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Flashcards in Chapter 14 Deck (54):
1

1. Ideally, when should prenatal care begin?
a. Before the first missed menstrual period
b. After the first missed menstrual period
c. After the second missed menstrual period
d. After the third missed menstrual period


ANS: B
Prenatal care should begin soon after the first missed menstrual period. This offers the greatest opportunities to ensure the health of the expectant mother and her infant. Prenatal care before missing the first menstrual period is too early. It is unlikely the woman is even aware of the pregnancy. Ideally, prenatal visits should begin soon after the first period is missed. Beginning prenatal care after the third missed menstrual period is too late. The woman will have completed the first trimester by that time.

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2. A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the client’s expected date of birth (EDB)?
a. September 17, 2015
b. November 7, 2015
c. November 21, 2015
d. December 17, 2015

ANS: C
Using the Nägele’s rule, the EDB is calculated by subtracting 3 months from the month of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2015, her due date is November 21, 2015. September 17, 2015, is too short a period to complete a normal pregnancy. Using the Nägele’s rule, an EDB of November 7, 2015, is 2 weeks early. December 17, 2015, is almost a month past the correct EDB.

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3. Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)?
a. All women, regardless of risk factors
b. Women who have had more than one sexual partner
c. Women who have had a sexually transmitted infection (STI)
d. Woman who are monogamous with one partner

ANS: A
An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated.

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4. Which sign or symptom is considered a first-trimester warning sign and should be immediately reported by the pregnant woman to her health care provider?
a. Nausea with occasional vomiting
b. Fatigue
c. Urinary frequency
d. Vaginal bleeding

ANS: D
Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of complications of the pregnancy. Nausea with occasional vomiting is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it is not usually an indication of a problem with the pregnancy. Fatigue is common during the first trimester. Because of physiologic changes that happen during pregnancy, clients should be taught that urinary frequency is normal.

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5. Which client might be well advised to continue condom use during intercourse throughout her pregnancy?
a. Unmarried pregnant women
b. Women at risk for acquiring or transmitting STIs
c. All pregnant women
d. Women at risk for candidiasis

ANS: B
The objective of safer sex is to provide prophylaxis against the acquisition and transmission of STIs. Because these diseases may be transmitted to the woman and then to her fetus, condom use is recommended throughout the pregnancy if the woman is at risk for acquiring an STI. Pregnant women are encouraged to practice safer sex behaviors. An unmarried pregnant woman may be in a monogamous relationship and not require the use of a condom. The client should be educated as to what may place both herself and her fetus at risk. Any pregnant woman can develop candidiasis, which is an infection not related to condom use.

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6. Which condition is likely to be identified by the quadruple marker screen?
a. Down syndrome
b. Diaphragmatic hernia
c. Congenital cardiac abnormality
d. Anencephaly

ANS: A
The maternal serum level marker of alpha-fetoprotein is used to screen for Down syndrome, trisomy 18, neural tube defects, and other chromosomal anomalies. The quadruple-marker screen will not detect diaphragmatic hernia. Additional testing, such as ultrasonography, is required to diagnose diaphragmatic hernia. Congenital cardiac abnormality will most likely be identified during an ultrasound examination. The quadruple-marker screen will not detect anencephaly.

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7. A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. Which intervention should the nurse recommend?
a. Kegel exercises
b. Pelvic rock exercises
c. Softer mattress
d. Bed rest for 24 hours

ANS: B
Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Stretching and other exercises to relieve back pain should be performed several times a day. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain.

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8. A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she does not know what is happening; one minute she is happy that she is pregnant and the next minute she cries for no reason. Which response by the nurse is most appropriate?
a. “Don’t worry about it; you’ll feel better in a month or so.”
b. “Have you talked to your husband about how you feel?”
c. “Perhaps you really don’t want to be pregnant.”
d. “Hormone changes during pregnancy commonly result in mood swings.”

