two words. “Mono”
means 1. Monozygotic twins, therefore,
Study These Flashcards
originate from one fertilized ovum. The
3. The right atrium does contain both
babies have the same DNA; therefore,
oxygen-rich and oxygen-poor blood.
they are the same sex. They share a placenta
and chorion. “Di” means 2. Dizygotic
twins arise from 2 separately fertilized
TEST-TAKING TIP: The test taker should
eggs. Their genetic relationship is
have an understanding of fetal circulation.
the same as if they were siblings born
One principle to remember when
from different pregnancies.
studying the circulation of the fetus is
that the blood bypasses the lungs since 96
the baby is receiving oxygen-rich A mother has just experienced quickening. Which
blood directly from the placenta via the of the following developmental
umbilical vein. The location of the three changes would the nurse expect to occur at the
ducts—ductus venosus, formen ovale, same time in the woman’s
ductus arteriosus—therefore, enable the pregnancy?
blood to bypass the lungs. 1. Fetal heart begins to beat.
2. Lanugo covers the fetal body.
94
3. Kidneys secrete urine.
The nurse is teaching a couple about fetal
4. Fingernails begin to form.
development. Which statement by the
nurse is correct about the morula stage of Study These Flashcards
development? 2. Lanugo does cover the fetal body at
1. “The fertilized egg has yet to implant into the approximately 20 weeks’ gestation.
uterus.”
2. “The lung fields are finally completely formed.”
3. “The sex of the fetus can be clearly identified.” TEST-TAKING TIP: Although the test taker
4. “The eye lids are unfused and begin to open and need not memorize all fetal developmental
close.” changes, it is important to have an
understanding of major periods of development.
Study These Flashcards
For example, organogenesis occurs
1. This is a true statement. In the
during the first trimester with all of
morula stage, about 2 to 4 days after
the major organs functioning at a primitive
fertilization, the fertilized egg has not
level by week 12.
yet implanted in the uterus.
97
A woman who is seen in the prenatal clinic is
TEST-TAKING TIP: The morula is the found to be 8 weeks pregnant. She
undifferentiated ball of cells that migrates confides to the nurse that she is afraid her baby
down the fallopian tube toward may be “permanently damaged because
the uterine body. The morular stage lasts I had at least 5 beers the night I had sex.” Which of
from about the 2nd to the 4th day after the following responses
fertilization. by the nurse would be appropriate?
1. “I would let the doctor know that if I were you.”
95
2. “It is unlikely that the baby was affected.”
A woman is carrying dizygotic twins. She asks the
3. “Abortions during the first trimester are very
nurse about the babies. Which of
safe.”
the following explanations is accurate?
4. “An ultrasound will tell you if the baby was
1. During a period of rapid growth, the fertilized egg
affected.”
divided completely.
2. When the woman ovulated, she expelled two Study These Flashcards
mature ova. 2. This statement is true
3. The babies share one placenta and a common
TEST-TAKING TIP: The 2-week period between 3. Blastocyst development is complete.
ovulation and implantation is often 4. Testes have descended into the scrotal sac.
called “the all or nothing period.”
Study These Flashcards
During that time, the fertilized egg/
The correct order is 3, 1, 2, 4.
embryo is floating freely in the woman’s
fallopian tubes toward the uterine body.
The mother is not supplying the embryo
with nutrients at this time. Rather, the 3. The blastocyst is developed about 6 days
embryo is self-sufficient. If an insult after fertilization and before implantation
occurs—for example, a teratogen is ingested in the uterus has occurred.
or an abdominal x-ray is taken— 1. The four-chambered heart is formed
the embryo is either destroyed or completely during the early part of the first
spared. And, since the pregnancy trimester.
of the woman in the scenario was maintained, 2. Vernix caseosa is present during the latter
the nurse can assure her that the half of pregnancy.
embryo was spared insult. 4. The testes descend in the scrotal sac
about mid third trimester.
98 TEST-TAKING TIP: Before putting these
A gravida’s fundal height is noted to be at the items into chronological order, the test
xiphoid process. The nurse is aware taker should carefully analyze each
that which of the following fetal changes is likely choice. The blastocyst is developed by
to be occurring at the same time about day 6 after fertilization. The egg
in the pregnancy? has yet even to implant into the uterine
1. Surfactant is formed in the fetal lungs. body at this point. The fetal heart develops
2. Eyes begin to open and close. during the early part of the first
3. Respiratory movements begin. trimester, but after implantation. Vernix
4. The spinal column is completely formed. is present during the entire latter half of
the pregnancy in order to protect the
Study These Flashcards
skin of the fetus. It appears, therefore, at
1. Surfactant is usually formed in the
about week 20. And, finally, the testes do
fetal lungs by the 36th week.
not descend into the scrotal sac until mid
third trimester. Indeed, male preterm babies
are often birthed before the testes
TEST-TAKING TIP: The test taker should
descend.
realize that this question is asking two
things. First, the test taker needs to 100
know what stage of pregnancy the A client is having an ultrasound assessment done
woman is in when the fundal height is at her prenatal appointment at 8
at the xiphoid process. Once the test weeks’ gestation. She asks the nurse, “Can you tell
taker realizes that this fundal height what sex my baby is yet?”
signifies 36 weeks’ gestation, he or she Which of the following responses would be
must determine what other change or appropriate for the nurse to make at
process is likely to be occurring at this time?
