Ante Sample Exam

An antenatal client is informing the nurse of her increase in preparation for delivery.
It is
prenatal signs and symptoms. the body’s means of protecting itself
Which of the following findings would the nurse against a large loss of blood at delivery.
determine are presumptive signs
3
of pregnancy? Select all that apply.
When analyzing the need for health teaching of a
1. Amenorrhea.
prenatal multigravida, the nurse
2. Breast tenderness.
should ask which of the following questions?
3. Quickening.
1. “What are the ages of your children?”
4. Frequent urination.
2. “What is your marital status?”
5. Uterine growth.
3. “Do you ever drink alcohol?”
1, 2, 3, and 4 are correct. 4. “Do you have any allergies?”
1. Amenorrhea is a presumptive sign of
3. This question is important to ask in
pregnancy.
order to determine a prenatal client’s
2. Breast tenderness is a presumptive
health teaching needs.
sign of pregnancy.
3. Quickening is a presumptive sign of
pregnancy.
TEST-TAKING TIP: When answering questions,
4. Frequent urination is a presumptive
it is essential that the test taker attend
sign of pregnancy.
to the specific question that is being asked. All of
the possible responses are
questions that should be asked of a pregnant
TEST-TAKING TIP: There are three classifications
multigravida, but only one is related
of signs of pregnancy: presumptive,
to the client’s needs for health teaching.
probable, and positive. Signs that
are totally subjective, or presumptive, include 4
amenorrhea, breast tenderness, A woman whose prenatal weight was 105 lb weighs
quickening, and frequent urination. Signs 109 lb at her 12-week visit.
that are objective, but not totally absolute, Which of the following comments by the nurse is
are termed probable and include appropriate at this time?
alterations in uterine shape and size and 1. “We expect you to gain 1 lb per week, so your
softening of the cervix. Signs that are weight is a little low at this time.”
absolute, or positive, include hearing 2. “Most women gain no weight during the first
the fetal heartbeat, detecting fetal movement, trimester, so I would suggest you
and ultrasound images of the fetal eat fewer desserts for the next few weeks.”
outline. 3. “You entered the pregnancy well underweight, so
we should check your diet to
make sure you are getting the nutrients you need.”
4. “Your weight gain is exactly what we would
expect it to be at this time.”
2
The nurse is assessing the laboratory report of a 40- The weight gain is within normal for
week gestation client. Which of the first trimester.
the following values would the nurse expect to find TEST-TAKING TIP: One of the assessments
elevated above prepregnancy that aids health care practitioners in
levels? assessing the health and well-being of
1. Glucose. antenatal clients and their babies is
2. Fibrinogen. weight gain. For women who enter the
3. Hematocrit. pregnancy with a normal weight for
4. Bilirubin. height, the expected weight gain is: 3 to
5 lb for the entire first trimester and
2. Fibrinogen levels will be elevated
approximately 1 lb per week from weeks
slightly in a 40-week pregnant woman
13 to 40.
because coagulation factors like fibrinogen
increase to help prevent excessive 5
blood loss during delivery Because nausea and vomiting are such common
complaints of pregnant women, the
nurse provides anticipatory guidance to a 6-week
TEST-TAKING TIP: During the latter part gestation client by telling her to
of the third trimester, coagulation factors do which of the following?
1. Avoid eating greasy foods. 1. The client will have a Pap smear
2. Drink orange juice before rising. done.
3. Drink 2 glasses of water with each meal.
4. Eat 3 large meals plus a bedtime snack.
TEST-TAKING TIP: At the first prenatal
Greasy foods should be avoided
visit, pregnant clients will undergo complete
obstetrical and medical physical assessments.
The assessments are performed
TEST-TAKING TIP: Although many women
to provide the health care
experience nausea and vomiting or
practitioner with baseline data regarding
morning sickness upon rising, many
the health and well-being of the woman
women complain of nausea and/or vomiting
as well as to inform the health care practitioner
at other times of the day. One theory
of any medical problems that the
that has been offered to explain this
mother has that might impact the pregnancy.
problem is that the body is ridding itself
A breast exam will be performed
of teratogens that could potentially harm
by the practitioner to assess for abnormalities,
the fetus.
but since mammograms are potentially
6 harm-producing x-rays, they are
A client enters the prenatal clinic. She states that only ordered in emergent cases.
she missed her period yesterday
8
and used a home pregnancy test this morning. She
A 10-week gravid client is being seen in the
states that the results were negative,
prenatal clinic. For the nurse caring for
but “I still think I am pregnant.” Which of the
this patient, providing anticipatory guidance for
following statements would be
which of the following should be a
appropriate for the nurse to make at this time?
priority?
1. “Your period is probably just irregular.”
1. Pain management during labor.
2. “We could do a blood test to check.”
2. Methods to relieve backaches.
3. “Home pregnancy test results are very accurate.”
3. Breastfeeding positions.
4. “My recommendation would be to repeat the test
4. Characteristics of the newborn.
in one week.”
2. It is appropriate for the nurse to provide
2. This response is correct. Serum pregnancy
anticipatory guidance regarding
tests are more sensitive than
methods to relieve back pain.
urine tests are.
TEST-TAKING TIP: Because quantitative

