Chapter 13

Question 1

1. A woman’s obstetric history indicates that she is pregnant for the fourth time, and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?
   a. 3-1-1-1-3
   b. 4-1-2-0-4
   c. 3-0-3-0-3
   d. 4-2-1-0-3

Answer 1

ANS: B
Using the GTPAL system, 4-1-2-0-4 is the correct calculation of this woman’s gravidity and parity. The numbers reflect the woman’s gravidity and parity information. Her information is calculated as: G reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies resulted in a fetus at term. P is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L signifies the number of children born who are currently living; the woman has four children. 3-1-1-1-3 is an incorrect calculation of this woman’s gravidity and parity; 3-0-3-0-3 is an incorrect calculation of this woman’s gravidity and parity; and 4-2-1-0-3 is an incorrect calculation of this woman’s gravidity and parity.

Question 2

2. Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation?
   a. Amenorrhea
   b. Positive pregnancy test
   c. Chadwick sign
   d. Hegar sign

Answer 2

ANS: A
Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. A positive pregnancy test and the presence of the Chadwick and Hegar signs are all probable signs of pregnancy.

Question 3

3. A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At which level does the nurse expect to palpate the fundus?
   a. Nonpalpable above the symphysis at 14 weeks of gestation
   b. Slightly above the symphysis pubis
   c. At the level of the umbilicus
   d. Slightly above the umbilicus

Answer 3

ANS: B
In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. At 14 weeks, the uterus is not yet at the level of the umbilicus. The fundus is not palpable above the umbilicus until 22 to 24 weeks of gestation.

Question 4

4. The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect?
   a. Her center of gravity will shift backward.
   b. She will have increased lordosis.
   c. She will have increased abdominal muscle tone.
   d. She will notice decreased mobility of her pelvic joints.

Answer 4

ANS: B
An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain balance. The center of gravity shifts forward. She will have decreased abdominal muscle tone and will notice increased mobility of her pelvic joints.

Question 5

5. A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman’s last menstrual period and asks whether she is taking any medications. The client states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?
   a. The pregnancy test was taken too early.
   b. Anticonvulsant medications may cause the false-positive test result.
   c. The woman has a fibroid tumor.
   d. She has been under considerable stress and has a hormone imbalance.

Answer 5

ANS: B
Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use enzyme-linked immunosorbent assay (ELISA) technology, which can yield positive results as soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, then she would be into her third week at this point (having missed her period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on human chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect hCG levels or produce positive pregnancy test results.

Question 6

6. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. Which statement best describes why this may be happening to this client?
   a. This respiratory change is normal in pregnancy and caused by an elevated level of estrogen.
   b. This cardiovascular change is abnormal, and the nosebleeds are an ominous sign.
   c. The woman is a victim of domestic violence and is being hit in the face by her partner.
   d. The woman has been intranasally using cocaine.

Answer 6

ANS: A
Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in the lower extremities. Domestic violence cannot be determined on the basis on the sparse facts provided. If the woman had been hit in the face, then she most likely would have additional physical findings. Cocaine use cannot be determined on the basis on the sparse facts provided.

Question 7

7. The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct?
   a. The visibility of blood vessels that form an intertwining blue network indicates full function of the Montgomery tubercles and possibly an infection of the tubercles.
   b. The mammary glands do not develop until 2 weeks before labor.
   c. Lactation is inhibited until the estrogen level declines after birth.
   d. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

Answer 7

ANS: C
Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by midpregnancy. Colostrum is a creamy white-to-yellow premilk fluid that can be expressed from the nipples before birth.

Question 8

8. Which hormone is essential for maintaining pregnancy?
   a. Estrogen
   b. hCG
   c. Oxytocin
   d. Progesterone

Answer 8

ANS: D
Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles, which reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels rise at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

Question 9

9. Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia?
   a. Ptyalism
   b. Pyrosis
   c. Pica
   d. Decreased peristalsis

Answer 9

ANS: C
Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Cravings include ice, clay, and laundry starch. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings.

Question 10

10. Why might it be more difficult to diagnose appendicitis during pregnancy?
    a. The appendix is displaced upward and laterally, high and to the right.
    b. The appendix is displaced upward and laterally, high and to the left.
    c. The appendix is deep at the McBurney’s point.
    d. The appendix is displaced downward and laterally, low and to the right.

Answer 10

ANS: A
The appendix is displaced high and to the right, not to the left. It is displaced beyond the McBurney’s point and is not displaced in a downward direction.

