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

her prenatal signs and symptoms. of a prenatal multigravida, the nurse

Which of the following findings would the should ask which of the following questions?
nurse determine are presumptive signs 1. “What are the ages of your children?”
of pregnancy? Select all that apply. 2. “What is your marital status?”
1. Amenorrhea. 3. “Do you ever drink alcohol?”
2. Breast tenderness. 4. “Do you have any allergies?”
3. Quickening.
4. Frequent urination. 3. This question is important to ask in
5. Uterine growth. order to determine a prenatal client’s
health teaching needs.
1, 2, 3, and 4 are correct.
1. Amenorrhea is a presumptive sign of
pregnancy. TEST-TAKING TIP: When answering
2. Breast tenderness is a presumptive questions,
sign of pregnancy. it is essential that the test taker attend
3. Quickening is a presumptive sign of to the specific question that is being asked.
pregnancy. All of the possible responses are
4. Frequent urination is a presumptive questions that should be asked of a pregnant
sign of pregnancy. multigravida, but only one is related
to the client’s needs for health teaching.

TEST-TAKING TIP: There are three 4

classifications A woman whose prenatal weight was 105 lb
of signs of pregnancy: presumptive, weighs 109 lb at her 12-week visit.
probable, and positive. Signs that Which of the following comments by the
are totally subjective, or presumptive, nurse is appropriate at this time?
include 1. “We expect you to gain 1 lb per week, so
amenorrhea, breast tenderness, your weight is a little low at this time.”
quickening, and frequent urination. Signs 2. “Most women gain no weight during the
that are objective, but not totally absolute, first trimester, so I would suggest you
are termed probable and include eat fewer desserts for the next few weeks.”
alterations in uterine shape and size and 3. “You entered the pregnancy well
softening of the cervix. Signs that are underweight, so we should check your diet to
absolute, or positive, include hearing make sure you are getting the nutrients you
the fetal heartbeat, detecting fetal need.”
movement, 4. “Your weight gain is exactly what we
and ultrasound images of the fetal would expect it to be at this time.”
outline. The weight gain is within normal for
the first trimester.
TEST-TAKING TIP: One of the assessments
that aids health care practitioners in
assessing the health and well-being of
2 antenatal clients and their babies is
The nurse is assessing the laboratory report weight gain. For women who enter the
of a 40-week gestation client. Which of pregnancy with a normal weight for
the following values would the nurse expect height, the expected weight gain is: 3 to
to find elevated above prepregnancy 5 lb for the entire first trimester and
levels? approximately 1 lb per week from weeks
1. Glucose. 13 to 40.
2. Fibrinogen.
3. Hematocrit. 5
4. Bilirubin. Because nausea and vomiting are such
common complaints of pregnant women, the
2. Fibrinogen levels will be elevated nurse provides anticipatory guidance to a 6-
slightly in a 40-week pregnant woman week gestation client by telling her to
because coagulation factors like fibrinogen do which of the following?
increase to help prevent excessive 1. Avoid eating greasy foods.
blood loss during delivery 2. Drink orange juice before rising.
3. Drink 2 glasses of water with each meal.
4. Eat 3 large meals plus a bedtime snack.
TEST-TAKING TIP: During the latter part
of the third trimester, coagulation factors Greasy foods should be avoided
increase in preparation for delivery. It is
the body’s means of protecting itself
against a large loss of blood at delivery. TEST-TAKING TIP: Although many women
experience nausea and vomiting or
3 morning sickness upon rising, many
women complain of nausea and/or vomiting pregnancy.
at other times of the day. One theory A breast exam will be performed
that has been offered to explain this by the practitioner to assess for
problem is that the body is ridding itself abnormalities,
of teratogens that could potentially harm but since mammograms are potentially
the fetus. harm-producing x-rays, they are
only ordered in emergent cases.
6
A client enters the prenatal clinic. She states 8
that she missed her period yesterday A 10-week gravid client is being seen in the
and used a home pregnancy test this prenatal clinic. For the nurse caring for
morning. She states that the results were this patient, providing anticipatory guidance
negative, for which of the following should be a
but “I still think I am pregnant.” Which of the priority?
following statements would be 1. Pain management during labor.
appropriate for the nurse to make at this 2. Methods to relieve backaches.
time? 3. Breastfeeding positions.
1. “Your period is probably just irregular.” 4. Characteristics of the newborn.
2. “We could do a blood test to check.”
3. “Home pregnancy test results are very 2. It is appropriate for the nurse to provide
accurate.” anticipatory guidance regarding
4. “My recommendation would be to repeat methods to relieve back pain.
the test in one week.”
2. This response is correct. Serum pregnancy TEST-TAKING TIP: This 10-week gravid
tests are more sensitive than client will be entering the second
urine tests are. trimester in a couple of weeks. As the
TEST-TAKING TIP: Because quantitative uterine body grows, the client is likely to
pregnancy tests measure the exact quantity experience backaches. It is appropriate for
of human chorionic gonadotropin in the nurse to provide information about
the bloodstream, they are more accurate this possibility and ways to relieve them.
than urine tests that simply measure 9
whether or not the hormone is present A client asks the nurse what was meant
in the urine. Similar to the urine tests on when the physician told her she had a
the market, qualitative serum tests detect positive
whether or not the hormone is present, Chadwick’s sign. Which of the following
but they are still considered to be more information about the finding would
accurate than urine tests are. be appropriate for the nurse to convey at
this time?
1. “It is a purplish stretch mark on your
7 abdomen.”
A gravida, G1 P0000, is having her first 2. “It means that you are having heart
prenatal physical examination. Which palpitations.”
of the following assessments should the 3. “It is a bluish coloration of your cervix and
nurse inform the client that she will have vagina.”
that day? 4. “It means the doctor heard abnormal
1. Pap smear. sounds 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
1. The client will have a Pap smear pregnancy.
done.

TEST-TAKING TIP: Chadwick’s sign is a

TEST-TAKING TIP: At the first prenatal probable sign of pregnancy. The bluish
visit, pregnant clients will undergo complete coloration is due to the increase in
obstetrical and medical physical vascularization
assessments. of the area in response to
The assessments are performed the high levels of circulating estrogen in
to provide the health care the pregnant woman’s system.
practitioner with baseline data regarding
the health and well-being of the woman 10
as well as to inform the health care A client enters the prenatal clinic. She states
practitioner that she believes she is pregnant.
of any medical problems that the Which of the following hormone elevations
mother has that might impact the will indicate a high probability that the
client is pregnant?
1. Chorionic gonadotropin. TEST-TAKING TIP: Some pregnant women
2. Oxytocin. are happy about their pregnancy, some
3. Prolactin. are sad, and still others are frightened.
4. Luteinizing hormone. At the initial interview, it is essential that
the nurse not assume that the woman
1. High levels of the hormone chorionic will respond in any particular way. The
gonadotropin in the bloodstream and nurse must ask open-ended questions in
urine of the woman is a probable sign order to elicit the woman’s feelings about
of pregnancy. the pregnancy.
13
TEST-TAKING TIP: Human chorionic A client is in the 10th week of her pregnancy.
gonadotropin is produced by the Which of the following symptoms
fertilized egg. Its presence in the would the nurse expect the client to exhibit?
bloodstream signals the body to keep 1. Backache.
the corpus luteum alive. Until the 2. Dyspnea.
placenta takes over the function of producing 3. Fatigue.
progesterone and estrogen, the 4. Diarrhea.
corpus luteum produces the hormones 3. Most women complain of fatigue
that are essential to the maintenance of during the first trimester.
the pregnancy.
11
A 16-year-old, G1 P0000, is being seen at her TEST-TAKING TIP: During the first
10-week gestation visit. She tells the trimester, the body undergoes a number
nurse that she felt the baby move that of important changes. The embryo is
morning. Which of the following responses developing,
by the nurse is appropriate? the hormones of the body are
1. “That is very exciting. The baby must be increasing, and the maternal blood supply
very healthy.” is increasing. To accomplish each of
2. “Would you please describe what you felt the tasks, the body uses energy. The
for me?” mother is fatigued not only because the
3. “That is impossible. The baby is not big body is undergoing great change but also
enough yet.” because the thyroid gland has not caught
4. “Would you please let me see if I can feel up with the increasing energy demands.
the baby?”
14
2. The nurse should query the young The midwife has just palpated the fundal
woman about what she felt height at the location noted on the picture
below. It is likely that the client is how many
weeks pregnant?
TEST-TAKING TIP: Quickening, or subjective 1. 12.
fetal movement, occurs between 2. 20.
16 and 20 weeks’ gestation. At 10 weeks’ 3. 28.
gestation it would be impossible for the 4. 36.
young woman to feel fetal movement.
The nurse, therefore, should elicit more
information from the teen to determine
what she had felt.
12
1. The client is likely 12 weeks pregnant.
A 20-year-old client states that the at-home
At 12 weeks, the fundal height is at
pregnancy test that she took this morning
the top of the symphysis.
was positive. Which of the following
comments by the nurse is appropriate at
this time?
1. “Congratulations, you and your family TEST-TAKING TIP: The fundal height is
must be so happy.” assessed
2. “Have you told the baby’s father yet?” at every prenatal visit. It is an
3. “How do you feel about the results?” easy, noninvasive means of assessing fetal
4. “Please tell me when your last menstrual growth. The nurse should know that the
period was.” top of the fundus is at the level of the

3. It is important for the nurse to ask symphysis at the end of the first
the young woman how she feels about trimester.
being pregnant. She may decide not 15
to continue with the pregnancy. When assessing the psychological
adjustment of an 8-week gravida, which of
the
following would the nurse expect to see signs a fetus is in utero. An ultrasound of a
of? fetus is one positive sign and the fetal
1. Ambivalence. heartbeat is another positive sign.
2. Depression.
3. Anxiety. 18
4. Ecstasy. The nurse takes the history of a client, G2
P1001, at her first prenatal visit. Which
1. It is common for women to be ambivalent of the following statements would indicate
about their pregnancy during that the client should be referred to a
the first trimester. genetic counselor?
1. “My first child has cerebral palsy.”
2. “My first child has hypertension.”
TEST-TAKING TIP: Even women who stop 3. “My first child has asthma.”
taking birth control pills in order to become 4. “My first child has cystic fibrosis.”
pregnant are often startled and
ambivalent when they actually get pregnant. 4. Cystic fibrosis is an autosomal recessive
This is not pathological. The genetic disease so the client with
women usually slowly accept the pregnancy a history of cystic fibrosis should be
and, by 20 weeks’ gestation, are referred to a genetic counselor.
happy and enthusiastic about the
16
A client makes the following statement after TEST-TAKING TIP: Virtually all diseases,
finding out that her pregnancy test is chronic and acute, have some genetic
positive, “This is not a good time. I am in component, but the ability for the genetic
college and the baby will be due during counselor to predict the impact of
final exams!” Which of the following many diseases is very poor. Those illnesses
responses by the nurse would be most with clear hereditary patterns,
appropriate however, do warrant referral to genetic
at this time? counselors. Cystic fibrosis has an autosomal
1. “I’m absolutely positive that everything recessive inheritance pattern.
will turn out all right.” 19
2. “I suggest that you e-mail your professors The nurse has taken a health history on four
to set up an alternate plan.” primigravid clients at their first prenatal
3. “It sounds like you’re feeling a little visits. It is high priority that which of the
overwhelmed right now.” clients receives nutrition counseling?
4. “You and the baby’s father will find a way 1. The woman diagnosed with
to get through the pregnancy.” phenylketonuria.
3. This is the best comment. It acknowledges 2. The woman who has Graves’ disease.
the concerns that the client is 3. The woman with Cushing’s syndrome.
having. 4. The woman diagnosed with myasthenia
gravis.
TEST-TAKING TIP: Nurses have two roles
when clients express concerns to them. 1. The client with phenylketonuria
First, the nurse must acknowledge the (PKU) must receive counseling from a
client’s concerns so that the client feels registered dietitian.
accepted and understood. Second, the
nurse must help the client to problem
solve the situation. It is very important, TEST-TAKING TIP: PKU is a genetic disease
however, that the acceptance precede the that is characterized by the absence
period of problem solving. of the enzyme needed to metabolize
phenylalanine, an essential amino acid.
17 When patients with PKU consume
The nurse notes each of the following phenylalanine, a metabolite that affects
findings in a 12-week gestation client. Which cognitive centers in the brain is created
of in the body. If a pregnant woman who
the findings would enable the nurse to tell has PKU were to eat foods high in
the client that she is positively pregnant? phenylalanine, her baby would develop
1. Fetal heart rate via Doppler. severe mental retardation in utero.
2. Positive pregnancy test.
3. Positive Chadwick’s sign. 20
4. Montgomery gland enlargements. Which of the following findings in an 8-week
gestation client, G2 P1001, should
1. Hearing a fetal heart rate is a positive the nurse highlight for the nurse midwife?
sign of pregnancy. 1. Body mass index of 17.
TEST-TAKING TIP: Positive signs of pregnancy 2. Blood pressure of 100/60.
are signs that irrefutably show that 3. Hematocrit of 36%.
4. Hemoglobin of 13.2.
20. 1. The BMI of 17 is of concern. This salivation.
client is entering her pregnancy 4. 34 weeks’ gestation; complains of
underweight. hemorrhoidal pain.
2. The fundal height at 24 weeks should
be 4 cm above the umbilicus. The
TEST-TAKING TIP: Women who enter their fundal height at the level of the
pregnancies underweight are encouraged umbilicus is expected at 20 weeks’
to gain slightly more—35 to 45 lb—during
their pregnancies than are women
of normal weight who are encouraged to
gain 25 to 35 lb. TEST-TAKING TIP: It is important for
the test taker to know the timing of key
21 pregnancy changes. The mother should
A woman, 6 weeks pregnant, is having a feel fetal movement by 20 weeks’ gestation.
vaginal examination. Which of the following Primigravidas often feel fetal
would the practitioner expect to find? movement later than multigravidas.
1. Thin cervical muscle. Specific fundal height measurements
2. An enlarged ovary.
3. Thick cervical mucus. are also expected at key times in the
4. Pale pink vaginal wall. pregnancy.

