CH 04
CH 04
CH 04
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A patient arrives for her fourth month prenatal visit and expresses concern because of a leakage of
yellow fluid from her breasts. Which topic does the nurse discuss during this visit?
1. Signs of infection
2. Breast changes
3. A change in EDD
4. Support bras
____ 2. A pregnant patient is at the prenatal clinic for a routine visit at 30 weeks gestation. The nurse
monitors the patient for indications of physiological demands by the fetus on the patient. Which
finding causes the nurse concern?
1. Hgb of 9.5 g/dL and Hct. of 30%
2. PT of 16.5 seconds
3. WBCs of 16,000 mm3
4. Heart rate up 20 bpm
____ 3. A patient in the first trimester of pregnancy states, “I don’t understand how a term baby can be
accommodated by my uterus.” Which information by the nurse specifically addresses the patient’s
comment?
1. The uterus size increases in size 20 times over a nonpregnant uterus.
2. The weight of the uterus increases from 7 g to 1,100 g during pregnancy.
3. About 80% of the increased capacity of the uterus is related to uteroplacental
content.
4. About 75% of the increase in uterus size during pregnancy is related to stretching.
____ 4. The nurse is providing care for a patient at 30 weeks gestation. Which topic related to patient
concern or discomfort is most important for the nurse to address?
1. Increased breast enlargement
2. Dizziness when lying supine
3. Dependent edema and varicosities
4. Hyperpigmentation on the face
____ 5. The nurse is counseling a patient who shares the intention to become pregnant. Which finding
during the collection of health information will the nurse feel the least concern to address?
1. The patient smokes a pack of cigarettes a week.
2. The patient lives in a recently renovated house.
3. The patient travels outside the country for work.
4. The patient has a family history of diabetes mellitus.
____ 6. A patient expresses a desire to become pregnant for a second child. The nurse notes that the
patient’s first child was born with a serious neural tube defect (NTD) and died of complications at
18 months of age. Which recommendation does the nurse make to this client?
1. Folic acid 0.6 mg/day orally 1 month before conception and throughout pregnancy.
2. Folic acid 0.4 mg/day orally started when pregnant and continued throughout
pregnancy
3. Folic acid 4 mg/day orally started when pregnant and continued throughout
pregnancy
4. Folic acid 4 mg/day orally for 1 month prior to conception through first trimester
of pregnancy
____ 7. The nurse is collecting health information from a patient who is early in the first trimester of
pregnancy. Which topic is most important for the nurse to discuss with the patient after learning
that the patient works for a commercial cleaning company?
1. Risk related to exposure to environmental toxins
2. Weight limit for lifting during the patient’s pregnancy
3. Importance of resting with feet up during the day
4. Reasons for the patient to look for a safer job
____ 8. A patient arrives at a maternal health client and tells the nurse she has missed a period and thinks
she is pregnant. Which information shared with the nurse is a presumptive sign of pregnancy?
1. Positive results on a home pregnancy test
2. Breast enlargement, tenderness, and tingling
3. First awareness of fetal movements
4. Increased appetite
____ 9. A patient who is pregnant asks the nurse when her baby is due to be born. The patient reports her
last menstrual period (LMP) date as April 14. Using Naegele’s rule, the nurse will set the
estimated date of delivery (EDD) as what date?
1. July 21
2. January 7
3. July 14
4. January 21
____ 10. A patient who is pregnant does not remember the last date of her menstrual period. In which
manner does the nurse expect the estimated date of delivery (EDD) to be determined for this
patient?
1. Having an ultrasound examination
2. Using the gestational wheel
3. Asking when previous babies were born
4. Obtaining a history of gestational length
____ 11. A patient is confirmed to be pregnant. Obstetric history includes two sets of twins born at 30 and
32 weeks gestation, respectively, a singleton birth born at 39 weeks gestation, and two pregnancies
lost in the first trimester. In which way will the nurse define the patient’s obstetrical history?
1. G4, T3, P2, A2, L3
2. G6, T1, P4, A2, L5
3. G5, T1, P2, A2, L5
4. G6, T4, P0, A4, L3
____ 12. A patient who is pregnant shares details of being in a physically and psychologically abusive
relationship with her baby’s father. Which statement by the nurse is indicative of AWHONN’s
standing regarding intimate partner violence (IPV)?
1. “If you are all alone, you need to make arrangements for someone to stay with
you.”
2. “Your partner needs to come to the office so that we can confront his behavior.”
3. “I will call a women’s shelter to make arrangement for you to move in
immediately.”