36 weeks. The spinal column is completely 1. “The technician did tell me the sex, but I will have
formed by the end of the first to let the doctor tell you
trimester, fetal respiratory movements what it is.”
begin at about 24 weeks, and the eyes 2. “The organs are completely formed and present,
open and close at about 28 weeks. Surfactant, but the baby is too small for
which is essential for mature any to be seen.”
lung function, forms in the fetal lungs 3. “The technician says that the baby has a penis. It
at about 36 weeks. It is important for looks like you are having a boy.”
the nurse to realize that babies who are 4. “I am sorry. It will not be possible to see which
born preterm are high risk for a number sex the baby is for another
of reasons, including lack of surfactant, month or so.”
lack of iron stores to sustain them
Study These Flashcards
during the early months of life, and lack
4. This statement is true. The sex is not
of brown adipose tissue needed for
visible yet.
thermoregulation.
TEST-TAKING TIP: The genitourinary system
99 is the last organ system to fully develop.
Below are four important landmarks of fetal Before 12 weeks, both female and
development. Please place them in male genitalia are present. The sex is determined
chronological order: genetically, but it is as yet impossible
1. Four-chambered heart is formed. to determine the sex visually. If
2. Vernix caseosa is present. the embryo secretes testosterone, the
male sex organs mature and the female
organs recede. If the embryo does not 2. “When the doctor clamps the cord, the blood
secrete testosterone, the male sex organs stops mixing.”
recede and the female organs mature. At 3. “The separation happens after the baby takes the
8 weeks, it is not possible to determine first breath. The baby’s oxygen
the sex of the fetus. no longer has to come from you.”
4. “The blood actually never mixes. Your blood
101
supply and the baby’s blood supply
Which of the following developmental features
are completely separate.”
would the nurse expect to be absent
in a 41-week gestation fetus? Study These Flashcards
1. Fingernails. 4. The blood supplies are completely
2. Eye lashes. separate.
3. Lanugo. TEST-TAKING TIP: It is important to understand
4. Milia. the relationship between the
maternal vascular system and the fetal
Study These Flashcards
system. There is a maternal portion to
3. Because this baby is postterm, lanugo
the placenta and a fetal portion of the
would likely not be present.
placenta. By the time the placenta is fully
functioning, at about 12 weeks’ gestation,
fetal blood vessels have burrowed
TEST-TAKING TIP: Lanugo is a fine hair into the decidual lining and maternal
that covers the body of the fetus. It begins to vessels have burrowed into the chorionic
disappear at about 38 weeks and layer. The vessels, therefore, lie next to
very likely has completely vanished by each other. Gases and nutrients, then,
41 weeks’ gestation. move across the membranes of the vessels
102 in order to provide the baby with
A woman delivers a fetal demise that has lanugo needed substances and in order for the
covering the entire body, nails that mother to dispose of waste products.
are present on the fingers and toes, but eyes that 104
are still fused. Prior to the death, Please place an “X” on the drawing of the cross
the mother stated that she had felt quickening. section of a placenta at the site of
Based on this information, the nurse gas exchange.
knows that the baby is about how many weeks’
gestation?
1. 15 weeks.
2. 22 weeks.
3. 29 weeks.
4. 36 weeks. Study These Flashcards
An “X” will be placed between the
Study These Flashcards neonatal and maternal vessels where gas
2. This fetus is about 22 weeks’ gestation. exchange occurs.
Nails start to develop in the first
trimester, and lanugo starts to develop TEST-TAKING TIP: It is important that the
at about 20 weeks, but eyes remain test taker have a complete understanding
fused until about 29 weeks. of the anatomy and the physiology of the
placenta. Since this is the sole organ that
maintains the health and well-being of
TEST-TAKING TIP: The test taker should the fetus, the nurse must be able to differentiate
not panic when reading a question like between the maternal portion
the one in the scenario. This is an application and the fetal portion as well as the function
question that requires the test of the structures.
taker to take things apart and put them
back together again. Each of the signs is
unique and relates to a specific period in
fetal development. After an analysis, the
only response that is plausible is response 105
“2.” The nurse is reading an article that states that the
103 maternal mortality rate in the
A client asks the nurse, “Could you explain how the United States in the year 2000 was 17. Which of the
baby’s blood and my blood separate following statements would be
at delivery?” Which of the following responses is an accurate interpretation of the statement?
appropriate for the nurse to 1. There were 17 maternal deaths in the United
make? States in 2000 per 100,000 live
1. “When the placenta is born, the circulatory births.
systems separate.” 2. There were 17 maternal deaths in the United
States in 2000 per 100,000 women B.Electrolyte imbalance
of childbearing age. C.Miscarriage
3. There were 17 maternal deaths in the United D.Pregnancy induced
States in 2000 per 100,000 hypertension (PIH)
pregnancies.