2. The practitioner would expect to 24

palpate an enlarged ovary. The following four changes occur during
pregnancy. Which of them usually increases
TEST-TAKING TIP: The cervix is long and the father’s interest and involvement in the
thick in order to retain the pregnancy in pregnancy?
the uterine cavity. The cervical mucus is 1. Learning the results of the pregnancy test.
thin and the vaginal wall is bluish in 2. Attending childbirth education classes.
color as a result of elevated estrogen 3. Hearing the fetal heartbeat.
levels. The ovary is enlarged because the 4. Meeting the obstetrician or midwife.
corpus luteum is still functioning.
3. Hearing the fetal heart beat often
22 increases fathers’ interests in their
A pregnant woman must have a glucose partners’ pregnancies.
challenge test (GCT). Which of the following
should be included in the preprocedure
teaching? TEST-TAKING TIP: Women who are in the
1. Fast for 12 hours before the test. first few weeks of pregnancy often
2. Bring a urine specimen to the laboratory experience
on the day of the test. a number of physical complaints—
3. Be prepared to have 4 blood specimens nausea and vomiting, fatigue, breast
taken on the day of the test. tenderness,
4. The test should take one hour to and urinary frequency.
complete. Prospective fathers whose partners’
4. The test does take about 1 hour to experience
complete. these complaints are often not
TEST-TAKING TIP: The GCT is done at very interested in the pregnancies. When
approximately 24 weeks’ gestation to assess the baby becomes “real,” with a positive
the client’s ability to metabolize glucose. heartbeat or fetal movement, the fathers
It is a 1-hour, nonfasting screening often become very excited.
test. One hour after a client consumes 25
50 grams of a concentrated glucose solution, The nurse midwife tells a client that the baby
a serum glucose level is done. If the is growing and that ballottement was
value is 130 mg/dL or higher, the client evident during the vaginal examination. How
is referred for a 3-hour glucose tolerance should the nurse explain what the
test to determine whether or not she has nurse midwife means by ballottement?
gestational diabetes. 1. The nurse midwife saw that the mucus
23 plug was intact.
The nurse working in an outpatient obstetric 2. The nurse midwife felt the baby rebound
office assesses four primigravid after being pushed.
clients. Which of the client findings would the 3. The nurse midwife palpated the fetal parts
nurse highlight for the physician? through the uterine wall.
1. 17 weeks’ gestation; denies feeling fetal 4. The nurse midwife assessed that the baby
movement. is head down.
2. 24 weeks’ gestation; fundal height at the 2. This is the definition of ballottement.
umbilicus.
3. 27 weeks’ gestation; complains of excess TEST-TAKING TIP: Although this question
discusses nurse-patient interaction, it is
simply a definition question. The test pregnancy.
taker is being asked to identify the definition TEST-TAKING TIP: It is important for
of the word ballottement. pregnant women to contact their health
care practitioners to find out which
26 medications
A multigravid client is 22 weeks pregnant. are safe to take during pregnancy
Which of the following symptoms would and which medications must be
the nurse expect the client to exhibit? avoided. All medications are assigned a
1. Nausea. pregnancy category from “A”—research
2. Dyspnea. has shown they are safe to be consumed
3. Urinary frequency. throughout pregnancy—to “X”—a
4. Leg cramping. teratogenic
4. Leg cramping is often a complaint of agent. Category “B” medications
clients in the second trimester. are considered safe because of anecdotal
evidence, although controlled
research has not been conducted to confirm
TEST-TAKING TIP: Although clients in the that evidence. Teratogens are agents
second trimester do experience some that have definitely been shown to cause
physical discomfort, such as leg cramps fetal damage.

and backaches, most women feel well. 29

They no longer are fatigued, nauseous, A 20-week gestation client is being seen in
and so on as in the first trimester, but the prenatal clinic. Place an “X” on the
the baby is not so large as to cause place on the abdomen where the nurse
significant would expect the fundal height to be felt.
complaints like dyspnea or the
recurrence of urinary frequency.
27
The glucose challenge screening test is
performed at or after 24 weeks’ gestation to TEST-TAKING TIP: At 20 weeks’ gestation,
assess for the maternal physiological the fundal height should be felt at the
response to which of the following pregnancy umbilicus. About 8 weeks later, it is felt
hormones? between the umbilicus and xiphoid
1. Estrogen. process and at the xiphoid process at
2. Progesterone. 36 weeks.
3. Human placental lactogen.
4. Human chorionic gonadotropin.
3. Human placental lactogen (hPL) is an
insulin antagonist.
TEST-TAKING TIP: hPL is produced by the 30
placenta. As the placenta grows, the A client who was seen in the prenatal clinic
hormone levels rise. At approximately at 20 weeks’ gestation weighed 128 lb
24 weeks’ gestation, the levels are high at that time. Approximately how many
enough to impact glucose metabolism. pounds would the nurse expect the client to
If performed earlier, the GCT test may weigh at her next visit at 24 weeks’
result in a false-negative result. gestation?
28 1. 129 lb.
A client is 15 weeks pregnant. She calls the 2. 130 lb.
obstetric office to request a medication 3. 131 lb.
for a headache. The nurse answers the 4. 132 lb.
telephone. Which of the following is the 4. The woman would be expected to
nurse’s best response? weigh about 132 lb. At this stage of
1. “Because the organ systems in the baby pregnancy, the woman is expected to
are developing right now, it is risky to gain about 1 lb a week.
take medicine.” TEST-TAKING TIP: The incremental weight
2. “You can take any of the over-the-counter gain of a client is an important means of
medications because they are all safe assessing the growth and development of
in pregnancy.” the fetus. The nurse would expect that,
3. “The physician will prescribe a category during the second and third trimesters,
“X” medication for you.” the woman should gain approximately
4. “You can take acetaminophen because it 1 lb per week.
is a category “B” medicine.”
31
4. Category “B” medications have been An 18-week gestation client telephones the
shown to be safe to take throughout obstetrician’s office stating, “I’m really
scared. I think I have breast cancer. My holding that position for a few seconds,
breasts are filled with tumors.” The nurse followed by holding the alternate position
should base the response on which of the for a few seconds—arching her back
following? while lifting her head and her buttocks
1. Breast cancer is often triggered by toward the ceiling. These positions should be
pregnancy. alternated repeatedly for about
2. Nodular breast tissue is normal during 5 minutes. The exercises are very relaxing
pregnancy. while also improving the muscle tone
3. The woman is exhibiting signs of a of the lower back.
psychotic break.
4. Anxiety attacks are especially common in 34
the second trimester. A woman in her third trimester advises the
nurse that she wishes to breastfeed her
2. Nodular breast tissue is normal in baby, “but I don’t think my nipples are
pregnancy. right.” Upon examination, the nurse notes
that the client has inverted nipples. Which of
TEST-TAKING TIP: The high levels of the following actions should the
estrogen seen in pregnancy result in a nurse take at this time?
number of changes. The hypertrophy 1. Advise the client that it is unlikely that she
and hyperplasia of the breast tissue, in will be able to breastfeed.
preparation for neonatal lactation, are 2. Refer the client to a lactation consultant
two of the changes. for advice.
32 3. Call the labor room and notify them that a
A woman states that she frequently awakens client with inverted nipples will be
with “painful leg cramps” during the admitted.
night. Which of the following assessments 4. Teach the woman exercises in order to
should the nurse make? evert her nipples.
1. Dietary evaluation. 2. The client should be referred to a lactation
2. Goodell’s sign. consultant.
3. Hegar’s sign.
4. Posture evaluation.
32. 1. A dietary evaluation is indicated since TEST-TAKING TIP: Research on eversion
painful leg cramps can be caused by exercises has shown that they are not
consuming too little calcium or too effective
much phosphorus. plus breast manipulation can
bring on contractions since oxytocin
production
TEST-TAKING TIP: Leg cramps can occur is stimulated. Lactation consultants
as a result of low calcium and/or high are breastfeeding specialists. A lactation
phosphorus since they are often related consultant would probably
to a poor calcium/phosphorus ratio. A dietary recommend that the client wear breast
assessment should be done to determine shields in her bra. The shields are made
whether or not the client is consuming of hard plastic and have a small hole
enough calcium, primarily found through which the nipple everts.
in dairy products, or large quantities of 35
phosphorus, found in carbonated beverages Which of the following vital sign changes
and processed sandwich meats. should the nurse highlight for a pregnant
33 woman’s obstetrician?
Which of the following exercises should be 1. Prepregnancy blood pressure (BP) 100/60
taught to a pregnant woman who complains and third trimester BP 140/90.
of backaches? 2. Prepregnancy respiratory rate (RR) 16 rpm
1. Kegeling. and third trimester RR 22 rpm.
2. Pelvic tilting. 3. Prepregnancy heart rate (HR) 76 bpm and
3. Leg lifting. third trimester HR 88 bpm.
4. Crunching. 4. Prepregnancy temperature (T) 98.6ºF and
third trimester T 99.2ºF.
2. The pelvic tilt is an exercise that can
reduce backache pain. 1. The blood pressure should not elevate
during pregnancy. This change
should be reported to the health care
TEST-TAKING TIP: Pelvic tilt exercises help practitioner.
to reduce backache pain. The client is
taught to get into an optimal position—
on the hands and knees is often best. She TEST-TAKING TIP: The basal metabolic
is then taught to force her back out while rate of the woman increases during
tucking her head and buttocks under and pregnancy.
As a result the nurse would expect breasts to stimulate an adequate milk
to observe a respiratory rate of 20 to 24 supply.
rpm. High levels of progesterone in the 3. Assess the liquid because a breast
body result in a decrease in the contractility discharge is diagnostic of a mammary
of the smooth musculature infection.
throughout the body. This results in an 4. Reassure the mother that this is normal in
increase in the pulse rate. In addition, the third trimester.
progesterone is thermogenic, resulting in
a slight rise in the woman’s core body 4. It is normal for colostrum to be
temperature. expressed late in pregnancy.
TEST-TAKING TIP: Even though colostrum
36 is present in the breasts in the latter part
A nurse midwife has advised a 39-week of the third trimester, it is important for
gestation gravid to take evening primrose women not to pump their breasts.
oil 2500 mg daily as a complementary Oxytocin, the hormone that promotes
therapy. This suggestion was made because the ejection of milk during lactation, is
evening primrose has been shown to perform the hormone of labor. Pumping of the
which of the following actions? breasts, therefore, could stimulate the
1. Relieve back strain. uterus to contract.
2. Improve development of colostrum.
3. Ripen the cervix. 39
4. Reduce the incidence of hemorrhoids. A 36-week gestation gravid client is
complaining of dyspnea when lying flat.
3. Evening primrose converts to a Which
prostaglandin substance in the body. of the following is the likely clinical reason
Prostaglandins are responsible for for this complaint?
readying the cervix for dilation. 1. Maternal hypertension.
2. Fundal height.
TEST-TAKING TIP: Nurse midwives often 3. Hydramnios.
recommend complementary therapies 4. Congestive heart failure
during pregnancy as well as during labor
and delivery. Nurse midwives usually believe 2. The fundal height is the likely cause
in promoting natural means for of the woman’s dyspnea.
maintaining a healthy pregnancy and for
stimulating labor. Evening primrose is
one of those interventions. TEST-TAKING TIP: As the uterus enlarges,
37 the woman’s organs are impacted. At 36
A 38-week gestation client, Bishop score 1, is weeks, the fundus is at the level of the
advised by her nurse midwife to take xiphoid process. The diaphragm is elevated
evening primrose daily. The office nurse and the lungs are displaced. When
advises the client to report which of the a client lies flat she has difficulty breathing.
following side effects that has been Most women use multiple pillows at
attributed to the oil? night for sleep. Whenever caring for a
1. Skin rash. pregnant woman, the nurse should elevate
2. Pedal edema. the head of the bed.
3. Blurred vision. 40
4. Tinnitus. The nurse is providing anticipatory guidance
1. Evening primrose has been shown to to a woman in her second trimester
cause skin rash in some women. regarding signs/symptoms that she might
experience in the coming weeks. Which
of the following comments by the client
indicates that further teaching is needed?
TEST-TAKING TIP: Even though evening 1. “During the third trimester I may
primrose is a “natural” substance, it can experience frequent urination.”
cause side effects in some clients. The 2. “During the third trimester I may
most common side effect seen from the experience heartburn.”
oil is a skin rash. Headaches and nausea 3. “During the third trimester I may
have also been seen. experience back pain.”
38 4. “During the third trimester I may
A 37-week gravid client states that she experience persistent headache.”
noticed a “white liquid” leaking from her 4. Persistent headache should not be
breasts during a recent shower. Which of the seen in pregnant women.
following nursing responses is appropriate TEST-TAKING TIP: This question is asking
at this time? the test taker to determine which complaint
1. Advise the woman that she may have a is not expected during the third
galactocele. trimester. The nurse, therefore, must
2. Encourage the woman to pump her know which symptoms are normal during
the third trimester in order to know 2. Lateral-recumbent.
which symptoms are not normal during 3. Sims’.
that period. Persistent headache can indicate 4. Semi-Fowler’s.
that the woman has developed a
complication of pregnancy 4. The client should be placed in a semi-
Fowler’s position.
41 TEST-TAKING TIP: Because of the growth
A client, in her third trimester, is concerned of the uterus, it is very difficult for
that she will not know the difference women in the third trimester to breathe
between labor contractions and normal in the supine position. During the prenatal
aches and pains of pregnancy. How should visit, the baby’s heartbeat will be
the nurse respond? monitored and the fundal height will be
1. “Don’t worry. You’ll know the difference assessed. Both of these procedures can
when the contractions start.” safely be performed in the semi-Fowler’s
2. “The contractions may feel just like a position.
backache, but they will come and go.” 44. 2, 3, and 4 ar
3. “Contractions are a lot worse than your
pregnancy aches and pains.” 44
4. “I understand. You don’t want to come to A third-trimester client is being seen for
the hospital before you are in labor.” routine prenatal care. Which of the following
assessments will the nurse perform during
2. This is a true statement the visit? Select all that apply.
1. Blood glucose.
2. Blood pressure.
TEST-TAKING TIP: Labor contractions often 3. Fetal heart rate.
begin in a woman’s back, feeling 4. Urine protein.
much like a backache. The difference is 5. Pelvic ultrasound.
that labor contractions are intermittent Study These Flashcards
and rhythmic. The client should be advised 2, 3, and 4 are correct.
to attend to any pains that come
and go and time them. She may be
beginning
the labor process. 2. The blood pressure is assessed at
each prenatal visit.
42 3. The fetal heart rate is assessed at
Which finding would the nurse view as each prenatal visit. Depending on
normal when evaluating the laboratory the equipment available, it will be
reports of a 34-week gestation client? assessed mechanically via Doppler
1. Anemia. or manually via fetoscope. The fetal
2. Thrombocytopenia. heart is audible via Doppler many weeks
3. Polycythemia. before it is audible via
4. Hyperbilirubinemia. fetoscope.
4. Urine protein is performed at each
1. Anemia is an expected finding. prenatal visit