ANS: D
Explaining that hormone changes can result in mood swings is an accurate statement and the most appropriate response by the nurse. Telling the woman not to worry dismisses her concerns and is not the most appropriate response. Although the woman should be encouraged to share her feelings, asking if she has spoken to her husband about them is not the most appropriate response and does not provide her with a rationale for the psychosocial dynamics of her pregnancy. Suggesting that the woman does not want to be pregnant is completely inappropriate and deleterious to the psychologic well-being of the woman. Hormonal and metabolic adaptations often cause mood swings in pregnancy. The woman’s responses are normal. She should be reassured about her feelings.

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9. What is the primary role of the nonpregnant partner during pregnancy?
a. To provide financial support
b. To protect the pregnant woman from “old wives’ tales”
c. To support and nurture the pregnant woman
d. To make sure the pregnant woman keeps prenatal appointments

ANS: C
The partner’s primary role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability. Although financial support is important, it is not the partner’s primary role in pregnancy. Protecting the pregnant woman from “old wives’ tales” is not the partner’s role. The woman’s partner can encourage the client to keep all appointments; however, this is not the most important role during the pregnancy.

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10. During the first trimester, which of the following changes regarding her sexual drive should a client be taught to expect?
a. Increased sexual drive, because of enlarging breasts
b. Decreased sexual drive, because of nausea and fatigue
c. No change in her sexual drive
d. Increased sexual drive, because of increased levels of female hormones

ANS: B
A pregnant woman usually experiences a decrease, not an increase, in libido during the first trimester. Maternal physiologic changes, such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses, may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy, the breasts may become enlarged and tender, which tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity.

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11. A 3-year-old girl’s mother is 6 months pregnant. What concern is this child most likely to verbalize?
a. How the baby will get out?
b. How will the baby eat?
c. Will you die having the baby?
d. What color eyes will the baby have?

ANS: B
By age 3 or 4 years, children like to be told the story of their own beginning and accept it being compared with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it will wear. School-age children take a more clinical interest in their mother’s pregnancy and may want to know “How did the baby get in there?” and “How will it get out?” Whether the child’s mother will die does not tend to be the focus of her questions about the impending birth of a sibling. The baby’s eye color does not tend to be the focus of children’s questions about the impending birth of a sibling.

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12. In her work with pregnant women of different cultures, a nurse practitioner has observed various practices that seemed unfamiliar. The nurse practitioner has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose?
a. To promote family unity
b. To ward off the “evil eye”
c. To appease the gods of fertility
d. To protect the mother and fetus during pregnancy

ANS: D
Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus. Promoting family unity is important, although not usually the premise for cultural rituals and practices. Warding off the “evil eye” may be specific to one particular culture; however, it is not the primary purpose of these practices. Appeasing the gods of fertility is not the impetus behind cultural rituals.

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13. A client has arrived for her first prenatal appointment. She asked the nurse to explain exactly how long the pregnancy will be. What is the nurse’s best response?
a. Normal pregnancy is 10 lunar months.
b. Pregnancy is made up of four trimesters.
c. Pregnancy is considered term at 36 weeks.
d. Estimated date of delivery (EDD) is 40 completed weeks.

ANS: A
Pregnancy spans 9 calendar months; but, health care providers prefer to use the lunar month of 28 days or 4 weeks. Pregnancy consists of three trimesters, each approximately 13 weeks long. A pregnancy is considered term at 37 completed weeks; however, EDD is based upon 40 weeks of gestation.

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14. What should the nurse be cognizant of concerning the client’s reordering of personal relationships during pregnancy?
a. Because of the special motherhood bond, a woman’s relationship with her mother is even more important than with the father of the child.
b. Nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other.
c. Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father.
d. The woman’s sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier.

ANS: C
Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman is usually the father of the child. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings to one another. The second trimester is the time when a woman’s sense of well-being, along with certain physical changes, increases her desire for sex. Sexual desire is down in the first and third trimesters.

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15. What represents a typical progression through the phases of a woman’s establishing a relationship with the fetus?
a. Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has feelings of caring and responsibility.
b. Fantasizes about the child’s gender and personality—views the child as part of herself—becomes introspective.
c. Views the child as part of herself—has feelings of well-being—accepts the biologic fact of the pregnancy.
d. “I am pregnant”—“I am going to have a baby”—“I am going to be a mother.”

