Exam 2 - Practice Questions (Antepartum)

Question 1

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.

Answer 1

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.

Question 2

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.

Answer 2

2. 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.

Question 3

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?”

Answer 3

3. 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.

Question 4

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.”

Answer 4

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.

Question 5

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.

Answer 5

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.

Question 6

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.”

Answer 6

2. 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.

Question 7

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.

Answer 7

1. 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.

Question 8

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.

Answer 8

2. 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.

Question 9

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.”

Answer 9

3. 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.

Question 10

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.

Answer 10

1. 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.

Question 11

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?”

Answer 11

2. 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.

Question 12

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.”

Answer 12

3. 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.

Question 13

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.

Answer 13

3. 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.

Question 14

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.

Answer 14

1. 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.

Question 15

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.

Answer 15

1. 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

Question 16

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.”

Answer 16

3. 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.

Question 17

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.

Answer 17

1. 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.

Question 18

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.”

Answer 18

4. 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.

Question 19

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.

Answer 19

1. 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.

Question 20

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.

Answer 20

20. 1. The BMI of 17 is of concern. This
       client is entering her pregnancy underweight.

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.

Question 21

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.

Answer 21

2. 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.

Question 22

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.

Answer 22

4. 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.

Question 23

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.

Answer 23

2. 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.

Question 24

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.

Answer 24

3. 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.

Question 25

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.

Answer 25

2. 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.

Question 26

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.

Answer 26

4. 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.

Question 27

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.

Answer 27

3. 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.

Question 28

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.”

Answer 28

4. 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.

Question 29

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. ![]()

Answer 29

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. ![]()

Question 30

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.

Answer 30

4. 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.

Question 31

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.

Answer 31

2. 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.

Question 32

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.

Answer 32

32. 1. A dietary evaluation is indicated since painful leg cramps can be caused by consuming too little calcium or too much phosphorus. 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.

Question 33

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.

Answer 33

2. 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.

Question 34

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.

Answer 34

2. 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.

Question 35

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.

Answer 35

1. 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.

Question 36

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.

Answer 36

3. 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.

Question 37

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.

Answer 37

1. 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.

Question 38

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.

Answer 38

4. 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.

Question 39

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

Answer 39

2. 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.

Question 40

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.”

Answer 40

4. 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

Question 41

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.”

Answer 41

2. 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.

Question 42

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.

Answer 42

1. 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.

Question 43

The nurse asks a 31-week gestation client to lie on the examining table during a prenatal examination. In which of the following positions should the client be placed? 1. Orthopneic. 2. Lateral-recumbent. 3. Sims’. 4. Semi-Fowler’s.

Answer 43

4. The client should be placed in a semi- Fowler’s position. TEST-TAKING TIP: Because of the growth of the uterus, it is very difficult for women in the third trimester to breathe in the supine position. During the prenatal visit, the baby’s heartbeat will be monitored and the fundal height will be assessed. Both of these procedures can safely be performed in the semi-Fowler’s position. 44. 2, 3, and 4 ar

Question 44

A third-trimester client is being seen for routine prenatal care. Which of the following assessments will the nurse perform during the visit? Select all that apply. 1. Blood glucose. 2. Blood pressure. 3. Fetal heart rate. 4. Urine protein. 5. Pelvic ultrasound.

Answer 44

2, 3, and 4 are correct. 2. The blood pressure is assessed at each prenatal visit. 3. The fetal heart rate is assessed at each prenatal visit. Depending on the equipment available, it will be assessed mechanically via Doppler or manually via fetoscope. The fetal heart is audible via Doppler many weeks before it is audible via fetoscope. 4. Urine protein is performed at each prenatal visit TEST-TAKING TIP: The test taker must read the question carefully. Although urine glucose assessments are done at each visit, blood glucoses are assessed only intermittently during the pregnancy. Similarly, although ultrasound assessments may be ordered intermittently during a pregnancy, they are certainly not done at every prenatal visit. As a matter of fact, there is no absolute mandate that a sonogram must be done at all during a pregnancy.

Question 45

A nurse is working in the prenatal clinic. Which of the following findings seen in third-trimester pregnant women would the nurse consider to be within normal limits? Select all that apply. 1. Leg cramps. 2. Varicose veins. 3. Hemorrhoids. 4. Fainting spells. 5. Lordosis.

Answer 45

1, 2, 3, and 5 are correct. 1. Leg cramps are normal, although the client’s diet should be assessed. 2. Varicose veins are normal, although client teaching may be needed. 3. Hemorrhoids are normal, although client teaching may be needed. 5. Lordosis, or change in the curvature of the spine, is normal, although patient teaching may be needed. TEST-TAKING TIP: There are a number of physical complaints that are “normal” during pregnancy. There are interventions, however, that can be taught to help to alleviate some of the discomforts. The test taker should be familiar with patient education information that should be conveyed regarding the physical complaints of pregnancy. For example, clients who complain of hemorrhoids should be encouraged to eat high-fiber foods and drink fluids in order to produce softer stools. The softer stools should decrease the irritation of the hemorrhoids.

Question 46

A 36-week gestation gravid lies flat on her back. Which of the following maternal signs/symptoms would the nurse expect to observe? 1. Hypertension. 2. Dizziness. 3. Rales. 4. Chloasma.

Answer 46

2. Dizziness is an expected finding TEST-TAKING TIP: Because the weight of the gravid uterus compresses the great vessels, the nurse would expect the client to complain of dizziness when lying supine. The blood supply to the head and other parts of the body is diminished when the great vessels are compressed.

Question 47

The nurse is interviewing a 38-week gestation Muslim woman. Which of the following questions would be inappropriate for the nurse to ask? 1. “Do you plan to breastfeed your baby?” 2. “What do you plan to name the baby?” 3. “Which pediatrician do you plan to use?” 4. “How do you feel about having an episiotomy?”

Answer 47

2. It is inappropriate to ask the Muslim client about the name for the baby. TEST-TAKING TIP: Traditional Muslim couples will not tell anyone the baby’s name until he or she has gone through the official naming ceremony, called “aqiqah.” Babies are rarely named before a week of age. The parents need time to get to know their baby and decide on an appropriate name for him or her.

Question 48

A woman is 36-weeks’ gestation. Which of the following tests will be done during her prenatal visit? 1. Glucose challenge test. 2. Amniotic fluid volume assessment. 3. Vaginal and rectal cultures. 4. Karyotype analysis.

Answer 48

3. Vaginal and rectal cultures are done at approximately 36 weeks’ gestation. TEST-TAKING TIP: Vaginal and rectal cultures are done to assess for the presence of group B streptococcal (GBS) bacteria in the woman’s vagina and rectum. If the woman has GBS as part of her normal flora, she will be given IV antibiotics during labor to prevent vertical transmission to her baby at birth. GBS is often called, “the baby killer.”