TEST-TAKING TIP: By the end of the second TEST-TAKING TIP: The test taker must
trimester, the blood supply of the read the question carefully. Although
woman increases by approximately 50%. urine glucose assessments are done at
This increase is necessary in order for each visit, blood glucoses are assessed
the client to be able to perfuse the placenta. only intermittently during the pregnancy.
There is a concurrent increase in Similarly, although ultrasound assessments
red blood cell production, but the vast may be ordered intermittently
majority of women are unable to produce during a pregnancy, they are certainly
the red blood cells in sufficient numbers not done at every prenatal visit. As a
to keep pace with the increase in blood matter of fact, there is no absolute
volume. As a result, clients develop what mandate that a sonogram must be done
is commonly called “physiological anemia at all during a pregnancy.
of pregnancy.” A hematocrit of 32% is
considered normal for a pregnant 45
woman. A nurse is working in the prenatal clinic.
Which of the following findings seen in
43 third-trimester pregnant women would the
The nurse asks a 31-week gestation client to nurse consider to be within normal
lie on the examining table during a limits? Select all that apply.
prenatal examination. In which of the 1. Leg cramps.
following positions should the client be 2. Varicose veins.
placed? 3. Hemorrhoids.
1. Orthopneic.
4. Fainting spells. 2. It is inappropriate to ask the Muslim
5. Lordosis. client about the name for the baby.
Study These Flashcards
1, 2, 3, and 5 are correct.
1. Leg cramps are normal, although the TEST-TAKING TIP: Traditional Muslim
client’s diet should be assessed. couples will not tell anyone the baby’s
2. Varicose veins are normal, although name until he or she has gone through
client teaching may be needed. the official naming ceremony, called
3. Hemorrhoids are normal, although “aqiqah.” Babies are rarely named before
client teaching may be needed. a week of age. The parents need time to
get to know their baby and decide on an
appropriate name for him or her.
5. Lordosis, or change in the curvature 48
of the spine, is normal, although patient A woman is 36-weeks’ gestation. Which of
teaching may be needed. the following tests will be done during
TEST-TAKING TIP: There are a number of her prenatal visit?
physical complaints that are “normal” 1. Glucose challenge test.
during pregnancy. There are interventions, 2. Amniotic fluid volume assessment.
however, that can be taught to 3. Vaginal and rectal cultures.
help to alleviate some of the discomforts. 4. Karyotype analysis.
The test taker should be familiar with
patient education information that Study These Flashcards
should be conveyed regarding the physical 3. Vaginal and rectal cultures are done at
complaints of pregnancy. For example, approximately 36 weeks’ gestation.
clients who complain of hemorrhoids
should be encouraged to eat high-fiber
foods and drink fluids in order to produce TEST-TAKING TIP: Vaginal and rectal cultures
softer stools. The softer stools are done to assess for the presence
should decrease the irritation of the of group B streptococcal (GBS) bacteria
hemorrhoids. in the woman’s vagina and rectum. If the
woman has GBS as part of her normal
flora, she will be given IV antibiotics
during labor to prevent vertical transmission
to her baby at birth. GBS is often
46 called, “the baby killer.”
A 36-week gestation gravid lies flat on her
back. Which of the following maternal 49
signs/symptoms would the nurse expect to A 34-week gestation woman calls the
observe? obstetric office stating, “Since last night
1. Hypertension. I have had three nosebleeds.” Which of the
2. Dizziness. following responses by the nurse is
3. Rales. appropriate?
4. Chloasma. 1. “You should see the doctor to make sure
you are not becoming severely anemic.”
Study These Flashcards 2. “Do you have a temperature?”
2. Dizziness is an expected finding 3. “One of the hormones of pregnancy
makes the nasal passages prone to bleeds.”
TEST-TAKING TIP: Because the weight of 4. “Do you use any inhaled drugs?”
the gravid uterus compresses the great
vessels, the nurse would expect the client Study These Flashcards
to complain of dizziness when lying 3. This is an accurate statement. Hormonal
supine. The blood supply to the head changes in pregnancy make the
and other parts of the body is diminished nasal passages prone to bleeds.
when the great vessels are compressed.
47
The nurse is interviewing a 38-week TEST-TAKING TIP: Estrogen, one of the
gestation Muslim woman. Which of the important hormones of pregnancy,
following promotes vasocongestion of the mucous
questions would be inappropriate for the membranes of the body. Increased vascular
nurse to ask? perfusion of the mucous membranes
1. “Do you plan to breastfeed your baby?” of the gynecological system is essential
2. “What do you plan to name the baby?” for the developing fetus to survive. The
3. “Which pediatrician do you plan to use?” vasocongestion occurs in all of the mucous
4. “How do you feel about having an membranes of the body, however,
episiotomy?” leading to many complaints including
nosebleeds and gingival bleeding.
Study These Flashcards
50
The nurse asks a woman about how the A client is 35 weeks’ gestation. Which of the
woman’s husband is dealing with the following findings would the nurse expect
pregnancy. to see?
The nurse concludes that counseling is 1. Nausea and vomiting.
needed when the woman makes 2. Maternal ambivalence.
which of the following statements? 3. Fundal height 10 cm above the umbilicus.
1. “My husband is ready for the pregnancy to 4. Use of three pillows for sleep comfort.
end so that we can have sex again.”
2. “My husband has gained quite a bit of Study These Flashcards
weight during this pregnancy.” 4. The use of three pillows for sleep
3. “My husband seems more worried about comfort is often seen in clients who
our finances now than before the are 35 weeks’ gestation.
pregnancy.” TEST-TAKING TIP: It is essential that the
4. “My husband plays his favorite music for test taker differentiate between normal
my belly so the baby will learn to like it.” and abnormal findings at various points
during the pregnancy—for example, nausea
Study These Flashcards and vomiting are normal during the
1. The woman implies that she and her first trimester but not during the second
husband are not having sex. There is or third trimesters. The fundal height
no need to refrain from sexual intercourse measurement is also important to
during a normal pregnancy— remember.
so the woman and her husband need From 20 weeks’ gestation,
further counseling. when the fundal height is usually at the
same height as the umbilicus, to 36
TEST-TAKING TIP: Couvade is the term weeks’ gestation, when the final height is
given to a father’s physiological responses at the xiphoid process, the height measures
to his partner’s pregnancy. are approximately the same number
Men have been seen to exhibit a number of centimeters above the symphysis
of physical complaints/changes that as the number of weeks of fetal gestation.
simulate their partner’s physical For example, at 24 weeks’ gestation,
complaints/changes—for example, the height is usually 24 cm above the
indigestion, symphysis or 4 cm above the umbilicus,
weight gain, urinary frequency, and at 35 weeks’ gestation, the height is
and backache. usually 35 cm above the symphysis, or
51 15 cm above the umbilicus.
The blood of a pregnant client was initially 53
assessed at 10 weeks’ gestation and A woman, 26-weeks’ gestation, calls the
reassessed triage nurse stating, “I’m really scared. I
at 38 weeks’ gestation. Which of the tried
following results would the nurse expect not to but I had an orgasm when we were
to see? making love. I just know that I will go into
1. Rise in hematocrit from 34% to 38%. preterm labor now.” Which of the following
2. Rise in white blood cells from 5,000 responses by the nurse is appropriate?
cells/mm3 to 15,000 cells/mm3. 1. “Lie down and drink a quart of water. If
3. Rise in potassium from 3.9 mEq/ L to 5.2 you feel any back pressure at all call me
mEq/ L. back right away.”
4. Rise in sodium from 137 mEq/ L to 150 2. “Although oxytocin was responsible for
mEq/ L. your orgasm, it is very unlikely that it
Study These Flashcards will stimulate preterm labor.”
2. The nurse would expect to see an 3. “I will inform the doctor for you. What I
elevated white blood cell count. want you to do is to come to the hospital
right now to be checked.”
4. “The best thing for you to do right now is
TEST-TAKING TIP: At the end of the third to take a warm shower, and then do a
trimester and through to the early fetal kick count assessment.”
postpartum Study These Flashcards
period, a normal leukocytosis, or 2. This is an accurate statement.
rise in white blood cell count, is seen.
This is a natural physiological change
that protects the woman’s body from the TEST-TAKING TIP: There is no
invasion of pathogens during the birth contraindication
process. The nurse should rely on a to intercourse or to orgasm
temperature during pregnancy, unless it has been
elevation to determine whether determined that a client is high risk for
or not the woman has an infection preterm labor. Until late in pregnancy,
52 there are very few oxytocin receptor sites
on the uterine body. The woman will, birth plan should be presented to the
therefore, not go into labor as a result of nursing staff in order to facilitate the
an orgasm during sexual relations. communication during that transition.
54 56
A couple is preparing to interview obstetric The nurse is assisting a couple to develop
primary care providers in order to determine decisions for their birth plan. Which of
who they will go to for care during their the following decisions should be considered
pregnancy and delivery. In order to nonnegotiable by the parents?
make the best choice, which of the following 1. Whether or not the father will be present
actions should the couple perform first? during labor.
1. Take a tour of hospital delivery areas. 2. Whether or not the woman will have an
2. Develop a preliminary birth plan. episiotomy.
3. Make appointments with three or four 3. Whether or not the woman will be able to
obstetric care providers. have an epidural.
4. Search the internet for the malpractice 4. Whether or not the father will be able to
histories of the providers. take pictures of the delivery.
Study These Flashcards Study These Flashcards
2. It is best that a couple first develop a 1. The presence of the father at delivery
birth plan. should be nonnegotiable.