4. There were 17 maternal deaths in the United 3. A 26-year old multigravida is C. The alpha-fetoprotein
States in 2000 per 100,000 women 14 weeks' pregnant and is test detects neural tube
in the country. scheduled for an alpha- defects and Down
Study These Flashcards fetoprotein test. She asks syndrome.
105. 1. This statement is correct. The maternal the nurse, "What does the
mortality rate is the number of alpha-fetoprotein test
deaths of women as a result of the indicate?" The nurse bases a
childbearing period per 100,000 live response on the knowledge
births. that this test can detect:
A.Kidney defects
B.Cardiac defects
TEST-TAKING TIP: One important indicator C.Neural tube defects
of the quality of health care in a D.Urinary tract defects
country is its maternal mortality rate.
The rate in the United States is very low 4. After the first four months A. When placental
as compared to many other countries in of pregnancy, the chief formation is complete,
the world. For example, the maternal source of estrogen and around the 16th week of
mortality rate in sub-Saharan Africa in progesterone is the: pregnancy; it produces
1995 was 1,100 deaths per 100,000 live A.Placenta estrogen and
births. B.Adrenal cortex progesterone.
C.Corpus luteum
106
D.Anterior hypophysis

The antagonist for A. Calcium gluconate is the


Antepartum NCLEX questions
5.
magnesium sulfate should antidote for magnesium
Study online at quizlet.com/_fvm37 be readily available to any toxicity. Ten ml of 10%
client receiving IV calcium gluconate is given
1. 1.21. Rho (D) immune A. Rh incompatibility can
magnesium. Which of the IV push over 3-5 minutes.
globulin (RhoGAM) is occur when an Rh-negative
following drugs is the Hydralazine is given for
prescribed for a woman mom becomes sensitized
antidote for magnesium sustained elevated blood
following delivery of a to the Rh antigen.
toxicity? pressures in preeclamptic
newborn infant and the Sensitization may develop
A.Calcium gluconate clients.
nurse provides information when an Rh-negative
B.Hydralazine (Apresoline)
to the woman about the woman becomes pregnant
C.Narcan
purpose of the medication. with a fetus who is Rh
D.RhoGAM
The nurse determines that positive. During pregnancy
the woman understands the and at delivery, some of
6. . A nurse is assisting in 1, 4, 5, and 6. The probable
purpose of the medication if the baby's Rh positive
performing an assessment signs of pregnancy include
the woman states that it will blood can enter the
on a client who suspects uterine enlargement,
protect her next baby from maternal circulation,
that she is pregnant and is Hegar's sign (softening and
which of the following? causing the woman's
checking the client for thinning of the uterine
A.Being affected by Rh immune system to form
probable signs of segment that occurs at
incompatibility antibodies against Rh
pregnancy. Select all week 6), Goodell's sign
B.Having Rh positive blood positive blood.
probable signs of (softening of the cervix that
C.Developing a rubella Administration of Rho (D)
pregnancy. 1.Uterine occurs at the beginning of
infection immune globulin prevents
enlargement the 2nd month), Chadwick's
D.Developing physiological the woman from
2.Fetal heart rate detected sign (bluish coloration of
jaundice developing antibodies
by nonelectric device the mucous membranes of
against Rh
3.Outline of the fetus via the cervix, vagina, and vulva
radiography or ultrasound that occurs at week 6),
2. A 21-year old client, 6 B. Excessive vomiting in
4.Chadwick's sign ballottement (rebounding
weeks' pregnant is clients with hyperemesis
5.Braxton Hicks of the fetus against the
diagnosed with hyperemesis gravidarum often causes
contractions examiners fingers of
gravidarum. This excessive weight loss and fluid,
6.Ballottement palpation), Braxton Hicks
vomiting during pregnancy electrolyte, and acid-base
contractions and a positive
will often result in which of imbalances.
pregnancy test measuring
the following conditions?
for hCG. Positive signs of
A.Bowel perforation
pregnancy include fetal
heart rate detected by care. Which statement, if physician. The woman is
electronic device (Doppler) made by the client, instructed to count the
at 10-12 weeks and by indicates a need for further number of perineal pads
nonelectronic device education? used daily and to note the
(fetoscope) at 20 weeks 1."I will maintain strict quantity and color of blood
gestation, active fetal bedrest throughout the on the pad. The woman
movements palpable by the remainder of pregnancy." also should watch for the
examiner, and an outline of 2."I will avoid sexual evidence of the passage of
the fetus via radiography or intercourse until the tissue.
ultrasound. bleeding has stopped, and
for 2 weeks following the
7. At a prenatal visit at 36 B. Ambulation relieves last evidence of bleeding."
weeks' gestation, a client Braxton Hicks. 3."I will count the number
complains of discomfort of perineal pads used on a
with irregularly occurring daily basis and note the
contractions. The nurse amount and color of blood
instructs the client to: on the pad."