Question 49

A 34-week gestation woman calls the obstetric office stating, “Since last night I have had three nosebleeds.” Which of the following responses by the nurse is appropriate? 1. “You should see the doctor to make sure you are not becoming severely anemic.” 2. “Do you have a temperature?” 3. “One of the hormones of pregnancy makes the nasal passages prone to bleeds.” 4. “Do you use any inhaled drugs?”

Answer 49

3. This is an accurate statement. Hormonal changes in pregnancy make the nasal passages prone to bleeds. TEST-TAKING TIP: Estrogen, one of the important hormones of pregnancy, promotes vasocongestion of the mucous membranes of the body. Increased vascular perfusion of the mucous membranes of the gynecological system is essential for the developing fetus to survive. The vasocongestion occurs in all of the mucous membranes of the body, however, leading to many complaints including nosebleeds and gingival bleeding.

Question 50

The nurse asks a woman about how the woman’s husband is dealing with the pregnancy. The nurse concludes that counseling is needed when the woman makes which of the following statements? 1. “My husband is ready for the pregnancy to end so that we can have sex again.” 2. “My husband has gained quite a bit of weight during this pregnancy.” 3. “My husband seems more worried about our finances now than before the pregnancy.” 4. “My husband plays his favorite music for my belly so the baby will learn to like it.”

Answer 50

1. The woman implies that she and her husband are not having sex. There is no need to refrain from sexual intercourse during a normal pregnancy— so the woman and her husband need further counseling. TEST-TAKING TIP: Couvade is the term given to a father’s physiological responses to his partner’s pregnancy. Men have been seen to exhibit a number of physical complaints/changes that simulate their partner’s physical complaints/changes—for example, indigestion, weight gain, urinary frequency, and backache.

Question 51

The blood of a pregnant client was initially assessed at 10 weeks’ gestation and reassessed at 38 weeks’ gestation. Which of the following results would the nurse expect to see? 1. Rise in hematocrit from 34% to 38%. 2. Rise in white blood cells from 5,000 cells/mm3 to 15,000 cells/mm3. 3. Rise in potassium from 3.9 mEq/ L to 5.2 mEq/ L. 4. Rise in sodium from 137 mEq/ L to 150 mEq/ L.

Answer 51

2. The nurse would expect to see an elevated white blood cell count. TEST-TAKING TIP: At the end of the third trimester and through to the early postpartum period, a normal leukocytosis, or rise in white blood cell count, is seen. This is a natural physiological change that protects the woman’s body from the invasion of pathogens during the birth process. The nurse should rely on a temperature elevation to determine whether or not the woman has an infection

Question 52

A client is 35 weeks’ gestation. Which of the following findings would the nurse expect to see? 1. Nausea and vomiting. 2. Maternal ambivalence. 3. Fundal height 10 cm above the umbilicus. 4. Use of three pillows for sleep comfort.

Answer 52

4. The use of three pillows for sleep comfort is often seen in clients who are 35 weeks’ gestation. TEST-TAKING TIP: It is essential that the test taker differentiate between normal and abnormal findings at various points during the pregnancy—for example, nausea and vomiting are normal during the first trimester but not during the second or third trimesters. The fundal height measurement is also important to remember. From 20 weeks’ gestation, when the fundal height is usually at the same height as the umbilicus, to 36 weeks’ gestation, when the final height is at the xiphoid process, the height measures are approximately the same number of centimeters above the symphysis as the number of weeks of fetal gestation. For example, at 24 weeks’ gestation, the height is usually 24 cm above the symphysis or 4 cm above the umbilicus, and at 35 weeks’ gestation, the height is usually 35 cm above the symphysis, or 15 cm above the umbilicus.

Question 53

A woman, 26-weeks’ gestation, calls the triage nurse stating, “I’m really scared. I tried not to but I had an orgasm when we were making love. I just know that I will go into preterm labor now.” Which of the following responses by the nurse is appropriate? 1. “Lie down and drink a quart of water. If you feel any back pressure at all call me back right away.” 2. “Although oxytocin was responsible for your orgasm, it is very unlikely that it will stimulate preterm labor.” 3. “I will inform the doctor for you. What I want you to do is to come to the hospital right now to be checked.” 4. “The best thing for you to do right now is to take a warm shower, and then do a fetal kick count assessment.”

Answer 53

2. This is an accurate statement. TEST-TAKING TIP: There is no contraindication to intercourse or to orgasm during pregnancy, unless it has been determined that a client is high risk for preterm labor. Until late in pregnancy, there are very few oxytocin receptor sites on the uterine body. The woman will, therefore, not go into labor as a result of an orgasm during sexual relations.

Question 54

A couple is preparing to interview obstetric primary care providers in order to determine who they will go to for care during their pregnancy and delivery. In order to make the best choice, which of the following actions should the couple perform first? 1. Take a tour of hospital delivery areas. 2. Develop a preliminary birth plan. 3. Make appointments with three or four obstetric care providers. 4. Search the internet for the malpractice histories of the providers.

Answer 54

2. It is best that a couple first develop a birth plan. TEST-TAKING TIP: It is important for a couple’s needs and wants to match their obstetrical care practitioner’s philosophy of care. If, for example, the couple is interested in the possibility of having a water birth, it is important that the health care provider be willing to perform a water birth. If, however, the woman wants to be “completely pain free,” the health care provider must be willing to order pain medications throughout the labor and delivery. A birth plan will list the couples’ many wishes.

Question 55

During a preconception counseling session, the nurse encourages a couple to prepare a birth plan. Which of the following is the most important goal for this action? 1. Promote communication between the couple and health care professionals. 2. Enable the couple to learn about the types of medicine used in labor. 3. Provide the couple with a list of items that they should put in a bag for labor. 4. Give the high-risk couple a sense of control over having to have a cesarean.

Answer 55

1. Birth plans help to facilitate communication between couples and their health care providers. TEST-TAKING TIP: The earlier a birth plan is developed, the better. A pregnant woman and her partner must feel comfortable with the communication methods, physical care, and health care philosophies of their obstetrical health care provider. The birth plan is a means for everyone to clearly understand each step of the birthing process. When the client enters the hospital for delivery, the birth plan should be presented to the nursing staff in order to facilitate the communication during that transition.

Question 56

The nurse is assisting a couple to develop decisions for their birth plan. Which of the following decisions should be considered nonnegotiable by the parents? 1. Whether or not the father will be present during labor. 2. Whether or not the woman will have an episiotomy. 3. Whether or not the woman will be able to have an epidural. 4. Whether or not the father will be able to take pictures of the delivery.