Question 11

11. The nurse is providing health education to a pregnant client regarding the cardiovascular system. Which information is correct and important to share?
    a. A pregnant woman experiencing disturbed cardiac rhythm, such as sinus arrhythmia, requires close medical and obstetric observation no matter how healthy she may appear otherwise.
    b. Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks of gestation to term.
    c. Palpitations are twice as likely to occur in twin gestations.
    d. All of the above changes will likely occur.

Answer 11

ANS: B
These auscultatory changes should be discernible after 20 weeks of gestation. A healthy woman with no underlying heart disease does not need any therapy. The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double. Auditory changes are discernible at 20 weeks of gestation.

Question 12

12. Which statement regarding the probable signs of pregnancy is most accurate?
    a. Determined by ultrasound
    b. Observed by the health care provider
    c. Reported by the client
    d. Confirmed by diagnostic tests

Answer 12

ANS: B
Probable signs are those detected through trained examination. Fetal visualization is a positive sign of pregnancy. Presumptive signs are those reported by the client. The term diagnostic tests is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy.

Question 13

13. Which time-based description of a stage of development in pregnancy is correct?
    a. Viability—22 to 37 weeks of gestation since the last menstrual period (assuming a fetal weight greater than 500 g)
    b. Term—pregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks of gestation
    c. Preterm—pregnancy from 20 to 28 weeks of gestation
    d. Postdate—pregnancy that extends beyond 38 weeks of gestation

Answer 13

ANS: B
Term is 38 to 42 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since the last menstrual period. Preterm is 20 to 37 weeks of gestation. Postdate or postterm is a pregnancy that extends beyond 42 weeks of gestation or what is considered the limit of full term.

Question 14

14. hCG is an important biochemical marker for pregnancy and therefore the basis for many tests. Which statement regarding hCG is true?
    a. hCG can be detected as early as weeks after conception.
    b. hCG levels gradually and uniformly increase throughout pregnancy.
    c. Significantly lower-than-normal increases in the levels of hCG may indicate a postdate pregnancy.
    d. Higher-than-normal levels of hCG may indicate an ectopic pregnancy or Down syndrome.

Answer 14

ANS: D
Higher hCG levels also could be a sign of a multiple gestation. hCG can be detected as early as 7 to 10 days after conception. The hCG levels fluctuate during pregnancy, peaking, declining, stabilizing, and then increasing again. Abnormally slow increases may indicate impending miscarriage.

Question 15

15. Of which physiologic alteration of the uterus during pregnancy is it important for the nurse to alert the patient?
    a. Lightening occurs near the end of the second trimester as the uterus rises into a different position.
    b. Woman’s increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening.
    c. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise.
    d. Uterine souffle is the movement of the fetus.

Answer 15

ANS: B
The softening of the lower uterine segment is called the Hegar sign. In this position, the uterine fundus presses on the bladder, causing urinary frequency that is a normal change of pregnancy. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

Question 16

16. What is the correct term used to describe the mucous plug that forms in the endocervical canal?
    a. Operculum
    b. Leukorrhea
    c. Funic souffle
    d. Ballottement

Answer 16

ANS: A
The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

Question 17

17. Some pregnant clients may complain of changes in their voice and impaired hearing. What should the nurse explain to the client concerning these findings?
    a. Voice changes are caused by decreased estrogen levels.
    b. Displacement of the diaphragm results in thoracic breathing.
    c. Voice changes and impaired hearing are due to the results of congestion and swelling of the upper respiratory tract.
    d. Increased blood volume causes changes in the voice.

Answer 17

ANS: C
Although the diaphragm is displaced and the volume of blood is increased, neither causes changes in the voice nor impairs hearing. The key is that estrogen levels increase, not decrease, which causes the upper respiratory tract to become more vascular, which produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing.

Question 18

18. Which renal system adaptation is an anticipated anatomic change of pregnancy?
    a. Increased urinary output makes pregnant women less susceptible to urinary infections.
    b. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty.
    c. Renal (kidney) function is more efficient when the woman assumes a supine position.
    d. Using diuretic agents during pregnancy can help keep kidney function regular.

Answer 18

ANS: B
Bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often, even when the bladder is almost empty. A number of anatomic changes in pregnancy make a woman more susceptible to urinary tract infections. Renal function is more efficient when the woman lies in the lateral recumbent position and is less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems.