A.Lie down until they stop 4."I will watch for the
B.Walk around until they evidence of the passage of
subside tissue."
C.Time contraction for 30
minutes 11. Clients with gestational A. Clients with gestational
D.Take 10 grains of aspirin diabetes are usually diabetes are usually
for the discomfort managed by which of the managed by diet alone to
following therapies? control their glucose
8. The chief function of C. Progesterone stimulates A.Diet intolerance. Oral
progesterone is the: differentiation of the B.NPH insulin (long-acting) hypoglycemic agents are
A.Development of the endometrium into a C.Oral hypoglycemic drugs contraindicated in
female reproductive system secretory type of tissue. D.Oral hypoglycemic drugs pregnancy. NPH isn't
B.Stimulation of the and insulin usually needed for blood
follicles for ovulation to glucose control for GDM.
occur
C.Preparation of the uterus 12. The developing cells are B. In the first 7-14 days the
to receive a fertilized egg called a fetus from the: ovum is known as a
D.Establishment of A.Time the fetal heart is blastocyst; it is called an
secondary male sex heard embryo until the eighth
characteristics B.Eighth week to the time week; the developing cells
of birth are then called a fetus until
9. A client arrives at a prenatal 3. Accurate use of Nagele's C.Implantation of the birth.
clinic for the first prenatal rule requires that the fertilized ovum
assessment. The client tells woman have a regular 28- D.End of the send week to
a nurse that the first day of day menstrual cycle. Add 7 the onset of labor
her last menstrual period days to the first day of the
was September 19th, 2005. last menstrual period, 13. During a prenatal A. When an Rh negative
Using Nagele's rule, the subtract three months, and examination, the nurse mother carries an Rh
nurse determines the then add one year to that draws blood from a young positive fetus there is a risk
estimated date of date. Rh negative client and for maternal antibodies
confinement as: explain that an indirect against Rh positive blood;
1.July 26, 2006 Coombs test will be antibodies cross the
2.June 12, 2007 performed to predict placenta and destroy the
3.June 26, 2006 whether the fetus is at risk fetal RBC's.
4.July 12, 2007 for:
A.Acute hemolytic disease
10. A client in the first 1. Strict bed rest B.Respiratory distress
trimester of pregnancy throughout the remainder syndrome
arrives at a health care of pregnancy is not C.Protein metabolic
clinic and reports that she required. The woman is deficiency
has been experiencing advised to curtail sexual D.Physiologic
vaginal bleeding. A activities until the bleeding hyperbilirubinemia
threatened abortion is has ceased, and for 2 weeks
suspected, and the nurse following the last evidence 14. During a prenatal visit at 38 .3. The fetal heart rate
instructs the client of bleeding or as weeks, a nurse assesses the depends in gestational age
regarding management of recommended by the fetal heart rate. The nurse and ranges from 160-170
determines that the fetal BPM in the first trimester 19. In the 12th week of A.RhoGAM is given within
heart rate is normal if but slows with fetal growth gestation, a client 72 hours postpartum if the
which of the following is to 120-160 BPM near or at completely expels the client has not been
noted? term. At or near term, if the products of conception. sensitized already.
1.80 BPM fetal heart rate is less than Because the client is Rh
2.100 BPM 120 or more than 160 BPM negative, the nurse must:
3.150 BPM with the uterus at rest, the A.Admister RhoGAM within
4.180 BPM fetus may be in distress. 72 hours
B.Make certain she receives
15. An expected D. This is an expected RhoGAM on her first clinic
cardiopulmonary cardiopulmonary visit
adaptation experienced by adaptation during C.Not give RhoGAM, since it
most pregnant women is: pregnancy; it is caused by is not used with the birth of
A.Tachycardia an increased ventricular a stillborn
B.Dyspnea at rest rate and elevated D.Make certain the client
C.Progression of dependent diaphragm does not receive RhoGAM,
edema since the gestation only
D.Shortness of breath on lasted 12 weeks.
exertion
20. A nurse implements a C. Exercise is safe for the
16. Gravida refers to which of B. Gravida refers to the teaching plan for a pregnant client with gestational
the following descriptions? number of times a female client who is newly diabetes and is helpful in
A.A serious pregnancy has been pregnant, diagnosed with gestational lowering the blood glucose
B.Number of times a regardless of pregnancy diabetes. Which statement level.
female has been pregnant outcome or the number of if made by the client
C.Number of children a neonates delivered. indicates a need for further
female has delivered education?