TEST-TAKING TIP: It is important for a TEST-TAKING TIP: Even though the birth
couple’s needs and wants to match their plan should include issues like the use or
obstetrical care practitioner’s philosophy nonuse of episiotomies, emergent issues
of care. If, for example, the couple is during the delivery may lead to a sudden
interested in the possibility of having a change in plans. For example, if a cesarean
water birth, it is important that the is needed for malpresentation, the
health care provider be willing to perform issue of episiotomy is moot and the
a water birth. If, however, the client will definitely need anesthesia.
woman wants to be “completely pain However, there are some issues that
free,” the health care provider must be should be nonnegotiable. If the father
willing to order pain medications wishes to be in the delivery room no
throughout the labor and delivery. A matter the type of delivery or whether or
birth plan will list the couples’ many not an emergent situation is occurring,
wishes. that should be stated in the plan and
accepted by the health care provider.
55
During a preconception counseling session, 57
the nurse encourages a couple to prepare During a prenatal visit, a gravid client is
a birth plan. Which of the following is the complaining of ptyalism. Which of the
most important goal for this action? following nursing interventions is
1. Promote communication between the appropriate?
couple and health care professionals. 1. Encourage the woman to brush her teeth
2. Enable the couple to learn about the types carefully.
of medicine used in labor. 2. Advise the woman to have her blood
3. Provide the couple with a list of items that pressure checked regularly.
they should put in a bag for labor. 3. Encourage the woman to wear supportive
4. Give the high-risk couple a sense of hosiery.
control over having to have a cesarean. 4. Advise the woman to avoid eating rare
meat.
Study These Flashcards
1. Birth plans help to facilitate Study These Flashcards
communication 1. Clients who experience ptyalism have
between couples and their an excess of saliva. They should be
health care providers. advised to be vigilant in the care for
their teeth and gums. Ptyalism is often
TEST-TAKING TIP: The earlier a birth plan accompanied by gingivitis and
is developed, the better. A pregnant nausea and vomiting.
woman and her partner must feel
comfortable
with the communication methods,
physical care, and health care TEST-TAKING TIP: Ptyalism is related to
philosophies of their obstetrical health the increase in vascular congestion of
care provider. The birth plan is a means the mucous membranes from increased
for everyone to clearly understand each estrogen production. Women with increased
step of the birthing process. When the salivation often also experience
client enters the hospital for delivery, the gingivitis, which is also related to estrogen
production. In addition, ptyalism is solder. Lead, when consumed either
seen in women with nausea and vomiting. through the respiratory tract or the
Because of the caustic affects of gastric GI tract, can cause permanent damage to
juices on the enamel of the teeth, the the central nervous system of the unborn
inflammation seen in the gums and the child. It is very important, therefore, that
increased salivation, it is essential that the woman not breathe in the air in
the pregnant woman take special care of rooms that have recently been sanded.
her teeth during pregnancy, including The paint aerosolizes and the lead can
regular visits to the dentist or the dental be inhaled. In addition, lead leaches into
hygienist. hot water more readily than into cold
so water from the cold tap should be
58 consumed—but only after the water has
A gravid woman who recently emigrated run through the pipes for a minimum of
from mainland China is being seen at her 2 minutes.
first prenatal visit. She was never vaccinated
in her home country. An injection to 60
prevent which of the following communicable After nutrition counseling, a woman, G3
diseases should be administered to P1101, proclaims that she certainly can’t
the woman during her pregnancy? eat any strawberries during her pregnancy.
1. Influenza. Which of the following is the likely
2. Mumps. reason for this statement?
3. Rubella. 1. The woman is allergic to strawberries.
4. Varicella. 2. Strawberries have been shown to cause
birth defects.
Study These Flashcards 3. The woman believes in old wives’ tales.
1. The woman should receive the influenza 4. The premature baby died because the
injection. The nasal spray, woman ate strawberries
however, should not be administered
to a pregnant woman Study These Flashcards
3. The woman believes in old wives’
tales.
TEST-TAKING TIP: It is very important for
pregnant women to be protected from the flu
by receiving the inactivated influenza TEST-TAKING TIP: There are a number of
injection. The fetus will not be old wives’ tales that pregnant women believe
injured from the shot and the woman in and live by. One of the common
will be protected from the many sequelae tales relates to the ingestion of strawberries:
that can develop from the flu. However, Women who eat strawberries have
the live nasal flu spray should not be babies with strawberry marks on their
administered to pregnant women. It is
contraindicated to vaccinate pregnant bodies. Unless old-wives’ tales have the
women with many other vaccines, including potential to impact the health of the baby
the measles-mumps-rubella and/or mother, it is ill advised and
(MMR) and the varicella vaccines. unnecessary
See http://www.acog.org/from_home/ to argue with the mother
publications/misc/bco282.pdf about her beliefs.

59 61
A gravid woman and her husband inform the A woman is planning to become pregnant.
nurse that they have just moved into a Which of the following actions should
three-story home that was built in the 1930s. she be counseled to take before stopping
Which of the following is critical for birth control? Select all that apply.
the nurse to advise the woman in order to 1. Take a daily multivitamin.
protect the unborn child? 2. See a medical doctor.
1. Stay out of any rooms that are being 3. Drink beer instead of vodka.
renovated. 4. Stop all over-the-counter medications.
2. Drink water only from the hot water tap. 5. Stop smoking cigarettes.
3. Refrain from entering the basement. Study These Flashcards
4. Climb the stairs only once per day. 1, 2, and 5 are correct.
Study These Flashcards 1. It is very important that women, before
1. The woman should stay out of rooms attempting to become pregnant,
that are being renovated. begin taking daily multivitamin
tablets.
2. Women who wish to become pregnant
should first see a medical doctor
TEST-TAKING TIP: Antique houses often for a complete check-up
contain lead-based paint and water
piping that has been soldered with leadbased
5. Women who wish to become pregnant as linea nigra, melasma, and
should be counseled to stop hyperpigmentation
smoking. of the areolae—are related
TEST-TAKING TIP: Because the embryo is to an increase in the melanin-producing
very sensitive during the first trimester bodies of the skin as a result of
of pregnancy, women should be advised stimulation by the female hormones,
to be vigilant about their health even before estrogen and progesterone. The
becoming pregnant. For example, presence of petechiae is usually related
folic acid, a vitamin in multivitamin to a pathological condition, such as
tablets, helps to prevent neural tube defects. thrombocytopenia.
Women of childbearing age often
fail to go for complete physical examinations. 64
It is important to discover the A pregnant woman informs the nurse that
presence of any medical illnesses before her last normal menstrual period was on
the pregnancy begins, however, so September 20, 2006. Using Nagele’s rule,
women should be counseled to have a the nurse calculates the client’s estimated
complete physical before stopping birth date of delivery as:
control methods. 1. May 30, 2007.
2. June 20, 2007.
62 3. June 27, 2007.
The nurse discusses sexual intimacy with a 4. July 3, 2007.
pregnant couple. Which of the following
should be included in the teaching plan? Study These Flashcards
1. Vaginal intercourse should cease by the 3. The estimated date of delivery is June
beginning of the third trimester. 27, 2007
2. Breast fondling should be discouraged
because of the potential for preterm labor.
3. The couple may find it necessary to TEST-TAKING TIP: Nagele’s rule is a simple
experiment with alternate positions. method used to calculate a client’s
4. Vaginal lubricant should be used sparingly estimated date of confinement (EDC) or
throughout the pregnancy. estimated date of delivery (EDD) from
the last normal menstrual period (LMP).
Study These Flashcards The nurse learns the date of the last
3. With increasing size of the uterine menstrual period from the client. He or
body, the couple may need counseling she then subtracts 3 months from the
regarding alternate options for sexual date, adds 7 days to the date, and adjusts
intimacy.
TEST-TAKING TIP: Pregnancy lasts 10
lunar months. It is essential that the the year, if needed. For the example
nurse counsel clients on ways to maintain given:
health and well-being in the many Last normal menstrual
facets of their lives. Sexual intimacy is period—September 20, 2006 = 9 - 20 - 2006
one of the important aspects of a married 37
couple’s life together. The couple 6 27
can be counseled to use alternate positions, adjust the year 6 - 27 - 2007
engage in mutual masturbation, June 27, 2007
or other means to satisfy their needs for 65
sexual expression during the pregnancy A father experiencing couvade syndrome is
period. likely to exhibit which of the following
63 symptoms/behaviors?
Which of the following skin changes should 1. Heartburn.
the nurse highlight for a pregnant 2. Promiscuity.
woman’s health care practitioner? 3. Hypertension.
1. Linea nigra. 4. Indifference.
2. Melasma. Study These Flashcards
3. Petechiae. 1. Heartburn is a common symptom
4. Spider nevi.
Study These Flashcards
3. Petechiae are pinpoint red or purple TEST-TAKING TIP: Heartburn is a subjective
spots on the skin. They are seen in complaint that fathers often experience
hemorrhagic conditions. during their partners’ pregnancies.
Fathers who are experiencing couvade
symptoms are exhibiting a strong affiliation
TEST-TAKING TIP: There are many skin between themselves and their partners.
changes that occur normally during It is inappropriate for prospective
pregnancy. Most of the changes—such fathers to engage in illicit relationships
and/or indifference toward their partners’ of each pregnancy are then documented
pregnancies. They should be fully as a para (P) in the following order. The
engaged in the process. Hypertension, an first number refers to full-term births or
objective sign, should be investigated births ≥ 38 weeks’ gestation; the second
further. The father may have developed a number refers to preterm births or
pathologic condition. births between 20 and 37 weeks’ gestation;
the third number refers to abortions,
66 whether spontaneous or therapeutic;
A nurse is advising a pregnant woman about and the fourth number refers to the
the danger signs of pregnancy. number of living children. The client has
The nurse should teach the mother that she been pregnant 5 times (G5); she birthed
should notify the physician immediately 1 son, 1 daughter, had 1 miscarriage, had
if she experiences which of the following 1 first trimester abortion, and is currently
signs/symptoms? Select all that pregnant. Her parity (P1122) accurately
apply. reflects her obstetrical history:
1. Convulsions. 1 full-term delivery (daughter at
2. Double vision. 39 weeks), 1 preterm delivery (son at
3. Epigastric pain. 28 weeks), 2 abortions (1 miscarriage,
4. Persistent vomiting. 1 first-trimester abortion), and,
5. Polyuria.
68
Study These Flashcards The partner of a gravida accompanies her to
1, 2, 3, and 4 are correct. her prenatal appointment. The nurse
1. Convulsions are a danger sign of notes that the father of the baby has gained
pregnancy. weight since she last saw him. Which of
2. Double vision is a danger sign of the following comments is most appropriate
pregnancy. for the nurse to make to the father?
3. Epigastric pain is a danger sign of 1. “I see that you are gaining weight right
pregnancy. along with your partner.”
4. Persistent vomiting is a danger sign of 2. “You and your partner will be able to go on
pregnancy. a diet together after the baby is born.”
3. “I can see that you are a bad influence on
your partner’s eating habits.”
TEST-TAKING TIP: The danger signs of 4. “I am so glad to see that you are taking so
pregnancy are signs or symptoms that can much interest in your partner’s
occur in an otherwise healthy pregnancy pregnancy.”
that are likely due to serious pregnancy
complications. For example, double vision, Study These Flashcards
epigastric pain, and blurred vision are 4. This is an appropriate comment to
symptoms of the hypertensive illnesses of make at this time.
pregnancy, and persistent vomiting is a TEST-TAKING TIP: This father is exhibiting
symptom of hyperemesis gravidarum. a sign of couvade; i.e., weight gain. This
is a positive response since it shows that
67 he is exhibiting a sympathetic response to
A woman provides the nurse with the his partner’s pregnancy. In addition, this
following obstetrical history: Delivered a son, father is accompanying his partner to the
now 7 years old, at 28 weeks’ gestation; prenatal visit, another positive sign.
delivered a daughter, now 5 years old, at
39 weeks’ gestation; had a miscarriage 3 69
years ago, and had a first-trimester The nurse is caring for a pregnant client who
abortion 2 years ago. She is currently is a vegan. Which of the following
pregnant. Which of the following portrays foods should the nurse suggest the client
an accurate picture of this woman’s gravidity consume as substitutes for restricted
and parity? foods?
1. G4 P2121. 1. Tofu, legumes, broccoli.
2. G4 P1212. 2. Corn, yams, green beans.
3. G5 P1122. 3. Potatoes, parsnips, turnips.
4. G5 P2211. 4. Cheese, yogurt, fish.

Study These Flashcards Study These Flashcards

3. This accurately reflects this woman’s 1. Tofu, legumes, and broccoli are excellent
gravidity and parity—G5P1122. substitutes for the restricted
foods.

TEST-TAKING TIP: Gravidity refers to

pregnancy and parity refers to delivery. TEST-TAKING TIP: Vegans are vegetarians
Every time a woman is pregnant, it is who eat absolutely no animal products.
counted as one gravida (G). The results Since animal products are most clients’
sources of protein and iron, it is necessary the excess quantities through the urine
for vegans to be very careful to meet their and stool. However, the fat-soluble
increased needs by eating excellent vitamins—vitamins A, D, E, and K—can
sources of these nutrients. It is build up in the body. Vitamins A and
recommended D have been shown to be teratogenic to
that vegans meet with a registered the fetus in megadoses.
dietitian early in their pregnancies
to discuss diet choices. 72
A vegan is being counseled regarding
70 vitamin intake. It is essential that this woman
When assessing the fruit intake of a supplement which of the following B
pregnant client, the nurse notes that the vitamins?
client 1. B1 (thiamine).
usually eats 1 piece of fruit per day and 2. B2 (niacin).
drinks 7 to 8 servings of fruit juice per day. 3. B6 (pyridoxine).
Which of the following is the most important 4. B12 (cobalamin).
communication for the nurse to make?
1. “You are effectively meeting your daily Study These Flashcards
fruit requirements.” 4. Vitamin B12 (cobalamin) should be
2. “Fruit juices are excellent sources of folic supplemented.
acid.”
3. “It would be even better if you were to
consume more whole fruits and less fruit TEST-TAKING TIP: Vitamin B12 (cobalamin)
juice.” is found almost exclusively in animal
4. “Your fruit intake far exceeds the products—meat, dairy, eggs. Since vegans
recommended daily fruit intake.” do not consume animal products, and
the vitamin is not in most nonanimal
Study These Flashcards sources, it is strongly recommended that
3. It is recommended that pregnant vegans supplement that vitamin. Those
clients eat whole fruits rather than who take in too little of the vitamin are
consume large quantities of fruit susceptible to anemia and nervous system
juice. This is the most important disorders. In addition, the vitamin is
statement for the nurse to make. especially important during pregnancy
since it is essential for DNA synthesis.