Answer 56

1. The presence of the father at delivery should be nonnegotiable. TEST-TAKING TIP: Even though the birth plan should include issues like the use or nonuse of episiotomies, emergent issues during the delivery may lead to a sudden change in plans. For example, if a cesarean is needed for malpresentation, the issue of episiotomy is moot and the client will definitely need anesthesia. However, there are some issues that should be nonnegotiable. If the father wishes to be in the delivery room no matter the type of delivery or whether or not an emergent situation is occurring, that should be stated in the plan and accepted by the health care provider.

Question 57

During a prenatal visit, a gravid client is complaining of ptyalism. Which of the following nursing interventions is appropriate? 1. Encourage the woman to brush her teeth carefully. 2. Advise the woman to have her blood pressure checked regularly. 3. Encourage the woman to wear supportive hosiery. 4. Advise the woman to avoid eating rare meat.

Answer 57

1. Clients who experience ptyalism have an excess of saliva. They should be advised to be vigilant in the care for their teeth and gums. Ptyalism is often accompanied by gingivitis and nausea and vomiting. TEST-TAKING TIP: Ptyalism is related to the increase in vascular congestion of the mucous membranes from increased estrogen production. Women with increased salivation often also experience gingivitis, which is also related to estrogen production. In addition, ptyalism is seen in women with nausea and vomiting. Because of the caustic affects of gastric juices on the enamel of the teeth, the inflammation seen in the gums and the increased salivation, it is essential that the pregnant woman take special care of her teeth during pregnancy, including regular visits to the dentist or the dental hygienist.

Question 58

A gravid woman who recently emigrated from mainland China is being seen at her first prenatal visit. She was never vaccinated in her home country. An injection to prevent which of the following communicable diseases should be administered to the woman during her pregnancy? 1. Influenza. 2. Mumps. 3. Rubella. 4. Varicella.

Answer 58

1. The woman should receive the influenza injection. The nasal spray, however, should not be administered to a pregnant woman TEST-TAKING TIP: It is very important for pregnant women to be protected from the flu by receiving the inactivated influenza injection. The fetus will not be injured from the shot and the woman will be protected from the many sequelae that can develop from the flu. However, the live nasal flu spray should not be administered to pregnant women. It is contraindicated to vaccinate pregnant women with many other vaccines, including the measles-mumps-rubella (MMR) and the varicella vaccines. See http://www.acog.org/from\_home/ publications/misc/bco282.pdf

Question 59

A gravid woman and her husband inform the nurse that they have just moved into a three-story home that was built in the 1930s. Which of the following is critical for the nurse to advise the woman in order to protect the unborn child? 1. Stay out of any rooms that are being renovated. 2. Drink water only from the hot water tap. 3. Refrain from entering the basement. 4. Climb the stairs only once per day.

Answer 59

1. The woman should stay out of rooms that are being renovated. TEST-TAKING TIP: Antique houses often contain lead-based paint and water piping that has been soldered with leadbased solder. Lead, when consumed either through the respiratory tract or the GI tract, can cause permanent damage to the central nervous system of the unborn child. It is very important, therefore, that the woman not breathe in the air in rooms that have recently been sanded. The paint aerosolizes and the lead can be inhaled. In addition, lead leaches into hot water more readily than into cold so water from the cold tap should be consumed—but only after the water has run through the pipes for a minimum of 2 minutes.

Question 60

After nutrition counseling, a woman, G3 P1101, proclaims that she certainly can’t eat any strawberries during her pregnancy. Which of the following is the likely reason for this statement? 1. The woman is allergic to strawberries. 2. Strawberries have been shown to cause birth defects. 3. The woman believes in old wives’ tales. 4. The premature baby died because the woman ate strawberries

Answer 60

3. The woman believes in old wives’ tales. TEST-TAKING TIP: There are a number of old wives’ tales that pregnant women believe in and live by. One of the common tales relates to the ingestion of strawberries: Women who eat strawberries have babies with strawberry marks on their bodies. Unless old-wives’ tales have the potential to impact the health of the baby and/or mother, it is ill advised and unnecessary to argue with the mother about her beliefs.

Question 61

A woman is planning to become pregnant. Which of the following actions should she be counseled to take before stopping birth control? Select all that apply. 1. Take a daily multivitamin. 2. See a medical doctor. 3. Drink beer instead of vodka. 4. Stop all over-the-counter medications. 5. Stop smoking cigarettes.

Answer 61

1, 2, and 5 are correct. 1. It is very important that women, before attempting to become pregnant, begin taking daily multivitamin tablets. 2. Women who wish to become pregnant should first see a medical doctor for a complete check-up 5. Women who wish to become pregnant should be counseled to stop smoking. TEST-TAKING TIP: Because the embryo is very sensitive during the first trimester of pregnancy, women should be advised to be vigilant about their health even before becoming pregnant. For example, folic acid, a vitamin in multivitamin tablets, helps to prevent neural tube defects. Women of childbearing age often fail to go for complete physical examinations. It is important to discover the presence of any medical illnesses before the pregnancy begins, however, so women should be counseled to have a complete physical before stopping birth control methods.

Question 62

The nurse discusses sexual intimacy with a pregnant couple. Which of the following should be included in the teaching plan? 1. Vaginal intercourse should cease by the beginning of the third trimester. 2. Breast fondling should be discouraged because of the potential for preterm labor. 3. The couple may find it necessary to experiment with alternate positions. 4. Vaginal lubricant should be used sparingly throughout the pregnancy.

Answer 62

3. With increasing size of the uterine body, the couple may need counseling regarding alternate options for sexual intimacy. TEST-TAKING TIP: Pregnancy lasts 10 lunar months. It is essential that the nurse counsel clients on ways to maintain health and well-being in the many facets of their lives. Sexual intimacy is one of the important aspects of a married couple’s life together. The couple can be counseled to use alternate positions, engage in mutual masturbation, or other means to satisfy their needs for sexual expression during the pregnancy period.

Question 63

Which of the following skin changes should the nurse highlight for a pregnant woman’s health care practitioner? 1. Linea nigra. 2. Melasma. 3. Petechiae. 4. Spider nevi.

Answer 63

3. Petechiae are pinpoint red or purple spots on the skin. They are seen in hemorrhagic conditions. TEST-TAKING TIP: There are many skin changes that occur normally during pregnancy. Most of the changes—such as linea nigra, melasma, and hyperpigmentation of the areolae—are related to an increase in the melanin-producing bodies of the skin as a result of stimulation by the female hormones, estrogen and progesterone. The presence of petechiae is usually related to a pathological condition, such as thrombocytopenia.