D.Number of term A."I need to stay on the
pregnancies a female has diabetic diet."
had. B."I will perform glucose
monitoring at home."
17. A homecare nurse visits a 3. If the client complains of C."I need to avoid exercise
pregnant client who has a a headache and blurred because of the negative
diagnosis of mild vision, the physician effects of insulin
Preeclampsia and who is should be notified because production."
being monitored for these are signs of D."I need to be aware of
pregnancy induced worsening Preeclampsia. any infections and report
hypertension (PIH). Which signs of infection
assessment finding immediately to my health
indicates a worsening of the care provider."
Preeclampsia and the need
to notify the physician? 21. The nurse is aware than an D. A purplish color results
1.Blood pressure reading is adaptation of pregnancy is from the increased
at the prenatal baseline an increased blood supply vascularity and blood
2.Urinary output has to the pelvic region that vessel engorgement of the
increased results in a purplish vagina.
3.The client complains of a discoloration of the vaginal
headache and blurred vision mucosa, which is known as:
4.Dependent edema has A.Ladin's sign
resolved B.Hegar's sign
C.Goodell's sign
18. In a lecture on sexual B. It is the surge of LH D.Chadwick's sign
functioning, the nurse plans secretion in midcycle that
to include the fact that is responsible for 22. A nurse is caring for a C. The immediate care
ovulation occurs when the: ovulation. pregnant client with during a seizure
A.Oxytocin is too high Preeclampsia. The nurse (eclampsia) is to ensure a
B.Blood level of LH is too prepares a plan of care for patent airway. The other
high the client and documents in options are actions that
C.Progesterone level is high the plan that if the client follow or will be
D.Endometrial wall is progresses from implemented after the
sloughed off. Preeclampsia to eclampsia, seizure has ceased.
the nurse's first action is to:
A.Administer magnesium
sulfate intravenously to a client during a embryo through two
B.Assess the blood pressure prenatal visit. The nurse umbilical arteries. Once
and fetal heart rate accurately tells the client oxygenated, the blood then
C.Clean and maintain an that fetal circulation is returned by one umbilical
open airway consists of: vein. Arteries carry
D.Administer oxygen by 1.Two umbilical veins and deoxygenated blood and
face mask one umbilical artery waste products from the
2.Two umbilical arteries fetus, and veins carry
23. nurse is caring for a 3, 4, 5, 6, and 7. When caring and one umbilical vein oxygenated blood and
pregnant client with for a client receiving 3.Arteries carrying provide oxygen and
severe preeclampsia who magnesium sulfate therapy, oxygenated blood to the nutrients to the fetus.
is receiving IV magnesium the nurse would monitor fetus
sulfate. Select all nursing maternal vital signs, 4.Veins carrying
interventions that apply in especially respirations, every deoxygenated blood to
the care for the client. 30-60 minutes and notify the the fetus
1.Monitor maternal vital physician if respirations are
signs every 2 hours less than 12, because this 26. A nurse is monitoring a A and C. The three classic
2.Notify the physician if would indicate respiratory pregnant client with signs of preeclampsia are
respirations are less than depression. Calcium pregnancy induced hypertension, generalized
18 per minute. gluconate is kept on hand in hypertension who is at edema, and protenuria.
3.Monitor renal function case of magnesium sulfate risk for Preeclampsia. The Increased respirations are
and cardiac function overdose, because calcium nurse checks the client for not a sign of preeclampsia
closely gluconate is the antidote for which specific signs of
4.Keep calcium gluconate magnesium sulfate toxicity. Preeclampsia (select all
on hand in case of a Deep tendon reflexes are that apply)? A.Elevated
magnesium sulfate assessed hourly. Cardiac and blood pressure
overdose renal function is monitored B.Negative urinary protein
5.Monitor deep tendon closely. The urine output C.Facial edema
reflexes hourly should be maintained at 30 D.Increased respirations
6.Monitor I and O's hourly ml per hour because the
7.Notify the physician if medication is eliminated 27. A nurse is performing an 2. The normal range of the
urinary output is less than through the kidneys. assessment of a fetal heart rate depends on
30 ml per hour. primapira who is being gestational age. The heart
evaluated in a clinic rate is usually 160-170 BPM
24. A nurse is collecting data 2. Pregnancy outcomes can during her second in the first trimester and
during an admission be described with the trimester of pregnancy. slows with fetal growth, near
assessment of a client acronym GTPAL. G is Which of the following and at term, the fetal heart
who is pregnant with gravidity, the number of indicates an abnormal rate ranges from 120-160
twins. The client has a pregnancies. T is term births, physical finding BPM. The other options are
healthy 5-year old child the number born at term necessitating further expected.