ANS: D
The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions “I am pregnant,” “I am going to have a baby,” and “I am going to be a mother” sum up the progression through the three phases. In phase one, the woman views the child as part of herself and not as a separate being. This is only the first step of the progression through phases of attachment. Accepting the fetus as distinct from herself occurs during the second phase of emotional attachment. Fantasizing about the child’s sex and personality based on fetal activity occurs during the third phase of attachment.

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16. Who is most likely to experience the phenomenon of someone other than the mother-to-be having pregnancy-like symptoms such as nausea and weight gain?
a. Mother of the pregnant woman
b. Couple’s teenage daughter
c. Sister of the pregnant woman
d. Expectant father

ANS: D
An expectant father’s experiencing of his partner’s pregnancy-like symptoms is called the couvade syndrome. The mother of the pregnant woman is unlikely to experience this phenomenon. She may be excited about becoming a grandmother or see her daughter’s pregnancy as a reminder that she is getting old. A couple’s teenage daughter is usually preoccupied with her own sexual development and may have difficulty accepting the overwhelming evidence of her parents’ sexual activity. It is the father of the pregnant woman, not the sister, who experiences these symptoms.

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17. During the initial visit with a client who is beginning prenatal care, which action should be the highest priority for the nurse?
a. The first interview is a relaxed, get-acquainted affair during which the nurse gathers some general impressions of his or her new client.
b. If the nurse observed handicapping conditions, he or she should be sensitive and not inquire about them because the client will do that in her own time.
c. The nurse should be alert to the appearance of potential parenting problems, such as depression or lack of family support.
d. Because of legal complications, the nurse should not ask about illegal drug use; that is left to the physician.

ANS: C
Besides these potential problems, the nurse needs to be alert to the woman’s attitude toward keeping regular health care appointments. If the client lacks insurance, then the nurse may be able to direct her to resources that provide assistance for pregnant women (i.e., Women, Infants, and Children [WIC]; Medicaid). The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. The nurse must be sensitive to special problems; he or she should inquire because discovering individual needs is important. A client with a chronic or handicapping condition might forget to mention it because she has adapted to it. Obtaining information on drug use is important and can be confidentially done. Actual testing for drug use requires the client’s consent.

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18. A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent’s class. Which aspect of their birth plan should be considered potentially unrealistic and require further discussion with the nurse?
a. “My husband and I have agreed that my sister will be my coach because he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is okay.”
b. “We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor.”
c. “We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born.”
d. “Regardless of the circumstances, we do not want the fetal monitor used during labor because it will interfere with movement and doing effleurage.”

ANS: D
Because monitoring is essential to assess fetal well-being, fetal monitoring is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low-risk pregnancy and as long as labor is normally progressing. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative. Having the woman’s sister as her coach with her husband nearby is an acceptable request for a laboring woman. Using breathing techniques to alleviate pain is a realistic part of a birth plan. Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation.

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19. During the physical examination of a client beginning prenatal care, which initial action is most important for the nurse to perform?
a. Only women who show physical signs or meet the sociologic profile should be assessed for physical abuse.
b. The client should empty her bladder before the pelvic examination.
c. The distribution, amount, and quality of body hair are of no particular importance.
d. The size of the uterus is discounted in the initial examination because it will be increasing in size during the second trimester.

ANS: B
The nurse should instruct the client to empty her bladder. An empty bladder facilitates the examination and also provides an opportunity to obtain a urine sample for a number of tests. All women should be assessed for a history of physical abuse, particularly because the likelihood of abuse increases during pregnancy. Noting body hair is important because body hair reflects nutritional status, endocrine function, and hygiene. Particular attention is paid to the size of the uterus because it is an indication of the duration of gestation.

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20. A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. To reassure the client regarding fetal well-being, which is the highest priority action for the nurse to perform?
a. Assess the fetal heart tones with a Doppler stethoscope.
b. Measure the girth of the woman’s abdomen.
c. Complete an ultrasound examination (sonogram).
d. Offer the woman and her family the opportunity to listen to the fetal heart tones.