pregnancy tests measure the exact quantity TEST-TAKING TIP: This 10-week gravid
of human chorionic gonadotropin in client will be entering the second
the bloodstream, they are more accurate trimester in a couple of weeks. As the
than urine tests that simply measure uterine body grows, the client is likely to
whether or not the hormone is present experience backaches. It is appropriate for
in the urine. Similar to the urine tests on the nurse to provide information about
the market, qualitative serum tests detect this possibility and ways to relieve them.
whether or not the hormone is present,
9
but they are still considered to be more
A client asks the nurse what was meant when the
accurate than urine tests are.
physician told her she had a positive
Chadwick’s sign. Which of the following information
about the finding would
7
be appropriate for the nurse to convey at this time?
A gravida, G1 P0000, is having her first prenatal
1. “It is a purplish stretch mark on your abdomen.”
physical examination. Which
2. “It means that you are having heart palpitations.”
of the following assessments should the nurse
3. “It is a bluish coloration of your cervix and
inform the client that she will have
vagina.”
that day?
4. “It means the doctor heard abnormal sounds
1. Pap smear.
when you breathed in.”
2. Mammogram.
3. Glucose challenge test. 3. A positive Chadwick’s sign means that
4. Biophysical profile. the client’s cervix and vagina are a
bluish color. It is a probable sign of 16 and 20 weeks’ gestation. At 10 weeks’
pregnancy. gestation it would be impossible for the
young woman to feel fetal movement.
The nurse, therefore, should elicit more
TEST-TAKING TIP: Chadwick’s sign is a information from the teen to determine
probable sign of pregnancy. The bluish what she had felt.
coloration is due to the increase in vascularization
12
of the area in response to
A 20-year-old client states that the at-home
the high levels of circulating estrogen in
pregnancy test that she took this morning
the pregnant woman’s system.
was positive. Which of the following comments by
10 the nurse is appropriate at
A client enters the prenatal clinic. She states that this time?
she believes she is pregnant. 1. “Congratulations, you and your family must be so
Which of the following hormone elevations will happy.”
indicate a high probability that the 2. “Have you told the baby’s father yet?”
client is pregnant? 3. “How do you feel about the results?”
1. Chorionic gonadotropin. 4. “Please tell me when your last menstrual period
2. Oxytocin. was.”
3. Prolactin.
3. It is important for the nurse to ask
4. Luteinizing hormone.
the young woman how she feels about
1. High levels of the hormone chorionic being pregnant. She may decide not
gonadotropin in the bloodstream and to continue with the pregnancy.
urine of the woman is a probable sign
of pregnancy.
TEST-TAKING TIP: Some pregnant women
are happy about their pregnancy, some
TEST-TAKING TIP: Human chorionic are sad, and still others are frightened.
gonadotropin is produced by the At the initial interview, it is essential that
fertilized egg. Its presence in the the nurse not assume that the woman
bloodstream signals the body to keep will respond in any particular way. The
the corpus luteum alive. Until the nurse must ask open-ended questions in
placenta takes over the function of producing order to elicit the woman’s feelings about
progesterone and estrogen, the the pregnancy.
corpus luteum produces the hormones
13
that are essential to the maintenance of
A client is in the 10th week of her pregnancy. Which
the pregnancy.
of the following symptoms
11 would the nurse expect the client to exhibit?
A 16-year-old, G1 P0000, is being seen at her 10- 1. Backache.
week gestation visit. She tells the 2. Dyspnea.
nurse that she felt the baby move that morning. 3. Fatigue.
Which of the following responses 4. Diarrhea.
by the nurse is appropriate?
3. Most women complain of fatigue
1. “That is very exciting. The baby must be very
during the first trimester.
healthy.”
2. “Would you please describe what you felt for
me?”
TEST-TAKING TIP: During the first
3. “That is impossible. The baby is not big enough
trimester, the body undergoes a number
yet.”
of important changes. The embryo is developing,
4. “Would you please let me see if I can feel the
the hormones of the body are
baby?”
increasing, and the maternal blood supply
2. The nurse should query the young is increasing. To accomplish each of
woman about what she felt the tasks, the body uses energy. The
mother is fatigued not only because the
body is undergoing great change but also
TEST-TAKING TIP: Quickening, or subjective because the thyroid gland has not caught
fetal movement, occurs between up with the increasing energy demands.
14 up an alternate plan.”
The midwife has just palpated the fundal height at 3. “It sounds like you’re feeling a little overwhelmed
the location noted on the picture right now.”
below. It is likely that the client is how many weeks 4. “You and the baby’s father will find a way to get
pregnant? through the pregnancy.”
1. 12.
3. This is the best comment. It acknowledges
2. 20.
the concerns that the client is
3. 28.
having.
4. 36.
TEST-TAKING TIP: Nurses have two roles
when clients express concerns to them.
First, the nurse must acknowledge the
client’s concerns so that the client feels
1. The client is likely 12 weeks pregnant. accepted and understood. Second, the
At 12 weeks, the fundal height is at nurse must help the client to problem
the top of the symphysis. solve the situation. It is very important,
however, that the acceptance precede the
period of problem solving.
TEST-TAKING TIP: The fundal height is assessed 17
at every prenatal visit. It is an The nurse notes each of the following findings in a
easy, noninvasive means of assessing fetal 12-week gestation client. Which of
growth. The nurse should know that the the findings would enable the nurse to tell the
top of the fundus is at the level of the client that she is positively pregnant?
symphysis at the end of the first 1. Fetal heart rate via Doppler.
trimester. 2. Positive pregnancy test.
3. Positive Chadwick’s sign.
15 4. Montgomery gland enlargements.
When assessing the psychological adjustment of an
8-week gravida, which of the 1. Hearing a fetal heart rate is a positive
following would the nurse expect to see signs of? sign of pregnancy.
1. Ambivalence. TEST-TAKING TIP: Positive signs of pregnancy
2. Depression. are signs that irrefutably show that
3. Anxiety.
4. Ecstasy. a fetus is in utero. An ultrasound of a
fetus is one positive sign and the fetal
1. It is common for women to be ambivalent heartbeat is another positive sign.
about their pregnancy during
the first trimester. 18
The nurse takes the history of a client, G2 P1001, at
her first prenatal visit. Which
TEST-TAKING TIP: Even women who stop of the following statements would indicate that the
taking birth control pills in order to become client should be referred to a
pregnant are often startled and genetic counselor?
ambivalent when they actually get pregnant. 1. “My first child has cerebral palsy.”
This is not pathological. The 2. “My first child has hypertension.”
women usually slowly accept the pregnancy 3. “My first child has asthma.”
and, by 20 weeks’ gestation, are 4. “My first child has cystic fibrosis.”
happy and enthusiastic about the
4. Cystic fibrosis is an autosomal recessive
16 genetic disease so the client with
A client makes the following statement after finding a history of cystic fibrosis should be
out that her pregnancy test is referred to a genetic counselor.
positive, “This is not a good time. I am in college
and the baby will be due during
final exams!” Which of the following responses by TEST-TAKING TIP: Virtually all diseases,
the nurse would be most appropriate chronic and acute, have some genetic
at this time? component, but the ability for the genetic
1. “I’m absolutely positive that everything will turn counselor to predict the impact of
out all right.” many diseases is very poor. Those illnesses
2. “I suggest that you e-mail your professors to set
with clear hereditary patterns, 2. The practitioner would expect to
however, do warrant referral to genetic palpate an enlarged ovary.
counselors. Cystic fibrosis has an autosomal
TEST-TAKING TIP: The cervix is long and
recessive inheritance pattern.
thick in order to retain the pregnancy in
19 the uterine cavity. The cervical mucus is
The nurse has taken a health history on four thin and the vaginal wall is bluish in
primigravid clients at their first prenatal color as a result of elevated estrogen
visits. It is high priority that which of the clients levels. The ovary is enlarged because the
receives nutrition counseling? corpus luteum is still functioning.
1. The woman diagnosed with phenylketonuria.
22
2. The woman who has Graves’ disease.
A pregnant woman must have a glucose challenge
3. The woman with Cushing’s syndrome.
test (GCT). Which of the following
4. The woman diagnosed with myasthenia gravis.
should be included in the preprocedure teaching?
1. The client with phenylketonuria 1. Fast for 12 hours before the test.
(PKU) must receive counseling from a 2. Bring a urine specimen to the laboratory on the
registered dietitian. day of the test.
3. Be prepared to have 4 blood specimens taken on
the day of the test.
TEST-TAKING TIP: PKU is a genetic disease 4. The test should take one hour to complete.
that is characterized by the absence
4. The test does take about 1 hour to
of the enzyme needed to metabolize
complete.
phenylalanine, an essential amino acid.
TEST-TAKING TIP: The GCT is done at
When patients with PKU consume
approximately 24 weeks’ gestation to assess
phenylalanine, a metabolite that affects
the client’s ability to metabolize glucose.
cognitive centers in the brain is created
It is a 1-hour, nonfasting screening
in the body. If a pregnant woman who
test. One hour after a client consumes
has PKU were to eat foods high in
50 grams of a concentrated glucose solution,
phenylalanine, her baby would develop
a serum glucose level is done. If the
severe mental retardation in utero.
value is 130 mg/dL or higher, the client
20 is referred for a 3-hour glucose tolerance
Which of the following findings in an 8-week test to determine whether or not she has
gestation client, G2 P1001, should gestational diabetes.
the nurse highlight for the nurse midwife?
23
1. Body mass index of 17.
The nurse working in an outpatient obstetric office
2. Blood pressure of 100/60.
assesses four primigravid
3. Hematocrit of 36%.
clients. Which of the client findings would the nurse
4. Hemoglobin of 13.2.
highlight for the physician?
20. 1. The BMI of 17 is of concern. This 1. 17 weeks’ gestation; denies feeling fetal
client is entering her pregnancy underweight. movement.
2. 24 weeks’ gestation; fundal height at the
umbilicus.
TEST-TAKING TIP: Women who enter their 3. 27 weeks’ gestation; complains of excess
pregnancies underweight are encouraged salivation.
to gain slightly more—35 to 45 lb—during their 4. 34 weeks’ gestation; complains of hemorrhoidal
pregnancies than are women pain.
of normal weight who are encouraged to
2. The fundal height at 24 weeks should
gain 25 to 35 lb.
be 4 cm above the umbilicus. The
21 fundal height at the level of the
A woman, 6 weeks pregnant, is having a vaginal umbilicus is expected at 20 weeks’
examination. Which of the following
would the practitioner expect to find?
1. Thin cervical muscle. TEST-TAKING TIP: It is important for
2. An enlarged ovary. the test taker to know the timing of key
3. Thick cervical mucus. pregnancy changes. The mother should
4. Pale pink vaginal wall. feel fetal movement by 20 weeks’ gestation.
Primigravidas often feel fetal
movement later than multigravidas. 3. Urinary frequency.
Specific fundal height measurements 4. Leg cramping.
are also expected at key times in the 4. Leg cramping is often a complaint of
pregnancy. clients in the second trimester.
24
The following four changes occur during
TEST-TAKING TIP: Although clients in the
pregnancy. Which of them usually increases
second trimester do experience some
the father’s interest and involvement in the
physical discomfort, such as leg cramps
pregnancy?
1. Learning the results of the pregnancy test. and backaches, most women feel well.
2. Attending childbirth education classes. They no longer are fatigued, nauseous,
3. Hearing the fetal heartbeat. and so on as in the first trimester, but
4. Meeting the obstetrician or midwife. the baby is not so large as to cause significant
complaints like dyspnea or the
3. Hearing the fetal heart beat often
recurrence of urinary frequency.
increases fathers’ interests in their
partners’ pregnancies. 27
The glucose challenge screening test is performed
at or after 24 weeks’ gestation to
TEST-TAKING TIP: Women who are in the assess for the maternal physiological response to
first few weeks of pregnancy often experience which of the following pregnancy
a number of physical complaints— hormones?
nausea and vomiting, fatigue, breast tenderness, 1. Estrogen.
and urinary frequency. 2. Progesterone.
Prospective fathers whose partners’ experience 3. Human placental lactogen.
these complaints are often not 4. Human chorionic gonadotropin.
very interested in the pregnancies. When
3. Human placental lactogen (hPL) is an
the baby becomes “real,” with a positive
insulin antagonist.
heartbeat or fetal movement, the fathers
often become very excited. TEST-TAKING TIP: hPL is produced by the
placenta. As the placenta grows, the
25
hormone levels rise. At approximately
The nurse midwife tells a client that the baby is
24 weeks’ gestation, the levels are high
growing and that ballottement was
enough to impact glucose metabolism.
evident during the vaginal examination. How
If performed earlier, the GCT test may
should the nurse explain what the
result in a false-negative result.
nurse midwife means by ballottement?
1. The nurse midwife saw that the mucus plug was 28
intact. A client is 15 weeks pregnant. She calls the
2. The nurse midwife felt the baby rebound after obstetric office to request a medication
being pushed. for a headache. The nurse answers the telephone.
3. The nurse midwife palpated the fetal parts Which of the following is the
through the uterine wall. nurse’s best response?
4. The nurse midwife assessed that the baby is head 1. “Because the organ systems in the baby are
down. developing right now, it is risky to
take medicine.”
2. This is the definition of ballottement.
2. “You can take any of the over-the-counter
TEST-TAKING TIP: Although this question medications because they are all safe
discusses nurse-patient interaction, it is in pregnancy.”
simply a definition question. The test 3. “The physician will prescribe a category “X”
taker is being asked to identify the definition medication for you.”
of the word ballottement. 4. “You can take acetaminophen because it is a
category “B” medicine.”
26
A multigravid client is 22 weeks pregnant. Which of 4. Category “B” medications have been
the following symptoms would shown to be safe to take throughout
the nurse expect the client to exhibit? pregnancy.
1. Nausea. TEST-TAKING TIP: It is important for
2. Dyspnea. pregnant women to contact their health
care practitioners to find out which medications scared. I think I have breast cancer. My breasts are
are safe to take during pregnancy filled with tumors.” The nurse
and which medications must be should base the response on which of the
avoided. All medications are assigned a following?
pregnancy category from “A”—research 1. Breast cancer is often triggered by pregnancy.
has shown they are safe to be consumed 2. Nodular breast tissue is normal during
throughout pregnancy—to “X”—a teratogenic pregnancy.
agent. Category “B” medications 3. The woman is exhibiting signs of a psychotic
are considered safe because of anecdotal break.
evidence, although controlled 4. Anxiety attacks are especially common in the
research has not been conducted to confirm second trimester.
that evidence. Teratogens are agents
2. Nodular breast tissue is normal in
that have definitely been shown to cause
pregnancy.
fetal damage.
TEST-TAKING TIP: The high levels of
29
estrogen seen in pregnancy result in a
A 20-week gestation client is being seen in the
number of changes. The hypertrophy
prenatal clinic. Place an “X” on the
and hyperplasia of the breast tissue, in
place on the abdomen where the nurse would
preparation for neonatal lactation, are
expect the fundal height to be felt.
two of the changes.
32
A woman states that she frequently awakens with
“painful leg cramps” during the
TEST-TAKING TIP: At 20 weeks’ gestation, night. Which of the following assessments should
the fundal height should be felt at the the nurse make?
umbilicus. About 8 weeks later, it is felt 1. Dietary evaluation.
between the umbilicus and xiphoid 2. Goodell’s sign.
process and at the xiphoid process at 3. Hegar’s sign.
36 weeks. 4. Posture evaluation.
32. 1. A dietary evaluation is indicated since