TEST-TAKING TIP: Approximately 6 oz 73

of fruit juice equals 1 serving from the foods would be best for the nurse to
fruit group. Fruit juices, however, are recommend to the client?
usually much higher in sugar than are 1. Bananas.
whole fruits. In addition, the client is not 2. Rice.
receiving the benefit of the fiber that is 3. Yogurt.
contained in the whole fruit. The nurse 4. Celery.
should compliment the client on her Study These Flashcards
fruit intake but encourage her to 4. Celery is an excellent food to reverse
consume whole fruits rather than large constipation.
quantities of juice. TEST-TAKING TIP: Most women complain
71 of constipation during pregnancy.
A client states that she is a strong believer in Progesterone,
vitamin supplements to maintain her a muscle-relaxant, is responsible
health. The nurse advises the woman that it for a slowing of the digestive system.
is recommended to refrain from consuming It is important, therefore, to recommend
excess quantities of which of the following foods to pregnant clients that will help to
vitamins during pregnancy? alleviate the problem. Foods high in fiber,
1. Vitamin C. like celery, are excellent suggestions.
2. Vitamin D. 74
3. Vitamin B2 (niacin). A pregnant client is lactose intolerant. Which
4. Vitamin B12 (cobalamin). of the following alternative calciumrich
Study These Flashcards foods could this woman consume?
2. Vitamin D supplementation can be 1. Turnip greens.
harmful during pregnancy. 2. Green beans.
3. Cantaloupe.
4. Nectarines.
TEST-TAKING TIP: The water-soluble Study These Flashcards
vitamins, if consumed in large quantities, 1. Turnip greens are calcium-rich.
have not been shown to be harmful
during pregnancy. The body eliminates
TEST-TAKING TIP: There are a number of
women who, for one reason or another,
do not consume large quantities of dairy TEST-TAKING TIP: It is essential that the
products. The nurse must be prepared to test taker know which foods are placed in
suggest alternate sources since dairy which food groups and the equivalent
products are the best sources for calcium quantity of food that meets one serving
intake. Any of the dark green leafy size. For example, 1 cup of any type
vegetables, of milk—whole, skim, butter, or even
like kale, spinach, collards, and chocolate—is equal to one dairy serving
turnip greens, are excellent sources, as while 11⁄2 oz of hard cheese is equal to
are small fish that are eaten with the one serving.
bones, like sardines. 77
75 Which of the following choices can the nurse
A nurse, who is providing nutrition teach a prenatal client is equivalent to
counseling to a new gravid client, advises one 2-oz meat serving?
the 1. 4 tbsp peanut butter.
woman that a serving of meat is 2. 2 eggs.
approximately equal in size to which of the 3. 1 cup cooked lima beans.
following items? 4. 2 ounces mixed nuts.
1. Deck of cards. Study These Flashcards
2. VCR tape. 2. 2 eggs 1 meat serving
3. CD case.
4. Video camera.
Study These Flashcards TEST-TAKING TIP: The test taker should
1. This is an accurate statement. A serving refer to the US Dietary Association
of meat is approximately equal to information
a deck of cards. at http://www.health.gov/
dietaryguidelines for up-to-date dietary
recommendations. As more research
TEST-TAKING TIP: The dietary information is forthcoming, dietary
recommendation recommendations change.
of the meat group for pregnant 78
clients is: 3 servings of meat per day. A nurse is discussing the serving sizes in the
Each serving is defined as 2 to 3 oz of grain food group with a new prenatal
meat, fish, or poultry. The average client. Which of the following foods equals 1
American diet well exceeds the serving size from the grain group?
recommended Select all that apply.
meat intake since most 1. 1 bagel.
Americans consider a serving of meat to 2. 1 slice of bread.
be larger than a deck of cards. 3. 1 cup cooked pasta.
4. 1 tortilla.
76 5. 1 cup dry cereal.
The nurse is evaluating the 24-hour dairy
intake of four gravid clients. Which of Study These Flashcards
the following clients consumed the highest 2, 4, and 5 are correct.
number of dairy servings during 1 day?
The client who consumed:
1. 4 oz whole milk, 2 oz hard cheese, 1 cup 2. 1 slice bread 1 serving.
of pudding made with milk and 2 oz
cream cheese.
2. 1 cup yogurt, 8 oz chocolate milk, 1 cup 4. 1 tortilla 1 serving.
cottage cheese, and 11⁄2 oz hard cheese. 5. 1 cup dry cereal 1 serving.
3. 1⁄2 cup cottage cheese, 8 oz whole milk, 1 TEST-TAKING TIP: The test taker should
cup of buttermilk, and 1⁄2 oz hard note that pregnant women are
cheese. recommended
4. 1⁄2 cup frozen yogurt, 8 oz skim milk, 4 oz to consume 7 to 11 servings of
cream cheese, and 11⁄2 cup of cottage grain. However, 1 sandwich equals 2
cheese. servings since each piece of bread equals
1 serving. Also, it is important to counsel
Study These Flashcards women to eat whole grain foods rather
2. This client consumed 32⁄3 servings: than processed grains. More nutrients as
1 cup yogurt 1 serving, 8 oz chocolate well as more fiber are obtained from
milk 1 serving; 1 cup cottage whole grain foods.
cheese 2⁄3 serving; and 11⁄2 oz hard
cheese 1 serving. 79
A woman asks the nurse about consuming the following foods should the nurse suggest
herbal supplements during pregnancy. the client consume?
Which of the following responses is 1. Potatoes and grapes.
appropriate? 2. Cranberries and squash.
1. Herbals are natural substances, so they 3. Apples and corn.
are safely ingested during pregnancy. 4. Oranges and spinach.
2. It is safe to take licorice and cat’s claw,
but no other herbs are safe. Study These Flashcards
3. A federal commission has established the 4. Oranges and spinach are excellent
safety of herbals during pregnancy. folic acid sources.
4. The woman should discuss everything she TEST-TAKING TIP: The intake of folic acid
eats with a health care practitioner. is especially important during the first
trimester of pregnancy to help to prevent
Study These Flashcards structural defects, including spina bifida
4. Every woman should advise her health and gastroschisis. The best sources of
care practitioner of what she is consuming, folic acid are liver and green leafy
including food, medicines, vegetables.
herbals, and all other substances. Oranges and orange juice are
TEST-TAKING TIP: Herbals are not regulated also good sources.
by the Food and Drug Administration
(FDA). There is some information 82
on selected herbals at the National Institute A nurse is discussing diet with a pregnant
of Health web site—http://nccam. woman. Which of the following foods
nih.gov/health—but because research on should the nurse advise the client to avoid
pregnant women is particularly sensitive consuming during her pregnancy?
there is very little definitive information 1. Bologna.
on the safety of many herbals in pregnancy. 2. Cantaloupe.
No matter what is consumed by 3. Asparagus.
the mother, however, the health care 4. Popcorn.
practitioner should be consulted. Study These Flashcards
80 82. 1. Bologna should not be consumed
A Chinese immigrant is being seen in the during pregnancy unless it is thoroughly
prenatal clinic. When providing nutrition cooked.
counseling, which of the following factors TEST-TAKING TIP: Because pregnant
should the nurse keep in mind? women are slightly immunocompromised,
1. Many Chinese eat very little protein. they are especially susceptible to
2. Many Chinese believe pregnant women certain diseases. Deli meats, unless
should eat cold foods. heated to steaming hot, can cause listeriosis.
3. Many Chinese are prone to anemia. Pregnant women should avoid
4. Many Chinese believe strawberries can these foods. Other foods that contain
cause birth defects. Listeria monocytogenes that should be
Study These Flashcards avoided are unpasteurized milk, soft
2. Many Chinese women do believe in cheese, and undercooked meats. See
the “hot and cold” theory of life. http://www.cfsan.fda.gov/~pregnant/
ataglanc.html and http://www.health.
gov/dietaryguidelines/dga2005/
document/html/chapter10.htm
TEST-TAKING TIP: Whenever a question
specifies that a client belongs to a specific
cultural or ethnic group, the test
taker should attend carefully to that 83
information. A 12-week gestation client tells the nurse
It is very likely that the that she and her husband eat sushi at least
question is asking the test taker to discern once per week. She states, “I know that fish
cultural/ethnic differences in order is good for me, so I make sure we eat it
to discern the test taker’s cultural regularly.” Which of the following responses
competence. Pregnancy is believed by by the nurse is appropriate?
many Chinese to be a “hot period.” In 1. “You are correct. Fish is very healthy for
order to maintain the equilibrium of the you.”
body, therefore, pregnant women consume 2. “You can eat fish, but sushi is too salty to
“cold” foods and drinks. eat during pregnancy.”
3. “Sushi is raw. Raw fish is especially high in
81 mercury.”
A nurse has identified the following nursing 4. “It is recommended that fish be cooked to
diagnosis for a prenatal client: Altered destroy harmful bacteria.”
nutrition: less than body requirements
related to poor folic acid intake. Which of Study These Flashcards
4. This is correct. It is recommended woman?
that during pregnancy the client eat 1. Replace laundry starch with salt.
only well-cooked fish. 2. Replace ice with frozen fruit juice.
TEST-TAKING TIP: Fish is an excellent 3. Replace soap with cream cheese.
source of omega-3 oil and protein. 4. Replace soil with uncooked pie crust.
During pregnancy fish should be eaten
well-cooked to avoid ingestion of Study These Flashcards
pathogens. The pregnant woman should 2. This is an excellent suggestion. Fruit
limit her intake to 12 oz per week or less juice, although high in sugar, does
to reduce the potential of her consuming contain vitamins.
toxic levels of methylmercury. See
http://www.cfsan.fda.gov/~pregnant/
safemea.html TEST-TAKING TIP: Although the nurse
might prefer that a client completely stop
84 a behavior that the nurse deems unsafe or
The nurse is caring for a prenatal client who inappropriate, the client may disagree.
states she is prone to developing anemia. The nurse, therefore, must attempt to
Which of the following foods should the provide a substitute for the client’s behavior.
nurse advise the gravida is the best Pica is a behavior that should be
source of iron? discouraged because of its potentially
1. Raisins. detrimental effects. If the client wishes to
2. Hamburger. consume ice, an excellent alternative is
3. Broccoli. ice pops, Italian ices, or iced fruit juice.
4. Molasses.
87
Study These Flashcards A mother is experiencing nausea and
2. Hamburger contains the most iron vomiting every afternoon. The ingestion of
which of the following spices has been shown
to be a safe complementary therapy
TEST-TAKING TIP: Iron is present in most for this complaint?
animal sources—seafood, meats, eggs— 1. Ginger.
although it is not present in milk. There 2. Sage.
also is iron in vegetable sources, although 3. Cloves.
not in the same concentration as 4. Nutmeg.
in animal products. If the nurse is caring
for a pregnant vegetarian, the nurse must Study These Flashcards
counsel the client regarding good nonanimal 1. Ginger has been shown to be a safe
sources of all nutrients. antiemetic agent for pregnant women.