4. “Let’s explore ways to protect you and stop the abuse you have been enduring.”
____ 13. The nurse is providing care for a patient in the third trimester of pregnancy. Which topic of patient
education is most likely to be needed during this time?
1. Update on fetus growth and behavioral patterns
2. Management for commonly experienced discomforts
3. General health maintenance and promotion topics
4. Counseling and guidance about diet and exercise
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 14. A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her
muscles, joints, and bones. Which conditions does the nurse reassure the patient are normal
changes of pregnancy? Select all that apply.
1. Waddling gait
2. Low back pain
3. Increased risk of falls
4. Fractures
5. Severe muscle aches
____ 15. The nurse is providing dietary teaching to a patient in the first trimester of pregnancy who is
overweight. Which daily dietary suggestions does the nurse make? Select all that apply.
1.
One cup of 100% juice and cup of dried fruit.
2. Three cups of raw leafy and 1 cup cooked vegetables
3. One and a half cups of cooked pasta, rice, or cereal
4.
Six ounces of lean meat, 2 eggs, and cup of beans
5.
One cup of milk, 1 cup of yogurt, and oz of cheese
____ 16. The nurse explains to a patient who has missed a second menstrual cycle that a combination of
presumptive and probable signs is used to make a practical diagnosis of pregnancy. Which signs
are expected by the nurse when making a practical diagnosis? Select all that apply.
1. Elevated hCG levels in blood and urine
2. Brownish pigmentation on the face
3. Fetal movement detected by the examiner
4. Bluish-purple coloration of vagina and cervix
5. Occasional mild contractions
____ 17. The nurse is preparing a prenatal plan of care for a patient who is in the first trimester of
pregnancy. Which long-range goals does the nurse include in the plan of care? Select all that
apply.
1. Perform an ongoing assessment of risk status
2. Determine parental outlook on immunizations
3. Build rapport with the childbearing family
4. Make referral to specific resources as needed
5. Implement a risk-appropriate intervention
____ 18. The nurse is planning an assessment on a patient in the second trimester of pregnancy. For which
assessments will the nurse plan? Select all that apply.
1. Urine testing with a dipstick.
2. Presence of dependent edema.
3. Determine EDD by Naegele’s rule.
4. Antibody screening for Rh?2- patient.
5. Check for chromosomal abnormalities.
____ 19. A patient in the third trimester of pregnancy reports having heartburn nearly every day. Which
recommendations does the nurse make to alleviate the problem? Select all that apply.
1. Consume three moderate-sized meals daily.
2. Sip clear, carbonated beverages when eating.
3. Assume a low Fowler position after meals.
4. Avoid eating 3 hours prior to bedtime.
5. Avoid consuming spicy, fatty, or fried food.
Chapter 4: Physiological Aspects of Antepartum Care
Answer Section
MULTIPLE CHOICE
1. ANS: 2
Chapter: Chapter 4 Physiological Aspects of Antepartum Care
Chapter Learning Objective: 3. Identify the anatomical and physiological changes over the course
of pregnancy.
Page: 58
Heading: Table 4-1: Physiological Changes in Pregnancy
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Analyzing [Analysis]
Concept: Ante/Intra/Post-partum
Difficulty: Moderate
Feedback
1 This is incorrect. There is no need to cover signs of infection because of the
patient’s concern.
2 This is correct. The leakage of yellow fluid from the patient’s breasts is a
normal change during pregnancy. The patient is experiencing a leakage of
colostrum, which is rich in antibodies for the neonate. This manifestation can
begin as early as 16 weeks.
3 This is incorrect. The presentation of colostrum does not affect the EDD.
4 This is incorrect. The topic of support bras should take place early in the first
trimester due to expected breast enlargement. Covering this topic does not
address the patient’s concern.
Feedback
1 This is correct. The patient’s hemoglobin and hematocrit are below normal for
the patient. This finding causes the nurse concern because the increased demand
of iron for fetal development results in maternal iron deficiency anemia.
2 This is incorrect. The patient’s PT is indicative of hypercoagulability, which is
an expected physiological response to pregnancy in anticipation of blood loss
during delivery. Normal PT is in the range of 11 to 13.5 seconds. This finding
does not cause the nurse concern.
3 This is incorrect. WBC count of 16,000 mm3 is not abnormal in a patient who is
at 30 weeks gestation, especially if there are no other indications of infection.
The scenario does not indicate manifestations of infection.
4 This is incorrect. A 15 to 20 bpm increase in heart rate is expected due to a 40%
increase in cardiac output. This finding does not cause the nurse concern.