Question 19

19. A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding?
    a. Melasma
    b. Linea nigra
    c. Striae gravidarum
    d. Palmar erythema

Answer 19

ANS: A
Melasma, (also called chloasma, the mask of pregnancy), usually fades after birth. This hyperpigmentation of the skin is more common in women with a dark complexion. Melasma appears in 50% to 70% of pregnant women. Linea nigra is a pigmented line that runs vertically up the abdomen. Striae gravidarum are also known as stretch marks. Palmar erythema is signified by pinkish red blotches on the hands.

Question 20

20. Which gastrointestinal alteration of pregnancy is a normal finding?
    a. Insufficient salivation (ptyalism) is caused by increases in estrogen.
    b. Acid indigestion (pyrosis) begins early but declines throughout pregnancy.
    c. Hyperthyroidism often develops (temporarily) because hormone production increases.
    d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

Answer 20

ANS: D
Normal nausea and vomiting rarely produce harmful effects and may be less likely to result in miscarriage or preterm labor. Ptyalism is excessive salivation that may be caused by a decrease in unconscious swallowing or by stimulation of the salivary glands. Pyrosis begins as early as the first trimester and intensifies through the third trimester. Increased hormone production does not lead to hyperthyroidism in pregnant women.

Question 21

21. A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that these are Braxton Hicks contractions. What other information is important for the nurse to share?
    a. Braxton Hicks contractions should be painless.
    b. They may increase in frequency with walking.
    c. These contractions might cause cervical dilation.
    d. Braxton Hicks contractions will impede oxygen flow to the fetus.

Answer 21

ANS: A
Soon after the fourth month of gestation, uterine contractions can be felt through the abdominal wall. Braxton Hicks contractions are regular and painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying. This type of contraction usually ceases with walking or exercise. Braxton Hicks contractions can be mistaken for true labor; however, they do not increase in intensity, frequency, or cause cervical dilation. These contractions facilitate uterine blood flow through the intervillous spaces of the placenta and thereby promote oxygen delivery to the fetus.

Question 22

22. Pregnancy hormones prepare the vagina for stretching during labor and birth. Which change related to the pelvic viscera should the nurse share with the client?
    a. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are easier to evaluate.
    b. Quickening is a technique of palpating the fetus to engage it in passive movement.
    c. The deepening color of the vaginal mucosa and cervix (Chadwick sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor.
    d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

Answer 22

ANS: D
Increased sensitivity and an increased interest in sex sometimes go together and frequently occur during the second trimester. These cervical changes make evaluation of abnormal Pap tests more difficult. Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. The Chadwick sign appears from the 6 to 8 weeks of gestation.

Question 23

23. Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth?
    a. Epulis
    b. Chloasma
    c. Telangiectasia
    d. Striae gravidarum

Answer 23

ANS: D
Striae gravidarum, or stretch marks, reflect a separation within the underlying connective tissue of the skin. They usually fade after birth, although they never completely disappear. An epulis is a red, raised nodule on the gums that easily bleeds; it disappears or shrinks after giving birth. Chloasma, or the mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasia, or vascular spiders, are tiny, star-shaped or branchlike, slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen and usually disappear after birth.

Question 24

24. What is the correct term for a woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability?
    a. Primipara
    b. Primigravida
    c. Multipara
    d. Nulligravida

Answer 24

ANS: A
A primipara is a woman who has completed one pregnancy with a viable fetus. To help remember the terms: gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. Therefore, a primigravida is a woman pregnant for the first time; a multipara is a woman who has completed two or more pregnancies with a viable fetus; and a nulligravida is a woman who has never been pregnant.

Question 25

25. To reassure and educate their pregnant clients regarding changes in their blood pressure, nurses should be cognizant of what?
    a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high.
    b. Shifting the client’s position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit.
    c. Systolic blood pressure slightly increases as the pregnancy advances; diastolic pressure remains constant.
    d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy.

Answer 25

ANS: D
Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy. This compression also leads to varicose veins in the legs and vulva. The tightness of a blood pressure cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as the pregnancy advances. The diastolic blood pressure first decreases and then gradually increases.

Question 26

26. Which finding in the urinalysis of a pregnant woman is considered a variation of normal?
    a. Proteinuria
    b. Glycosuria
    c. Bacteria in the urine
    d. Ketones in the urine

Answer 26

ANS: B
Small amounts of glucose may indicate physiologic spilling. The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

Question 27

27. Cardiac output increases from 30% to 50% by the 32nd week of pregnancy. What is the rationale for this change?
    a. To compensate for the decreased renal plasma flow
    b. To provide adequate perfusion of the placenta
    c. To eliminate metabolic wastes of the mother
    d. To prevent maternal and fetal dehydration

Answer 27

ANS: B
The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume.