that was delivered at 37 (38-41 weeks). P is preterm testing?
weeks and tells the nurse births, the number born 1.Consistent increase in
that she doesn't have any before 38 weeks gestation. A fundal height
history of abortion or fetal is abortions or miscarriages 2.Fetal heart rate of 180
demise. The nurse would (included in gravida if before BPM
document the GTPAL for 20 weeks gestation; included 3.Braxton hicks
this client as: in parity if past 20 weeks contractions
1.G = 3, T = 2, P = 0, A = 0, gestation). L is live births, 4.Quickening
L =1 the number of live births or
2.G = 2, T = 0, P = 1, A = 0, living children. Therefore, a 28. A nurse is providing 4. The pregnant woman
L =1 woman who is pregnant instructions to a client in should be instructed to wash
3.G = 1, T = 1. P = 1, A = 0, with twins and has a child the first trimester of the breasts with warm water
L=1 has a gravida of 2. Because pregnancy regarding and keep them dry. The
4.G = 2, T = 0, P = 0, A = 0, the child was delivered at 37 measures to assist in woman should be instructed
L=1 weeks, the number of reducing breast to avoid using soap on the
preterm births is 1, and the tenderness. The nurse nipples and areola area to
number of term births is 0. tells the client to: prevent the drying of tissues.
The number of abortions is 1.Avoid wearing a bra Wearing a supportive bra
0, and the number of live 2.Wash the nipples and with wide adjustable straps
births is 1. areola area daily with can decrease breast
soap, and massage the tenderness. Tight-fitting
25. A nurse is describing the 2. Blood pumped by the breasts with lotion. blouses or dresses will cause
process of fetal circulation embryo's heart leaves the 3.Wear tight-fitting discomfort (especially on test
blouses or dresses to days, even if you're not avoid lying on her back. gravid uterus, which causes
provide support pregnant. Yo.). The nurse has based this hypotension and decreased
4.Wash the breasts with statement on the systemic perfusion.
warm water and keep knowledge that the
them dry supine position can:
A.Unduly prolong labor
29. A nurse is reviewing the 1. In the early weeks of B.Cause decreased
record of a client who has pregnancy the cervix placental perfusion
just been told that a becomes softer as a result of C.Lead to transient
pregnancy test is positive. increased vascularity and episodes of hypotension
The physician has hyperplasia, which causes D.Interfere with free
documented the the Goodell's sign movement of the coccyx
presence of a Goodell's
sign. The nurse 33. A nursing instructor asks 3. Quickening is fetal
determines this sign a nursing student who is movement and may occur as
indicates: preparing to assist with early as the 16th and 18th
1.A softening of the the assessment of a week of gestation, and the
cervix pregnant client to mother first notices subtle
2.A soft blowing sound describe the process of fetal movements that
that corresponds to the quickening. Which of the gradually increase in
maternal pulse during following statements if intensity. Braxton Hicks
auscultation of the made by the student contractions are irregular,
uterus. indicates an painless contractions that
3.The presence of hCG in understanding of this may occur throughout the
the urine term? pregnancy. A thinning of the
4.The presence of fetal 1."It is the irregular, lower uterine segment occurs
movement painless contractions about the 6th week of
that occur throughout pregnancy and is called
30. A nurse midwife is 4. Ballottement is a pregnancy." Hegar's sign.
performing an technique of palpating a 2."It is the soft blowing
assessment of a pregnant floating structure by sound that can be heard
client and is assessing the bouncing it gently and feeling when the uterus is
client for the presence of it rebound. In the technique auscultated."
ballottement. Which of used to palpate the fetus, the 3."It is the fetal
the following would the examiner places a finger in movement that is felt by
nurse implement to test the vagina and taps gently the mother."
for the presence of upward, causing the fetus to 4."It is the thinning of
ballottement? rise. The fetus then sinks, and the lower uterine
1.Auscultating for fetal the examiner feels a gentle segment."
heart sounds tap on the finger.
2.Palpating the abdomen 34. A nursing instructor is A. FSH and LH, when
for fetal movement conducting lecture and is stimulated by gonadotropin-
3.Assessing the cervix for reviewing the functions releasing hormone from the
thinning of the female hypothalamus, are released
4.Initiating a gentle reproductive system. She from the anterior pituitary
upward tap on the cervix asks Mark to describe gland to stimulate follicular
the follicle-stimulating growth and development,
31. The nurse recognizes that C. The blood volume hormone (FSH) and the growth of the graafian follicle,
an expected change in increases by approximately luteinizing hormone (LH). and production of
the hematologic system 40-50% during pregnancy. Mark accurately progesterone.
that occurs during the The peak blood volume responds by stating that:
2nd trimester of occurs between 30 and 34 A.FSH and LH are
pregnancy is: weeks of gestation. The released from the
A.A decrease in WBC's hematocrit decreases as a anterior pituitary gland.