Question 64

A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2006. Using Nagele’s rule, the nurse calculates the client’s estimated date of delivery as: 1. May 30, 2007. 2. June 20, 2007. 3. June 27, 2007. 4. July 3, 2007.

Answer 64

3. The estimated date of delivery is June 27, 2007 TEST-TAKING TIP: Nagele’s rule is a simple method used to calculate a client’s estimated date of confinement (EDC) or estimated date of delivery (EDD) from the last normal menstrual period (LMP). The nurse learns the date of the last menstrual period from the client. He or she then subtracts 3 months from the date, adds 7 days to the date, and adjusts the year, if needed. For the example given: Last normal menstrual period—September 20, 2006 = 9 - 20 - 2006 3 7 6 27 adjust the year 6 - 27 - 2007 June 27, 2007

Question 65

A father experiencing couvade syndrome is likely to exhibit which of the following symptoms/behaviors? 1. Heartburn. 2. Promiscuity. 3. Hypertension. 4. Indifference.

Answer 65

1. Heartburn is a common symptom TEST-TAKING TIP: Heartburn is a subjective complaint that fathers often experience during their partners’ pregnancies. Fathers who are experiencing couvade symptoms are exhibiting a strong affiliation between themselves and their partners. It is inappropriate for prospective fathers to engage in illicit relationships and/or indifference toward their partners’ pregnancies. They should be fully engaged in the process. Hypertension, an objective sign, should be investigated further. The father may have developed a pathologic condition.

Question 66

A nurse is advising a pregnant woman about the danger signs of pregnancy. The nurse should teach the mother that she should notify the physician immediately if she experiences which of the following signs/symptoms? Select all that apply. 1. Convulsions. 2. Double vision. 3. Epigastric pain. 4. Persistent vomiting. 5. Polyuria.

Answer 66

1, 2, 3, and 4 are correct. 1. Convulsions are a danger sign of pregnancy. 2. Double vision is a danger sign of pregnancy. 3. Epigastric pain is a danger sign of pregnancy. 4. Persistent vomiting is a danger sign of pregnancy. TEST-TAKING TIP: The danger signs of pregnancy are signs or symptoms that can occur in an otherwise healthy pregnancy that are likely due to serious pregnancy complications. For example, double vision, epigastric pain, and blurred vision are symptoms of the hypertensive illnesses of pregnancy, and persistent vomiting is a symptom of hyperemesis gravidarum.

Question 67

A woman provides the nurse with the following obstetrical history: Delivered a son, now 7 years old, at 28 weeks’ gestation; delivered a daughter, now 5 years old, at 39 weeks’ gestation; had a miscarriage 3 years ago, and had a first-trimester abortion 2 years ago. She is currently pregnant. Which of the following portrays an accurate picture of this woman’s gravidity and parity? 1. G4 P2121. 2. G4 P1212. 3. G5 P1122. 4. G5 P2211.

Answer 67

3. This accurately reflects this woman’s gravidity and parity—G5P1122. TEST-TAKING TIP: Gravidity refers to pregnancy and parity refers to delivery. Every time a woman is pregnant, it is counted as one gravida (G). The results of each pregnancy are then documented as a para (P) in the following order. The first number refers to full-term births or births ≥ 38 weeks’ gestation; the second number refers to preterm births or births between 20 and 37 weeks’ gestation; the third number refers to abortions, whether spontaneous or therapeutic; and the fourth number refers to the number of living children. The client has been pregnant 5 times (G5); she birthed 1 son, 1 daughter, had 1 miscarriage, had 1 first trimester abortion, and is currently pregnant. Her parity (P1122) accurately reflects her obstetrical history: 1 full-term delivery (daughter at 39 weeks), 1 preterm delivery (son at 28 weeks), 2 abortions (1 miscarriage, 1 first-trimester abortion), and,

Question 68

The partner of a gravida accompanies her to her prenatal appointment. The nurse notes that the father of the baby has gained weight since she last saw him. Which of the following comments is most appropriate for the nurse to make to the father? 1. “I see that you are gaining weight right along with your partner.” 2. “You and your partner will be able to go on a diet together after the baby is born.” 3. “I can see that you are a bad influence on your partner’s eating habits.” 4. “I am so glad to see that you are taking so much interest in your partner’s pregnancy.”

Answer 68

4. This is an appropriate comment to make at this time. TEST-TAKING TIP: This father is exhibiting a sign of couvade; i.e., weight gain. This is a positive response since it shows that he is exhibiting a sympathetic response to his partner’s pregnancy. In addition, this father is accompanying his partner to the prenatal visit, another positive sign.

Question 69

The nurse is caring for a pregnant client who is a vegan. Which of the following foods should the nurse suggest the client consume as substitutes for restricted foods? 1. Tofu, legumes, broccoli. 2. Corn, yams, green beans. 3. Potatoes, parsnips, turnips. 4. Cheese, yogurt, fish.

Answer 69

1. Tofu, legumes, and broccoli are excellent substitutes for the restricted foods. TEST-TAKING TIP: Vegans are vegetarians who eat absolutely no animal products. Since animal products are most clients’ sources of protein and iron, it is necessary for vegans to be very careful to meet their increased needs by eating excellent sources of these nutrients. It is recommended that vegans meet with a registered dietitian early in their pregnancies to discuss diet choices.

Question 70

When assessing the fruit intake of a pregnant client, the nurse notes that the client usually eats 1 piece of fruit per day and drinks 7 to 8 servings of fruit juice per day. Which of the following is the most important communication for the nurse to make? 1. “You are effectively meeting your daily fruit requirements.” 2. “Fruit juices are excellent sources of folic acid.” 3. “It would be even better if you were to consume more whole fruits and less fruit juice.” 4. “Your fruit intake far exceeds the recommended daily fruit intake.”

Answer 70

3. It is recommended that pregnant clients eat whole fruits rather than consume large quantities of fruit juice. This is the most important statement for the nurse to make. TEST-TAKING TIP: Approximately 6 oz of fruit juice equals 1 serving from the fruit group. Fruit juices, however, are usually much higher in sugar than are whole fruits. In addition, the client is not receiving the benefit of the fiber that is contained in the whole fruit. The nurse should compliment the client on her fruit intake but encourage her to consume whole fruits rather than large quantities of juice.

Question 71

A client states that she is a strong believer in vitamin supplements to maintain her health. The nurse advises the woman that it is recommended to refrain from consuming excess quantities of which of the following vitamins during pregnancy? 1. Vitamin C. 2. Vitamin D. 3. Vitamin B2 (niacin). 4. Vitamin B12 (cobalamin).