painful leg cramps can be caused by
consuming too little calcium or too
much phosphorus.
30
A client who was seen in the prenatal clinic at 20
weeks’ gestation weighed 128 lb TEST-TAKING TIP: Leg cramps can occur
at that time. Approximately how many pounds as a result of low calcium and/or high
would the nurse expect the client to phosphorus since they are often related
weigh at her next visit at 24 weeks’ gestation? to a poor calcium/phosphorus ratio. A dietary
1. 129 lb. assessment should be done to determine
2. 130 lb. whether or not the client is consuming
3. 131 lb. enough calcium, primarily found
4. 132 lb. in dairy products, or large quantities of
4. The woman would be expected to phosphorus, found in carbonated beverages
weigh about 132 lb. At this stage of and processed sandwich meats.
pregnancy, the woman is expected to 33
gain about 1 lb a week. Which of the following exercises should be taught
TEST-TAKING TIP: The incremental weight to a pregnant woman who complains
gain of a client is an important means of of backaches?
assessing the growth and development of 1. Kegeling.
the fetus. The nurse would expect that, 2. Pelvic tilting.
during the second and third trimesters, 3. Leg lifting.
the woman should gain approximately 4. Crunching.
1 lb per week.
2. The pelvic tilt is an exercise that can
31 reduce backache pain.
An 18-week gestation client telephones the
obstetrician’s office stating, “I’m really
TEST-TAKING TIP: Pelvic tilt exercises help 4. Prepregnancy temperature (T) 98.6ºF and third
to reduce backache pain. The client is trimester T 99.2ºF.
taught to get into an optimal position—
1. The blood pressure should not elevate
on the hands and knees is often best. She
during pregnancy. This change
is then taught to force her back out while
should be reported to the health care
tucking her head and buttocks under and
practitioner.
holding that position for a few seconds,
followed by holding the alternate position
for a few seconds—arching her back
TEST-TAKING TIP: The basal metabolic
while lifting her head and her buttocks
rate of the woman increases during pregnancy.
toward the ceiling. These positions should be
As a result the nurse would expect
alternated repeatedly for about
to observe a respiratory rate of 20 to 24
5 minutes. The exercises are very relaxing
rpm. High levels of progesterone in the
while also improving the muscle tone
body result in a decrease in the contractility
of the lower back.
of the smooth musculature
34 throughout the body. This results in an
A woman in her third trimester advises the nurse increase in the pulse rate. In addition,
that she wishes to breastfeed her progesterone is thermogenic, resulting in
baby, “but I don’t think my nipples are right.” Upon a slight rise in the woman’s core body
examination, the nurse notes temperature.
that the client has inverted nipples. Which of the
36
following actions should the
A nurse midwife has advised a 39-week gestation
nurse take at this time?
gravid to take evening primrose
1. Advise the client that it is unlikely that she will be
oil 2500 mg daily as a complementary therapy. This
able to breastfeed.
suggestion was made because
2. Refer the client to a lactation consultant for
evening primrose has been shown to perform
advice.
which of the following actions?
3. Call the labor room and notify them that a client
1. Relieve back strain.
with inverted nipples will be
2. Improve development of colostrum.
admitted.
3. Ripen the cervix.
4. Teach the woman exercises in order to evert her
4. Reduce the incidence of hemorrhoids.
nipples.
3. Evening primrose converts to a
2. The client should be referred to a lactation
prostaglandin substance in the body.
consultant.
Prostaglandins are responsible for
readying the cervix for dilation.
TEST-TAKING TIP: Research on eversion TEST-TAKING TIP: Nurse midwives often
exercises has shown that they are not effective recommend complementary therapies
plus breast manipulation can during pregnancy as well as during labor
bring on contractions since oxytocin production and delivery. Nurse midwives usually believe
is stimulated. Lactation consultants in promoting natural means for
are breastfeeding specialists. A lactation maintaining a healthy pregnancy and for
consultant would probably stimulating labor. Evening primrose is
recommend that the client wear breast one of those interventions.
shields in her bra. The shields are made
37
of hard plastic and have a small hole
A 38-week gestation client, Bishop score 1, is
through which the nipple everts.
advised by her nurse midwife to take
35 evening primrose daily. The office nurse advises the
Which of the following vital sign changes should client to report which of the
the nurse highlight for a pregnant following side effects that has been attributed to
woman’s obstetrician? the oil?
1. Prepregnancy blood pressure (BP) 100/60 and 1. Skin rash.
third trimester BP 140/90. 2. Pedal edema.
2. Prepregnancy respiratory rate (RR) 16 rpm and 3. Blurred vision.
third trimester RR 22 rpm. 4. Tinnitus.
3. Prepregnancy heart rate (HR) 76 bpm and third
trimester HR 88 bpm.
1. Evening primrose has been shown to Most women use multiple pillows at
cause skin rash in some women. night for sleep. Whenever caring for a
pregnant woman, the nurse should elevate
the head of the bed.
TEST-TAKING TIP: Even though evening
40
primrose is a “natural” substance, it can
The nurse is providing anticipatory guidance to a
cause side effects in some clients. The
woman in her second trimester
most common side effect seen from the
regarding signs/symptoms that she might
oil is a skin rash. Headaches and nausea
experience in the coming weeks. Which
have also been seen.
of the following comments by the client indicates
38 that further teaching is needed?
A 37-week gravid client states that she noticed a 1. “During the third trimester I may experience
“white liquid” leaking from her frequent urination.”
breasts during a recent shower. Which of the 2. “During the third trimester I may experience
following nursing responses is appropriate heartburn.”
at this time? 3. “During the third trimester I may experience back
1. Advise the woman that she may have a pain.”
galactocele. 4. “During the third trimester I may experience
2. Encourage the woman to pump her breasts to persistent headache.”
stimulate an adequate milk
4. Persistent headache should not be
supply.
seen in pregnant women.
3. Assess the liquid because a breast discharge is
TEST-TAKING TIP: This question is asking
diagnostic of a mammary
the test taker to determine which complaint
infection.
is not expected during the third
4. Reassure the mother that this is normal in the
trimester. The nurse, therefore, must
third trimester.
know which symptoms are normal during
4. It is normal for colostrum to be the third trimester in order to know
expressed late in pregnancy. which symptoms are not normal during
TEST-TAKING TIP: Even though colostrum that period. Persistent headache can indicate
is present in the breasts in the latter part that the woman has developed a
of the third trimester, it is important for complication of pregnancy
women not to pump their breasts.
41
Oxytocin, the hormone that promotes
A client, in her third trimester, is concerned that she
the ejection of milk during lactation, is
will not know the difference
the hormone of labor. Pumping of the
between labor contractions and normal aches and
breasts, therefore, could stimulate the
pains of pregnancy. How should
uterus to contract.
the nurse respond?
39 1. “Don’t worry. You’ll know the difference when the
A 36-week gestation gravid client is complaining of contractions start.”
dyspnea when lying flat. Which 2. “The contractions may feel just like a backache,
of the following is the likely clinical reason for this but they will come and go.”
complaint? 3. “Contractions are a lot worse than your
1. Maternal hypertension. pregnancy aches and pains.”
2. Fundal height. 4. “I understand. You don’t want to come to the
3. Hydramnios. hospital before you are in labor.”
4. Congestive heart failure
2. This is a true statement
2. The fundal height is the likely cause
of the woman’s dyspnea.
TEST-TAKING TIP: Labor contractions often
begin in a woman’s back, feeling
TEST-TAKING TIP: As the uterus enlarges, much like a backache. The difference is
the woman’s organs are impacted. At 36 that labor contractions are intermittent
weeks, the fundus is at the level of the and rhythmic. The client should be advised
xiphoid process. The diaphragm is elevated to attend to any pains that come
and the lungs are displaced. When and go and time them. She may be beginning
a client lies flat she has difficulty breathing. the labor process.
42 4. Urine protein.
Which finding would the nurse view as normal 5. Pelvic ultrasound.
when evaluating the laboratory
Study These Flashcards
reports of a 34-week gestation client?
2, 3, and 4 are correct.
1. Anemia.
2. Thrombocytopenia.
3. Polycythemia.
2. The blood pressure is assessed at
4. Hyperbilirubinemia.
each prenatal visit.
1. Anemia is an expected finding. 3. The fetal heart rate is assessed at
each prenatal visit. Depending on
the equipment available, it will be
TEST-TAKING TIP: By the end of the second assessed mechanically via Doppler
trimester, the blood supply of the or manually via fetoscope. The fetal
woman increases by approximately 50%. heart is audible via Doppler many weeks before it is
This increase is necessary in order for audible via
the client to be able to perfuse the placenta. fetoscope.
There is a concurrent increase in 4. Urine protein is performed at each
red blood cell production, but the vast prenatal visit
majority of women are unable to produce
the red blood cells in sufficient numbers
to keep pace with the increase in blood TEST-TAKING TIP: The test taker must
volume. As a result, clients develop what read the question carefully. Although
is commonly called “physiological anemia urine glucose assessments are done at
of pregnancy.” A hematocrit of 32% is each visit, blood glucoses are assessed
considered normal for a pregnant only intermittently during the pregnancy.
woman. Similarly, although ultrasound assessments
may be ordered intermittently
43
during a pregnancy, they are certainly
The nurse asks a 31-week gestation client to lie on
not done at every prenatal visit. As a
the examining table during a
matter of fact, there is no absolute
prenatal examination. In which of the following
mandate that a sonogram must be done
positions should the client be
at all during a pregnancy.
placed?
1. Orthopneic. 45
2. Lateral-recumbent. A nurse is working in the prenatal clinic. Which of
3. Sims’. the following findings seen in
4. Semi-Fowler’s. third-trimester pregnant women would the nurse
consider to be within normal
4. The client should be placed in a semi-
limits? Select all that apply.
Fowler’s position.
1. Leg cramps.
TEST-TAKING TIP: Because of the growth
2. Varicose veins.
of the uterus, it is very difficult for
3. Hemorrhoids.
women in the third trimester to breathe
4. Fainting spells.
in the supine position. During the prenatal
5. Lordosis.
visit, the baby’s heartbeat will be
monitored and the fundal height will be Study These Flashcards
assessed. Both of these procedures can 1, 2, 3, and 5 are correct.
safely be performed in the semi-Fowler’s 1. Leg cramps are normal, although the
position. client’s diet should be assessed.
44. 2, 3, and 4 ar 2. Varicose veins are normal, although
client teaching may be needed.
44
3. Hemorrhoids are normal, although
A third-trimester client is being seen for routine
client teaching may be needed.
prenatal care. Which of the following
assessments will the nurse perform during the visit?
Select all that apply.
5. Lordosis, or change in the curvature
1. Blood glucose.
of the spine, is normal, although patient
2. Blood pressure.
teaching may be needed.
3. Fetal heart rate.
TEST-TAKING TIP: There are a number of
physical complaints that are “normal” get to know their baby and decide on an
during pregnancy. There are interventions, appropriate name for him or her.
however, that can be taught to
48
help to alleviate some of the discomforts.
A woman is 36-weeks’ gestation. Which of the
The test taker should be familiar with
following tests will be done during
patient education information that
her prenatal visit?
should be conveyed regarding the physical
1. Glucose challenge test.
complaints of pregnancy. For example,
2. Amniotic fluid volume assessment.
clients who complain of hemorrhoids
3. Vaginal and rectal cultures.
should be encouraged to eat high-fiber
4. Karyotype analysis.
foods and drink fluids in order to produce
softer stools. The softer stools Study These Flashcards
should decrease the irritation of the 3. Vaginal and rectal cultures are done at
hemorrhoids. approximately 36 weeks’ gestation.
TEST-TAKING TIP: Vaginal and rectal cultures