ANS: D
To provide the parents with the greatest sense of reassurance, the nurse should offer to have the client and her significant other the chance to listen to their baby’s heartbeat. A fetoscope can detect the fetal heart rate around 20 weeks of gestation. Doppler can detect the fetal heart rate between 10 and 12 weeks and should be performed as part of routine fetal assessment. Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an important measure that should be determined with precision, with the same technique and positioning of the client consistently used at every prenatal visit. Routine ultrasound examinations are recommended in early pregnancy; they date the pregnancy and provide useful information about the health of the fetus. However, they are not necessary at each prenatal visit.

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21. What is the primary role of the doula during labor?
a. Helps the woman perform Lamaze breathing techniques and to provide support to the woman and her partner
b. Checks the fetal monitor tracing for effects of the labor process on the fetal heart rate
c. Takes the place of the father as a coach and support provider
d. Administers pain medications as needed by the woman

ANS: A
A doula is professionally trained to provide labor support, including physical, emotional, and informational support, to both the woman and her partner during labor and the birth. The doula does not become involved with clinical tasks.

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22. A client at 34 weeks of gestation seeks guidance from the nurse regarding personal hygiene. Which information should the nurse provide?
a. Tub bathing is permitted even in late pregnancy unless membranes have ruptured.
b. The perineum should be wiped from back to front.
c. Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath.
d. Expectant mothers should use specially treated soap to cleanse the nipples.

ANS: A
The primary danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

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23. The client is instructed to place her thumb and forefinger on the areola and gently press inward. What is the purpose of this exercise?
a. To check the sensitivity of the nipples
b. To determine whether the nipple is everted or inverted
c. To calculate the adipose buildup in the abdomen
d. To see whether the fetus has become inactive

ANS: B
Sometimes known as the pinch test, this exercise is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. The pinch does not determine the level of sensitivity of the nipples, nor is it not used to determine the level of adipose tissue in the abdomen. Fetal activity is not determined by using the pinch test.

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24. Dental care during pregnancy is an important component of good prenatal care. Which instruction regarding dental health should the nurse provide?
a. Regular brushing and flossing may not be necessary during early pregnancy because it may stimulate the woman who is already nauseated to vomit. A cleaning is all that is necessary.
b. Dental surgery, in particular, is contraindicated during pregnancy and should be delayed until after delivery.
c. If dental treatment is necessary, then the woman will be most comfortable with it in the second trimester.
d. If a woman has dental anxiety, then dental care may interfere with the expectant mother’s need to practice conscious relaxation and to prepare for labor.

ANS: C
The second trimester is the best time for dental treatment because the woman will be able to sit most comfortably in the dental chair. Dental care, such as brushing with a fluoride toothpaste, is especially important during pregnancy. Periodontal disease has been linked to both preterm labor and low-birth-weight (LBW) infants. Emergency dental surgery is permissible; however, the mother must clearly understand the risks and benefits. Conscious relaxation is useful and may even help the woman get through any dental appointments, but it is not a reason to avoid them.

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25. Many pregnant women have questions regarding work and travel during pregnancy. Which education is a priority for the nurse to provide?
a. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise.
b. Women should avoid seat belts and shoulder restraints in the car because they press on the fetus.
c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times.
d. While working or traveling in a car or on an airplane, women should arrange to walk around at least every hour or so.

ANS: D
Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

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26. Which statement accurately describes the centering model of care?
a. Group sessions begin with the first prenatal visit.
b. Blood pressure (BP), weight, and urine dipsticks are obtained by the nurse at each visit.
c. Approximately 8 to 12 women are placed in each gestational-age cohort group.
d. Outcomes are similar to traditional prenatal care.

ANS: C
Gestational-age cohorts comprise the groups, with approximately 8 to 12 women in each group. The groups remain intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Before the group sessions, the client has an individual assessment, physical examination, and history. At the beginning of each group meeting, clients measure their own BP, weight, and urine dips and enter these findings in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. Results evaluating this approach have been very promising. In a recent study of adolescent clients, the number of LBW infants decreased and breastfeeding rates increased.