85
It is discovered that a pregnant woman TEST-TAKING TIP: Morning sickness and
practices pica. Which of the following daytime nausea and vomiting are common
complications complaints of pregnant women during the
is most often associated with this behavior? first trimester. Ginger, consumed as ginger
1. Hypothyroidism. tea, ginger ale, or the like, has been
2. Iron deficiency anemia. shown to be a safe and an effective
3. Hypercalcemia. antinausea
4. Overexposure to zinc. agent for many pregnant women.
Study These Flashcards 88
2. Iron deficiency anemia is often seen A woman tells the nurse that she would like
in clients who engage in pica. suggestions for alternate vitamin C
sources because she isn’t very fond of citrus
fruits. Which of the following suggestions
TEST-TAKING TIP: Clients who engage in is appropriate?
pica eat large quantities of nonfood items 1. Barley and brown rice.
like ice, laundry starch, soap, and dirt. 2. Strawberries and potatoes.
There are a number of problems related 3. Buckwheat and lentils.
to pica, including teratogenesis related to 4. Wheat flour and figs.
eating foods harmful to the fetus. More
commonly, the women fill up on items Study These Flashcards
like ice instead of eating high-quality 2. Strawberries and potatoes are
foods. This practice is often culturally excellent sources of vitamin C, as are
related. zucchini, blueberries, kiwi, green
beans, green peas, and the like.
86
A woman confides in the nurse that she TEST-TAKING TIP: The test taker must be
practices pica. Which of the following prepared to answer basic nutrition questions
alternatives could the nurse suggest to the related to the health of the pregnant
woman. Even though citrus fruits the missed menstrual period.
are commonly thought of as the primary 2. Insurance companies must preapprove
sources of vitamin C, the test taker many prenatal care expenditures.
should realize that virtually all fruits and 3. It is recommended that women be
vegetables contain the vitamin, while pregnant no more than 3 times during their
grains do not. lifetime.
4. The cardiovascular system is stressed
when pregnancies are less than 2 years
89 apart.
A nurse is providing diet counseling to a new Study These Flashcards
prenatal client. Which of the following 1. This statement is true. Organogenesis
dairy products should the client be advised begins prior to the missed menstrual
to avoid eating during the pregnancy? period.
1. Vanilla yogurt.
2. Parmesan cheese.
3. Gorgonzola cheese.
4. Chocolate milk. TEST-TAKING TIP: The test taker may be
unfamiliar with the term organogenesis.
Study These Flashcards To answer the question correctly, however, it
3. The intake of gorgonzola cheese is essential that the test taker
should be discouraged during pregnancy. be able to decipher the definition. It is
important that the nurse break the word
down into its parts in order to deduce
TEST-TAKING TIP: Gorgonzola cheese is a the meaning. Organo means “organ” and
soft cheese. Soft cheeses harbor Listeria genesis means “origin.” The definition of
monocytogenes, the organism that causes the term, therefore, is origin, or
listeriosis. Pregnant women are at high development,
risk of developing this infection because of the organ systems.
they are slightly immunosuppressed. The 92
adult disease can assume many forms, A woman has just completed her first
including trimester. Which of the following fetal
meningitis, pneumonia, and sepsis. structures
Pregnant women who develop the can the nurse tell the woman are well formed
disease often deliver stillborn babies or at this time? Select all that apply.
babies who are at risk of dying postdelivery 1. Genitals.
from fulminant disease. 2. Heart.
90 3. Fingers.
A woman asks the nurse about the function 4. Alveoli.
of amniotic fluid. Which of the following 5. Kidneys.
statements by the woman indicates that Study These Flashcards
additional teaching is needed? 1, 2, 3, and 5 are correct.
1. The fluid provides fetal nutrition. 1. The genitalia are formed by the end
2. The fluid cushions the fetus from injury. of the first trimester.
3. The fluid enables the fetus to grow. 2. The heart is formed by the end of the
4. The fluid provides a stable thermal first trimester.
environment 3. The fingers are formed by the end of
Study These Flashcards the first trimester.
90. 1. The umbilical cord, not the amniotic
fluid, delivers nutrition to the developing
fetus. 5. The kidneys are formed by the end of
the first trimester.
TEST-TAKING TIP: The test taker should
TEST-TAKING TIP: The amniotic fluid is be familiar with the basic developmental
produced primarily by the fetus as fetal changes that occur during the three
urine. In addition to the functions noted trimesters. In addition, the test taker
above, the baby practices “breathing” the should be able to develop a basic timeline
amniotic fluid in and out of the lungs in of developmental milestones that
preparation for breathing air in the occur during the pregnancy. By the
extrauterine conclusion of the first trimester, all
environment. major organs are completely formed.
The maturation of the organ systems
91 must, however, still occur.
Why is it essential that women of
childbearing age be counseled to plan their 93
pregnancies? An ultrasound of a fetus’ heart shows that
1. Much of the organogenesis occurs before normal fetal circulation is occurring.
Which of the following statements should the 4. The babies will definitely be the same sex
nurse interpret as correct in relation and have the same blood type.
to the fetal circulation?
1. The foramen ovale is a hole between the Study These Flashcards
ventricles. 2. This is a true statement. Dizygotic
2. The umbilical vein contains oxygen-poor twins result from two mature ova that
blood. are fertilized.
3. The right atrium contains both oxygen-rich TEST-TAKING TIP: The best way for the
and oxygen-poor blood. test taker to differentiate between
4. The ductus venosus lies between the aorta monozygotic twinning and dizygotic
and pulmonary artery. twinning is to remember the meaning of
Study These Flashcards the prefixes to the two words. “Mono”
3. The right atrium does contain both means 1. Monozygotic twins, therefore,
oxygen-rich and oxygen-poor blood. originate from one fertilized ovum. The
babies have the same DNA; therefore,
they are the same sex. They share a
placenta
TEST-TAKING TIP: The test taker should and chorion. “Di” means 2. Dizygotic
have an understanding of fetal circulation. twins arise from 2 separately fertilized
One principle to remember when eggs. Their genetic relationship is
studying the circulation of the fetus is the same as if they were siblings born
that the blood bypasses the lungs since from different pregnancies.
the baby is receiving oxygen-rich
blood directly from the placenta via the 96
umbilical vein. The location of the three A mother has just experienced quickening.
ducts—ductus venosus, formen ovale, Which of the following developmental
ductus arteriosus—therefore, enable the changes would the nurse expect to occur at
blood to bypass the lungs. the same time in the woman’s
pregnancy?
94 1. Fetal heart begins to beat.
The nurse is teaching a couple about fetal 2. Lanugo covers the fetal body.
development. Which statement by the 3. Kidneys secrete urine.
nurse is correct about the morula stage of 4. Fingernails begin to form.
development?
1. “The fertilized egg has yet to implant into Study These Flashcards
the uterus.” 2. Lanugo does cover the fetal body at
2. “The lung fields are finally completely approximately 20 weeks’ gestation.
formed.”
3. “The sex of the fetus can be clearly
identified.” TEST-TAKING TIP: Although the test taker
4. “The eye lids are unfused and begin to need not memorize all fetal developmental
open and close.” changes, it is important to have an
Study These Flashcards understanding of major periods of
1. This is a true statement. In the development.
morula stage, about 2 to 4 days after For example, organogenesis occurs
fertilization, the fertilized egg has not during the first trimester with all of
yet implanted in the uterus. the major organs functioning at a primitive
level by week 12.
97
TEST-TAKING TIP: The morula is the A woman who is seen in the prenatal clinic is
undifferentiated ball of cells that migrates found to be 8 weeks pregnant. She
down the fallopian tube toward confides to the nurse that she is afraid her
the uterine body. The morular stage lasts baby may be “permanently damaged
from about the 2nd to the 4th day after because
fertilization. I had at least 5 beers the night I had sex.”
Which of the following responses
95 by the nurse would be appropriate?
A woman is carrying dizygotic twins. She 1. “I would let the doctor know that if I were
asks the nurse about the babies. Which of you.”
the following explanations is accurate? 2. “It is unlikely that the baby was affected.”
1. During a period of rapid growth, the 3. “Abortions during the first trimester are
fertilized egg divided completely. very safe.”
2. When the woman ovulated, she expelled 4. “An ultrasound will tell you if the baby was
two mature ova. affected.”
3. The babies share one placenta and a
common chorion. Study These Flashcards
2. This statement is true
 1. Four-chambered heart is formed.
2. Vernix caseosa is present.
TEST-TAKING TIP: The 2-week period 3. Blastocyst development is complete.
between 4. Testes have descended into the scrotal
ovulation and implantation is often sac.
called “the all or nothing period.”
During that time, the fertilized egg/ Study These Flashcards
embryo is floating freely in the woman’s The correct order is 3, 1, 2, 4.
fallopian tubes toward the uterine body.
The mother is not supplying the embryo
with nutrients at this time. Rather, the 3. The blastocyst is developed about 6 days
embryo is self-sufficient. If an insult after fertilization and before implantation
occurs—for example, a teratogen is ingested in the uterus has occurred.
or an abdominal x-ray is taken— 1. The four-chambered heart is formed
the embryo is either destroyed or completely during the early part of the first
spared. And, since the pregnancy trimester.
of the woman in the scenario was 2. Vernix caseosa is present during the latter
maintained, half of pregnancy.
the nurse can assure her that the 4. The testes descend in the scrotal sac
embryo was spared insult. about mid third trimester.
98 TEST-TAKING TIP: Before putting these
A gravida’s fundal height is noted to be at items into chronological order, the test
the xiphoid process. The nurse is aware taker should carefully analyze each
that which of the following fetal changes is choice. The blastocyst is developed by
likely to be occurring at the same time about day 6 after fertilization. The egg
in the pregnancy? has yet even to implant into the uterine
1. Surfactant is formed in the fetal lungs. body at this point. The fetal heart develops
2. Eyes begin to open and close. during the early part of the first
3. Respiratory movements begin. trimester, but after implantation. Vernix
4. The spinal column is completely formed. is present during the entire latter half of
the pregnancy in order to protect the
Study These Flashcards skin of the fetus. It appears, therefore, at
1. Surfactant is usually formed in the about week 20. And, finally, the testes do
fetal lungs by the 36th week. not descend into the scrotal sac until mid
third trimester. Indeed, male preterm babies
are often birthed before the testes
TEST-TAKING TIP: The test taker should descend.
realize that this question is asking two 100
things. First, the test taker needs to A client is having an ultrasound assessment
know what stage of pregnancy the done at her prenatal appointment at 8
woman is in when the fundal height is weeks’ gestation. She asks the nurse, “Can
at the xiphoid process. Once the test you tell what sex my baby is yet?”
taker realizes that this fundal height Which of the following responses would be
signifies 36 weeks’ gestation, he or she appropriate for the nurse to make at
must determine what other change or this time?
process is likely to be occurring at 1. “The technician did tell me the sex, but I
36 weeks. The spinal column is completely will have to let the doctor tell you
formed by the end of the first what it is.”
trimester, fetal respiratory movements 2. “The organs are completely formed and
begin at about 24 weeks, and the eyes present, but the baby is too small for
open and close at about 28 weeks. any to be seen.”
Surfactant, 3. “The technician says that the baby has a
which is essential for mature penis. It looks like you are having a boy.”
lung function, forms in the fetal lungs 4. “I am sorry. It will not be possible to see
at about 36 weeks. It is important for which sex the baby is for another
the nurse to realize that babies who are month or so.”
born preterm are high risk for a number
of reasons, including lack of surfactant, Study These Flashcards
lack of iron stores to sustain them 4. This statement is true. The sex is not
during the early months of life, and lack visible yet.
of brown adipose tissue needed for TEST-TAKING TIP: The genitourinary system
thermoregulation. is the last organ system to fully develop.
Before 12 weeks, both female and
99 male genitalia are present. The sex is
Below are four important landmarks of fetal determined
development. Please place them in genetically, but it is as yet impossible
chronological order: to determine the sex visually. If
the embryo secretes testosterone, the circulatory systems separate.”
male sex organs mature and the female 2. “When the doctor clamps the cord, the
organs recede. If the embryo does not blood stops mixing.”
secrete testosterone, the male sex organs 3. “The separation happens after the baby
recede and the female organs mature. At takes the first breath. The baby’s oxygen
8 weeks, it is not possible to determine no longer has to come from you.”
the sex of the fetus. 4. “The blood actually never mixes. Your
blood supply and the baby’s blood supply
101 are completely separate.”
Which of the following developmental
features would the nurse expect to be absent Study These Flashcards
in a 41-week gestation fetus? 4. The blood supplies are completely
1. Fingernails. separate.
2. Eye lashes. TEST-TAKING TIP: It is important to
3. Lanugo. understand
4. Milia. the relationship between the
maternal vascular system and the fetal
Study These Flashcards system. There is a maternal portion to
3. Because this baby is postterm, lanugo the placenta and a fetal portion of the
would likely not be present. placenta. By the time the placenta is fully
functioning, at about 12 weeks’ gestation,
fetal blood vessels have burrowed
TEST-TAKING TIP: Lanugo is a fine hair into the decidual lining and maternal
that covers the body of the fetus. It begins to vessels have burrowed into the chorionic
disappear at about 38 weeks and layer. The vessels, therefore, lie next to
very likely has completely vanished by each other. Gases and nutrients, then,
41 weeks’ gestation. move across the membranes of the vessels
102 in order to provide the baby with
A woman delivers a fetal demise that has needed substances and in order for the
lanugo covering the entire body, nails that mother to dispose of waste products.
are present on the fingers and toes, but eyes 104
that are still fused. Prior to the death, Please place an “X” on the drawing of the
the mother stated that she had felt cross section of a placenta at the site of
quickening. Based on this information, the gas exchange.
nurse
knows that the baby is about how many
weeks’ gestation?
1. 15 weeks.
2. 22 weeks.
3. 29 weeks.
Study These Flashcards
4. 36 weeks.
An “X” will be placed between the
Study These Flashcards neonatal and maternal vessels where gas
2. This fetus is about 22 weeks’ gestation. exchange occurs.
Nails start to develop in the first
TEST-TAKING TIP: It is important that the
trimester, and lanugo starts to develop
test taker have a complete understanding
at about 20 weeks, but eyes remain
of the anatomy and the physiology of the
fused until about 29 weeks.
placenta. Since this is the sole organ that
maintains the health and well-being of
the fetus, the nurse must be able to
TEST-TAKING TIP: The test taker should differentiate
not panic when reading a question like between the maternal portion
the one in the scenario. This is an application and the fetal portion as well as the function
question that requires the test of the structures.
taker to take things apart and put them
back together again. Each of the signs is
unique and relates to a specific period in
fetal development. After an analysis, the
only response that is plausible is response
“2.”
105
103 The nurse is reading an article that states