Answer 71

2. Vitamin D supplementation can be harmful during pregnancy. TEST-TAKING TIP: The water-soluble vitamins, if consumed in large quantities, have not been shown to be harmful during pregnancy. The body eliminates the excess quantities through the urine and stool. However, the fat-soluble vitamins—vitamins A, D, E, and K—can build up in the body. Vitamins A and D have been shown to be teratogenic to the fetus in megadoses.

Question 72

A vegan is being counseled regarding vitamin intake. It is essential that this woman supplement which of the following B vitamins? 1. B1 (thiamine). 2. B2 (niacin). 3. B6 (pyridoxine). 4. B12 (cobalamin).

Answer 72

4. Vitamin B12 (cobalamin) should be supplemented. TEST-TAKING TIP: Vitamin B12 (cobalamin) is found almost exclusively in animal products—meat, dairy, eggs. Since vegans do not consume animal products, and the vitamin is not in most nonanimal sources, it is strongly recommended that vegans supplement that vitamin. Those who take in too little of the vitamin are susceptible to anemia and nervous system disorders. In addition, the vitamin is especially important during pregnancy since it is essential for DNA synthesis.

Question 73

foods would be best for the nurse to recommend to the client? 1. Bananas. 2. Rice. 3. Yogurt. 4. Celery.

Answer 73

4. Celery is an excellent food to reverse constipation. TEST-TAKING TIP: Most women complain of constipation during pregnancy. Progesterone, a muscle-relaxant, is responsible for a slowing of the digestive system. It is important, therefore, to recommend foods to pregnant clients that will help to alleviate the problem. Foods high in fiber, like celery, are excellent suggestions.

Question 74

A pregnant client is lactose intolerant. Which of the following alternative calciumrich foods could this woman consume? 1. Turnip greens. 2. Green beans. 3. Cantaloupe. 4. Nectarines.

Answer 74

1. Turnip greens are calcium-rich. TEST-TAKING TIP: There are a number of women who, for one reason or another, do not consume large quantities of dairy products. The nurse must be prepared to suggest alternate sources since dairy products are the best sources for calcium intake. Any of the dark green leafy vegetables, like kale, spinach, collards, and turnip greens, are excellent sources, as are small fish that are eaten with the bones, like sardines.

Question 75

A nurse, who is providing nutrition counseling to a new gravid client, advises the woman that a serving of meat is approximately equal in size to which of the following items? 1. Deck of cards. 2. VCR tape. 3. CD case. 4. Video camera.

Answer 75

1. This is an accurate statement. A serving of meat is approximately equal to a deck of cards. TEST-TAKING TIP: The dietary recommendation of the meat group for pregnant clients is: 3 servings of meat per day. Each serving is defined as 2 to 3 oz of meat, fish, or poultry. The average American diet well exceeds the recommended meat intake since most Americans consider a serving of meat to be larger than a deck of cards.

Question 76

The nurse is evaluating the 24-hour dairy intake of four gravid clients. Which of the following clients consumed the highest number of dairy servings during 1 day? The client who consumed: 1. 4 oz whole milk, 2 oz hard cheese, 1 cup of pudding made with milk and 2 oz cream cheese. 2. 1 cup yogurt, 8 oz chocolate milk, 1 cup cottage cheese, and 11⁄2 oz hard cheese. 3. 1⁄2 cup cottage cheese, 8 oz whole milk, 1 cup of buttermilk, and 1⁄2 oz hard cheese. 4. 1⁄2 cup frozen yogurt, 8 oz skim milk, 4 oz cream cheese, and 11⁄2 cup of cottage cheese.

Answer 76

2. This client consumed 32⁄3 servings: 1 cup yogurt 1 serving, 8 oz chocolate milk 1 serving; 1 cup cottage cheese 2⁄3 serving; and 11⁄2 oz hard cheese 1 serving. TEST-TAKING TIP: It is essential that the test taker know which foods are placed in which food groups and the equivalent quantity of food that meets one serving size. For example, 1 cup of any type of milk—whole, skim, butter, or even chocolate—is equal to one dairy serving while 11⁄2 oz of hard cheese is equal to one serving.

Question 77

Which of the following choices can the nurse teach a prenatal client is equivalent to one 2-oz meat serving? 1. 4 tbsp peanut butter. 2. 2 eggs. 3. 1 cup cooked lima beans. 4. 2 ounces mixed nuts.

Answer 77

2. 2 eggs 1 meat serving TEST-TAKING TIP: The test taker should refer to the US Dietary Association information at http://www.health.gov/ dietaryguidelines for up-to-date dietary recommendations. As more research information is forthcoming, dietary recommendations change.

Question 78

A nurse is discussing the serving sizes in the grain food group with a new prenatal client. Which of the following foods equals 1 serving size from the grain group? Select all that apply. 1. 1 bagel. 2. 1 slice of bread. 3. 1 cup cooked pasta. 4. 1 tortilla. 5. 1 cup dry cereal.

Answer 78

2, 4, and 5 are correct. 2. 1 slice bread 1 serving. 4. 1 tortilla 1 serving. 5. 1 cup dry cereal 1 serving. TEST-TAKING TIP: The test taker should note that pregnant women are recommended to consume 7 to 11 servings of grain. However, 1 sandwich equals 2 servings since each piece of bread equals 1 serving. Also, it is important to counsel women to eat whole grain foods rather than processed grains. More nutrients as well as more fiber are obtained from whole grain foods.

Question 79

A woman asks the nurse about consuming herbal supplements during pregnancy. Which of the following responses is appropriate? 1. Herbals are natural substances, so they are safely ingested during pregnancy. 2. It is safe to take licorice and cat’s claw, but no other herbs are safe. 3. A federal commission has established the safety of herbals during pregnancy. 4. The woman should discuss everything she eats with a health care practitioner.

Answer 79

4. Every woman should advise her health care practitioner of what she is consuming, including food, medicines, herbals, and all other substances. TEST-TAKING TIP: Herbals are not regulated by the Food and Drug Administration (FDA). There is some information on selected herbals at the National Institute of Health web site—http://nccam. nih.gov/health—but because research on pregnant women is particularly sensitive there is very little definitive information on the safety of many herbals in pregnancy. No matter what is consumed by the mother, however, the health care practitioner should be consulted.

Question 80

A Chinese immigrant is being seen in the prenatal clinic. When providing nutrition counseling, which of the following factors should the nurse keep in mind? 1. Many Chinese eat very little protein. 2. Many Chinese believe pregnant women should eat cold foods. 3. Many Chinese are prone to anemia. 4. Many Chinese believe strawberries can cause birth defects.