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27. A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of the exercise on the fetus. Which guidance should the nurse provide?
a. “You don’t need to modify your exercising any time during your pregnancy.”
b. “Stop exercising because it will harm the fetus.”
c. “You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
d. “Jogging is too hard on your joints; switch to walking now.”

ANS: C
Typically, running should be replaced with walking around the seventh month of pregnancy. The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.

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28. Which sign of a potential complication is the most important for the nurse to share with the client?
a. Constipation
b. Alteration in the pattern of fetal movement
c. Heart palpitations
d. Edema in the ankles and feet at the end of the day


ANS: B
An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation, heart palpitations, and ankle and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.

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29. A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. Which guidance should the nurse provide?
a. “Since you’re in your second trimester, there’s no problem with having one drink with dinner.”
b. “One drink every night is too much. One drink three times a week should be fine.”
c. “Since you’re in your second trimester, you can drink as much as you like.”
d. “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”

ANS: D
The statement “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy” is accurate. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.

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30. Which behavior indicates that a woman is “seeking safe passage” for herself and her infant?
a. She keeps all prenatal appointments.
b. She “eats for two.”
c. She slowly drives her car.
d. She wears only low-heeled shoes.

ANS: A
The goal of prenatal care is to foster a safe birth for the infant and mother. Although properly eating, carefully driving, and using proper body mechanics all are healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

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31. What type of cultural concern is the most likely deterrent to many women seeking prenatal care?
a. Religion
b. Modesty
c. Ignorance
d. Belief that physicians are evil

ANS: B
A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs.

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32. The nurse working with pregnant clients must seek to gain understanding of the process whereby women accept their pregnancy. Which statement regarding this process is most accurate?
a. Nonacceptance of the pregnancy very often equates to a rejection of the child.
b. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.
c. Ambivalent feelings during pregnancy are usually only expressed in emotionally immature or very young mothers.
d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will naturally resolve themselves after birth.

ANS: B
Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for the mature or immature woman and for the younger or older woman. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues.

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33. What is important for the nurse to recognize regarding the new father and his acceptance of the pregnancy and preparation for childbirth?
a. The father goes through three phases of acceptance of his own.
b. The father’s attachment to the fetus cannot be as strong as that of the mother because it does not start until after the birth.
c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home.
d. Typically, men remain ambivalent about fatherhood right up to the birth of their child.

ANS: A
A father typically goes through three phases of development to reach acceptance of fatherhood: the announcement phase, the moratorium phase, and the focusing phase. The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy. During the last 2 months of the pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant father’s ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role.

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34. Which consideration is essential for the nurse to understand regarding follow-up prenatal care visits?
a. The interview portions become more intensive as the visits become more frequent over the course of the pregnancy.
b. Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester.
c. During the abdominal examination, the nurse should be alert for supine hypotension.
d. For pregnant women, a systolic BP of 130 mm Hg and a diastolic BP of 80 mm Hg is sufficient to be considered hypertensive.

ANS: C
The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in BP and a feeling of faintness. The interview portion of the follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women, hypertension is defined as a systolic BP of 140 mm Hg or higher and a diastolic BP of 90 mm Hg or higher.

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35. With regard to medications, herbs, boosters, and other substances normally encountered by pregnant women, what is important for the nurse to be aware of?
a. Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
b. The greatest danger of drug-caused developmental deficits in the fetus is observed in the final trimester.
c. Killed-virus vaccines (e.g., tetanus) should not be administered during pregnancy, but live-virus vaccines (e.g., measles) are permissible.
d. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

ANS: A
Both prescription and OTC drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, during which a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

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36. Which statement regarding multifetal pregnancy is incorrect?
a. The expectant mother often develops anemia because the fetuses have a greater demand for iron.
b. Twin pregnancies come to term with the same frequency as single pregnancies.
c. The mother should be counseled to increase her nutritional intake and gain more weight.
d. Backache and varicose veins often are more pronounced with a multifetal pregnancy.

ANS: B
Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions.

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37. While assessing the vital signs of a pregnant woman in her third trimester, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?
a. Have the patient stand up, and then retake her BP.
b. Have the patient sit down, and then hold her arm in a dependent position.
c. Have the patient lie supine for 5 minutes, and then recheck her BP on both arms.
d. Have the patient turn to her left side, and then recheck her BP in 5 minutes.