are done to assess for the presence
46
of group B streptococcal (GBS) bacteria
A 36-week gestation gravid lies flat on her back.
in the woman’s vagina and rectum. If the
Which of the following maternal
woman has GBS as part of her normal
signs/symptoms would the nurse expect to
flora, she will be given IV antibiotics
observe?
during labor to prevent vertical transmission
1. Hypertension.
to her baby at birth. GBS is often
2. Dizziness.
called, “the baby killer.”
3. Rales.
4. Chloasma. 49
A 34-week gestation woman calls the obstetric
office stating, “Since last night
2. Dizziness is an expected finding
I have had three nosebleeds.” Which of the
TEST-TAKING TIP: Because the weight of following responses by the nurse is
the gravid uterus compresses the great vessels, the appropriate?
nurse would expect the client 1. “You should see the doctor to make sure you are
to complain of dizziness when lying not becoming severely anemic.”
supine. The blood supply to the head 2. “Do you have a temperature?”
and other parts of the body is diminished 3. “One of the hormones of pregnancy makes the
when the great vessels are compressed. nasal passages prone to bleeds.”
4. “Do you use any inhaled drugs?”
47
The nurse is interviewing a 38-week gestation Study These Flashcards
Muslim woman. Which of the following 3. This is an accurate statement. Hormonal
questions would be inappropriate for the nurse to changes in pregnancy make the
ask? nasal passages prone to bleeds.
1. “Do you plan to breastfeed your baby?”
2. “What do you plan to name the baby?”
3. “Which pediatrician do you plan to use?” TEST-TAKING TIP: Estrogen, one of the
4. “How do you feel about having an episiotomy?” important hormones of pregnancy,
promotes vasocongestion of the mucous
membranes of the body. Increased vascular
2. It is inappropriate to ask the Muslim
perfusion of the mucous membranes
client about the name for the baby.
of the gynecological system is essential
for the developing fetus to survive. The
vasocongestion occurs in all of the mucous
TEST-TAKING TIP: Traditional Muslim
membranes of the body, however,
couples will not tell anyone the baby’s
leading to many complaints including
name until he or she has gone through
nosebleeds and gingival bleeding.
the official naming ceremony, called
“aqiqah.” Babies are rarely named before 50
a week of age. The parents need time to The nurse asks a woman about how the woman’s
husband is dealing with the pregnancy.
The nurse concludes that counseling is needed A client is 35 weeks’ gestation. Which of the
when the woman makes following findings would the nurse expect
which of the following statements? to see?
1. “My husband is ready for the pregnancy to end 1. Nausea and vomiting.
so that we can have sex again.” 2. Maternal ambivalence.
2. “My husband has gained quite a bit of weight 3. Fundal height 10 cm above the umbilicus.
during this pregnancy.” 4. Use of three pillows for sleep comfort.
3. “My husband seems more worried about our
finances now than before the
4. The use of three pillows for sleep
pregnancy.”
comfort is often seen in clients who
4. “My husband plays his favorite music for my belly
are 35 weeks’ gestation.
so the baby will learn to like it.”
TEST-TAKING TIP: It is essential that the
Study These Flashcards test taker differentiate between normal
1. The woman implies that she and her and abnormal findings at various points
husband are not having sex. There is during the pregnancy—for example, nausea
no need to refrain from sexual intercourse and vomiting are normal during the
during a normal pregnancy— first trimester but not during the second
so the woman and her husband need or third trimesters. The fundal height
further counseling. measurement is also important to remember.
From 20 weeks’ gestation,
TEST-TAKING TIP: Couvade is the term
when the fundal height is usually at the
given to a father’s physiological responses
same height as the umbilicus, to 36
to his partner’s pregnancy.
weeks’ gestation, when the final height is
Men have been seen to exhibit a number
at the xiphoid process, the height measures
of physical complaints/changes that
are approximately the same number
simulate their partner’s physical
of centimeters above the symphysis
complaints/changes—for example, indigestion,
as the number of weeks of fetal gestation.
weight gain, urinary frequency,
For example, at 24 weeks’ gestation,
and backache.
the height is usually 24 cm above the
51 symphysis or 4 cm above the umbilicus,
The blood of a pregnant client was initially assessed and at 35 weeks’ gestation, the height is
at 10 weeks’ gestation and reassessed usually 35 cm above the symphysis, or
at 38 weeks’ gestation. Which of the following 15 cm above the umbilicus.
results would the nurse expect
53
to see?
A woman, 26-weeks’ gestation, calls the triage
1. Rise in hematocrit from 34% to 38%.
nurse stating, “I’m really scared. I tried
2. Rise in white blood cells from 5,000 cells/mm3 to
not to but I had an orgasm when we were making
15,000 cells/mm3.
love. I just know that I will go into
3. Rise in potassium from 3.9 mEq/ L to 5.2 mEq/ L.
preterm labor now.” Which of the following
4. Rise in sodium from 137 mEq/ L to 150 mEq/ L.
responses by the nurse is appropriate?
Study These Flashcards 1. “Lie down and drink a quart of water. If you feel
2. The nurse would expect to see an any back pressure at all call me
elevated white blood cell count. back right away.”
2. “Although oxytocin was responsible for your
orgasm, it is very unlikely that it
TEST-TAKING TIP: At the end of the third will stimulate preterm labor.”
trimester and through to the early postpartum 3. “I will inform the doctor for you. What I want you
period, a normal leukocytosis, or to do is to come to the hospital
rise in white blood cell count, is seen. right now to be checked.”
This is a natural physiological change 4. “The best thing for you to do right now is to take
that protects the woman’s body from the a warm shower, and then do a
invasion of pathogens during the birth fetal kick count assessment.”
process. The nurse should rely on a temperature
elevation to determine whether
2. This is an accurate statement.
or not the woman has an infection
52
TEST-TAKING TIP: There is no contraindication 1. Birth plans help to facilitate communication
to intercourse or to orgasm between couples and their
during pregnancy, unless it has been health care providers.
determined that a client is high risk for
TEST-TAKING TIP: The earlier a birth plan
preterm labor. Until late in pregnancy,
is developed, the better. A pregnant
there are very few oxytocin receptor sites
woman and her partner must feel comfortable
on the uterine body. The woman will,
with the communication methods,
therefore, not go into labor as a result of
physical care, and health care
an orgasm during sexual relations.
philosophies of their obstetrical health
54 care provider. The birth plan is a means
A couple is preparing to interview obstetric primary for everyone to clearly understand each
care providers in order to determine step of the birthing process. When the
who they will go to for care during their pregnancy client enters the hospital for delivery, the
and delivery. In order to birth plan should be presented to the
make the best choice, which of the following nursing staff in order to facilitate the
actions should the couple perform first? communication during that transition.
1. Take a tour of hospital delivery areas.
56
2. Develop a preliminary birth plan.
The nurse is assisting a couple to develop decisions
3. Make appointments with three or four obstetric
for their birth plan. Which of
care providers.
the following decisions should be considered
4. Search the internet for the malpractice histories
nonnegotiable by the parents?
of the providers.
1. Whether or not the father will be present during
Study These Flashcards labor.
2. It is best that a couple first develop a 2. Whether or not the woman will have an
birth plan. episiotomy.
3. Whether or not the woman will be able to have
an epidural.
TEST-TAKING TIP: It is important for a 4. Whether or not the father will be able to take
couple’s needs and wants to match their obstetrical pictures of the delivery.
care practitioner’s philosophy
of care. If, for example, the couple is
1. The presence of the father at delivery
interested in the possibility of having a
should be nonnegotiable.
water birth, it is important that the
health care provider be willing to perform
a water birth. If, however, the
TEST-TAKING TIP: Even though the birth
woman wants to be “completely pain
plan should include issues like the use or
free,” the health care provider must be
nonuse of episiotomies, emergent issues
willing to order pain medications
during the delivery may lead to a sudden
throughout the labor and delivery. A
change in plans. For example, if a cesarean
birth plan will list the couples’ many
is needed for malpresentation, the
wishes.
issue of episiotomy is moot and the
55 client will definitely need anesthesia.
During a preconception counseling session, the However, there are some issues that
nurse encourages a couple to prepare should be nonnegotiable. If the father
a birth plan. Which of the following is the most wishes to be in the delivery room no
important goal for this action? matter the type of delivery or whether or
1. Promote communication between the couple and not an emergent situation is occurring,
health care professionals. that should be stated in the plan and
2. Enable the couple to learn about the types of accepted by the health care provider.
medicine used in labor.
57
3. Provide the couple with a list of items that they
During a prenatal visit, a gravid client is
should put in a bag for labor.
complaining of ptyalism. Which of the
4. Give the high-risk couple a sense of control over
following nursing interventions is appropriate?
having to have a cesarean.
1. Encourage the woman to brush her teeth
Study These Flashcards carefully.
2. Advise the woman to have her blood pressure
checked regularly. contraindicated to vaccinate pregnant
3. Encourage the woman to wear supportive women with many other vaccines, including
hosiery. the measles-mumps-rubella
4. Advise the woman to avoid eating rare meat. (MMR) and the varicella vaccines.
See http://www.acog.org/from_home/
publications/misc/bco282.pdf
1. Clients who experience ptyalism have
an excess of saliva. They should be 59
advised to be vigilant in the care for A gravid woman and her husband inform the nurse
their teeth and gums. Ptyalism is often that they have just moved into a
accompanied by gingivitis and three-story home that was built in the 1930s. Which
nausea and vomiting. of the following is critical for
the nurse to advise the woman in order to protect
the unborn child?
TEST-TAKING TIP: Ptyalism is related to 1. Stay out of any rooms that are being renovated.
the increase in vascular congestion of 2. Drink water only from the hot water tap.
the mucous membranes from increased 3. Refrain from entering the basement.
estrogen production. Women with increased 4. Climb the stairs only once per day.
salivation often also experience
gingivitis, which is also related to estrogen
1. The woman should stay out of rooms
production. In addition, ptyalism is
that are being renovated.
seen in women with nausea and vomiting.
Because of the caustic affects of gastric
juices on the enamel of the teeth, the
TEST-TAKING TIP: Antique houses often
inflammation seen in the gums and the
contain lead-based paint and water
increased salivation, it is essential that
piping that has been soldered with leadbased
the pregnant woman take special care of
solder. Lead, when consumed either
her teeth during pregnancy, including
through the respiratory tract or the
regular visits to the dentist or the dental
GI tract, can cause permanent damage to
hygienist.
the central nervous system of the unborn
58 child. It is very important, therefore, that
A gravid woman who recently emigrated from the woman not breathe in the air in
mainland China is being seen at her rooms that have recently been sanded.
first prenatal visit. She was never vaccinated in her The paint aerosolizes and the lead can
home country. An injection to be inhaled. In addition, lead leaches into
prevent which of the following communicable hot water more readily than into cold
diseases should be administered to so water from the cold tap should be
the woman during her pregnancy? consumed—but only after the water has
1. Influenza. run through the pipes for a minimum of
2. Mumps. 2 minutes.
3. Rubella.
60
4. Varicella.
After nutrition counseling, a woman, G3 P1101,
Study These Flashcards proclaims that she certainly can’t
1. The woman should receive the influenza eat any strawberries during her pregnancy. Which
injection. The nasal spray, of the following is the likely
however, should not be administered reason for this statement?
to a pregnant woman 1. The woman is allergic to strawberries.
2. Strawberries have been shown to cause birth
defects.
TEST-TAKING TIP: It is very important for 3. The woman believes in old wives’ tales.
pregnant women to be protected from the flu by 4. The premature baby died because the woman
receiving the inactivated influenza ate strawberries
injection. The fetus will not be
injured from the shot and the woman
3. The woman believes in old wives’
will be protected from the many sequelae
tales.
that can develop from the flu. However,
the live nasal flu spray should not be
administered to pregnant women. It is
TEST-TAKING TIP: There are a number of 3. The couple may find it necessary to experiment
old wives’ tales that pregnant women believe with alternate positions.
in and live by. One of the common 4. Vaginal lubricant should be used sparingly
tales relates to the ingestion of strawberries: throughout the pregnancy.
Women who eat strawberries have
babies with strawberry marks on their
3. With increasing size of the uterine
bodies. Unless old-wives’ tales have the body, the couple may need counseling
potential to impact the health of the baby regarding alternate options for sexual
and/or mother, it is ill advised and unnecessary intimacy.
to argue with the mother
TEST-TAKING TIP: Pregnancy lasts 10
about her beliefs.
lunar months. It is essential that the
61 nurse counsel clients on ways to maintain
A woman is planning to become pregnant. Which health and well-being in the many
of the following actions should facets of their lives. Sexual intimacy is
she be counseled to take before stopping birth one of the important aspects of a married
control? Select all that apply. couple’s life together. The couple
1. Take a daily multivitamin. can be counseled to use alternate positions,
2. See a medical doctor. engage in mutual masturbation,
3. Drink beer instead of vodka. or other means to satisfy their needs for
4. Stop all over-the-counter medications. sexual expression during the pregnancy
5. Stop smoking cigarettes. period.
Study These Flashcards 63