B.In increase in result of the increased blood B.FSH and LH are
hematocrit volume. secreted by the corpus
C.An increase in blood luteum of the ovary
volume C.FSH and LH are
D.A decrease in secreted by the adrenal
sedimentation rate glands
D.FSH and LH stimulate
32. The nurse teaches a B. This is because impedance the formation of milk
pregnant woman to of venous return by the
during pregnancy. movement followed by
quiet periods
35. Nutritional planning for a B. This is the recommended 4.Complaints of feeling
newly pregnant woman caloric increase for adult hot when the room is
of average height and women to meet the increased cool
weighing 145 pounds metabolic demands of
should include: pregnancy. 39. A pregnant client is C. 5 pregnancies; 2 term
A.A decrease of 200 making her first births; twins count as 1; one
calories a day Antepartal visit. She has a abortion; 4 living children.
B.An increase of 300 two year old son born at
calories a day 40 weeks, a 5 year old
C.An increase of 500 daughter born at 38
calories a day weeks, and 7 year old
D.A maintenance of her twin daughters born at 35
present caloric intake per weeks. She had a
day spontaneous abortion 3
years ago at 10 weeks.
36. The pituitary hormone A. Prolactin is the hormone Using the GTPAL format,
that stimulates the from the anterior pituitary the nurse should identify
secretion of milk from gland that stimulates that the client is:
the mammary glands is: mammary gland secretion. A.G4 T3 P2 A1 L4
A.Prolactin Oxytocin, a posterior pituitary B.G5 T2 P2 A1 L4
B.Oxytocin hormone, stimulates the C.G5 T2 P1 A1 L4
C.Estrogen uterine musculature to D.G4 T3 P1 A1 L4
D.Progesterone contract and causes the "let
down" reflex 40. A pregnant client is D. Magnesium toxicity can
receiving magnesium occur from magnesium
37. A pregnant client calls the 1. Legs cramps occur when sulfate for the sulfate therapy. Signs of
clinic and tells a nurse the pregnant woman management of toxicity relate to the central
that she is experiencing stretches the leg and plantar preeclampsia. A nurse nervous system depressant
leg cramps and is flexes the foot. Dorsiflexion determines the client is effects of the medication and
awakened by the cramps of the foot while extending experiencing toxicity from include respiratory
at night. To provide relief the knee stretches the the medication if which of depression, loss of deep
from the leg cramps, the affected muscle, prevents the following is noted on tendon reflexes, and a
nurse tells the client to: the muscle from contracting, assessment? sudden drop in the fetal
1.Dorsiflex the foot while and stops the cramping. A.Presence of deep heart rate and maternal
extending the knee when tendon reflexes heart rate and blood
the cramps occur B.Serum magnesium level pressure. Therapeutic levels
2.Dorsiflex the foot while of 6 mEq/L of magnesium are 4-7 mEq/L.
flexing the knee when the C.Proteinuria of +3 Proteinuria of +3 would be
cramps occur D.Respirations of 10 per noted in a client with
3.Plantar flex the foot minute preeclampsia.
while flexing the knee
when the cramps occur 41. A pregnant woman at 32 D. During a fundal height
4.Plantar flex the foot weeks' gestation measurement the woman is
while extending the knee complains of feeling dizzy placed in a supine position.
when the cramps occur. and lightheaded while her This woman is experiencing
fundal height is being supine hypotension as a
38. A pregnant client in the 1. Severe Preeclampsia can measured. Her skin is result of uterine compression
last trimester has been trigger disseminated pale and moist. The of the vena cava and
admitted to the hospital intravascular coagulation nurse's initial response abdominal aorta. Turning her
with a diagnosis of severe (DIC; remember the Peds would be to: A.Assess the on her side will remove the
preeclampsia. A nurse lecture?) because of the woman's blood pressure compression and restore
monitors for widespread damage to and pulse cardiac output and blood
complications associated vascular integrity. Bleeding is B.Have the woman pressure. Then vital signs can
with the diagnosis and an early sign of DIC and breathe into a paper bag be assessed. Raising her legs
assesses the client for: should be reported to the C.Raise the woman's legs will not solve the problem
1.Any bleeding, such as in M.D D.Turn the woman on her since pressure will still
the gums, petechiae, and side. remain on the major
purpura. abdominal blood vessels,
2.Enlargement of the thereby continuing to
breasts impede cardiac output.