Feedback
1 This is correct. The information that specifically addresses the patient’s
comment about how her uterus will accommodate a term baby is clarified with
the fact that the uterus increases in size 20 times over the non-pregnant size.
2 This is incorrect. The weight of the uterus does increase from 7 g to 1,100 g;
however, this fact does not specifically address the patient’s comment.
3 This is incorrect. Eighty percent of the increased uterine capacity is related to
uteroplacental content; however, this information does not specifically address
the patient’s comment. A better factor is the increase in uterine capacity from 10
mL to 5,000 mL.
4 This is incorrect. Both stretching and growth are involved in the increase in the
size of the uterus to accommodate the developing fetus. However, an increase
from 7 g to 1,000 g supports a greater amount of growth instead of stretching.
Feedback
1 This is incorrect. If the patient is experiencing increased breast enlargement, the
nurse should reiterate the importance of a well-fitting bra. This not the most
important issue for the nurse to address.
2 This is correct. The most important issue for the nurse to address is the patient’s
experience of dizziness when lying supine. The nurse will provide education
about supine and orthostatic hypotension and advise the patient to refrain from
supine positioning. The patient needs to be instructed to use side-lying positions.
3 This is incorrect. The nurse will need to instruct the patient about the
management of dependent edema and varicosities, which is to sit or lie with the
feet and legs elevated several times daily. This is not the most important issue
for the nurse to address.
4 This is incorrect. Because it is so noticeable, many patients will express concern
over hyperpigmentation on the face. The nurse needs to review the cause and
remind the patient that the coloration is likely to be temporary. This is not the
most important issue for the nurse to address.
Feedback
1 This is incorrect. The nurse needs to express the need for the patient to stop
smoking; there is no amount of smoking that is harmless during pregnancy.
2 This is correct. The fact that the patient lives in a recently renovated house is the
least concern to the nurse. If renovation was in process or the house was old and
not renovated, the nurse would be concerned about exposure to environmental
hazards.
3 This is incorrect. The nurse needs to further assess where the patient travels for
work. Greatest concerns are about sanitation, environmental issues, exposure to
potential diseases, and availability of health care if needed.
4 This is incorrect. The nurse needs to further assess the patient’s family history of
diabetes mellitus. The nurse needs to determine the type of diabetes and any
predisposing factors such as obesity. The nurse will provide information for
prevention and address a need for additional monitoring.
Feedback
1 This is incorrect. Folic acid at a dose of 0.6 mg/day is recommended for women
who have not delivered a neonate with a neural tube defect (NTD).
2 This is incorrect. After a patient delivers a neonate with an NTD, a dosage of 0.4
mg/day is prescribed for the second and third trimesters.
3 This is incorrect. For a patient who has delivered a neonate with NTD, folic acid
is prescribed at 4 mg/day only for 1 month prior to conception and through the
first trimester. It is not necessary to continue this dosage through the entire
pregnancy.
4 This is correct. The correct dose of folic acid for the patient who previously
delivered a neonate with NTD is 4 mg/day for 1 month prior to conception,
which is continued through the first trimester. The dose is then reduced to 0.4
mg/day for the remainder of the pregnancy.
Feedback
1 This is correct. Exposure to environmental toxins increases the risk for
miscarriage, preterm birth, and other complications. The patient’s job may
involve exposure to solvents and/or cleaning chemicals.
2 This is incorrect. The nurse needs to ascertain if the patient’s job involves lifting
and make appropriate recommendations; however, this is not currently the most
important topic.
3 This is incorrect. Pregnancy sometimes causes edema in the feet and legs, which
can be reduced by elevating the feet and legs periodically during the day.
However, this is not currently the most important topic.
4 This is incorrect. The nurse needs to explain any identifiable risk the patient’s
job may create during pregnancy. The nurse will be open to discussion and
suggestions for the patient’s concerns. It is not appropriate for the nurse to
suggest the patient find a safer job, which may not be possible since financial
constraints will also cause risks.
Feedback
1 This is incorrect. A positive result on a home pregnancy test is a probable sign
of pregnancy, not a presumptive sign, which is primarily subjective information
provided by the patient.
2 This is correct. If the patient experiences breast enlargement, tenderness, and
tingling after missing a period, the patient has a presumptive sign of pregnancy.
This is considered a subjective finding that occurs 2 to 3 weeks after conception.
3 This is incorrect. After missing one period, it is not likely the patient will
experience the first awareness of fetal movement, which is a presumptive sign
but does not occur until 18 to 20 weeks after conception.