Answer 80

2. Many Chinese women do believe in the “hot and cold” theory of life. TEST-TAKING TIP: Whenever a question specifies that a client belongs to a specific cultural or ethnic group, the test taker should attend carefully to that information. It is very likely that the question is asking the test taker to discern cultural/ethnic differences in order to discern the test taker’s cultural competence. Pregnancy is believed by many Chinese to be a “hot period.” In order to maintain the equilibrium of the body, therefore, pregnant women consume “cold” foods and drinks.

Question 81

A nurse has identified the following nursing diagnosis for a prenatal client: Altered nutrition: less than body requirements related to poor folic acid intake. Which of the following foods should the nurse suggest the client consume? 1. Potatoes and grapes. 2. Cranberries and squash. 3. Apples and corn. 4. Oranges and spinach.

Answer 81

4. Oranges and spinach are excellent folic acid sources. TEST-TAKING TIP: The intake of folic acid is especially important during the first trimester of pregnancy to help to prevent structural defects, including spina bifida and gastroschisis. The best sources of folic acid are liver and green leafy vegetables. Oranges and orange juice are also good sources.

Question 82

A nurse is discussing diet with a pregnant woman. Which of the following foods should the nurse advise the client to avoid consuming during her pregnancy? 1. Bologna. 2. Cantaloupe. 3. Asparagus. 4. Popcorn.

Answer 82

82. 1. Bologna should not be consumed during pregnancy unless it is thoroughly cooked. TEST-TAKING TIP: Because pregnant women are slightly immunocompromised, they are especially susceptible to certain diseases. Deli meats, unless heated to steaming hot, can cause listeriosis. Pregnant women should avoid these foods. Other foods that contain Listeria monocytogenes that should be avoided are unpasteurized milk, soft cheese, and undercooked meats. See http://www.cfsan.fda.gov/~pregnant/ ataglanc.html and http://www.health. gov/dietaryguidelines/dga2005/ document/html/chapter10.htm

Question 83

A 12-week gestation client tells the nurse that she and her husband eat sushi at least once per week. She states, “I know that fish is good for me, so I make sure we eat it regularly.” Which of the following responses by the nurse is appropriate? 1. “You are correct. Fish is very healthy for you.” 2. “You can eat fish, but sushi is too salty to eat during pregnancy.” 3. “Sushi is raw. Raw fish is especially high in mercury.” 4. “It is recommended that fish be cooked to destroy harmful bacteria.”

Answer 83

4. This is correct. It is recommended that during pregnancy the client eat only well-cooked fish. TEST-TAKING TIP: Fish is an excellent source of omega-3 oil and protein. During pregnancy fish should be eaten well-cooked to avoid ingestion of pathogens. The pregnant woman should limit her intake to 12 oz per week or less to reduce the potential of her consuming toxic levels of methylmercury. See http://www.cfsan.fda.gov/~pregnant/ safemea.html

Question 84

The nurse is caring for a prenatal client who states she is prone to developing anemia. Which of the following foods should the nurse advise the gravida is the best source of iron? 1. Raisins. 2. Hamburger. 3. Broccoli. 4. Molasses.

Answer 84

2. Hamburger contains the most iron TEST-TAKING TIP: Iron is present in most animal sources—seafood, meats, eggs— although it is not present in milk. There also is iron in vegetable sources, although not in the same concentration as in animal products. If the nurse is caring for a pregnant vegetarian, the nurse must counsel the client regarding good nonanimal sources of all nutrients.

Question 85

It is discovered that a pregnant woman practices pica. Which of the following complications is most often associated with this behavior? 1. Hypothyroidism. 2. Iron deficiency anemia. 3. Hypercalcemia. 4. Overexposure to zinc.

Answer 85

2. Iron deficiency anemia is often seen in clients who engage in pica. TEST-TAKING TIP: Clients who engage in pica eat large quantities of nonfood items like ice, laundry starch, soap, and dirt. There are a number of problems related to pica, including teratogenesis related to eating foods harmful to the fetus. More commonly, the women fill up on items like ice instead of eating high-quality foods. This practice is often culturally related.

Question 86

A woman confides in the nurse that she practices pica. Which of the following alternatives could the nurse suggest to the woman? 1. Replace laundry starch with salt. 2. Replace ice with frozen fruit juice. 3. Replace soap with cream cheese. 4. Replace soil with uncooked pie crust.

Answer 86

2. This is an excellent suggestion. Fruit juice, although high in sugar, does contain vitamins. TEST-TAKING TIP: Although the nurse might prefer that a client completely stop a behavior that the nurse deems unsafe or inappropriate, the client may disagree. The nurse, therefore, must attempt to provide a substitute for the client’s behavior. Pica is a behavior that should be discouraged because of its potentially detrimental effects. If the client wishes to consume ice, an excellent alternative is ice pops, Italian ices, or iced fruit juice.

Question 87

A mother is experiencing nausea and vomiting every afternoon. The ingestion of which of the following spices has been shown to be a safe complementary therapy for this complaint? 1. Ginger. 2. Sage. 3. Cloves. 4. Nutmeg.

Answer 87

1. Ginger has been shown to be a safe antiemetic agent for pregnant women. TEST-TAKING TIP: Morning sickness and daytime nausea and vomiting are common complaints of pregnant women during the first trimester. Ginger, consumed as ginger tea, ginger ale, or the like, has been shown to be a safe and an effective antinausea agent for many pregnant women.

Question 88

A woman tells the nurse that she would like suggestions for alternate vitamin C sources because she isn’t very fond of citrus fruits. Which of the following suggestions is appropriate? 1. Barley and brown rice. 2. Strawberries and potatoes. 3. Buckwheat and lentils. 4. Wheat flour and figs.

Answer 88

2. Strawberries and potatoes are excellent sources of vitamin C, as are zucchini, blueberries, kiwi, green beans, green peas, and the like. TEST-TAKING TIP: The test taker must be prepared to answer basic nutrition questions related to the health of the pregnant woman. Even though citrus fruits are commonly thought of as the primary sources of vitamin C, the test taker should realize that virtually all fruits and vegetables contain the vitamin, while grains do not.

Question 89

A nurse is providing diet counseling to a new prenatal client. Which of the following dairy products should the client be advised to avoid eating during the pregnancy? 1. Vanilla yogurt. 2. Parmesan cheese. 3. Gorgonzola cheese. 4. Chocolate milk.

Answer 89

3. The intake of gorgonzola cheese should be discouraged during pregnancy. TEST-TAKING TIP: Gorgonzola cheese is a soft cheese. Soft cheeses harbor Listeria monocytogenes, the organism that causes listeriosis. Pregnant women are at high risk of developing this infection because they are slightly immunosuppressed. The adult disease can assume many forms, including meningitis, pneumonia, and sepsis. Pregnant women who develop the disease often deliver stillborn babies or babies who are at risk of dying postdelivery from fulminant disease.

