Exam 2 - Practice Questions (Antepartum) Flashcards
An antenatal client is informing the nurse of her prenatal signs and symptoms.
Which of the following findings would the nurse determine are presumptive signs
of pregnancy? Select all that apply.
1. Amenorrhea.
2. Breast tenderness.
3. Quickening.
4. Frequent urination.
5. Uterine growth.
1, 2, 3, and 4 are correct.
1. Amenorrhea is a presumptive sign of
pregnancy.
2. Breast tenderness is a presumptive
sign of pregnancy.
3. Quickening is a presumptive sign of
pregnancy.
4. Frequent urination is a presumptive
sign of pregnancy.
TEST-TAKING TIP: There are three classifications
of signs of pregnancy: presumptive,
probable, and positive. Signs that
are totally subjective, or presumptive, include
amenorrhea, breast tenderness,
quickening, and frequent urination. Signs
that are objective, but not totally absolute,
are termed probable and include
alterations in uterine shape and size and
softening of the cervix. Signs that are
absolute, or positive, include hearing
the fetal heartbeat, detecting fetal movement,
and ultrasound images of the fetal
outline.
The nurse is assessing the laboratory report of a 40-week gestation client. Which of
the following values would the nurse expect to find elevated above prepregnancy
levels?
1. Glucose.
2. Fibrinogen.
3. Hematocrit.
4. Bilirubin.
- Fibrinogen levels will be elevated
slightly in a 40-week pregnant woman
because coagulation factors like fibrinogen
increase to help prevent excessive
blood loss during delivery
TEST-TAKING TIP: During the latter part
of the third trimester, coagulation factors
increase in preparation for delivery. It is
the body’s means of protecting itself
against a large loss of blood at delivery.
When analyzing the need for health teaching of a prenatal multigravida, the nurse
should ask which of the following questions?
1. “What are the ages of your children?”
2. “What is your marital status?”
3. “Do you ever drink alcohol?”
4. “Do you have any allergies?”
- This question is important to ask in
order to determine a prenatal client’s
health teaching needs.
TEST-TAKING TIP: When answering questions,
it is essential that the test taker attend
to the specific question that is being asked. All of the possible responses are
questions that should be asked of a pregnant
multigravida, but only one is related
to the client’s needs for health teaching.
A woman whose prenatal weight was 105 lb weighs 109 lb at her 12-week visit.
Which of the following comments by the nurse is appropriate at this time?
1. “We expect you to gain 1 lb per week, so your weight is a little low at this time.”
2. “Most women gain no weight during the first trimester, so I would suggest you
eat fewer desserts for the next few weeks.”
3. “You entered the pregnancy well underweight, so we should check your diet to
make sure you are getting the nutrients you need.”
4. “Your weight gain is exactly what we would expect it to be at this time.”
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
antenatal clients and their babies is
weight gain. For women who enter the
pregnancy with a normal weight for
height, the expected weight gain is: 3 to
5 lb for the entire first trimester and
approximately 1 lb per week from weeks
13 to 40.
Because nausea and vomiting are such common complaints of pregnant women, the
nurse provides anticipatory guidance to a 6-week gestation client by telling her to
do which of the following?
1. Avoid eating greasy foods.
2. Drink orange juice before rising.
3. Drink 2 glasses of water with each meal.
4. Eat 3 large meals plus a bedtime snack.
Greasy foods should be avoided
TEST-TAKING TIP: Although many women
experience nausea and vomiting or
morning sickness upon rising, many
women complain of nausea and/or vomiting
at other times of the day. One theory
that has been offered to explain this
problem is that the body is ridding itself
of teratogens that could potentially harm
the fetus.
A client enters the prenatal clinic. She states that she missed her period yesterday
and used a home pregnancy test this morning. She states that the results were negative,
but “I still think I am pregnant.” Which of the following statements would be
appropriate for the nurse to make at this time?
1. “Your period is probably just irregular.”
2. “We could do a blood test to check.”
3. “Home pregnancy test results are very accurate.”
4. “My recommendation would be to repeat the test in one week.”
- This response is correct. Serum pregnancy
tests are more sensitive than
urine tests are.