4 This is incorrect. An increase in appetite is not a presumptive sign of pregnancy.
A more likely sign is nausea and vomiting, which can occur from 2 through 12
weeks.
Feedback
1 This is incorrect. Naegele’s rule requires counting back 3 months from the LMP
and adding 7 days. This answer indicates that 3 months forward were
considered.
2 This is incorrect. Naegele’s rule requires counting back 3 months from the LMP
and adding 7 days. In this calculation, 7 days were not added to the LMP.
3 This is incorrect. Naegele’s rule requires counting back 3 months from the LMP
and adding 7 days. Both the month and the date were miscalculated in this
option.
4 This is correct. Naegele’s rule requires counting back 3 months from the LMP
and adding 7 days. This is the correct calculation and EDD.
Feedback
1 This is correct. A fetal ultrasound will provide information about the fetal
development, allowing for an accurate estimated date of delivery (EDD). The
nurse expects this manner of determination.
2 This is incorrect. The gestational wheel can only be used if the date of the LMP
is known.
3 This is incorrect. The birthdays of the child’s siblings are irrelevant.
4 This is incorrect. Whether a mother carries to term is secondary to determining
the normal EDD.
Feedback
1 This is incorrect. The only correct information in this option is the one
indicating two spontaneous abortions.
2 This is correct. The nurse will correctly determine that the patient has been
pregnant six times; delivered one term neonate; had two set of twins born
prematurely for a total of four births; had two spontaneous abortions before 20
weeks gestation; and currently has five living children.
3 This is incorrect. In this option, the number of pregnancies and number of
premature neonates are wrong.
4 This is incorrect. In this option, all determinations are incorrect except for the
number of pregnancies, which is correct at six.
Feedback
1 This is incorrect. AWHONN’s view about being alone does not focus on
arranging for someone to stay with the patient; the focus is on relaying that the
patient is not alone in her situation. Many women experience abuse and receive
protection from agencies and individuals.
2 This is incorrect. Stating that the patient’s partner needs to come to the office in
order to have his behavior confronted is a potential breach in confidentiality.
This action is not supported by AWHONN.
3 This is incorrect. The patient needs to be aware of agencies that are available to
protect her safety. However, beyond providing the contact information, the
nurse is not the decision maker for moving to a shelter.
4 This is correct. AWHONN promotes safety, support, education, and
confidentiality as part of the interventions to protect the woman who is
experiencing partner abuse; this statement covers the patient’s needs.
Feedback
1 This is incorrect. Update of fetal growth and development is appropriate during
all trimesters of pregnancy and not specific to the third trimester.
2 This is correct. The patient education most likely needed in the third trimester is
related to the management of commonly experienced discomforts.
3 This is incorrect. General health promotion and health maintenance education is
appropriate during all trimesters of pregnancy and not specific to the third
trimester.
4 This is incorrect. Counseling about diet and exercise is appropriate during all
trimesters of pregnancy and not specific to the third trimester.
MULTIPLE RESPONSE
14. ANS: 1, 2, 3
Chapter: Chapter 4 Physiological Aspects of Antepartum Care
Chapter Learning Objective: 4. Link the anatomical and physiological changes of pregnancy to
signs, symptoms, and common discomforts of pregnancy.
Page: 58
Heading: Table 4-1: Physiological Changes in Pregnancy
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Analysis [Analyzing]
Concept: Ante/Intra/Post-partum
Difficulty: Moderate
Feedback
1 This is correct. A waddling gait is a normal change during pregnancy and related
to increased progesterone and relaxin levels causing softening of joints and
increased joint mobility. Widening and increased mobility of the sacroiliac and
symphysis pubis result.
2 This is correct. Low back pain is expected during pregnancy and related to
increased progesterone and relaxin levels leading to softening of joints and
increased joint mobility, resulting in widening and increased mobility of the
sacroiliac and symphysis pubis.
3 This is correct. Although it is hazardous, increased risk of falls is expected during
pregnancy due to a shift in the center of gravity related to the enlarged uterus. The
patient needs to take precautions to avoid falls or activities requiring balance.
4 This is incorrect. Fractures are not expected or normal during pregnancy.
5 This is incorrect. Muscle aches are not normal during pregnancy and may signal an
electrolyte imbalance.
Feedback
1 This is correct. In the first trimester of pregnancy, the patient requires 2 cups of
fruit; 1 cup of 100% juice and cup of dried fruit daily is a correct suggestion by
the nurse.