Question 90

A woman asks the nurse about the function of amniotic fluid. Which of the following statements by the woman indicates that additional teaching is needed? 1. The fluid provides fetal nutrition. 2. The fluid cushions the fetus from injury. 3. The fluid enables the fetus to grow. 4. The fluid provides a stable thermal environment

Answer 90

90. 1. The umbilical cord, not the amniotic fluid, delivers nutrition to the developing fetus. TEST-TAKING TIP: The amniotic fluid is produced primarily by the fetus as fetal urine. In addition to the functions noted above, the baby practices “breathing” the amniotic fluid in and out of the lungs in preparation for breathing air in the extrauterine environment.

Question 91

Why is it essential that women of childbearing age be counseled to plan their pregnancies? 1. Much of the organogenesis occurs before the missed menstrual period. 2. Insurance companies must preapprove many prenatal care expenditures. 3. It is recommended that women be pregnant no more than 3 times during their lifetime. 4. The cardiovascular system is stressed when pregnancies are less than 2 years apart.

Answer 91

1. This statement is true. Organogenesis begins prior to the missed menstrual period. TEST-TAKING TIP: The test taker may be unfamiliar with the term organogenesis. To answer the question correctly, however, it is essential that the test taker be able to decipher the definition. It is important that the nurse break the word down into its parts in order to deduce the meaning. Organo means “organ” and genesis means “origin.” The definition of the term, therefore, is origin, or development, of the organ systems.

Question 92

A woman has just completed her first trimester. Which of the following fetal structures can the nurse tell the woman are well formed at this time? Select all that apply. 1. Genitals. 2. Heart. 3. Fingers. 4. Alveoli. 5. Kidneys.

Answer 92

1, 2, 3, and 5 are correct. 1. The genitalia are formed by the end of the first trimester. 2. The heart is formed by the end of the first trimester. 3. The fingers are formed by the end of the first trimester. 5. The kidneys are formed by the end of the first trimester. TEST-TAKING TIP: The test taker should be familiar with the basic developmental changes that occur during the three trimesters. In addition, the test taker should be able to develop a basic timeline of developmental milestones that occur during the pregnancy. By the conclusion of the first trimester, all major organs are completely formed. The maturation of the organ systems must, however, still occur.

Question 93

An ultrasound of a fetus’ heart shows that normal fetal circulation is occurring. Which of the following statements should the nurse interpret as correct in relation to the fetal circulation? 1. The foramen ovale is a hole between the ventricles. 2. The umbilical vein contains oxygen-poor blood. 3. The right atrium contains both oxygen-rich and oxygen-poor blood. 4. The ductus venosus lies between the aorta and pulmonary artery.

Answer 93

3. The right atrium does contain both oxygen-rich and oxygen-poor blood. TEST-TAKING TIP: The test taker should have an understanding of fetal circulation. One principle to remember when studying the circulation of the fetus is that the blood bypasses the lungs since the baby is receiving oxygen-rich blood directly from the placenta via the umbilical vein. The location of the three ducts—ductus venosus, formen ovale, ductus arteriosus—therefore, enable the blood to bypass the lungs.

Question 94

The nurse is teaching a couple about fetal development. Which statement by the nurse is correct about the morula stage of development? 1. “The fertilized egg has yet to implant into the uterus.” 2. “The lung fields are finally completely formed.” 3. “The sex of the fetus can be clearly identified.” 4. “The eye lids are unfused and begin to open and close.”

Answer 94

1. This is a true statement. In the morula stage, about 2 to 4 days after fertilization, the fertilized egg has not yet implanted in the uterus. TEST-TAKING TIP: The morula is the undifferentiated ball of cells that migrates down the fallopian tube toward the uterine body. The morular stage lasts from about the 2nd to the 4th day after fertilization.

Question 95

A woman is carrying dizygotic twins. She asks the nurse about the babies. Which of the following explanations is accurate? 1. During a period of rapid growth, the fertilized egg divided completely. 2. When the woman ovulated, she expelled two mature ova. 3. The babies share one placenta and a common chorion. 4. The babies will definitely be the same sex and have the same blood type.

Answer 95

2. This is a true statement. Dizygotic twins result from two mature ova that are fertilized. TEST-TAKING TIP: The best way for the test taker to differentiate between monozygotic twinning and dizygotic twinning is to remember the meaning of the prefixes to the two words. “Mono” means 1. Monozygotic twins, therefore, originate from one fertilized ovum. The babies have the same DNA; therefore, they are the same sex. They share a placenta and chorion. “Di” means 2. Dizygotic twins arise from 2 separately fertilized eggs. Their genetic relationship is the same as if they were siblings born from different pregnancies.

Question 96

A mother has just experienced quickening. Which of the following developmental changes would the nurse expect to occur at the same time in the woman’s pregnancy? 1. Fetal heart begins to beat. 2. Lanugo covers the fetal body. 3. Kidneys secrete urine. 4. Fingernails begin to form.

Answer 96

2. Lanugo does cover the fetal body at approximately 20 weeks’ gestation. TEST-TAKING TIP: Although the test taker need not memorize all fetal developmental changes, it is important to have an understanding of major periods of development. For example, organogenesis occurs during the first trimester with all of the major organs functioning at a primitive level by week 12.

Question 97

A woman who is seen in the prenatal clinic is found to be 8 weeks pregnant. She confides to the nurse that she is afraid her baby may be “permanently damaged because I had at least 5 beers the night I had sex.” Which of the following responses by the nurse would be appropriate? 1. “I would let the doctor know that if I were you.” 2. “It is unlikely that the baby was affected.” 3. “Abortions during the first trimester are very safe.” 4. “An ultrasound will tell you if the baby was affected.”

Answer 97

2. This statement is true TEST-TAKING TIP: The 2-week period between ovulation and implantation is often called “the all or nothing period.” During that time, the fertilized egg/ embryo is floating freely in the woman’s fallopian tubes toward the uterine body. The mother is not supplying the embryo with nutrients at this time. Rather, the embryo is self-sufficient. If an insult occurs—for example, a teratogen is ingested or an abdominal x-ray is taken— the embryo is either destroyed or completely spared. And, since the pregnancy of the woman in the scenario was maintained, the nurse can assure her that the embryo was spared insult.

Question 98

A gravida’s fundal height is noted to be at the xiphoid process. The nurse is aware that which of the following fetal changes is likely to be occurring at the same time in the pregnancy? 1. Surfactant is formed in the fetal lungs. 2. Eyes begin to open and close. 3. Respiratory movements begin. 4. The spinal column is completely formed.