TEST-TAKING TIP: Because quantitative
pregnancy tests measure the exact quantity
of human chorionic gonadotropin in
the bloodstream, they are more accurate
than urine tests that simply measure
whether or not the hormone is present
in the urine. Similar to the urine tests on
the market, qualitative serum tests detect
whether or not the hormone is present,
but they are still considered to be more
accurate than urine tests are.
A gravida, G1 P0000, is having her first prenatal physical examination. Which
of the following assessments should the nurse inform the client that she will have
that day?
1. Pap smear.
2. Mammogram.
3. Glucose challenge test.
4. Biophysical profile.
- The client will have a Pap smear
done.
TEST-TAKING TIP: At the first prenatal
visit, pregnant clients will undergo complete
obstetrical and medical physical assessments.
The assessments are performed
to provide the health care
practitioner with baseline data regarding
the health and well-being of the woman
as well as to inform the health care practitioner
of any medical problems that the
mother has that might impact the pregnancy.
A breast exam will be performed
by the practitioner to assess for abnormalities,
but since mammograms are potentially
harm-producing x-rays, they are
only ordered in emergent cases.
A 10-week gravid client is being seen in the prenatal clinic. For the nurse caring for
this patient, providing anticipatory guidance for which of the following should be a
priority?
1. Pain management during labor.
2. Methods to relieve backaches.
3. Breastfeeding positions.
4. Characteristics of the newborn.
- It is appropriate for the nurse to provide
anticipatory guidance regarding
methods to relieve back pain.
TEST-TAKING TIP: This 10-week gravid
client will be entering the second
trimester in a couple of weeks. As the
uterine body grows, the client is likely to
experience backaches. It is appropriate for
the nurse to provide information about
this possibility and ways to relieve them.
A client asks the nurse what was meant when the physician told her she had a positive
Chadwick’s sign. Which of the following information about the finding would
be appropriate for the nurse to convey at this time?
1. “It is a purplish stretch mark on your abdomen.”
2. “It means that you are having heart palpitations.”
3. “It is a bluish coloration of your cervix and vagina.”
4. “It means the doctor heard abnormal sounds when you breathed in.”
- A positive Chadwick’s sign means that
the client’s cervix and vagina are a
bluish color. It is a probable sign of
pregnancy.
TEST-TAKING TIP: Chadwick’s sign is a
probable sign of pregnancy. The bluish
coloration is due to the increase in vascularization
of the area in response to
the high levels of circulating estrogen in
the pregnant woman’s system.
A client enters the prenatal clinic. She states that she believes she is pregnant.
Which of the following hormone elevations will indicate a high probability that the
client is pregnant?
1. Chorionic gonadotropin.
2. Oxytocin.
3. Prolactin.
4. Luteinizing hormone.
- High levels of the hormone chorionic
gonadotropin in the bloodstream and
urine of the woman is a probable sign
of pregnancy.
TEST-TAKING TIP: Human chorionic
gonadotropin is produced by the
fertilized egg. Its presence in the
bloodstream signals the body to keep
the corpus luteum alive. Until the
placenta takes over the function of producing
progesterone and estrogen, the
corpus luteum produces the hormones
that are essential to the maintenance of
the pregnancy.
A 16-year-old, G1 P0000, is being seen at her 10-week gestation visit. She tells the
nurse that she felt the baby move that morning. Which of the following responses
by the nurse is appropriate?
1. “That is very exciting. The baby must be very healthy.”
2. “Would you please describe what you felt for me?”
3. “That is impossible. The baby is not big enough yet.”
4. “Would you please let me see if I can feel the baby?”
- The nurse should query the young
woman about what she felt
TEST-TAKING TIP: Quickening, or subjective
fetal movement, occurs between
16 and 20 weeks’ gestation. At 10 weeks’
gestation it would be impossible for the
young woman to feel fetal movement.
The nurse, therefore, should elicit more
information from the teen to determine
what she had felt.
A 20-year-old client states that the at-home pregnancy test that she took this morning
was positive. Which of the following comments by the nurse is appropriate at
this time?
1. “Congratulations, you and your family must be so happy.”
2. “Have you told the baby’s father yet?”
3. “How do you feel about the results?”
4. “Please tell me when your last menstrual period was.”