1, 2, and 5 are correct. Which of the following skin changes should the
1. It is very important that women, before nurse highlight for a pregnant
attempting to become pregnant, woman’s health care practitioner?
begin taking daily multivitamin 1. Linea nigra.
tablets. 2. Melasma.
2. Women who wish to become pregnant 3. Petechiae.
should first see a medical doctor 4. Spider nevi.
for a complete check-up
5. Women who wish to become pregnant 3. Petechiae are pinpoint red or purple
should be counseled to stop spots on the skin. They are seen in
smoking. hemorrhagic conditions.
TEST-TAKING TIP: Because the embryo is
very sensitive during the first trimester
of pregnancy, women should be advised TEST-TAKING TIP: There are many skin
to be vigilant about their health even before changes that occur normally during
becoming pregnant. For example, pregnancy. Most of the changes—such
folic acid, a vitamin in multivitamin as linea nigra, melasma, and hyperpigmentation
tablets, helps to prevent neural tube defects. of the areolae—are related
Women of childbearing age often to an increase in the melanin-producing
fail to go for complete physical examinations. bodies of the skin as a result of
It is important to discover the stimulation by the female hormones,
presence of any medical illnesses before estrogen and progesterone. The
the pregnancy begins, however, so presence of petechiae is usually related
women should be counseled to have a to a pathological condition, such as
complete physical before stopping birth thrombocytopenia.
control methods.
64
62 A pregnant woman informs the nurse that her last
The nurse discusses sexual intimacy with a pregnant normal menstrual period was on
couple. Which of the following September 20, 2006. Using Nagele’s rule, the nurse
should be included in the teaching plan? calculates the client’s estimated
1. Vaginal intercourse should cease by the date of delivery as:
beginning of the third trimester. 1. May 30, 2007.
2. Breast fondling should be discouraged because 2. June 20, 2007.
of the potential for preterm labor.
3. June 27, 2007. notify the physician immediately
4. July 3, 2007. if she experiences which of the following
signs/symptoms? Select all that
apply.
3. The estimated date of delivery is June
1. Convulsions.
27, 2007
2. Double vision.
3. Epigastric pain.
4. Persistent vomiting.
TEST-TAKING TIP: Nagele’s rule is a simple
5. Polyuria.
method used to calculate a client’s
estimated date of confinement (EDC) or Study These Flashcards
estimated date of delivery (EDD) from 1, 2, 3, and 4 are correct.
the last normal menstrual period (LMP). 1. Convulsions are a danger sign of
The nurse learns the date of the last pregnancy.
menstrual period from the client. He or 2. Double vision is a danger sign of
she then subtracts 3 months from the pregnancy.
date, adds 7 days to the date, and adjusts 3. Epigastric pain is a danger sign of
pregnancy.
4. Persistent vomiting is a danger sign of
the year, if needed. For the example pregnancy.
given:
Last normal menstrual
period—September 20, 2006 = 9 - 20 - 2006 TEST-TAKING TIP: The danger signs of
37 pregnancy are signs or symptoms that can
6 27 occur in an otherwise healthy pregnancy
adjust the year 6 - 27 - 2007 that are likely due to serious pregnancy
June 27, 2007 complications. For example, double vision,
epigastric pain, and blurred vision are
65
symptoms of the hypertensive illnesses of
A father experiencing couvade syndrome is likely to
pregnancy, and persistent vomiting is a
exhibit which of the following
symptom of hyperemesis gravidarum.
symptoms/behaviors?
1. Heartburn. 67
2. Promiscuity. A woman provides the nurse with the following
3. Hypertension. obstetrical history: Delivered a son,
4. Indifference. now 7 years old, at 28 weeks’ gestation; delivered a
daughter, now 5 years old, at
39 weeks’ gestation; had a miscarriage 3 years ago,
1. Heartburn is a common symptom
and had a first-trimester
abortion 2 years ago. She is currently pregnant.
Which of the following portrays
TEST-TAKING TIP: Heartburn is a subjective
an accurate picture of this woman’s gravidity and
complaint that fathers often experience
parity?
during their partners’ pregnancies.
1. G4 P2121.
Fathers who are experiencing couvade
2. G4 P1212.
symptoms are exhibiting a strong affiliation
3. G5 P1122.
between themselves and their partners.
4. G5 P2211.
It is inappropriate for prospective
fathers to engage in illicit relationships Study These Flashcards
and/or indifference toward their partners’ 3. This accurately reflects this woman’s
pregnancies. They should be fully gravidity and parity—G5P1122.
engaged in the process. Hypertension, an
objective sign, should be investigated
further. The father may have developed a TEST-TAKING TIP: Gravidity refers to
pathologic condition. pregnancy and parity refers to delivery.
Every time a woman is pregnant, it is
66
counted as one gravida (G). The results
A nurse is advising a pregnant woman about the
of each pregnancy are then documented
danger signs of pregnancy.
as a para (P) in the following order. The
The nurse should teach the mother that she should
first number refers to full-term births or
births ≥ 38 weeks’ gestation; the second
number refers to preterm births or
TEST-TAKING TIP: Vegans are vegetarians
births between 20 and 37 weeks’ gestation;
who eat absolutely no animal products.
the third number refers to abortions,
Since animal products are most clients’
whether spontaneous or therapeutic;
sources of protein and iron, it is necessary
and the fourth number refers to the
for vegans to be very careful to meet their
number of living children. The client has
increased needs by eating excellent
been pregnant 5 times (G5); she birthed
sources of these nutrients. It is recommended
1 son, 1 daughter, had 1 miscarriage, had
that vegans meet with a registered
1 first trimester abortion, and is currently
dietitian early in their pregnancies
pregnant. Her parity (P1122) accurately
to discuss diet choices.
reflects her obstetrical history:
1 full-term delivery (daughter at 70
39 weeks), 1 preterm delivery (son at When assessing the fruit intake of a pregnant client,
28 weeks), 2 abortions (1 miscarriage, the nurse notes that the client
1 first-trimester abortion), and, usually eats 1 piece of fruit per day and drinks 7 to
8 servings of fruit juice per day.
68
Which of the following is the most important
The partner of a gravida accompanies her to her
communication for the nurse to make?
prenatal appointment. The nurse
1. “You are effectively meeting your daily fruit
notes that the father of the baby has gained weight
requirements.”
since she last saw him. Which of
2. “Fruit juices are excellent sources of folic acid.”
the following comments is most appropriate for the
3. “It would be even better if you were to consume
nurse to make to the father?
more whole fruits and less fruit
1. “I see that you are gaining weight right along
juice.”
with your partner.”
4. “Your fruit intake far exceeds the recommended
2. “You and your partner will be able to go on a diet
daily fruit intake.”
together after the baby is born.”
3. “I can see that you are a bad influence on your Study These Flashcards
partner’s eating habits.” 3. It is recommended that pregnant
4. “I am so glad to see that you are taking so much clients eat whole fruits rather than
interest in your partner’s consume large quantities of fruit
pregnancy.” juice. This is the most important
statement for the nurse to make.
4. This is an appropriate comment to
make at this time.
TEST-TAKING TIP: Approximately 6 oz
TEST-TAKING TIP: This father is exhibiting
of fruit juice equals 1 serving from the
a sign of couvade; i.e., weight gain. This
fruit group. Fruit juices, however, are
is a positive response since it shows that
usually much higher in sugar than are
he is exhibiting a sympathetic response to
whole fruits. In addition, the client is not
his partner’s pregnancy. In addition, this
receiving the benefit of the fiber that is
father is accompanying his partner to the
contained in the whole fruit. The nurse
prenatal visit, another positive sign.
should compliment the client on her
69 fruit intake but encourage her to
The nurse is caring for a pregnant client who is a consume whole fruits rather than large
vegan. Which of the following quantities of juice.
foods should the nurse suggest the client consume
71
as substitutes for restricted
A client states that she is a strong believer in
foods?
vitamin supplements to maintain her
1. Tofu, legumes, broccoli.
health. The nurse advises the woman that it is
2. Corn, yams, green beans.
recommended to refrain from consuming
3. Potatoes, parsnips, turnips.
excess quantities of which of the following vitamins
4. Cheese, yogurt, fish.
during pregnancy?
Study These Flashcards 1. Vitamin C.
1. Tofu, legumes, and broccoli are excellent 2. Vitamin D.
substitutes for the restricted 3. Vitamin B2 (niacin).
foods. 4. Vitamin B12 (cobalamin).
Study These Flashcards alleviate the problem. Foods high in fiber,
2. Vitamin D supplementation can be like celery, are excellent suggestions.
harmful during pregnancy.
74
A pregnant client is lactose intolerant. Which of the
following alternative calciumrich
TEST-TAKING TIP: The water-soluble
foods could this woman consume?
vitamins, if consumed in large quantities,
1. Turnip greens.
have not been shown to be harmful
2. Green beans.
during pregnancy. The body eliminates
3. Cantaloupe.
the excess quantities through the urine
4. Nectarines.
and stool. However, the fat-soluble
vitamins—vitamins A, D, E, and K—can Study These Flashcards
build up in the body. Vitamins A and 1. Turnip greens are calcium-rich.
D have been shown to be teratogenic to
the fetus in megadoses.
TEST-TAKING TIP: There are a number of
72
women who, for one reason or another,
A vegan is being counseled regarding vitamin
do not consume large quantities of dairy
intake. It is essential that this woman
products. The nurse must be prepared to
supplement which of the following B vitamins?
suggest alternate sources since dairy
1. B1 (thiamine).
products are the best sources for calcium
2. B2 (niacin).
intake. Any of the dark green leafy vegetables,
3. B6 (pyridoxine).
like kale, spinach, collards, and
4. B12 (cobalamin).
turnip greens, are excellent sources, as
Study These Flashcards are small fish that are eaten with the
4. Vitamin B12 (cobalamin) should be bones, like sardines.
supplemented.
75
A nurse, who is providing nutrition counseling to a
new gravid client, advises the
TEST-TAKING TIP: Vitamin B12 (cobalamin)
woman that a serving of meat is approximately
is found almost exclusively in animal
equal in size to which of the
products—meat, dairy, eggs. Since vegans
following items?
do not consume animal products, and
1. Deck of cards.
the vitamin is not in most nonanimal
2. VCR tape.
sources, it is strongly recommended that
3. CD case.
vegans supplement that vitamin. Those
4. Video camera.
who take in too little of the vitamin are
susceptible to anemia and nervous system Study These Flashcards
disorders. In addition, the vitamin is 1. This is an accurate statement. A serving
especially important during pregnancy of meat is approximately equal to
since it is essential for DNA synthesis. a deck of cards.
73
foods would be best for the nurse to recommend
TEST-TAKING TIP: The dietary recommendation
to the client?
of the meat group for pregnant
1. Bananas.
clients is: 3 servings of meat per day.
2. Rice.
3. Yogurt. Each serving is defined as 2 to 3 oz of
4. Celery. meat, fish, or poultry. The average
American diet well exceeds the recommended
meat intake since most
4. Celery is an excellent food to reverse
Americans consider a serving of meat to
constipation.
be larger than a deck of cards.
TEST-TAKING TIP: Most women complain
of constipation during pregnancy. Progesterone, 76
a muscle-relaxant, is responsible The nurse is evaluating the 24-hour dairy intake of
for a slowing of the digestive system. four gravid clients. Which of
It is important, therefore, to recommend the following clients consumed the highest number
foods to pregnant clients that will help to of dairy servings during 1 day?
The client who consumed: 3. 1 cup cooked pasta.
1. 4 oz whole milk, 2 oz hard cheese, 1 cup of 4. 1 tortilla.
pudding made with milk and 2 oz 5. 1 cup dry cereal.
cream cheese.
2. 1 cup yogurt, 8 oz chocolate milk, 1 cup cottage
2, 4, and 5 are correct.
cheese, and 11⁄2 oz hard cheese.
3. 1⁄2 cup cottage cheese, 8 oz whole milk, 1 cup of
buttermilk, and 1⁄2 oz hard
2. 1 slice bread 1 serving.
cheese.
4. 1⁄2 cup frozen yogurt, 8 oz skim milk, 4 oz cream
cheese, and 11⁄2 cup of cottage
4. 1 tortilla 1 serving.
cheese.
5. 1 cup dry cereal 1 serving.
Study These Flashcards TEST-TAKING TIP: The test taker should
2. This client consumed 32⁄3 servings: note that pregnant women are recommended
1 cup yogurt 1 serving, 8 oz chocolate to consume 7 to 11 servings of
milk 1 serving; 1 cup cottage grain. However, 1 sandwich equals 2
cheese 2⁄3 serving; and 11⁄2 oz hard servings since each piece of bread equals
cheese 1 serving. 1 serving. Also, it is important to counsel
women to eat whole grain foods rather
than processed grains. More nutrients as
TEST-TAKING TIP: It is essential that the well as more fiber are obtained from
test taker know which foods are placed in whole grain foods.
which food groups and the equivalent
79
quantity of food that meets one serving
A woman asks the nurse about consuming herbal
size. For example, 1 cup of any type
supplements during pregnancy.
of milk—whole, skim, butter, or even
Which of the following responses is appropriate?
chocolate—is equal to one dairy serving
1. Herbals are natural substances, so they are safely
while 11⁄2 oz of hard cheese is equal to
ingested during pregnancy.
one serving.
2. It is safe to take licorice and cat’s claw, but no
77 other herbs are safe.
Which of the following choices can the nurse teach 3. A federal commission has established the safety
a prenatal client is equivalent to of herbals during pregnancy.
one 2-oz meat serving? 4. The woman should discuss everything she eats
1. 4 tbsp peanut butter. with a health care practitioner.
2. 2 eggs.
3. 1 cup cooked lima beans.
4. Every woman should advise her health
4. 2 ounces mixed nuts.
care practitioner of what she is consuming,
Study These Flashcards including food, medicines,
2. 2 eggs 1 meat serving herbals, and all other substances.
TEST-TAKING TIP: Herbals are not regulated
by the Food and Drug Administration
TEST-TAKING TIP: The test taker should (FDA). There is some information
refer to the US Dietary Association information on selected herbals at the National Institute
at http://www.health.gov/ of Health web site—http://nccam.
dietaryguidelines for up-to-date dietary nih.gov/health—but because research on
recommendations. As more research pregnant women is particularly sensitive
information is forthcoming, dietary there is very little definitive information
recommendations change. on the safety of many herbals in pregnancy.
No matter what is consumed by
78
the mother, however, the health care
A nurse is discussing the serving sizes in the grain
practitioner should be consulted.
food group with a new prenatal
client. Which of the following foods equals 1 80
serving size from the grain group? A Chinese immigrant is being seen in the prenatal
Select all that apply. clinic. When providing nutrition
1. 1 bagel. counseling, which of the following factors should
2. 1 slice of bread. the nurse keep in mind?
1. Many Chinese eat very little protein. 82. 1. Bologna should not be consumed
2. Many Chinese believe pregnant women should during pregnancy unless it is thoroughly
eat cold foods. cooked.
3. Many Chinese are prone to anemia.
TEST-TAKING TIP: Because pregnant
4. Many Chinese believe strawberries can cause
women are slightly immunocompromised,
birth defects.
they are especially susceptible to
Study These Flashcards certain diseases. Deli meats, unless
2. Many Chinese women do believe in heated to steaming hot, can cause listeriosis.
the “hot and cold” theory of life. Pregnant women should avoid
these foods. Other foods that contain
Listeria monocytogenes that should be
TEST-TAKING TIP: Whenever a question avoided are unpasteurized milk, soft
specifies that a client belongs to a specific cheese, and undercooked meats. See
cultural or ethnic group, the test http://www.cfsan.fda.gov/~pregnant/
taker should attend carefully to that information. ataglanc.html and http://www.health.
It is very likely that the gov/dietaryguidelines/dga2005/
question is asking the test taker to discern document/html/chapter10.htm
cultural/ethnic differences in order
to discern the test taker’s cultural
competence. Pregnancy is believed by 83
many Chinese to be a “hot period.” In A 12-week gestation client tells the nurse that she
order to maintain the equilibrium of the and her husband eat sushi at least
body, therefore, pregnant women consume once per week. She states, “I know that fish is good
“cold” foods and drinks. for me, so I make sure we eat it
regularly.” Which of the following responses by the
81
nurse is appropriate?
A nurse has identified the following nursing
1. “You are correct. Fish is very healthy for you.”
diagnosis for a prenatal client: Altered
2. “You can eat fish, but sushi is too salty to eat
nutrition: less than body requirements related to
during pregnancy.”
poor folic acid intake. Which of
3. “Sushi is raw. Raw fish is especially high in
the following foods should the nurse suggest the
mercury.”
client consume?
4. “It is recommended that fish be cooked to
1. Potatoes and grapes.
destroy harmful bacteria.”
2. Cranberries and squash.
3. Apples and corn. Study These Flashcards
4. Oranges and spinach. 4. This is correct. It is recommended
that during pregnancy the client eat
only well-cooked fish.
4. Oranges and spinach are excellent
TEST-TAKING TIP: Fish is an excellent
folic acid sources.
source of omega-3 oil and protein.
TEST-TAKING TIP: The intake of folic acid
During pregnancy fish should be eaten
is especially important during the first
well-cooked to avoid ingestion of
trimester of pregnancy to help to prevent
pathogens. The pregnant woman should
structural defects, including spina bifida
limit her intake to 12 oz per week or less
and gastroschisis. The best sources of
to reduce the potential of her consuming
folic acid are liver and green leafy vegetables.
toxic levels of methylmercury. See
Oranges and orange juice are
http://www.cfsan.fda.gov/~pregnant/
also good sources.
safemea.html
82
84
A nurse is discussing diet with a pregnant woman.
The nurse is caring for a prenatal client who states
Which of the following foods
she is prone to developing anemia.
should the nurse advise the client to avoid
Which of the following foods should the nurse
consuming during her pregnancy?
advise the gravida is the best
1. Bologna.
source of iron?
2. Cantaloupe.
1. Raisins.
3. Asparagus.
2. Hamburger.
4. Popcorn.
3. Broccoli.
Study These Flashcards 4. Molasses.
Study These Flashcards Pica is a behavior that should be
2. Hamburger contains the most iron discouraged because of its potentially
detrimental effects. If the client wishes to
consume ice, an excellent alternative is
TEST-TAKING TIP: Iron is present in most ice pops, Italian ices, or iced fruit juice.
animal sources—seafood, meats, eggs—
87
although it is not present in milk. There
A mother is experiencing nausea and vomiting
also is iron in vegetable sources, although
every afternoon. The ingestion of
not in the same concentration as
which of the following spices has been shown to be
in animal products. If the nurse is caring
a safe complementary therapy
for a pregnant vegetarian, the nurse must
for this complaint?
counsel the client regarding good nonanimal
1. Ginger.
sources of all nutrients.
2. Sage.
85 3. Cloves.
It is discovered that a pregnant woman practices 4. Nutmeg.
pica. Which of the following complications
is most often associated with this behavior?
1. Ginger has been shown to be a safe
1. Hypothyroidism.
antiemetic agent for pregnant women.
2. Iron deficiency anemia.
3. Hypercalcemia.
4. Overexposure to zinc.
TEST-TAKING TIP: Morning sickness and
Study These Flashcards daytime nausea and vomiting are common
2. Iron deficiency anemia is often seen complaints of pregnant women during the
in clients who engage in pica. first trimester. Ginger, consumed as ginger
tea, ginger ale, or the like, has been
shown to be a safe and an effective antinausea
TEST-TAKING TIP: Clients who engage in agent for many pregnant women.
pica eat large quantities of nonfood items
88
like ice, laundry starch, soap, and dirt.
A woman tells the nurse that she would like
There are a number of problems related
suggestions for alternate vitamin C
to pica, including teratogenesis related to
sources because she isn’t very fond of citrus fruits.
eating foods harmful to the fetus. More
Which of the following suggestions
commonly, the women fill up on items
is appropriate?
like ice instead of eating high-quality
1. Barley and brown rice.
foods. This practice is often culturally
2. Strawberries and potatoes.
related.
3. Buckwheat and lentils.
86 4. Wheat flour and figs.
A woman confides in the nurse that she practices
pica. Which of the following
2. Strawberries and potatoes are
alternatives could the nurse suggest to the woman?
excellent sources of vitamin C, as are
1. Replace laundry starch with salt.
zucchini, blueberries, kiwi, green
2. Replace ice with frozen fruit juice.
beans, green peas, and the like.
3. Replace soap with cream cheese.
4. Replace soil with uncooked pie crust. TEST-TAKING TIP: The test taker must be
prepared to answer basic nutrition questions
related to the health of the pregnant
2. This is an excellent suggestion. Fruit
woman. Even though citrus fruits
juice, although high in sugar, does
are commonly thought of as the primary
contain vitamins.
sources of vitamin C, the test taker
should realize that virtually all fruits and
vegetables contain the vitamin, while
TEST-TAKING TIP: Although the nurse
grains do not.
might prefer that a client completely stop
a behavior that the nurse deems unsafe or
inappropriate, the client may disagree.
89
The nurse, therefore, must attempt to
A nurse is providing diet counseling to a new
provide a substitute for the client’s behavior.
prenatal client. Which of the following
dairy products should the client be advised to avoid 4. The cardiovascular system is stressed when
eating during the pregnancy? pregnancies are less than 2 years apart.
1. Vanilla yogurt.
2. Parmesan cheese.
1. This statement is true. Organogenesis
3. Gorgonzola cheese.
begins prior to the missed menstrual
4. Chocolate milk.
period.
3. The intake of gorgonzola cheese
should be discouraged during pregnancy. TEST-TAKING TIP: The test taker may be
unfamiliar with the term organogenesis.
To answer the question correctly, however, it is
TEST-TAKING TIP: Gorgonzola cheese is a essential that the test taker
soft cheese. Soft cheeses harbor Listeria be able to decipher the definition. It is
monocytogenes, the organism that causes important that the nurse break the word
listeriosis. Pregnant women are at high down into its parts in order to deduce
risk of developing this infection because the meaning. Organo means “organ” and
they are slightly immunosuppressed. The genesis means “origin.” The definition of
adult disease can assume many forms, including the term, therefore, is origin, or development,
meningitis, pneumonia, and sepsis. of the organ systems.
Pregnant women who develop the
92
disease often deliver stillborn babies or
A woman has just completed her first trimester.
babies who are at risk of dying postdelivery
Which of the following fetal structures
from fulminant disease.
can the nurse tell the woman are well formed at this
90 time? Select all that apply.
A woman asks the nurse about the function of 1. Genitals.
amniotic fluid. Which of the following 2. Heart.
statements by the woman indicates that additional 3. Fingers.
teaching is needed? 4. Alveoli.
1. The fluid provides fetal nutrition. 5. Kidneys.
2. The fluid cushions the fetus from injury.
3. The fluid enables the fetus to grow.
1, 2, 3, and 5 are correct.
4. The fluid provides a stable thermal environment
1. The genitalia are formed by the end
Study These Flashcards of the first trimester.
90. 1. The umbilical cord, not the amniotic 2. The heart is formed by the end of the
fluid, delivers nutrition to the developing first trimester.
fetus. 3. The fingers are formed by the end of
the first trimester.
TEST-TAKING TIP: The amniotic fluid is