Answer 98

1. Surfactant is usually formed in the fetal lungs by the 36th week. TEST-TAKING TIP: The test taker should realize that this question is asking two things. First, the test taker needs to know what stage of pregnancy the woman is in when the fundal height is at the xiphoid process. Once the test taker realizes that this fundal height signifies 36 weeks’ gestation, he or she must determine what other change or process is likely to be occurring at 36 weeks. The spinal column is completely formed by the end of the first trimester, fetal respiratory movements begin at about 24 weeks, and the eyes open and close at about 28 weeks. Surfactant, which is essential for mature lung function, forms in the fetal lungs at about 36 weeks. It is important for the nurse to realize that babies who are born preterm are high risk for a number of reasons, including lack of surfactant, lack of iron stores to sustain them during the early months of life, and lack of brown adipose tissue needed for thermoregulation.

Question 99

Below are four important landmarks of fetal development. Please place them in chronological order: 1. Four-chambered heart is formed. 2. Vernix caseosa is present. 3. Blastocyst development is complete. 4. Testes have descended into the scrotal sac.

Answer 99

The correct order is 3, 1, 2, 4. 3. The blastocyst is developed about 6 days after fertilization and before implantation in the uterus has occurred. 1. The four-chambered heart is formed during the early part of the first trimester. 2. Vernix caseosa is present during the latter half of pregnancy. 4. The testes descend in the scrotal sac about mid third trimester. TEST-TAKING TIP: Before putting these items into chronological order, the test taker should carefully analyze each choice. The blastocyst is developed by about day 6 after fertilization. The egg has yet even to implant into the uterine body at this point. The fetal heart develops during the early part of the first trimester, but after implantation. Vernix is present during the entire latter half of the pregnancy in order to protect the skin of the fetus. It appears, therefore, at about week 20. And, finally, the testes do not descend into the scrotal sac until mid third trimester. Indeed, male preterm babies are often birthed before the testes descend.

Question 100

A client is having an ultrasound assessment done at her prenatal appointment at 8 weeks’ gestation. She asks the nurse, “Can you tell what sex my baby is yet?” Which of the following responses would be appropriate for the nurse to make at this time? 1. “The technician did tell me the sex, but I will have to let the doctor tell you what it is.” 2. “The organs are completely formed and present, but the baby is too small for any to be seen.” 3. “The technician says that the baby has a penis. It looks like you are having a boy.” 4. “I am sorry. It will not be possible to see which sex the baby is for another month or so.”

Answer 100

4. This statement is true. The sex is not visible yet. TEST-TAKING TIP: The genitourinary system is the last organ system to fully develop. Before 12 weeks, both female and male genitalia are present. The sex is determined genetically, but it is as yet impossible to determine the sex visually. If the embryo secretes testosterone, the male sex organs mature and the female organs recede. If the embryo does not secrete testosterone, the male sex organs recede and the female organs mature. At 8 weeks, it is not possible to determine the sex of the fetus.

Question 101

Which of the following developmental features would the nurse expect to be absent in a 41-week gestation fetus? 1. Fingernails. 2. Eye lashes. 3. Lanugo. 4. Milia.

Answer 101

3. Because this baby is postterm, lanugo would likely not be present. TEST-TAKING TIP: Lanugo is a fine hair that covers the body of the fetus. It begins to disappear at about 38 weeks and very likely has completely vanished by 41 weeks’ gestation.

Question 102

A woman delivers a fetal demise that has lanugo covering the entire body, nails that are present on the fingers and toes, but eyes that are still fused. Prior to the death, the mother stated that she had felt quickening. Based on this information, the nurse knows that the baby is about how many weeks’ gestation? 1. 15 weeks. 2. 22 weeks. 3. 29 weeks. 4. 36 weeks.

Answer 102

2. This fetus is about 22 weeks’ gestation. Nails start to develop in the first trimester, and lanugo starts to develop at about 20 weeks, but eyes remain fused until about 29 weeks. TEST-TAKING TIP: The test taker should not panic when reading a question like the one in the scenario. This is an application question that requires the test taker to take things apart and put them back together again. Each of the signs is unique and relates to a specific period in fetal development. After an analysis, the only response that is plausible is response “2.”

Question 103

A client asks the nurse, “Could you explain how the baby’s blood and my blood separate at delivery?” Which of the following responses is appropriate for the nurse to make? 1. “When the placenta is born, the circulatory systems separate.” 2. “When the doctor clamps the cord, the blood stops mixing.” 3. “The separation happens after the baby takes the first breath. The baby’s oxygen no longer has to come from you.” 4. “The blood actually never mixes. Your blood supply and the baby’s blood supply are completely separate.”

Answer 103

4. The blood supplies are completely separate. TEST-TAKING TIP: It is important to understand the relationship between the maternal vascular system and the fetal system. There is a maternal portion to the placenta and a fetal portion of the placenta. By the time the placenta is fully functioning, at about 12 weeks’ gestation, fetal blood vessels have burrowed into the decidual lining and maternal vessels have burrowed into the chorionic layer. The vessels, therefore, lie next to each other. Gases and nutrients, then, move across the membranes of the vessels in order to provide the baby with needed substances and in order for the mother to dispose of waste products.

Question 104

Please place an “X” on the drawing of the cross section of a placenta at the site of gas exchange. ![]()

Answer 104

An “X” will be placed between the neonatal and maternal vessels where gas exchange occurs. TEST-TAKING TIP: It is important that the test taker have a complete understanding of the anatomy and the physiology of the placenta. Since this is the sole organ that maintains the health and well-being of the fetus, the nurse must be able to differentiate between the maternal portion and the fetal portion as well as the function of the structures. ![]()

Question 105

The nurse is reading an article that states that the maternal mortality rate in the United States in the year 2000 was 17. Which of the following statements would be an accurate interpretation of the statement? 1. There were 17 maternal deaths in the United States in 2000 per 100,000 live births. 2. There were 17 maternal deaths in the United States in 2000 per 100,000 women of childbearing age. 3. There were 17 maternal deaths in the United States in 2000 per 100,000 pregnancies. 4. There were 17 maternal deaths in the United States in 2000 per 100,000 women in the country.

Answer 105

105. 1. This statement is correct. The maternal mortality rate is the number of deaths of women as a result of the childbearing period per 100,000 live births. TEST-TAKING TIP: One important indicator of the quality of health care in a country is its maternal mortality rate. The rate in the United States is very low as compared to many other countries in the world. For example, the maternal mortality rate in sub-Saharan Africa in 1995 was 1,100 deaths per 100,000 live births.