- It is important for the nurse to ask
the young woman how she feels about
being pregnant. She may decide not
to continue with the pregnancy.
TEST-TAKING TIP: Some pregnant women
are happy about their pregnancy, some
are sad, and still others are frightened.
At the initial interview, it is essential that
the nurse not assume that the woman
will respond in any particular way. The
nurse must ask open-ended questions in
order to elicit the woman’s feelings about
the pregnancy.
A client is in the 10th week of her pregnancy. Which of the following symptoms
would the nurse expect the client to exhibit?
1. Backache.
2. Dyspnea.
3. Fatigue.
4. Diarrhea.
- Most women complain of fatigue
during the first trimester.
TEST-TAKING TIP: During the first
trimester, the body undergoes a number
of important changes. The embryo is developing,
the hormones of the body are
increasing, and the maternal blood supply
is increasing. To accomplish each of
the tasks, the body uses energy. The
mother is fatigued not only because the
body is undergoing great change but also
because the thyroid gland has not caught
up with the increasing energy demands.
The midwife has just palpated the fundal height at the location noted on the picture
below. It is likely that the client is how many weeks pregnant?
1. 12.
2. 20.
3. 28.
4. 36.
- The client is likely 12 weeks pregnant.
At 12 weeks, the fundal height is at
the top of the symphysis.
TEST-TAKING TIP: The fundal height is assessed
at every prenatal visit. It is an
easy, noninvasive means of assessing fetal
growth. The nurse should know that the
top of the fundus is at the level of the
symphysis at the end of the first
trimester.
When assessing the psychological adjustment of an 8-week gravida, which of the
following would the nurse expect to see signs of?
1. Ambivalence.
2. Depression.
3. Anxiety.
4. Ecstasy.
- It is common for women to be ambivalent
about their pregnancy during
the first trimester.
TEST-TAKING TIP: Even women who stop
taking birth control pills in order to become
pregnant are often startled and
ambivalent when they actually get pregnant.
This is not pathological. The
women usually slowly accept the pregnancy
and, by 20 weeks’ gestation, are
happy and enthusiastic about the
A client makes the following statement after finding out that her pregnancy test is
positive, “This is not a good time. I am in college and the baby will be due during
final exams!” Which of the following responses by the nurse would be most appropriate
at this time?
1. “I’m absolutely positive that everything will turn out all right.”
2. “I suggest that you e-mail your professors to set up an alternate plan.”
3. “It sounds like you’re feeling a little overwhelmed right now.”
4. “You and the baby’s father will find a way to get through the pregnancy.”
- This is the best comment. It acknowledges
the concerns that the client is
having.
TEST-TAKING TIP: Nurses have two roles
when clients express concerns to them.
First, the nurse must acknowledge the
client’s concerns so that the client feels
accepted and understood. Second, the
nurse must help the client to problem
solve the situation. It is very important,
however, that the acceptance precede the
period of problem solving.
The nurse notes each of the following findings in a 12-week gestation client. Which of
the findings would enable the nurse to tell the client that she is positively pregnant?
1. Fetal heart rate via Doppler.
2. Positive pregnancy test.
3. Positive Chadwick’s sign.
4. Montgomery gland enlargements.
- Hearing a fetal heart rate is a positive
sign of pregnancy.
TEST-TAKING TIP: Positive signs of pregnancy
are signs that irrefutably show that
a fetus is in utero. An ultrasound of a
fetus is one positive sign and the fetal
heartbeat is another positive sign.
The nurse takes the history of a client, G2 P1001, at her first prenatal visit. Which
of the following statements would indicate that the client should be referred to a
genetic counselor?
1. “My first child has cerebral palsy.”
2. “My first child has hypertension.”
3. “My first child has asthma.”
4. “My first child has cystic fibrosis.”
- Cystic fibrosis is an autosomal recessive
genetic disease so the client with
a history of cystic fibrosis should be
referred to a genetic counselor.
TEST-TAKING TIP: Virtually all diseases,
chronic and acute, have some genetic
component, but the ability for the genetic
counselor to predict the impact of
many diseases is very poor. Those illnesses
with clear hereditary patterns,
however, do warrant referral to genetic
counselors. Cystic fibrosis has an autosomal
recessive inheritance pattern.