ANS: D
BP is affected by maternal position during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the client is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

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1. Which signs and symptoms should a woman immediately report to her health care provider? (Select all that apply.)
a. Vaginal bleeding
b. Rupture of membranes
c. Heartburn accompanied by severe headache
d. Decreased libido
e. Urinary frequency

ANS: A, B, C
Vaginal bleeding, rupture of membranes, and severe headaches are signs of potential complications in pregnancy. Clients should be advised to report these signs to their health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

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2. A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, the nurse learns that the client has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? (Select all that apply.)
a. Tetanus
b. Diphtheria
c. Chickenpox
d. Rubella
e. Hepatitis B

ANS: A, B, E
Vaccines consisting of killed viruses may be used. Those that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines. Immunizations with live or attenuated viruses are contraindicated during pregnancy because of their potential teratogenicity. Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps.

40

3. The number of routine laboratory tests during follow-up visits is limited; however, those that are performed are essential. Which statements regarding group B Streptococcus (GBS) testing are correct? (Select all that apply.)
a. Performed between 32 and 34 weeks of gestation.
b. Performed between 35 and 37 weeks of gestation.
c. All women should be tested.
d. Only women planning a vaginal birth should be tested.
e. Women with a history of GBS should be retested.

ANS: B, D, E
GBS testing is recommended between 35 and 37 weeks of gestation; cultures collected earlier will not accurately predict the presence of GBS at birth. All women should be tested, even those planning an elective cesarean birth. Membranes may rupture early, requiring prophylactic antibiotics. Clients with a history of GBS should be retested.

41

1. A woman arrives at the clinic for a pregnancy test. The first day of her LMP was September 10, 2014. Her expected date of birth (EDB) is __________.

ANS:
June 17, 2015
Using the Nägele’s rule, June 17, 2015, is the correct EDB. The EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of September 10, 2014: September 10, 2014 – 3 months = June 10, 2014 + 7 days = June 17, 2014 + 1 year = June 17, 2015.

42

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should tell her:
a. “You don’t need to modify your exercising any time during your pregnancy.”
b. “Stop exercising, because it will harm the fetus.”
c. “You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
d. “Jogging is too hard on your joints; switch to walking now.”

Ans: C
The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Typically, running should be replaced with walking around the seventh month of pregnancy. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises, to prepare the joints for more strenuous exercise.

43

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be:
a. Constipation
b. Alteration in the pattern of fetal movement
c. Heart palpitations
d. Edema in the ankles and feet at the end of the day

Ans: B
An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. Heart palpitations are a normal change related to pregnancy; they are most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.

44

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know whether it is safe for her to have a drink with dinner now. The nurse tells her:
a. “Because you’re in your second trimester, there’s no problem with having one drink with dinner.”
b. “One drink every night is too much. One drink three times a week should be fine.”
c. “Because you’re in your second trimester, you can drink as much as you like.”
d. “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”

Ans: D
Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised. A safe level of alcohol consumption during pregnancy has not yet been established. The first trimester is a crucial period of fetal development, but pregnant women at all gestations are counseled to eliminate all alcohol from their diet.

45

Which behavior indicates that a woman is “seeking safe passage” for herself and her infant?
a. She keeps all prenatal appointments.
b. She “eats for two.”
c. She drives her car slowly.
d. She wears only low-heeled shoes.

Ans: A
The goal of prenatal care is to foster a safe birth for the infant and mother. Keeping all prenatal appointments is a good indication that the woman is indeed seeking “safe passage.” Eating properly, driving carefully, using proper body mechanics, and wearing appropriate footwear during pregnancy are healthy measures that all pregnant women should take.