A client asks the nurse, “Could you explain that the maternal mortality rate in the
how the baby’s blood and my blood separate United States in the year 2000 was 17.
at delivery?” Which of the following Which of the following statements would be
responses is appropriate for the nurse to an accurate interpretation of the statement?
make? 1. There were 17 maternal deaths in the
1. “When the placenta is born, the United States in 2000 per 100,000 live
births. result in which of the imbalances.
2. There were 17 maternal deaths in the following conditions?
United States in 2000 per 100,000 women A.Bowel perforation
of childbearing age.
B.Electrolyte imbalance
3. There were 17 maternal deaths in the
C.Miscarriage
United States in 2000 per 100,000
D.Pregnancy induced
pregnancies.
4. There were 17 maternal deaths in the hypertension (PIH)
United States in 2000 per 100,000 women
in the country. 3 A 26-year old multigravida C. The alpha-fetoprotein
. is 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
fetoprotein test. She asks syndrome.
maternal
the nurse, "What does the
mortality rate is the number of
alpha-fetoprotein test
deaths of women as a result of the
childbearing period per 100,000 live indicate?" The nurse bases
births. a response on the
knowledge that this test
can detect:
TEST-TAKING TIP: One important indicator A.Kidney defects
of the quality of health care in a B.Cardiac defects
country is its maternal mortality rate. C.Neural tube defects
The rate in the United States is very low D.Urinary tract defects
as compared to many other countries in
the world. For example, the maternal 4 After the first four months A. When placental
mortality rate in sub-Saharan Africa in . of pregnancy, the chief formation is complete,
1995 was 1,100 deaths per 100,000 live source of estrogen and around the 16th week of
births. progesterone is the: pregnancy; it produces
106 A.Placenta estrogen and
B.Adrenal cortex progesterone.
C.Corpus luteum
D.Anterior hypophysis
Antepartum NCLEX questions
Study online at quizlet.com/_fvm37 5 The antagonist for A. Calcium gluconate is the
. magnesium sulfate should antidote for magnesium
1 1.21. Rho (D) immune A. Rh incompatibility can
be readily available to any toxicity. Ten ml of 10%
. globulin (RhoGAM) is occur when an Rh-negative
client receiving IV calcium gluconate is given
prescribed for a woman mom becomes sensitized
magnesium. Which of the IV push over 3-5 minutes.
following delivery of a to the Rh antigen.
following drugs is the Hydralazine is given for
newborn infant and the Sensitization may develop
antidote for magnesium sustained elevated blood
nurse provides information when an Rh-negative
toxicity? pressures in preeclamptic
to the woman about the woman becomes pregnant
A.Calcium gluconate clients.
purpose of the medication. with a fetus who is Rh
B.Hydralazine (Apresoline)
The nurse determines that positive. During pregnancy
C.Narcan
the woman understands the and at delivery, some of
D.RhoGAM
purpose of the medication the baby's Rh positive
if the woman states that it blood can enter the
will protect her next baby maternal circulation, 6 . A nurse is assisting in 1, 4, 5, and 6. The probable
from which of the causing the woman's . performing an assessment signs of pregnancy include
following? immune system to form on a client who suspects uterine enlargement,
A.Being affected by Rh antibodies against Rh that she is pregnant and is Hegar's sign (softening and
incompatibility positive blood. checking the client for thinning of the uterine
B.Having Rh positive blood Administration of Rho (D) probable signs of segment that occurs at
C.Developing a rubella immune globulin prevents pregnancy. Select all week 6), Goodell's sign
infection the woman from probable signs of (softening of the cervix that
D.Developing physiological developing antibodies pregnancy. 1.Uterine occurs at the beginning of
jaundice against Rh enlargement the 2nd month),
2.Fetal heart rate detected Chadwick's sign (bluish
by nonelectric device coloration of the mucous
2 A 21-year old client, 6 B. Excessive vomiting in
3.Outline of the fetus via membranes of the cervix,
. weeks' pregnant is clients with hyperemesis
radiography or ultrasound vagina, and vulva that
diagnosed with gravidarum often causes
4.Chadwick's sign occurs at week 6),
hyperemesis gravidarum. weight loss and fluid,
5.Braxton Hicks ballottement (rebounding
This excessive vomiting electrolyte, and acid-base
contractions of the fetus against the
during pregnancy will often
6.Ballottement examiners fingers of
 palpation), Braxton Hicks clinic and reports that she required. The woman is
contractions and a positive has been experiencing advised to curtail sexual
pregnancy test measuring vaginal bleeding. A activities until the bleeding
for hCG. Positive signs of threatened abortion is has ceased, and for 2
pregnancy include fetal suspected, and the nurse weeks following the last
heart rate detected by instructs the client evidence of bleeding or as
electronic device (Doppler) regarding management of recommended by the
at 10-12 weeks and by care. Which statement, if physician. The woman is
nonelectronic device made by the client, instructed to count the
(fetoscope) at 20 weeks indicates a need for number of perineal pads
gestation, active fetal further education? used daily and to note the
movements palpable by the 1."I will maintain strict quantity and color of blood
examiner, and an outline of bedrest throughout the on the pad. The woman
the fetus via radiography or remainder of pregnancy." also should watch for the
ultrasound. 2."I will avoid sexual evidence of the passage of
intercourse until the tissue.
7 At a prenatal visit at 36 B. Ambulation relieves bleeding has stopped, and
. weeks' gestation, a client Braxton Hicks. for 2 weeks following the
complains of discomfort last evidence of bleeding."
with irregularly occurring 3."I will count the number
contractions. The nurse of perineal pads used on a
instructs the client to: daily basis and note the
A.Lie down until they stop amount and color of blood
B.Walk around until they on the pad."
subside 4."I will watch for the
C.Time contraction for 30 evidence of the passage of
minutes tissue."
D.Take 10 grains of aspirin
for the discomfort 11 Clients with gestational A. Clients with gestational
. diabetes are usually diabetes are usually
8 The chief function of C. Progesterone stimulates managed by which of the managed by diet alone to
. progesterone is the: differentiation of the following therapies? control their glucose
A.Development of the endometrium into a A.Diet intolerance. Oral
female reproductive secretory type of tissue. B.NPH insulin (long-acting) hypoglycemic agents are
system C.Oral hypoglycemic drugs contraindicated in
B.Stimulation of the D.Oral hypoglycemic drugs pregnancy. NPH isn't
follicles for ovulation to and insulin usually needed for blood
occur glucose control for GDM.
C.Preparation of the uterus
to receive a fertilized egg 12 The developing cells are B. In the first 7-14 days the
D.Establishment of . called a fetus from the: ovum is known as a
secondary male sex A.Time the fetal heart is blastocyst; it is called an
characteristics heard embryo until the eighth
B.Eighth week to the time week; the developing cells
9 A client arrives at a 3. Accurate use of Nagele's of birth are then called a fetus until
. prenatal clinic for the first rule requires that the C.Implantation of the birth.
prenatal assessment. The woman have a regular 28- fertilized ovum
client tells a nurse that the day menstrual cycle. Add 7 D.End of the send week to
first day of her last days to the first day of the the onset of labor
menstrual period was last menstrual period,
September 19th, 2005. subtract three months, and 13 During a prenatal A. When an Rh negative
Using Nagele's rule, the then add one year to that . examination, the nurse mother carries an Rh
nurse determines the date. draws blood from a young positive fetus there is a risk
estimated date of Rh negative client and for maternal antibodies
confinement as: explain that an indirect against Rh positive blood;
1.July 26, 2006 Coombs test will be antibodies cross the
2.June 12, 2007 performed to predict placenta and destroy the
3.June 26, 2006 whether the fetus is at risk fetal RBC's.
4.July 12, 2007 for:
A.Acute hemolytic disease
10 A client in the first 1. Strict bed rest B.Respiratory distress
. trimester of pregnancy throughout the remainder syndrome
arrives at a health care of pregnancy is not C.Protein metabolic
 deficiency . functioning, the nurse plans secretion in midcycle that
D.Physiologic to include the fact that is responsible for
hyperbilirubinemia ovulation occurs when the: ovulation.
A.Oxytocin is too high
14 During a prenatal visit at .3. The fetal heart rate B.Blood level of LH is too
. 38 weeks, a nurse assesses depends in gestational age high
the fetal heart rate. The and ranges from 160-170 C.Progesterone level is high
nurse determines that the BPM in the first trimester D.Endometrial wall is
fetal heart rate is normal if but slows with fetal growth sloughed off.
which of the following is to 120-160 BPM near or at
noted? term. At or near term, if 19 In the 12th week of A.RhoGAM is given within
1.80 BPM the fetal heart rate is less . gestation, a client 72 hours postpartum if
2.100 BPM than 120 or more than 160 completely expels the the client has not been
3.150 BPM BPM with the uterus at products of conception. sensitized already.
4.180 BPM rest, the fetus may be in Because the client is Rh
distress. negative, the nurse must:
A.Admister RhoGAM within
15 An expected D. This is an expected 72 hours
. cardiopulmonary cardiopulmonary B.Make certain she
adaptation experienced by adaptation during receives RhoGAM on her
most pregnant women is: pregnancy; it is caused by first clinic visit
A.Tachycardia an increased ventricular C.Not give RhoGAM, since
B.Dyspnea at rest rate and elevated it is not used with the birth
C.Progression of diaphragm of a stillborn
dependent edema D.Make certain the client
D.Shortness of breath on does not receive RhoGAM,
exertion since the gestation only
lasted 12 weeks.
16 Gravida refers to which of B. Gravida refers to the
. the following descriptions? number of times a female 20 A nurse implements a C. Exercise is safe for the
A.A serious pregnancy has been pregnant, . teaching plan for a client with gestational
B.Number of times a regardless of pregnancy pregnant client who is diabetes and is helpful in
female has been pregnant outcome or the number of newly diagnosed with lowering the blood
C.Number of children a neonates delivered. gestational diabetes. Which glucose level.
female has delivered statement if made by the
D.Number of term client indicates a need for
pregnancies a female has further education?
had. A."I need to stay on the
diabetic diet."
17 A homecare nurse visits a 3. If the client complains B."I will perform glucose
. pregnant client who has a of a headache and blurred monitoring at home."
diagnosis of mild vision, the physician C."I need to avoid exercise
Preeclampsia and who is should be notified because of the negative
being monitored for because these are signs of effects of insulin
pregnancy induced worsening Preeclampsia. production."
hypertension (PIH). Which D."I need to be aware of
assessment finding any infections and report
indicates a worsening of signs of infection
the Preeclampsia and the immediately to my health
need to notify the care provider."
physician?
1.Blood pressure reading is 21 The nurse is aware than an D. A purplish color results
at the prenatal baseline . adaptation of pregnancy is from the increased
2.Urinary output has an increased blood supply vascularity and blood
increased to the pelvic region that vessel engorgement of the
3.The client complains of a results in a purplish vagina.
headache and blurred discoloration of the vaginal
vision mucosa, which is known
4.Dependent edema has as:
resolved A.Ladin's sign
B.Hegar's sign
18 In a lecture on sexual B. It is the surge of LH C.Goodell's sign
 D.Chadwick's sign 2.G = 2, T = 0, P = 1, A = 0, of live births or living
L =1 children. Therefore, a
22 A nurse is caring for a C. The immediate care 3.G = 1, T = 1. P = 1, A = 0, woman who is pregnant
. pregnant client with during a seizure L=1 with twins and has a child
Preeclampsia. The nurse (eclampsia) is to ensure a 4.G = 2, T = 0, P = 0, A = 0, has a gravida of 2. Because
prepares a plan of care for patent airway. The other L=1 the child was delivered at
the client and documents in options are actions that 37 weeks, the number of
the plan that if the client follow or will be preterm births is 1, and the
progresses from implemented after the number of term births is 0.
Preeclampsia to eclampsia, seizure has ceased. The number of abortions is
the nurse's first action is 0, and the number of live
to: births is 1.
A.Administer magnesium
sulfate intravenously 25 A nurse is describing the 2. Blood pumped by the
B.Assess the blood pressure . process of fetal embryo's heart leaves the
and fetal heart rate circulation to a client embryo through two
C.Clean and maintain an during a prenatal visit. umbilical arteries. Once
open airway The nurse accurately tells oxygenated, the blood then
D.Administer oxygen by the client that fetal is returned by one umbilical
face mask circulation consists of: vein. Arteries carry
1.Two umbilical veins and deoxygenated blood and
23 nurse is caring for a 3, 4, 5, 6, and 7. When one umbilical artery waste products from the
. pregnant client with caring for a client receiving 2.Two umbilical arteries fetus, and veins carry
severe preeclampsia who magnesium sulfate therapy, and one umbilical vein oxygenated blood and
is receiving IV magnesium the nurse would monitor 3.Arteries carrying provide oxygen and
sulfate. Select all nursing maternal vital signs, oxygenated blood to the nutrients to the fetus.
interventions that apply especially respirations, fetus
in the care for the client. every 30-60 minutes and 4.Veins carrying
1.Monitor maternal vital notify the physician if deoxygenated blood to
signs every 2 hours respirations are less than the fetus
2.Notify the physician if 12, because this would
respirations are less than indicate respiratory 26 A nurse is monitoring a A and C. The three classic
18 per minute. depression. Calcium . pregnant client with signs of preeclampsia are
3.Monitor renal function gluconate is kept on hand in pregnancy induced hypertension, generalized
and cardiac function case of magnesium sulfate hypertension who is at edema, and protenuria.
closely overdose, because calcium risk for Preeclampsia. The Increased respirations are
4.Keep calcium gluconate gluconate is the antidote for nurse checks the client for not a sign of preeclampsia
on hand in case of a magnesium sulfate toxicity. which specific signs of
magnesium sulfate Deep tendon reflexes are Preeclampsia (select all
overdose assessed hourly. Cardiac that apply)? A.Elevated
5.Monitor deep tendon and renal function is blood pressure
reflexes hourly monitored closely. The B.Negative urinary
6.Monitor I and O's urine output should be protein
hourly maintained at 30 ml per C.Facial edema
7.Notify the physician if hour because the D.Increased respirations
urinary output is less than medication is eliminated
30 ml per hour. through the kidneys. 27 A nurse is performing an 2. The normal range of the
. assessment of a fetal heart rate depends on
24 A nurse is collecting data 2. Pregnancy outcomes can primapira who is being gestational age. The heart
. during an admission be described with the evaluated in a clinic rate is usually 160-170 BPM
assessment of a client acronym GTPAL. G is during her second in the first trimester and
who is pregnant with gravidity, the number of trimester of pregnancy. slows with fetal growth, near
twins. The client has a pregnancies. T is term Which of the following and at term, the fetal heart
healthy 5-year old child births, the number born at indicates an abnormal rate ranges from 120-160
that was delivered at 37 term (38-41 weeks). P is physical finding BPM. The other options are
weeks and tells the nurse preterm births, the number necessitating further expected.
that she doesn't have any born before 38 weeks testing?
history of abortion or gestation. A is abortions or 1.Consistent increase in
fetal demise. The nurse miscarriages (included in fundal height
would document the gravida if before 20 weeks 2.Fetal heart rate of 180
GTPAL for this client as: gestation; included in parity BPM
1.G = 3, T = 2, P = 0, A = 0, if past 20 weeks gestation). 3.Braxton hicks
L =1 L is live births, the number contractions
 4.Quickening upward tap on the cervix