The nurse has taken a health history on four primigravid clients at their first prenatal
visits. It is high priority that which of the clients receives nutrition counseling?
1. The woman diagnosed with phenylketonuria.
2. The woman who has Graves’ disease.
3. The woman with Cushing’s syndrome.
4. The woman diagnosed with myasthenia gravis.
- The client with phenylketonuria
(PKU) must receive counseling from a
registered dietitian.
TEST-TAKING TIP: PKU is a genetic disease
that is characterized by the absence
of the enzyme needed to metabolize
phenylalanine, an essential amino acid.
When patients with PKU consume
phenylalanine, a metabolite that affects
cognitive centers in the brain is created
in the body. If a pregnant woman who
has PKU were to eat foods high in
phenylalanine, her baby would develop
severe mental retardation in utero.
Which of the following findings in an 8-week gestation client, G2 P1001, should
the nurse highlight for the nurse midwife?
1. Body mass index of 17.
2. Blood pressure of 100/60.
3. Hematocrit of 36%.
4. Hemoglobin of 13.2.
- The BMI of 17 is of concern. This
client is entering her pregnancy underweight.
- The BMI of 17 is of concern. This
TEST-TAKING TIP: Women who enter their
pregnancies underweight are encouraged
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.
A woman, 6 weeks pregnant, is having a vaginal examination. Which of the following
would the practitioner expect to find?
1. Thin cervical muscle.
2. An enlarged ovary.
3. Thick cervical mucus.
4. Pale pink vaginal wall.
- The practitioner would expect to
palpate an enlarged ovary.
TEST-TAKING TIP: The cervix is long and
thick in order to retain the pregnancy in
the uterine cavity. The cervical mucus is
thin and the vaginal wall is bluish in
color as a result of elevated estrogen
levels. The ovary is enlarged because the
corpus luteum is still functioning.
A pregnant woman must have a glucose challenge test (GCT). Which of the following
should be included in the preprocedure teaching?
1. Fast for 12 hours before the test.
2. Bring a urine specimen to the laboratory on the day of the test.
3. Be prepared to have 4 blood specimens taken on the day of the test.
4. The test should take one hour to complete.
- The test does take about 1 hour to
complete.
TEST-TAKING TIP: The GCT is done at
approximately 24 weeks’ gestation to assess
the client’s ability to metabolize glucose.
It is a 1-hour, nonfasting screening
test. One hour after a client consumes
50 grams of a concentrated glucose solution,
a serum glucose level is done. If the
value is 130 mg/dL or higher, the client
is referred for a 3-hour glucose tolerance
test to determine whether or not she has
gestational diabetes.
The nurse working in an outpatient obstetric office assesses four primigravid
clients. Which of the client findings would the nurse highlight for the physician?
1. 17 weeks’ gestation; denies feeling fetal movement.
2. 24 weeks’ gestation; fundal height at the umbilicus.
3. 27 weeks’ gestation; complains of excess salivation.
4. 34 weeks’ gestation; complains of hemorrhoidal pain.
- The fundal height at 24 weeks should
be 4 cm above the umbilicus. The
fundal height at the level of the
umbilicus is expected at 20 weeks’
TEST-TAKING TIP: It is important for
the test taker to know the timing of key
pregnancy changes. The mother should
feel fetal movement by 20 weeks’ gestation.
Primigravidas often feel fetal
movement later than multigravidas.
Specific fundal height measurements
are also expected at key times in the
pregnancy.
The following four changes occur during pregnancy. Which of them usually increases
the father’s interest and involvement in the pregnancy?
1. Learning the results of the pregnancy test.
2. Attending childbirth education classes.
3. Hearing the fetal heartbeat.
4. Meeting the obstetrician or midwife.
- Hearing the fetal heart beat often
increases fathers’ interests in their
partners’ pregnancies.
TEST-TAKING TIP: Women who are in the
first few weeks of pregnancy often experience
a number of physical complaints—
nausea and vomiting, fatigue, breast tenderness,
and urinary frequency.
Prospective fathers whose partners’ experience
these complaints are often not
very interested in the pregnancies. When
the baby becomes “real,” with a positive
heartbeat or fetal movement, the fathers
often become very excited.