Question 28

28. Which statement best describes the rationale for the physiologic anemia that occurs during pregnancy?
    a. Physiologic anemia involves an inadequate intake of iron.
    b. Dilution of hemoglobin concentration occurs in pregnancy with physiologic anemia.
    c. Fetus establishes the iron stores.
    d. Decreased production of erythrocytes occur.

Answer 28

ANS: B
When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman has physiologic anemia, which is the result of the dilution of hemoglobin concentration rather than inadequate hemoglobin. An inadequate intake of iron may lead to true anemia. The production of erythrocytes increases during pregnancy.

Question 29

29. A patient in her first trimester complains of nausea and vomiting. She asks, “Why does this happen?” What is the nurse’s best response?
    a. “Nausea and vomiting are due to an increase in gastric motility.”
    b. “Nausea and vomiting may be due to changes in hormones.”
    c. “Nausea and vomiting are related to an increase in glucose levels.”
    d. “Nausea and vomiting are caused by a decrease in gastric secretions.”

Answer 29

ANS: B
Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Although gastric secretions decrease, these secretions are not the primary cause of the nausea and vomiting.

Question 30

1. The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that apply.)
   a. Identification of fetal heartbeat
   b. Palpation of fetal outline
   c. Visualization of the fetus
   d. Verification of fetal movement
   e. Positive hCG test

Answer 30

ANS: A, C, D
Identification of a fetal heartbeat, the visualization of the fetus, and verification of fetal movement are all positive, objective signs of pregnancy. Palpation of fetal outline and positive hCG test are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests.

Question 31

2. A woman is in for a routine prenatal checkup. The nurse is assessing her urine for glycosuria and proteinuria. Which findings are considered normal? (Select all that apply.)
   a. Dipstick assessment of trace to +1
   b. 300 mg/24 hours
   e. Albumin

Answer 31

ANS: A, B, E
Small amounts of protein in the urine are acceptable during pregnancy. The presence of protein in greater amounts may indicate renal problems. A dipstick assessment of +2 and proteinuria >300 mg/24 hours, and albuminuria greater than 30 mg/24 hours are excessive and should be further evaluated.

Question 32

3. During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criterion? (Select all that apply.)
   a. Leukorrhea
   b. Development of the operculum
   c. Quickening
   d. Ballottement
   e. Lightening

Answer 32

ANS: C, D, E
Quickening is the first recognition of fetal movements or “feeling life.” Quickening is often described as a flutter and is felt earlier in the multiparous woman than in the primiparous woman. Passive movement of the unengaged fetus is referred to as ballottement. Lightening occurs when the fetus begins to descend into the pelvis and occurs 2 weeks before labor in the nulliparous woman and at the start of labor in the multiparous woman. Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Mucus fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy.

Question 33

4. Pregnancy is a hypercoagulable state in which women are at a fivefold to sixfold increased risk for thromboembolic disease. The tendency for blood to clot is greater, attributable to an increase in various clotting factors. Which of these come into play during pregnancy? (Select all that apply.)
   a. Factor VII
   b. Factor VIII
   c. Factor IX
   d. Factor XIII
   e. Fibrinogen

Answer 33

ANS: A, B, C, E
Factors VII, VIII, IX, X, and fibrinogen increase in pregnancy. Factors that inhibit coagulation decrease. Fibrinolytic activity (dissolving of a clot) is depressed during pregnancy and the early postpartum period to protect the women from postpartum hemorrhage.

Question 34

1. To provide optimal prenatal care, a blood pressure reading should be obtained at every prenatal visit. Calculating the mean arterial pressure (MAP) can increase the value of this diagnostic finding. MAP readings for a pregnant woman at term are 90+ = 5.8 mm Hg. The nurse has just obtained a BP of 106/70 mm Hg on a 37-week primiparous client. The formula for the MAP reading is (systolic + [2 x diastolic]) divided by 3. The MAP reading for this client is _____ mm Hg.

Answer 34

ANS:	
82 
(106 + [2 x 70]) divided by 3
(106 + 140) divided by 3
246 divided by 3 = 82 mm Hg

The MAP can also be thought of as the mean of the blood pressure present in arterial circulation.