2
This is incorrect. In the first trimester of pregnancy, the patient requires cups
of vegetables daily; 3 cups of raw leafy vegetables and 1 cup of cooked vegetables
is too much.
3 This is incorrect. One and a half cups of cooked rice, pasta, or cereal daily is too
much; the patient in the first trimester of pregnancy needs 6 ounces of grains per
day.
4
This is incorrect. A patient in the first trimester of pregnancy needs ounces of
protein daily; the suggested amounts are too much. One ounce of protein consists
of 1 ounce of lean meat, poultry, or seafood; cup of cooked beans, ounce of
nuts or 2 tablespoons of peanut butter; or 1 egg. The suggested foods provide 10
ounces of protein.
5
This is correct. One cup of milk, 1 cup of yogurt, and ounces of cheese is
equal to the recommended daily dairy intake. This suggestion by the nurse is
correct.
Feedback
1 This is correct. Elevated hCG levels in the patient’s blood and urine are probable
signs of pregnancy and will be considered when making a practical diagnosis of
pregnancy.
2 This is correct. Brownish pigmentation on the patient’s forehead, temples, cheeks,
and/or upper lip is melisma (chloasma), which is a probable sign of pregnancy and
will be considered when making a practical diagnosis of pregnancy.
3 This is incorrect. Fetal movement that can be observed and detected by the
examiner is considered a positive sign of pregnancy, which does not occur until
after or about 20 weeks gestation. The finding would be unexpected at this time.
4 This is correct. Bluish-purple coloration (Chadwick’s sign) of the vaginal mucosa,
cervix, and vulva occurs at 6 to 8 weeks gestation and is considered a probable
sign of pregnancy and will be considered when making a practical diagnosis of
pregnancy.
5 This is incorrect. Contractions are not expected, even Braxton-Hicks contractions,
until long after the pregnancy is identified.
Feedback
1 This is correct. An appropriate long-term goal in a prenatal care plan is to perform
an ongoing assessment of risk status of the patient, fetus, and expectant family.
2 This is incorrect. The parenteral outlook regarding immunizations is not an
appropriate long-term goal on a prenatal care plan. Attitudes about immunizations
can be discussed by health care providers involved with pediatric care.
3 This is correct. An appropriate long-term goal in a prenatal care plan is for the
nurse to build a rapport with the child-bearing family. Communication is an
important part of prenatal care.
4 This is correct. An appropriate long-term goal in a prenatal care plan is to ascertain
and make referrals to specific resources for the fetus, neonate, and family.
5 This is correct. An appropriate long-term goal in a prenatal care plan is for the
nurse to implement any risk-appropriate intervention. During the prenatal period,
risks can occur and interventions must be implemented in a timely manner.
Feedback
1 This is correct. During the second trimester, it is common for the nurse to perform
urine testing with a dipstick to check for glucose, albumin, and ketones. Mild
proteinuria and glycosuria are expected.
2 This is correct. During the second trimester, the nurse should be checking the
patient for slight, dependent edema in the lower extremities due to decreased
venous return. Upper body edema is abnormal and requires additional evaluation.
3 This is incorrect. The EDD is estimated using Naegele’s rule during the first
trimester; EDD is determined in the second trimester if the patient is not aware of
her last menstrual cycle.
4 This is correct. In the second trimester, the nurse will perform screening needed to
determine if the Rh– patient has produced antibodies. If so, the patient will receive
the first dose of Rhogam. The patient’s Rh factor is determined in the first
trimester.
5 This is incorrect. Chromosomal abnormalities are not routinely screened; however,
during the early stage of the second trimester, all patients should be offered the
screening and diagnostic testing regardless of age or other risk factors.
Feedback
1 This is incorrect. Heartburn during the third trimester of pregnancy is managed by
eating small, frequent meals. Eating three moderate-sized meals daily is a normal
eating pattern and will not be effective in managing the discomfort of heartburn.
2 This is incorrect. When a patient experiences heartburn in the third trimester of
pregnancy, fluid intake should be avoided during meals.
3 This is incorrect. If a patient experiences heartburn in the third trimester of
pregnancy, the patient needs to remain upright for 30 to 45 minutes after eating; a
low Fowler position will only increase the incidence of discomfort.
4 This is correct. When a patient experiences heartburn in the third trimester of
pregnancy, the patient should avoid eating at least 3 hours prior to bedtime.
5 This is correct. Spicy, fatty, and/or fried foods can contribute to heartburn,
especially in the patient who is in the third trimester of pregnancy. These foods
need to be eliminated from the diet.