The nurse midwife tells a client that the baby is growing and that ballottement was
evident during the vaginal examination. How should the nurse explain what the
nurse midwife means by ballottement?
1. The nurse midwife saw that the mucus plug was intact.
2. The nurse midwife felt the baby rebound after being pushed.
3. The nurse midwife palpated the fetal parts through the uterine wall.
4. The nurse midwife assessed that the baby is head down.
- This is the definition of ballottement.
TEST-TAKING TIP: Although this question
discusses nurse-patient interaction, it is
simply a definition question. The test
taker is being asked to identify the definition
of the word ballottement.
A multigravid client is 22 weeks pregnant. Which of the following symptoms would
the nurse expect the client to exhibit?
1. Nausea.
2. Dyspnea.
3. Urinary frequency.
4. Leg cramping.
- Leg cramping is often a complaint of
clients in the second trimester.
TEST-TAKING TIP: Although clients in the
second trimester do experience some
physical discomfort, such as leg cramps
and backaches, most women feel well.
They no longer are fatigued, nauseous,
and so on as in the first trimester, but
the baby is not so large as to cause significant
complaints like dyspnea or the
recurrence of urinary frequency.
The glucose challenge screening test is performed at or after 24 weeks’ gestation to
assess for the maternal physiological response to which of the following pregnancy
hormones?
1. Estrogen.
2. Progesterone.
3. Human placental lactogen.
4. Human chorionic gonadotropin.
- Human placental lactogen (hPL) is an
insulin antagonist.
TEST-TAKING TIP: hPL is produced by the
placenta. As the placenta grows, the
hormone levels rise. At approximately
24 weeks’ gestation, the levels are high
enough to impact glucose metabolism.
If performed earlier, the GCT test may
result in a false-negative result.
A client is 15 weeks pregnant. She calls the obstetric office to request a medication
for a headache. The nurse answers the telephone. Which of the following is the
nurse’s best response?
1. “Because the organ systems in the baby are developing right now, it is risky to
take medicine.”
2. “You can take any of the over-the-counter medications because they are all safe
in pregnancy.”
3. “The physician will prescribe a category “X” medication for you.”
4. “You can take acetaminophen because it is a category “B” medicine.”
- Category “B” medications have been
shown to be safe to take throughout
pregnancy.
TEST-TAKING TIP: It is important for
pregnant women to contact their health
care practitioners to find out which medications
are safe to take during pregnancy
and which medications must be
avoided. All medications are assigned a
pregnancy category from “A”—research
has shown they are safe to be consumed
throughout pregnancy—to “X”—a teratogenic
agent. Category “B” medications
are considered safe because of anecdotal
evidence, although controlled
research has not been conducted to confirm
that evidence. Teratogens are agents
that have definitely been shown to cause
fetal damage.
A 20-week gestation client is being seen in the prenatal clinic. Place an “X” on the
place on the abdomen where the nurse would expect the fundal height to be felt.
TEST-TAKING TIP: At 20 weeks’ gestation,
the fundal height should be felt at the
umbilicus. About 8 weeks later, it is felt
between the umbilicus and xiphoid
process and at the xiphoid process at
36 weeks.
A client who was seen in the prenatal clinic at 20 weeks’ gestation weighed 128 lb
at that time. Approximately how many pounds would the nurse expect the client to
weigh at her next visit at 24 weeks’ gestation?
1. 129 lb.
2. 130 lb.
3. 131 lb.
4. 132 lb.
- The woman would be expected to
weigh about 132 lb. At this stage of
pregnancy, the woman is expected to
gain about 1 lb a week.
TEST-TAKING TIP: The incremental weight
gain of a client is an important means of
assessing the growth and development of
the fetus. The nurse would expect that,
during the second and third trimesters,
the woman should gain approximately
1 lb per week.
An 18-week gestation client telephones the obstetrician’s office stating, “I’m really
scared. I think I have breast cancer. My breasts are filled with tumors.” The nurse
should base the response on which of the following?
1. Breast cancer is often triggered by pregnancy.
2. Nodular breast tissue is normal during pregnancy.
3. The woman is exhibiting signs of a psychotic break.
4. Anxiety attacks are especially common in the second trimester.
- Nodular breast tissue is normal in
pregnancy.