produced primarily by the fetus as fetal 5. The kidneys are formed by the end of
urine. In addition to the functions noted the first trimester.
above, the baby practices “breathing” the TEST-TAKING TIP: The test taker should
amniotic fluid in and out of the lungs in be familiar with the basic developmental
preparation for breathing air in the extrauterine changes that occur during the three
environment. trimesters. In addition, the test taker
should be able to develop a basic timeline
91
of developmental milestones that
Why is it essential that women of childbearing age
occur during the pregnancy. By the
be counseled to plan their
conclusion of the first trimester, all
pregnancies?
major organs are completely formed.
1. Much of the organogenesis occurs before the
The maturation of the organ systems
missed menstrual period.
must, however, still occur.
2. Insurance companies must preapprove many
prenatal care expenditures. 93
3. It is recommended that women be pregnant no An ultrasound of a fetus’ heart shows that normal
more than 3 times during their fetal circulation is occurring.
lifetime. Which of the following statements should the nurse
interpret as correct in relation mature ova.
to the fetal circulation? 3. The babies share one placenta and a common
1. The foramen ovale is a hole between the chorion.
ventricles. 4. The babies will definitely be the same sex and
2. The umbilical vein contains oxygen-poor blood. have the same blood type.
3. The right atrium contains both oxygen-rich and
oxygen-poor blood.
2. This is a true statement. Dizygotic
4. The ductus venosus lies between the aorta and
twins result from two mature ova that
pulmonary artery.
are fertilized.
TEST-TAKING TIP: The best way for the
3. The right atrium does contain both
test taker to differentiate between
oxygen-rich and oxygen-poor blood.
monozygotic twinning and dizygotic
twinning is to remember the meaning of
the prefixes to the two words. “Mono”
TEST-TAKING TIP: The test taker should
means 1. Monozygotic twins, therefore,
have an understanding of fetal circulation.
originate from one fertilized ovum. The
One principle to remember when
babies have the same DNA; therefore,
studying the circulation of the fetus is
they are the same sex. They share a placenta
that the blood bypasses the lungs since
and chorion. “Di” means 2. Dizygotic
the baby is receiving oxygen-rich
twins arise from 2 separately fertilized
blood directly from the placenta via the
eggs. Their genetic relationship is
umbilical vein. The location of the three
the same as if they were siblings born
ducts—ductus venosus, formen ovale,
from different pregnancies.
ductus arteriosus—therefore, enable the
blood to bypass the lungs. 96
A mother has just experienced quickening. Which
94
of the following developmental
The nurse is teaching a couple about fetal
changes would the nurse expect to occur at the
development. Which statement by the
same time in the woman’s
nurse is correct about the morula stage of
pregnancy?
development?
1. Fetal heart begins to beat.
1. “The fertilized egg has yet to implant into the
2. Lanugo covers the fetal body.
uterus.”
3. Kidneys secrete urine.
2. “The lung fields are finally completely formed.”
4. Fingernails begin to form.
3. “The sex of the fetus can be clearly identified.”
4. “The eye lids are unfused and begin to open and Study These Flashcards
close.” 2. Lanugo does cover the fetal body at
approximately 20 weeks’ gestation.
1. This is a true statement. In the
morula stage, about 2 to 4 days after
TEST-TAKING TIP: Although the test taker
fertilization, the fertilized egg has not
need not memorize all fetal developmental
yet implanted in the uterus.
changes, it is important to have an
understanding of major periods of development.
For example, organogenesis occurs
TEST-TAKING TIP: The morula is the
during the first trimester with all of
undifferentiated ball of cells that migrates
the major organs functioning at a primitive
down the fallopian tube toward
level by week 12.
the uterine body. The morular stage lasts
from about the 2nd to the 4th day after 97
fertilization. A woman who is seen in the prenatal clinic is found
to be 8 weeks pregnant. She
95
confides to the nurse that she is afraid her baby
A woman is carrying dizygotic twins. She asks the
may be “permanently damaged because
nurse about the babies. Which of
I had at least 5 beers the night I had sex.” Which of
the following explanations is accurate?
the following responses
1. During a period of rapid growth, the fertilized
by the nurse would be appropriate?
egg divided completely.
1. “I would let the doctor know that if I were you.”
2. When the woman ovulated, she expelled two
2. “It is unlikely that the baby was affected.”
3. “Abortions during the first trimester are very the nurse to realize that babies who are
safe.” born preterm are high risk for a number
4. “An ultrasound will tell you if the baby was of reasons, including lack of surfactant,
affected.” lack of iron stores to sustain them
during the early months of life, and lack
of brown adipose tissue needed for
2. This statement is true
thermoregulation.
99
TEST-TAKING TIP: The 2-week period between Below are four important landmarks of fetal
ovulation and implantation is often development. Please place them in
called “the all or nothing period.” chronological order:
During that time, the fertilized egg/ 1. Four-chambered heart is formed.
embryo is floating freely in the woman’s 2. Vernix caseosa is present.
fallopian tubes toward the uterine body. 3. Blastocyst development is complete.
The mother is not supplying the embryo 4. Testes have descended into the scrotal sac.
with nutrients at this time. Rather, the
embryo is self-sufficient. If an insult
The correct order is 3, 1, 2, 4.
occurs—for example, a teratogen is ingested
or an abdominal x-ray is taken—
the embryo is either destroyed or completely
3. The blastocyst is developed about 6 days
spared. And, since the pregnancy
after fertilization and before implantation
of the woman in the scenario was maintained,
in the uterus has occurred.
the nurse can assure her that the
1. The four-chambered heart is formed
embryo was spared insult.
during the early part of the first
98 trimester.
A gravida’s fundal height is noted to be at the 2. Vernix caseosa is present during the latter
xiphoid process. The nurse is aware half of pregnancy.
that which of the following fetal changes is likely to 4. The testes descend in the scrotal sac
be occurring at the same time about mid third trimester.
in the pregnancy? TEST-TAKING TIP: Before putting these
1. Surfactant is formed in the fetal lungs. items into chronological order, the test
2. Eyes begin to open and close. taker should carefully analyze each
3. Respiratory movements begin. choice. The blastocyst is developed by
4. The spinal column is completely formed. about day 6 after fertilization. The egg
has yet even to implant into the uterine
body at this point. The fetal heart develops
1. Surfactant is usually formed in the
during the early part of the first
fetal lungs by the 36th week.
trimester, but after implantation. Vernix
is present during the entire latter half of
the pregnancy in order to protect the
TEST-TAKING TIP: The test taker should
skin of the fetus. It appears, therefore, at
realize that this question is asking two
about week 20. And, finally, the testes do
things. First, the test taker needs to
not descend into the scrotal sac until mid
know what stage of pregnancy the
third trimester. Indeed, male preterm babies
woman is in when the fundal height is
are often birthed before the testes
at the xiphoid process. Once the test
descend.
taker realizes that this fundal height
signifies 36 weeks’ gestation, he or she 100
must determine what other change or A client is having an ultrasound assessment done at
process is likely to be occurring at her prenatal appointment at 8
36 weeks. The spinal column is completely weeks’ gestation. She asks the nurse, “Can you tell
formed by the end of the first what sex my baby is yet?”
trimester, fetal respiratory movements Which of the following responses would be
begin at about 24 weeks, and the eyes appropriate for the nurse to make at
open and close at about 28 weeks. Surfactant, this time?
which is essential for mature 1. “The technician did tell me the sex, but I will have
lung function, forms in the fetal lungs to let the doctor tell you
at about 36 weeks. It is important for what it is.”
2. “The organs are completely formed and present, 2. This fetus is about 22 weeks’ gestation.
but the baby is too small for Nails start to develop in the first
any to be seen.” trimester, and lanugo starts to develop
3. “The technician says that the baby has a penis. It at about 20 weeks, but eyes remain
looks like you are having a boy.” fused until about 29 weeks.
4. “I am sorry. It will not be possible to see which
sex the baby is for another
month or so.” TEST-TAKING TIP: The test taker should
not panic when reading a question like
the one in the scenario. This is an application
4. This statement is true. The sex is not
question that requires the test
visible yet.
taker to take things apart and put them
TEST-TAKING TIP: The genitourinary system
back together again. Each of the signs is
is the last organ system to fully develop.
unique and relates to a specific period in
Before 12 weeks, both female and
fetal development. After an analysis, the
male genitalia are present. The sex is determined
only response that is plausible is response
genetically, but it is as yet impossible
“2.”
to determine the sex visually. If
the embryo secretes testosterone, the 103
male sex organs mature and the female A client asks the nurse, “Could you explain how the
organs recede. If the embryo does not baby’s blood and my blood separate
secrete testosterone, the male sex organs at delivery?” Which of the following responses is
recede and the female organs mature. At appropriate for the nurse to
8 weeks, it is not possible to determine make?
the sex of the fetus. 1. “When the placenta is born, the circulatory
systems separate.”
101
2. “When the doctor clamps the cord, the blood
Which of the following developmental features
stops mixing.”
would the nurse expect to be absent
3. “The separation happens after the baby takes the
in a 41-week gestation fetus?
first breath. The baby’s oxygen
1. Fingernails.
no longer has to come from you.”
2. Eye lashes.
4. “The blood actually never mixes. Your blood
3. Lanugo.
supply and the baby’s blood supply
4. Milia.
are completely separate.”
3. Because this baby is postterm, lanugo
4. The blood supplies are completely
would likely not be present.
separate.
TEST-TAKING TIP: It is important to understand
the relationship between the
TEST-TAKING TIP: Lanugo is a fine hair
maternal vascular system and the fetal
that covers the body of the fetus. It begins to
system. There is a maternal portion to
disappear at about 38 weeks and
the placenta and a fetal portion of the
very likely has completely vanished by
placenta. By the time the placenta is fully
41 weeks’ gestation.
functioning, at about 12 weeks’ gestation,
102 fetal blood vessels have burrowed
A woman delivers a fetal demise that has lanugo into the decidual lining and maternal
covering the entire body, nails that vessels have burrowed into the chorionic
are present on the fingers and toes, but eyes that layer. The vessels, therefore, lie next to
are still fused. Prior to the death, each other. Gases and nutrients, then,
the mother stated that she had felt quickening. move across the membranes of the vessels
Based on this information, the nurse in order to provide the baby with
knows that the baby is about how many weeks’ needed substances and in order for the
gestation? mother to dispose of waste products.
1. 15 weeks.
104
2. 22 weeks.
Please place an “X” on the drawing of the cross
3. 29 weeks.
section of a placenta at the site of
4. 36 weeks.
gas exchange.
Antepartum NCLEX questions
Study These Flashcards Study online at quizlet.com/_fvm37
An “X” will be placed between the 1. 1.21. Rho (D) immune A. Rh incompatibility can
neonatal and maternal vessels where gas globulin (RhoGAM) is occur when an Rh-negative
exchange occurs. prescribed for a woman mom becomes sensitized
following delivery of a to the Rh antigen.
TEST-TAKING TIP: It is important that the
newborn infant and the Sensitization may develop
test taker have a complete understanding nurse provides information when an Rh-negative
of the anatomy and the physiology of the to the woman about the woman becomes pregnant
placenta. Since this is the sole organ that purpose of the medication. with a fetus who is Rh
maintains the health and well-being of The nurse determines that positive. During pregnancy
the fetus, the nurse must be able to differentiate the woman understands the and at delivery, some of
between the maternal portion purpose of the medication if the baby's Rh positive
and the fetal portion as well as the function the woman states that it will blood can enter the
of the structures. protect her next baby from maternal circulation,
which of the following? causing the woman's
A.Being affected by Rh immune system to form
incompatibility antibodies against Rh
B.Having Rh positive blood positive blood.
C.Developing a rubella Administration of Rho (D)
105 infection immune globulin prevents
The nurse is reading an article that states that the D.Developing physiological the woman from
maternal mortality rate in the jaundice developing antibodies
United States in the year 2000 was 17. Which of the against Rh
following statements would be
an accurate interpretation of the statement? 2. A 21-year old client, 6 B. Excessive vomiting in
1. There were 17 maternal deaths in the United weeks' pregnant is clients with hyperemesis
States in 2000 per 100,000 live diagnosed with hyperemesis gravidarum often causes
gravidarum. This excessive weight loss and fluid,
births.
vomiting during pregnancy electrolyte, and acid-base
2. There were 17 maternal deaths in the United
will often result in which of imbalances.
States in 2000 per 100,000 women
the following conditions?
of childbearing age. A.Bowel perforation
3. There were 17 maternal deaths in the United B.Electrolyte imbalance
States in 2000 per 100,000 C.Miscarriage
pregnancies. D.Pregnancy induced
4. There were 17 maternal deaths in the United hypertension (PIH)
States in 2000 per 100,000 women
in the country. 3. A 26-year old multigravida is C. The alpha-fetoprotein
14 weeks' pregnant and is test detects neural tube
Study These Flashcards scheduled for an alpha- defects and Down
105. 1. This statement is correct. The maternal fetoprotein test. She asks syndrome.
mortality rate is the number of the nurse, "What does the
deaths of women as a result of the alpha-fetoprotein test
childbearing period per 100,000 live indicate?" The nurse bases a
births. response on the knowledge
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 After the first four months A. When placental
4.
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 8. The chief function of C. Progesterone stimulates
progesterone is the: differentiation of the
5. The antagonist for A. Calcium gluconate is the A.Development of the endometrium into a
magnesium sulfate should antidote for magnesium female reproductive system secretory type of tissue.
be readily available to any toxicity. Ten ml of 10% B.Stimulation of the
client receiving IV calcium gluconate is given follicles for ovulation to
magnesium. Which of the IV push over 3-5 minutes. occur
following drugs is the Hydralazine is given for C.Preparation of the uterus
antidote for magnesium sustained elevated blood to receive a fertilized egg
toxicity? pressures in preeclamptic D.Establishment of
A.Calcium gluconate clients. secondary male sex
B.Hydralazine (Apresoline) characteristics
C.Narcan
D.RhoGAM 9. A client arrives at a prenatal 3. Accurate use of Nagele's
clinic for the first prenatal rule requires that the
6. . A nurse is assisting in 1, 4, 5, and 6. The probable assessment. The client tells woman have a regular 28-
performing an assessment signs of pregnancy include a nurse that the first day of day menstrual cycle. Add 7
on a client who suspects uterine enlargement, her last menstrual period days to the first day of the
that she is pregnant and is Hegar's sign (softening and was September 19th, 2005. last menstrual period,
checking the client for thinning of the uterine Using Nagele's rule, the subtract three months, and
probable signs of segment that occurs at nurse determines the then add one year to that
pregnancy. Select all week 6), Goodell's sign estimated date of date.
probable signs of (softening of the cervix that confinement as:
pregnancy. 1.Uterine occurs at the beginning of 1.July 26, 2006
enlargement the 2nd month), Chadwick's 2.June 12, 2007
2.Fetal heart rate detected sign (bluish coloration of 3.June 26, 2006
by nonelectric device the mucous membranes of 4.July 12, 2007
3.Outline of the fetus via the cervix, vagina, and vulva
radiography or ultrasound that occurs at week 6), 10. A client in the first 1. Strict bed rest
4.Chadwick's sign ballottement (rebounding trimester of pregnancy throughout the remainder
5.Braxton Hicks of the fetus against the arrives at a health care of pregnancy is not
contractions examiners fingers of clinic and reports that she required. The woman is
6.Ballottement palpation), Braxton Hicks has been experiencing advised to curtail sexual
contractions and a positive vaginal bleeding. A activities until the bleeding
pregnancy test measuring threatened abortion is has ceased, and for 2 weeks
for hCG. Positive signs of suspected, and the nurse following the last evidence
pregnancy include fetal instructs the client of bleeding or as
heart rate detected by regarding management of recommended by the
electronic device (Doppler) care. Which statement, if physician. The woman is