46

What type of cultural concern is the most likely deterrent to many women seeking prenatal care?
a. Religion
b. Modesty
c. Ignorance
d. Belief that physicians are evil

Ans: B
A concern for modesty is a strong deterrent to many women seeking prenatal care; for some women, exposing body parts, especially to a man, is considered a major violation of modesty. There are other deterrents. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group or religion to which she belongs. For many cultural groups a physician is deemed appropriate only in times of illness. Because pregnancy is considered a normal process and the woman is in a state of health, the services of a physician are considered inappropriate. Many cultural variations are found in prenatal care, so ignorance is not likely to be a deterrent to women seeking prenatal care.

47

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that:
a. Nonacceptance of the pregnancy very often equates to rejection of the child.
b. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.
c. Ambivalent feelings during pregnancy are usually seen only in emotionally immature or very young mothers.
d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth.

Ans: B
Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for mature or immature women, young or older. Conflicts about desire to perform childrearing and career-related concerns, however, need to be resolved; the baby’s arrival ends the pregnancy but not all the issues.

48

With regard to the father’s acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that:
a. The father goes through three phases of acceptance of his own.
b. The father’s attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth.
c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home.
d. Typically men remain ambivalent about fatherhood right up to the birth of their child.

Ans: A
A father typically goes through three phases of acceptance: accepting the biologic fact, adjusting to the reality, and focusing on his role. Typically, the expectant father’s ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and focusing on his role. The father-child attachment can be as strong as the mother-child relationship and can begin during pregnancy. In the last 2 months of pregnancy, many expectant fathers work hard to improve the environment of the home for the child.

49

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that during pregnancy:
a. Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.
b. The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester.
c. Killed-virus vaccines (e.g., tetanus) should not be given, but live-virus vaccines (e.g., measles) are permissible.
d. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

Ans: A
The statement in A is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

50

Which statement about multifetal pregnancy is not accurate?
a. The expectant mother often experiences anemia because the fetuses have a greater demand for iron.
b. Twin pregnancies come to term with the same frequency as single pregnancies.
c. The mother should be counseled to increase her nutritional intake and gain more weight.
d. Backache and varicose veins are often more pronounced.

Ans: B
Twin pregnancies often end in prematurity; serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often experiences anemia because of the increased demands of two fetuses; this issue should be monitored closely throughout her pregnancy. The client may need nutrition counseling to ensure that she gains more weight than what is needed for a singleton birth. The considerable uterine distention in multifetal pregnancy is likely to cause backache and leg varicosities; maternal support hose should be recommended.

51

The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that:
a. She will have to give birth at home.
b. She must see an obstetrician as well as the midwife during pregnancy.
c. She will not be able to have epidural analgesia for labor pain.
d. She must be having a low-risk pregnancy.

Ans: D
Midwives usually see low-risk obstetric clients. Nurse-midwives must refer clients to physicians for complications. Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer clients to physicians for complications, but patients are not required to see an obstetrician otherwise. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care; this does not imply that medications for pain control are prohibited.

52

An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. The nurse should tell the couple that:
a. Intercourse should be avoided if any spotting from the vagina occurs afterward.
b. Intercourse is safe until the third trimester.
c. Safer-sex practices should be used once the membranes rupture.
d. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

Ans: D
Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.

53

A pregnant woman demonstrates understanding of the nurse’s instructions regarding relief of leg cramps if she:
a. Wiggles and points her toes during the cramp.
b. Applies cold compresses to the affected leg.
c. Extends her leg and dorsiflexes her foot during the cramp.
d. Avoids weight bearing on the affected leg during the cramp.

Ans: C
Extending the leg and dorsiflexing the foot are the appropriate relief measure for a leg cramp. Pointing the toes can aggravate rather than relieve the cramp. Application of heat is recommended. Bearing weight on the affected leg can help relieve the leg cramp, so it should not be avoided.

54

An expectant father confides in the nurse that his pregnant wife, at 10 weeks of gestation, is driving him crazy. “One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?” The nurse’s best response is:
a. “This is normal behavior and should begin to subside by the second trimester.”
b. “She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know.”
c. “This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant.”
d. “You seem impatient with her. Perhaps this is precipitating her behavior.”

Ans: C
The statement in C is the most appropriate response because it gives an explanation and a time frame for when the mood swings may stop. The statement in A is an appropriate response but it does not answer the father’s question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. The statement in D is judgmental and not appropriate.