TEST-TAKING TIP: The high levels of
estrogen seen in pregnancy result in a
number of changes. The hypertrophy
and hyperplasia of the breast tissue, in
preparation for neonatal lactation, are
two of the changes.
A woman states that she frequently awakens with “painful leg cramps” during the
night. Which of the following assessments should the nurse make?
1. Dietary evaluation.
2. Goodell’s sign.
3. Hegar’s sign.
4. Posture evaluation.
- A dietary evaluation is indicated since
painful leg cramps can be caused by
consuming too little calcium or too
much phosphorus.
- A dietary evaluation is indicated since
TEST-TAKING TIP: Leg cramps can occur
as a result of low calcium and/or high
phosphorus since they are often related
to a poor calcium/phosphorus ratio. A dietary
assessment should be done to determine
whether or not the client is consuming
enough calcium, primarily found
in dairy products, or large quantities of
phosphorus, found in carbonated beverages
and processed sandwich meats.
Which of the following exercises should be taught to a pregnant woman who complains
of backaches?
1. Kegeling.
2. Pelvic tilting.
3. Leg lifting.
4. Crunching.
- The pelvic tilt is an exercise that can
reduce backache pain.
TEST-TAKING TIP: Pelvic tilt exercises help
to reduce backache pain. The client is
taught to get into an optimal position—
on the hands and knees is often best. She
is then taught to force her back out while
tucking her head and buttocks under and
holding that position for a few seconds,
followed by holding the alternate position
for a few seconds—arching her back
while lifting her head and her buttocks
toward the ceiling. These positions should be alternated repeatedly for about
5 minutes. The exercises are very relaxing
while also improving the muscle tone
of the lower back.
A woman in her third trimester advises the nurse that she wishes to breastfeed her
baby, “but I don’t think my nipples are right.” Upon examination, the nurse notes
that the client has inverted nipples. Which of the following actions should the
nurse take at this time?
1. Advise the client that it is unlikely that she will be able to breastfeed.
2. Refer the client to a lactation consultant for advice.
3. Call the labor room and notify them that a client with inverted nipples will be
admitted.
4. Teach the woman exercises in order to evert her nipples.
- The client should be referred to a lactation
consultant.
TEST-TAKING TIP: Research on eversion
exercises has shown that they are not effective
plus breast manipulation can
bring on contractions since oxytocin production
is stimulated. Lactation consultants
are breastfeeding specialists. A lactation
consultant would probably
recommend that the client wear breast
shields in her bra. The shields are made
of hard plastic and have a small hole
through which the nipple everts.
Which of the following vital sign changes should the nurse highlight for a pregnant
woman’s obstetrician?
1. Prepregnancy blood pressure (BP) 100/60 and third trimester BP 140/90.
2. Prepregnancy respiratory rate (RR) 16 rpm and third trimester RR 22 rpm.
3. Prepregnancy heart rate (HR) 76 bpm and third trimester HR 88 bpm.
4. Prepregnancy temperature (T) 98.6ºF and third trimester T 99.2ºF.
- The blood pressure should not elevate
during pregnancy. This change
should be reported to the health care
practitioner.
TEST-TAKING TIP: The basal metabolic
rate of the woman increases during pregnancy.
As a result the nurse would expect
to observe a respiratory rate of 20 to 24
rpm. High levels of progesterone in the
body result in a decrease in the contractility
of the smooth musculature
throughout the body. This results in an
increase in the pulse rate. In addition,
progesterone is thermogenic, resulting in
a slight rise in the woman’s core body
temperature.
A nurse midwife has advised a 39-week gestation gravid to take evening primrose
oil 2500 mg daily as a complementary therapy. This suggestion was made because
evening primrose has been shown to perform which of the following actions?
1. Relieve back strain.
2. Improve development of colostrum.
3. Ripen the cervix.
4. Reduce the incidence of hemorrhoids.
- Evening primrose converts to a
prostaglandin substance in the body. Prostaglandins are responsible for
readying the cervix for dilation.