3.Periods of fetal Breathing into a paper bag is
the solution for dizziness BPM
related to respiratory
alkalosis associated with 45. When involved in B. The increase of estrogen
hyperventilation. prenatal teaching, the during pregnancy causes
nurse should advise the hyperplasia of the vaginal
42. A pregnant woman's last A. Nägele's rule requires clients that an increase in mucosa, which leads to
menstrual period began subtracting 3 months and vaginal secretions during increased production of
on April 8, 2005, and adding 7 days and 1 year if pregnancy is called mucus by the endocervical
ended on April 13. Using appropriate to the first day leukorrhea and is caused glands. The mucus contains
Nägele's rule her of a pregnant woman's last by increased: A.Metabolic exfoliated epithelial cells.
estimated date of birth menstrual period. When this rates
would be: rule, is used with April 8, B.Production of estrogen
A.January 15, 2006 2005, the estimated date of C.Functioning of the
B.January 20, 2006 birth is January 15, 2006. Bartholin glands
C.July 1, 2006 D.Supply of sodium
D.November 5, 2005 chloride to the cells of the
vagina
43. A prenatal nurse is 3. All pregnant women
providing instructions to a should be advised to do the 46. Which of the following D. Only nutrients and waste
group of pregnant client following to prevent the answers best describes products are transferred
regarding measures to development of the stage of pregnancy in across the placenta. Blood
prevent toxoplasmosis. toxoplasmosis. Women which maternal and fetal exchange only occurs in
Which statement if made should be instructed to cook blood are exchanged? complications and some
by one of the clients meats thoroughly, avoid A.Conception medical procedures
indicates a need for touching mucous B.9 weeks' gestation, accidentally.
further instructions? 1."I membranes and eyes while when the fetal heart is
need to cook meat handling raw meat; well developed
thoroughly." thoroughly wash all kitchen C.32-34 weeks gestation
2."I need to avoid surfaces that come into D.maternal and fetal
touching mucous contact with uncooked meat, blood are never
membranes of the mouth wash the hands thoroughly exchanged
or eyes while handling after handling raw meat;
raw meat." avoid uncooked eggs and 47. Which of the following C. Hemoglobin and
3."I need to drink unpasteurized milk; wash conditions is common in hematocrit levels decrease
unpasteurized milk only." fruits and vegetables before pregnant women in the during pregnancy as the
4."I need to avoid contact consumption, and avoid 2nd trimester of increase in plasma volume
with materials that are contact with materials that pregnancy? A.Mastitis exceeds the increase in red
possibly contaminated possibly are contaminated B.Metabolic alkalosis blood cell production.
with cat feces." with cat feces, such as cat C.Physiologic anemia
litter boxes, sand boxes, and D.Respiratory acidosis
garden soil.
48. Which of the following D. The chorionic villi of a
44. A primagravida is C. Magnesium sulfate symptoms occurs with a molar pregnancy resemble a
receiving magnesium depresses the respiratory hydatidiform mole? snowstorm pattern on
sulfate for the treatment rate. If the respiratory rate is A.Heavy, bright red ultrasound. Bleeding with a
of pregnancy induced less than 12 breaths per bleeding every 21 days hydatidiform mole is often
hypertension (PIH). The minute, the physician or B.Fetal cardiac motion dark brown and may occur
nurse who is caring for other health care provider after 6 weeks gestation erratically for weeks or
the client is performing needs to be notified, and C.Benign tumors found in months.
assessments every 30 continuation of the the smooth muscle of the
minutes. Which medication needs to be uterus
assessment finding would reassessed. A urinary output D."snowstorm" pattern
be of most concern to the of 20 ml in a 30 minute on ultrasound with no
nurse? period is adequate; less than fetus or gestational sac
A.Urinary output of 20 ml 30 ml in one hour needs to
since the previous be reported. Deep tendon 49. Which of the following D. The dilated arterioles that
assessment reflexes of 2+ are normal. terms applies to the tiny, occur during pregnancy are
B.Deep tendon reflexes of The fetal heart rate is WNL blanced, slightly raised due to the elevated level of
2+ for a resting fetus. end arterioles found on circulating estrogen. The
C.Respiratory rate of 10 the face, neck, arms, and linea nigra is a pigmented line
BPM chest during pregnancy? extending from the
D.Fetal heart rate of 120 A.Epulis symphysis pubis to the top of
B.Linea nigra
C.Striae gravidarum the fundus during pregnancy.
D.Telangiectasias

50. A woman with C. For a client with


preeclampsia is receiving preeclampsia, the goal of
magnesium sulfate. The care is directed at preventing
nurse assigned to care for eclampsia (seizures).
the client determines Magnesium sulfate is an
that the magnesium anticonvulsant, not an
therapy is effective if: antihypertensive agent.
A.Ankle clonus in noted Although a decrease in blood
B.The blood pressure pressure may be noted
decreases initially, this effect is usually
C.Seizures do not occur transient. Ankle clonus
D.Scotoma's are present indicated hyperrelexia and
may precede the onset of
eclampsia. Scotomas are
areas of complete or partial
blindness. Visual
disturbances, such as
scotomas, often precede an
eclamptic seizure.

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