at 10-12 weeks and by made by the client, instructed to count the
nonelectronic device indicates a need for further number of perineal pads
(fetoscope) at 20 weeks education? used daily and to note the
gestation, active fetal 1."I will maintain strict quantity and color of blood
movements palpable by the bedrest throughout the on the pad. The woman
examiner, and an outline of remainder of pregnancy." also should watch for the
the fetus via radiography or 2."I will avoid sexual evidence of the passage of
ultrasound. intercourse until the tissue.
bleeding has stopped, and
7. At a prenatal visit at 36 B. Ambulation relieves for 2 weeks following the
weeks' gestation, a client Braxton Hicks. last evidence of bleeding."
complains of discomfort 3."I will count the number
with irregularly occurring of perineal pads used on a
contractions. The nurse daily basis and note the
instructs the client to: amount and color of blood
A.Lie down until they stop on the pad."
B.Walk around until they 4."I will watch for the
subside evidence of the passage of
C.Time contraction for 30 tissue."
minutes
D.Take 10 grains of aspirin 11. Clients with gestational A. Clients with gestational
for the discomfort diabetes are usually diabetes are usually
managed by which of the managed by diet alone to
following therapies? control their glucose
A.Diet intolerance. Oral C.Number of children a neonates delivered.
B.NPH insulin (long-acting) hypoglycemic agents are female has delivered
C.Oral hypoglycemic drugs contraindicated in D.Number of term
D.Oral hypoglycemic drugs pregnancy. NPH isn't pregnancies a female has
and insulin usually needed for blood had.
glucose control for GDM.
17. A homecare nurse visits a 3. If the client complains of
12. The developing cells are B. In the first 7-14 days the pregnant client who has a a headache and blurred
called a fetus from the: ovum is known as a diagnosis of mild vision, the physician
A.Time the fetal heart is blastocyst; it is called an Preeclampsia and who is should be notified because
heard embryo until the eighth being monitored for these are signs of
B.Eighth week to the time week; the developing cells pregnancy induced worsening Preeclampsia.
of birth are then called a fetus until hypertension (PIH). Which
C.Implantation of the birth. assessment finding
fertilized ovum indicates a worsening of the
D.End of the send week to Preeclampsia and the need
the onset of labor to notify the physician?
1.Blood pressure reading is
13. During a prenatal A. When an Rh negative at the prenatal baseline
examination, the nurse mother carries an Rh 2.Urinary output has
draws blood from a young positive fetus there is a risk increased
Rh negative client and for maternal antibodies 3.The client complains of a
explain that an indirect against Rh positive blood; headache and blurred vision
Coombs test will be antibodies cross the 4.Dependent edema has
performed to predict placenta and destroy the resolved
whether the fetus is at risk fetal RBC's.
for: 18. In a lecture on sexual B. It is the surge of LH
A.Acute hemolytic disease functioning, the nurse plans secretion in midcycle that
B.Respiratory distress to include the fact that is responsible for
syndrome ovulation occurs when the: ovulation.
C.Protein metabolic A.Oxytocin is too high
deficiency B.Blood level of LH is too
D.Physiologic high
hyperbilirubinemia C.Progesterone level is high
D.Endometrial wall is
14. During a prenatal visit at 38 .3. The fetal heart rate sloughed off.
weeks, a nurse assesses the depends in gestational age
fetal heart rate. The nurse and ranges from 160-170 19. In the 12th week of A.RhoGAM is given within
determines that the fetal BPM in the first trimester gestation, a client 72 hours postpartum if the
heart rate is normal if but slows with fetal growth completely expels the client has not been
which of the following is to 120-160 BPM near or at products of conception. sensitized already.
noted? term. At or near term, if the Because the client is Rh
1.80 BPM fetal heart rate is less than negative, the nurse must:
2.100 BPM 120 or more than 160 BPM A.Admister RhoGAM within
3.150 BPM with the uterus at rest, the 72 hours
4.180 BPM fetus may be in distress. B.Make certain she receives
RhoGAM on her first clinic
15. An expected D. This is an expected visit
cardiopulmonary cardiopulmonary C.Not give RhoGAM, since it
adaptation experienced by adaptation during is not used with the birth of
most pregnant women is: pregnancy; it is caused by a stillborn
A.Tachycardia an increased ventricular D.Make certain the client
B.Dyspnea at rest rate and elevated does not receive RhoGAM,
C.Progression of dependent diaphragm since the gestation only
edema lasted 12 weeks.
D.Shortness of breath on
exertion 20. A nurse implements a C. Exercise is safe for the
teaching plan for a pregnant client with gestational
16. Gravida refers to which of B. Gravida refers to the client who is newly diabetes and is helpful in
the following descriptions? number of times a female diagnosed with gestational lowering the blood glucose
A.A serious pregnancy has been pregnant, diabetes. Which statement level.
B.Number of times a regardless of pregnancy if made by the client
female has been pregnant outcome or the number of indicates a need for further
education? overdose renal function is monitored
A."I need to stay on the 5.Monitor deep tendon closely. The urine output
diabetic diet." reflexes hourly should be maintained at 30
B."I will perform glucose 6.Monitor I and O's hourly ml per hour because the
monitoring at home." 7.Notify the physician if medication is eliminated
C."I need to avoid exercise urinary output is less than through the kidneys.
because of the negative 30 ml per hour.
effects of insulin
production." 24. A nurse is collecting data 2. Pregnancy outcomes can
D."I need to be aware of during an admission be described with the
any infections and report assessment of a client acronym GTPAL. G is
signs of infection who is pregnant with gravidity, the number of
immediately to my health twins. The client has a pregnancies. T is term births,
care provider." healthy 5-year old child the number born at term
that was delivered at 37 (38-41 weeks). P is preterm
21. The nurse is aware than an D. A purplish color results weeks and tells the nurse births, the number born
adaptation of pregnancy is from the increased that she doesn't have any before 38 weeks gestation. A
an increased blood supply vascularity and blood history of abortion or fetal is abortions or miscarriages
to the pelvic region that vessel engorgement of the demise. The nurse would (included in gravida if before
results in a purplish vagina. document the GTPAL for 20 weeks gestation; included
discoloration of the vaginal this client as: in parity if past 20 weeks
mucosa, which is known as: 1.G = 3, T = 2, P = 0, A = 0, gestation). L is live births,
A.Ladin's sign L =1 the number of live births or
B.Hegar's sign 2.G = 2, T = 0, P = 1, A = 0, living children. Therefore, a
C.Goodell's sign L =1 woman who is pregnant
D.Chadwick's sign 3.G = 1, T = 1. P = 1, A = 0, with twins and has a child
L=1 has a gravida of 2. Because
22. A nurse is caring for a C. The immediate care 4.G = 2, T = 0, P = 0, A = 0, the child was delivered at 37
pregnant client with during a seizure L=1 weeks, the number of
Preeclampsia. The nurse (eclampsia) is to ensure a preterm births is 1, and the
prepares a plan of care for patent airway. The other number of term births is 0.
the client and documents in options are actions that The number of abortions is
the plan that if the client follow or will be 0, and the number of live
progresses from implemented after the births is 1.
Preeclampsia to eclampsia, seizure has ceased.
the nurse's first action is to: 25. A nurse is describing the 2. Blood pumped by the
A.Administer magnesium process of fetal circulation embryo's heart leaves the
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
B.Negative urinary protein movement
C.Facial edema
D.Increased respirations 30. A nurse midwife is 4. Ballottement is a
performing an technique of palpating a
27. A nurse is performing an 2. The normal range of the assessment of a pregnant floating structure by
assessment of a fetal heart rate depends on client and is assessing the bouncing it gently and feeling
primapira who is being gestational age. The heart client for the presence of it rebound. In the technique
evaluated in a clinic rate is usually 160-170 BPM ballottement. Which of used to palpate the fetus, the
during her second in the first trimester and the following would the examiner places a finger in
trimester of pregnancy. slows with fetal growth, near nurse implement to test the vagina and taps gently
Which of the following and at term, the fetal heart for the presence of upward, causing the fetus to
indicates an abnormal rate ranges from 120-160 ballottement? rise. The fetus then sinks, and
physical finding BPM. The other options are 1.Auscultating for fetal the examiner feels a gentle
necessitating further expected. heart sounds tap on the finger.
testing? 2.Palpating the abdomen
1.Consistent increase in for fetal movement
fundal height 3.Assessing the cervix for
2.Fetal heart rate of 180 thinning
BPM 4.Initiating a gentle
3.Braxton hicks upward tap on the cervix
contractions
4.Quickening 31. The nurse recognizes that C. The blood volume
an expected change in increases by approximately
28. A nurse is providing 4. The pregnant woman the hematologic system 40-50% during pregnancy.
instructions to a client in should be instructed to wash that occurs during the The peak blood volume
the first trimester of the breasts with warm water 2nd trimester of occurs between 30 and 34
pregnancy regarding and keep them dry. The pregnancy is: weeks of gestation. The
measures to assist in woman should be instructed A.A decrease in WBC's hematocrit decreases as a
reducing breast to avoid using soap on the B.In increase in result of the increased blood
tenderness. The nurse nipples and areola area to hematocrit volume.
tells the client to: prevent the drying of tissues. C.An increase in blood
1.Avoid wearing a bra Wearing a supportive bra volume
2.Wash the nipples and with wide adjustable straps D.A decrease in
areola area daily with can decrease breast sedimentation rate
soap, and massage the tenderness. Tight-fitting
breasts with lotion. blouses or dresses will cause 32. The nurse teaches a B. This is because impedance
3.Wear tight-fitting discomfort (especially on test pregnant woman to of venous return by the
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
painless contractions about the 6th week of 37. A pregnant client calls the 1. Legs cramps occur when
that occur throughout pregnancy and is called clinic and tells a nurse the pregnant woman
pregnancy." Hegar's sign. that she is experiencing stretches the leg and plantar
2."It is the soft blowing leg cramps and is flexes the foot. Dorsiflexion
sound that can be heard awakened by the cramps of the foot while extending
when the uterus is at night. To provide relief the knee stretches the
auscultated." from the leg cramps, the affected muscle, prevents
3."It is the fetal nurse tells the client to: the muscle from contracting,
movement that is felt by 1.Dorsiflex the foot while and stops the cramping.
the mother." extending the knee when
4."It is the thinning of the cramps occur
the lower uterine 2.Dorsiflex the foot while
segment." flexing the knee when the
cramps occur
34. A nursing instructor is A. FSH and LH, when 3.Plantar flex the foot
conducting lecture and is stimulated by gonadotropin- while flexing the knee
reviewing the functions releasing hormone from the when the cramps occur
of the female hypothalamus, are released 4.Plantar flex the foot
reproductive system. She from the anterior pituitary while extending the knee
asks Mark to describe gland to stimulate follicular when the cramps occur.
the follicle-stimulating growth and development,
hormone (FSH) and the growth of the graafian follicle, 38. A pregnant client in the 1. Severe Preeclampsia can
luteinizing hormone (LH). and production of last trimester has been trigger disseminated
Mark accurately progesterone. admitted to the hospital intravascular coagulation
responds by stating that: with a diagnosis of severe (DIC; remember the Peds
A.FSH and LH are preeclampsia. A nurse lecture?) because of the
released from the monitors for widespread damage to
anterior pituitary gland. complications associated vascular integrity. Bleeding is
B.FSH and LH are with the diagnosis and an early sign of DIC and
secreted by the corpus assesses the client for: should be reported to the
luteum of the ovary 1.Any bleeding, such as in M.D
C.FSH and LH are the gums, petechiae, and
secreted by the adrenal purpura.
glands 2.Enlargement of the
D.FSH and LH stimulate breasts
the formation of milk 3.Periods of fetal
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
sulfate for the sulfate therapy. Signs of thoroughly." thoroughly wash all kitchen
management of toxicity relate to the central 2."I need to avoid surfaces that come into
preeclampsia. A nurse nervous system depressant touching mucous contact with uncooked meat,
determines the client is effects of the medication and membranes of the mouth wash the hands thoroughly
experiencing toxicity from include respiratory or eyes while handling after handling raw meat;
the medication if which of depression, loss of deep raw meat." avoid uncooked eggs and
the following is noted on tendon reflexes, and a 3."I need to drink unpasteurized milk; wash
assessment? sudden drop in the fetal unpasteurized milk only." fruits and vegetables before
A.Presence of deep heart rate and maternal 4."I need to avoid contact consumption, and avoid
tendon reflexes heart rate and blood with materials that are contact with materials that
B.Serum magnesium level pressure. Therapeutic levels possibly contaminated possibly are contaminated
of 6 mEq/L of magnesium are 4-7 mEq/L. with cat feces." with cat feces, such as cat
C.Proteinuria of +3 Proteinuria of +3 would be litter boxes, sand boxes, and
D.Respirations of 10 per noted in a client with garden soil.
minute preeclampsia.
44. A primagravida is C. Magnesium sulfate
41. A pregnant woman at 32 D. During a fundal height receiving magnesium depresses the respiratory
weeks' gestation measurement the woman is sulfate for the treatment rate. If the respiratory rate is
complains of feeling dizzy placed in a supine position. of pregnancy induced less than 12 breaths per
and lightheaded while her This woman is experiencing hypertension (PIH). The minute, the physician or
fundal height is being supine hypotension as a nurse who is caring for other health care provider
measured. Her skin is result of uterine compression the client is performing needs to be notified, and
pale and moist. The of the vena cava and assessments every 30 continuation of the
nurse's initial response abdominal aorta. Turning her minutes. Which medication needs to be
would be to: A.Assess the on her side will remove the assessment finding would reassessed. A urinary output
woman's blood pressure compression and restore be of most concern to the of 20 ml in a 30 minute
and pulse cardiac output and blood nurse? period is adequate; less than
B.Have the woman pressure. Then vital signs can A.Urinary output of 20 ml 30 ml in one hour needs to
breathe into a paper bag be assessed. Raising her legs since the previous be reported. Deep tendon
C.Raise the woman's legs will not solve the problem assessment reflexes of 2+ are normal.
D.Turn the woman on her since pressure will still B.Deep tendon reflexes of The fetal heart rate is WNL
side. remain on the major 2+ for a resting fetus.
abdominal blood vessels, C.Respiratory rate of 10
thereby continuing to BPM
impede cardiac output. D.Fetal heart rate of 120
Breathing into a paper bag is BPM
the solution for dizziness
related to respiratory 45. When involved in B. The increase of estrogen
alkalosis associated with prenatal teaching, the during pregnancy causes
hyperventilation. nurse should advise the hyperplasia of the vaginal
clients that an increase in mucosa, which leads to
42. A pregnant woman's last A. Nägele's rule requires vaginal secretions during increased production of
menstrual period began subtracting 3 months and pregnancy is called mucus by the endocervical
on April 8, 2005, and adding 7 days and 1 year if leukorrhea and is caused glands. The mucus contains
ended on April 13. Using appropriate to the first day by increased: A.Metabolic exfoliated epithelial cells.
Nägele's rule her of a pregnant woman's last rates
estimated date of birth menstrual period. When this B.Production of estrogen
would be: rule, is used with April 8, C.Functioning of the
A.January 15, 2006 2005, the estimated date of Bartholin glands
B.January 20, 2006 birth is January 15, 2006. D.Supply of sodium
C.July 1, 2006 chloride to the cells of the
D.November 5, 2005 vagina
43. A prenatal nurse is 3. All pregnant women 46. Which of the following D. Only nutrients and waste
providing instructions to a should be advised to do the answers best describes products are transferred
group of pregnant client following to prevent the the stage of pregnancy in across the placenta. Blood
regarding measures to development of which maternal and fetal exchange only occurs in
prevent toxoplasmosis. toxoplasmosis. Women blood are exchanged? complications and some
Which statement if made should be instructed to cook A.Conception medical procedures
by one of the clients meats thoroughly, avoid B.9 weeks' gestation, accidentally.
indicates a need for touching mucous when the fetal heart is
further instructions? 1."I membranes and eyes while well developed
need to cook meat handling raw meat; C.32-34 weeks gestation
D.maternal and fetal
blood are never
exchanged
47. Which of the following C. Hemoglobin and