28 A nurse is providing 4. The pregnant woman 31 The nurse recognizes that C. The blood volume
. instructions to a client in should be instructed to wash . an expected change in increases by approximately
the first trimester of the breasts with warm water the hematologic system 40-50% during pregnancy.
pregnancy regarding and keep them dry. The that occurs during the The peak blood volume
measures to assist in woman should be instructed 2nd trimester of occurs between 30 and 34
reducing breast to avoid using soap on the pregnancy is: weeks of gestation. The
tenderness. The nurse nipples and areola area to A.A decrease in WBC's hematocrit decreases as a
tells the client to: prevent the drying of tissues. B.In increase in result of the increased blood
1.Avoid wearing a bra Wearing a supportive bra hematocrit volume.
2.Wash the nipples and with wide adjustable straps C.An increase in blood
areola area daily with can decrease breast volume
soap, and massage the tenderness. Tight-fitting D.A decrease in
breasts with lotion. blouses or dresses will cause sedimentation rate
3.Wear tight-fitting discomfort (especially on
blouses or dresses to test days, even if you're not 32 The nurse teaches a B. This is because impedance
provide support pregnant. Yo.). . pregnant woman to of venous return by the
4.Wash the breasts with avoid lying on her back. gravid uterus, which causes
warm water and keep The nurse has based this hypotension and decreased
them dry statement on the systemic perfusion.
knowledge that the
29 A nurse is reviewing the 1. In the early weeks of supine position can:
. record of a client who pregnancy the cervix A.Unduly prolong labor
has just been told that a becomes softer as a result of B.Cause decreased
pregnancy test is increased vascularity and placental perfusion
positive. The physician hyperplasia, which causes C.Lead to transient
has documented the the Goodell's sign episodes of hypotension
presence of a Goodell's D.Interfere with free
sign. The nurse movement of the coccyx
determines this sign
indicates: 33 A nursing instructor asks 3. Quickening is fetal
1.A softening of the . a nursing student who is movement and may occur as
cervix preparing to assist with early as the 16th and 18th
2.A soft blowing sound the assessment of a week of gestation, and the
that corresponds to the pregnant client to mother first notices subtle
maternal pulse during describe the process of fetal movements that
auscultation of the quickening. Which of the gradually increase in
uterus. following statements if intensity. Braxton Hicks
3.The presence of hCG in made by the student contractions are irregular,
the urine indicates an painless contractions that
4.The presence of fetal understanding of this may occur throughout the
movement term? pregnancy. A thinning of the
1."It is the irregular, lower uterine segment
30 A nurse midwife is 4. Ballottement is a painless contractions occurs about the 6th week of
. performing an technique of palpating a that occur throughout pregnancy and is called
assessment of a pregnant floating structure by pregnancy." Hegar's sign.
client and is assessing bouncing it gently and 2."It is the soft blowing
the client for the feeling it rebound. In the sound that can be heard
presence of technique used to palpate when the uterus is
ballottement. Which of the fetus, the examiner auscultated."
the following would the places a finger in the vagina 3."It is the fetal
nurse implement to test and taps gently upward, movement that is felt by
for the presence of causing the fetus to rise. The the mother."
ballottement? fetus then sinks, and the 4."It is the thinning of
1.Auscultating for fetal examiner feels a gentle tap the lower uterine
heart sounds on the finger. segment."
2.Palpating the abdomen
for fetal movement 34 A nursing instructor is A. FSH and LH, when
3.Assessing the cervix for . conducting lecture and is stimulated by gonadotropin-
thinning reviewing the functions releasing hormone from the
4.Initiating a gentle of the female hypothalamus, are released
reproductive system. from the anterior pituitary
 She asks Mark to gland to stimulate follicular 4.Plantar flex the foot
describe the follicle- growth and development, while extending the knee
stimulating hormone growth of the graafian when the cramps occur.
(FSH) and the luteinizing follicle, and production of
hormone (LH). Mark progesterone. 38 A pregnant client in the 1. Severe Preeclampsia can
accurately responds by . last trimester has been trigger disseminated
stating that: admitted to the hospital intravascular coagulation
A.FSH and LH are with a diagnosis of (DIC; remember the Peds
released from the severe preeclampsia. A lecture?) because of the
anterior pituitary gland. nurse monitors for widespread damage to
B.FSH and LH are complications associated vascular integrity. Bleeding is
secreted by the corpus with the diagnosis and an early sign of DIC and
luteum of the ovary assesses the client for: should be reported to the
C.FSH and LH are 1.Any bleeding, such as M.D
secreted by the adrenal in the gums, petechiae,
glands and purpura.
D.FSH and LH stimulate 2.Enlargement of the
the formation of milk breasts
during pregnancy. 3.Periods of fetal
movement followed by
35 Nutritional planning for B. This is the recommended quiet periods
. a newly pregnant caloric increase for adult 4.Complaints of feeling
woman of average women to meet the hot when the room is
height and weighing 145 increased metabolic cool
pounds should include: demands of pregnancy.
A.A decrease of 200 39 A pregnant client is C. 5 pregnancies; 2 term
calories a day . making her first births; twins count as 1; one
B.An increase of 300 Antepartal visit. She has abortion; 4 living children.
calories a day a two year old son born
C.An increase of 500 at 40 weeks, a 5 year old
calories a day daughter born at 38
D.A maintenance of her weeks, and 7 year old
present caloric intake twin daughters born at
per day 35 weeks. She had a
spontaneous abortion 3
36 The pituitary hormone A. Prolactin is the hormone years ago at 10 weeks.
. that stimulates the from the anterior pituitary Using the GTPAL format,
secretion of milk from gland that stimulates the nurse should identify
the mammary glands is: mammary gland secretion. that the client is:
A.Prolactin Oxytocin, a posterior A.G4 T3 P2 A1 L4
B.Oxytocin pituitary hormone, B.G5 T2 P2 A1 L4
C.Estrogen stimulates the uterine C.G5 T2 P1 A1 L4
D.Progesterone musculature to contract and D.G4 T3 P1 A1 L4
causes the "let down" reflex
40 A pregnant client is D. Magnesium toxicity can
37 A pregnant client calls 1. Legs cramps occur when . receiving magnesium occur from magnesium
. the clinic and tells a the pregnant woman sulfate for the sulfate therapy. Signs of
nurse that she is stretches the leg and plantar management of toxicity relate to the central
experiencing leg cramps flexes the foot. Dorsiflexion preeclampsia. A nurse nervous system depressant
and is awakened by the of the foot while extending determines the client is effects of the medication
cramps at night. To the knee stretches the experiencing toxicity and include respiratory
provide relief from the affected muscle, prevents from the medication if depression, loss of deep
leg cramps, the nurse the muscle from contracting, which of the following is tendon reflexes, and a
tells the client to: and stops the cramping. noted on assessment? sudden drop in the fetal
1.Dorsiflex the foot while A.Presence of deep heart rate and maternal
extending the knee when tendon reflexes heart rate and blood
the cramps occur B.Serum magnesium pressure. Therapeutic levels
2.Dorsiflex the foot while level of 6 mEq/L of magnesium are 4-7
flexing the knee when C.Proteinuria of +3 mEq/L. Proteinuria of +3
the cramps occur D.Respirations of 10 per would be noted in a client
3.Plantar flex the foot minute with preeclampsia.
while flexing the knee
when the cramps occur
41 A pregnant woman at 32 D. During a fundal height 44 A primagravida is C. Magnesium sulfate
. weeks' gestation measurement the woman is . receiving magnesium depresses the respiratory
complains of feeling dizzy placed in a supine position. sulfate for the treatment rate. If the respiratory rate is
and lightheaded while This woman is experiencing of pregnancy induced less than 12 breaths per
her fundal height is being supine hypotension as a hypertension (PIH). The minute, the physician or
measured. Her skin is result of uterine nurse who is caring for other health care provider
pale and moist. The compression of the vena the client is performing needs to be notified, and
nurse's initial response cava and abdominal aorta. assessments every 30 continuation of the
would be to: A.Assess the Turning her on her side will minutes. Which medication needs to be
woman's blood pressure remove the compression assessment finding would reassessed. A urinary output
and pulse and restore cardiac output be of most concern to the of 20 ml in a 30 minute
B.Have the woman and blood pressure. Then nurse? period is adequate; less than
breathe into a paper bag vital signs can be assessed. A.Urinary output of 20 ml 30 ml in one hour needs to
C.Raise the woman's legs Raising her legs will not since the previous be reported. Deep tendon
D.Turn the woman on solve the problem since assessment reflexes of 2+ are normal.
her side. pressure will still remain on B.Deep tendon reflexes The fetal heart rate is WNL
the major abdominal blood of 2+ for a resting fetus.
vessels, thereby continuing C.Respiratory rate of 10
to impede cardiac output. BPM
Breathing into a paper bag is D.Fetal heart rate of 120
the solution for dizziness BPM
related to respiratory
alkalosis associated with 45 When involved in B. The increase of estrogen
hyperventilation. . prenatal teaching, the during pregnancy causes
nurse should advise the hyperplasia of the vaginal
42 A pregnant woman's last A. Nägele's rule requires clients that an increase in mucosa, which leads to
. menstrual period began subtracting 3 months and vaginal secretions during increased production of
on April 8, 2005, and adding 7 days and 1 year if pregnancy is called mucus by the endocervical
ended on April 13. Using appropriate to the first day leukorrhea and is caused glands. The mucus contains
Nägele's rule her of a pregnant woman's last by increased: exfoliated epithelial cells.
estimated date of birth menstrual period. When this A.Metabolic rates
would be: rule, is used with April 8, B.Production of estrogen
A.January 15, 2006 2005, the estimated date of C.Functioning of the
B.January 20, 2006 birth is January 15, 2006. Bartholin glands
C.July 1, 2006 D.Supply of sodium
D.November 5, 2005 chloride to the cells of
the vagina
43 A prenatal nurse is 3. All pregnant women
. providing instructions to should be advised to do the 46 Which of the following D. Only nutrients and waste
a group of pregnant client following to prevent the . answers best describes products are transferred
regarding measures to development of the stage of pregnancy in across the placenta. Blood
prevent toxoplasmosis. toxoplasmosis. Women which maternal and fetal exchange only occurs in
Which statement if made should be instructed to cook blood are exchanged? complications and some
by one of the clients meats thoroughly, avoid A.Conception medical procedures
indicates a need for touching mucous B.9 weeks' gestation, accidentally.
further instructions? 1."I membranes and eyes while when the fetal heart is
need to cook meat handling raw meat; well developed
thoroughly." thoroughly wash all kitchen C.32-34 weeks gestation
2."I need to avoid surfaces that come into D.maternal and fetal
touching mucous contact with uncooked blood are never
membranes of the mouth meat, wash the hands exchanged
or eyes while handling thoroughly after handling
raw meat." raw meat; avoid uncooked 47 Which of the following C. Hemoglobin and
3."I need to drink eggs and unpasteurized . conditions is common in hematocrit levels decrease
unpasteurized milk only." milk; wash fruits and pregnant women in the during pregnancy as the
4."I need to avoid contact vegetables before 2nd trimester of increase in plasma volume
with materials that are consumption, and avoid pregnancy? A.Mastitis exceeds the increase in red
possibly contaminated contact with materials that B.Metabolic alkalosis blood cell production.
with cat feces." possibly are contaminated C.Physiologic anemia
with cat feces, such as cat D.Respiratory acidosis
litter boxes, sand boxes, and
garden soil. 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 months.
in 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
chest during pregnancy? line 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 eclampsia (seizures).
for 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.