Question 35

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity according to the GTPAL system?

a. 2-0-0-1-1
b. 2-1-0-1-0
c. 3-1-0-1-0
d. 3-0-1-1-0

Answer 35

Ans: C
According to the GPTAL system, this woman’s gravidity and parity information is calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time)
T: Number of pregnancies carried to term (only one pregnancy resulted in a fetus at term)
P: Number of pregnancies that resulted in a preterm birth (none)
A: Abortions or miscarriages before the period of viability (she has had one)
L: Number of children born who are currently living (she has no living children)
3-1-0-1-0 is the correct calculation of this woman’s gravidity and parity.

Question 36

Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)?

a. Radioimmunoassay
b. Radioreceptor assay
c. Latex agglutination test
d. Enzyme-linked immunosorbent assay (ELISA)

Answer 36

Ans: D
OTC pregnancy tests use ELISA for its one-step, accurate results. Radioimmunoassays test for the subunit of hCG in serum or urine samples and must be performed in the laboratory. The radioreceptor assay is a serum test that measures the ability of a blood sample to inhibit the binding of hCG to receptors. The latex agglutination test in no way determines pregnancy. Rather it is done to detect specific antigens and antibodies.

Question 37

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse’s instructions if she states that a positive sign of pregnancy is:

a. A positive pregnancy test result.
b. Fetal movement palpated by the nurse-midwife.
c. Braxton Hicks contractions.
d. Quickening.

Answer 37

Ans: B
Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat and palpating fetal movement. A positive pregnancy test result and Braxton Hicks contractions are probable signs of pregnancy. Quickening is a presumptive sign of pregnancy.

Question 38

During a client’s physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as:

a. Hegar sign.
b. McDonald sign.
c. Chadwick sign.
d. Goodell sign.

Answer 38

Ans: A
At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The Chadwick sign is a blue-violet cervix caused by increased vascularity; it is seen around the fourth week of gestation. Softening of the cervical tip, which may be observed around the sixth week of pregnancy, is called the Goodell sign. (The McDonald’s sign indicates a fast-food restaurant.)

Question 39

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?

a. Less audible heart sounds (S1, S2)
b. Increased pulse rate
c. Increased blood pressure
d. Decreased red blood cell (RBC) production

Answer 39

Ans: B
Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

Question 40

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a:

a. Primipara
b. Primigravida
c. Multipara
d. Nulligravida

Answer 40

Ans: A
A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.

Question 41

Which presumptive sign (felt by woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause(s)?

a. Amenorrhea—stress, endocrine problems
b. Quickening—gas, peristalsis
c. Goodell sign—cervical polyps
d. Chadwick sign—pelvic congestion

Answer 41

Ans: C
Goodell sign might be the result of pelvic congestion, not polyps. Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Chadwick sign might be the result of pelvic congestion.

Question 42

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that:

a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high.
b. Shifting the client’s position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit.
c. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant.
d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.

Answer 42

Ans: D
In addition to hemorrhoids, compression of the iliac veins and inferior vena cava by the uterus also leads to varicose veins in the legs and vulva. The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, each blood pressure measurement should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases.

Question 43

Which hematocrit (HCT) and hemoglobin (HGB) results represent the lowest acceptable values for a woman in the third trimester of pregnancy?

a. 38% HCT; 14 g/dL HGB
b. 35% HCT; 13 g/dL HGB
c. 33% HCT; 11 g/dL HGB
d. 32% HCT; 10.5 g/dL HGB

Answer 43

Ans: C
38% HCT; 14 g/dL HGB and 35% HCT; 13 g/dL HGB are within normal limits in a nonpregnant woman. 33% HCT; 11 g/dL HGB represents the lowest acceptable values during the first and the third trimesters, and 32% HCT; 10.5 g/dl HGB represents the lowest acceptable values for the second trimester, when the hemodilution effect of blood volume expansion is at its peak.

Question 44

A pregnant patient is experiencing some integumentary changes and is concerned that they may represent abnormal findings. The nurse provides information to the patient that the following findings would be considered “normal abnormal” findings during pregnancy so that she should not be alarmed. (Select all that apply.)

a. Facial edema
b. Melasma
c. Linea nigra
d. Superficial thrombophlebitis
e. Vascular spiders
f. Allodynia

Answer 44

Ans: B, C, E
Facial edema is a concern because it can represent toxemia of pregnancy. Superficial thrombophlebitis is a concern because it can represent a risk factor for development of a DVT during pregnancy. The presentation of allodynia (pain upon normal touch) is considered to be a significant finding and requires additional investigation. Melasma (also known as the mask of pregnancy or chloasma), linea nigra (a hyperpigmentation line extending from the fundus to the symphysis pubis), and the presence of vascular spiders are all considered to be normal abnormal findings in pregnancy.