conditions is common in hematocrit levels decrease
pregnant women in the during pregnancy as the
2nd trimester of increase in plasma volume
pregnancy? A.Mastitis exceeds the increase in red
B.Metabolic alkalosis blood cell production.
C.Physiologic anemia
D.Respiratory acidosis
48. Which of the following D. The chorionic villi of a

symptoms occurs with a molar pregnancy resemble a
hydatidiform mole? snowstorm pattern on
A.Heavy, bright red ultrasound. Bleeding with a
bleeding every 21 days hydatidiform mole is often
B.Fetal cardiac motion dark brown and may occur
after 6 weeks gestation erratically for weeks or
C.Benign tumors found in months.
the smooth muscle of the
uterus
D."snowstorm" pattern
on ultrasound with no
fetus or gestational sac
49. Which of the following D. The dilated arterioles that

terms applies to the tiny, occur during pregnancy are
blanced, slightly raised due to the elevated level of
end arterioles found on circulating estrogen. The
the face, neck, arms, and linea nigra is a pigmented line
chest during pregnancy? extending from the
A.Epulis symphysis pubis to the top of
B.Linea nigra the fundus during pregnancy.
C.Striae gravidarum
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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An antenatal client is informing the nurse of her increase in preparation for delivery.

TEST-TAKING TIP: Because quantitative

32. 1. A dietary evaluation is indicated since

TEST-TAKING TIP: Vaginal and rectal cultures

Study These Flashcards 63

TEST-TAKING TIP: The amniotic fluid is

47. Which of the following C. Hemoglobin and

48. Which of the following D. The chorionic villi of a

49. Which of the following D. The dilated arterioles that

50. A woman with C. For a client with

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