TEST-TAKING TIP: Nurse midwives often
recommend complementary therapies
during pregnancy as well as during labor
and delivery. Nurse midwives usually believe
in promoting natural means for
maintaining a healthy pregnancy and for
stimulating labor. Evening primrose is
one of those interventions.
A 38-week gestation client, Bishop score 1, is advised by her nurse midwife to take
evening primrose daily. The office nurse advises the client to report which of the
following side effects that has been attributed to the oil?
1. Skin rash.
2. Pedal edema.
3. Blurred vision.
4. Tinnitus.
- Evening primrose has been shown to
cause skin rash in some women.
TEST-TAKING TIP: Even though evening
primrose is a “natural” substance, it can
cause side effects in some clients. The
most common side effect seen from the
oil is a skin rash. Headaches and nausea
have also been seen.
A 37-week gravid client states that she noticed a “white liquid” leaking from her
breasts during a recent shower. Which of the following nursing responses is appropriate
at this time?
1. Advise the woman that she may have a galactocele.
2. Encourage the woman to pump her breasts to stimulate an adequate milk
supply.
3. Assess the liquid because a breast discharge is diagnostic of a mammary
infection.
4. Reassure the mother that this is normal in the third trimester.
- It is normal for colostrum to be
expressed late in pregnancy.
TEST-TAKING TIP: Even though colostrum
is present in the breasts in the latter part
of the third trimester, it is important for
women not to pump their breasts.
Oxytocin, the hormone that promotes
the ejection of milk during lactation, is
the hormone of labor. Pumping of the
breasts, therefore, could stimulate the
uterus to contract.
A 36-week gestation gravid client is complaining of dyspnea when lying flat. Which
of the following is the likely clinical reason for this complaint?
1. Maternal hypertension.
2. Fundal height.
3. Hydramnios.
4. Congestive heart failure
- The fundal height is the likely cause
of the woman’s dyspnea.
TEST-TAKING TIP: As the uterus enlarges,
the woman’s organs are impacted. At 36
weeks, the fundus is at the level of the
xiphoid process. The diaphragm is elevated
and the lungs are displaced. When
a client lies flat she has difficulty breathing.
Most women use multiple pillows at
night for sleep. Whenever caring for a
pregnant woman, the nurse should elevate
the head of the bed.
The nurse is providing anticipatory guidance to a woman in her second trimester
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?
1. “During the third trimester I may experience frequent urination.”
2. “During the third trimester I may experience heartburn.”
3. “During the third trimester I may experience back pain.”
4. “During the third trimester I may experience persistent headache.”
- Persistent headache should not be
seen in pregnant women.
TEST-TAKING TIP: This question is asking
the test taker to determine which complaint
is not expected during the third
trimester. The nurse, therefore, must
know which symptoms are normal during
the third trimester in order to know
which symptoms are not normal during
that period. Persistent headache can indicate
that the woman has developed a
complication of pregnancy
A client, in her third trimester, is concerned that she will not know the difference
between labor contractions and normal aches and pains of pregnancy. How should
the nurse respond?
1. “Don’t worry. You’ll know the difference when the contractions start.”
2. “The contractions may feel just like a backache, but they will come and go.”
3. “Contractions are a lot worse than your pregnancy aches and pains.”
4. “I understand. You don’t want to come to the hospital before you are in labor.”
- This is a true statement
TEST-TAKING TIP: Labor contractions often
begin in a woman’s back, feeling
much like a backache. The difference is
that labor contractions are intermittent
and rhythmic. The client should be advised
to attend to any pains that come
and go and time them. She may be beginning
the labor process.
Which finding would the nurse view as normal when evaluating the laboratory
reports of a 34-week gestation client?
1. Anemia.
2. Thrombocytopenia.
3. Polycythemia.
4. Hyperbilirubinemia.
- Anemia is an expected finding.
TEST-TAKING TIP: By the end of the second
trimester, the blood supply of the
woman increases by approximately 50%.
This increase is necessary in order for
the client to be able to perfuse the placenta.
There is a concurrent increase in
red blood cell production, but the vast
majority of women are unable to produce
the red blood cells in sufficient numbers
to keep pace with the increase in blood
volume. As a result, clients develop what
is commonly called “physiological anemia
of pregnancy.” A hematocrit of 32% is
considered normal for a pregnant
woman.
