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Maternal & Child Practice Exam 8 (Antepartum) PM
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Question 1
Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following?
A
Developing a rubella infection
B
Developing physiological jaundice
C
Being affected by Rh incompatibility
D
Having Rh positive blood
Question 1 Explanation:
Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the baby’s Rh positive blood can enter the maternal circulation, causing the woman’s immune system to form antibodies against Rh positive blood. Administration of Rho(D) immune globulin prevents the woman from developing antibodies against Rh positive blood by providing passive antibody protection against the Rh antigen.
Question 2
A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse’s first action is to:
A
Assess the blood pressure and fetal heart rate
B
Clean and maintain an open airway
C
Administer magnesium sulfate intravenously
D
Administer oxygen by face mask
Question 2 Explanation:
The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.
Question 3
A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term?
A
“It is the thinning of the lower uterine segment.”
B
“It is the soft blowing sound that can be heard when the uterus is auscultated.”
C
“It is the fetal movement that is felt by the mother.”
D
“It is the irregular, painless contractions that occur throughout pregnancy.”
Question 3 Explanation:
Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar’s sign.
Question 4
The pituitary hormone that stimulates the secretion of milk from the mammary glands is:
A
Prolactin
B
Progesterone
C
Oxytocin
D
Estrogen
Question 4 Explanation:
Prolactin is the hormone from the anterior pituitary gland that stimulates mammary gland secretion. Oxytocin, a posterior pituitary hormone, stimulates the uterine musculature to contract and causes the “let down” reflex.
Question 5
The chief function of progesterone is the:
A
Stimulation of the follicles for ovulation to occur
B
Development of the female reproductive system
C
Establishment of secondary male sex characteristics
D
Preparation of the uterus to receive a fertilized egg
Question 5 Explanation:
Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.
Question 6
A nurse is performing an assessment of a primipara who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing?
A
Consistent increase in fundal height
B
Braxton hicks contractions
C
Quickening
D
Fetal heart rate of 180 BPM
Question 6 Explanation:
The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected.
Question 7
A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse?
A
Respiratory rate of 10 BPM
B
Fetal heart rate of 120 BPM
C
Urinary output of 20 ml since the previous assessment
D
Deep tendon reflexes of 2+
Question 7 Explanation:
Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.
Question 8
The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine position can:
A
Interfere with free movement of the coccyx
B
Unduly prolong labor
C
Cause decreased placental perfusion
D
Lead to transient episodes of hypotension
Question 8 Explanation:
This is because impedance of venous return by the gravid uterus, which causes hypotension and decreased systemic perfusion.
Question 9
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year old child that was delivered at 37 weeks and tells the nurse that she doesn’t have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as:
A
G = 2, T = 0, P = 1, A = 0, L =1
B
G = 2, T = 0, P = 0, A = 0, L = 1
C
G = 3, T = 2, P = 0, A = 0, L =1
D
G = 1, T = 1. P = 1, A = 0, L = 1
Question 9 Explanation:
Pregnancy outcomes can be described with the acronym GTPAL.
“G” is Gravidity, the number of pregnancies.
“T” is term births, the number of born at term (38 to 41 weeks).
“P” is preterm births, the number born before 38 weeks gestation.
“A” is abortions or miscarriages, included in “G” if before 20 weeks gestation, included in parity if past 20 weeks AOE.
“L” is live births, the number of births of living children.
Therefore, a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 37 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1.
Question 10
A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy.
A
Fetal heart rate detected by nonelectric device
B
Ballottement
C
Braxton Hicks contractions
D
Uterine enlargement
E
Chadwick’s sign
F
Outline of the fetus via radiography or ultrasound
Question 10 Explanation:
The probable signs of pregnancy include:
Uterine Enlargement
Hegar’s sign or softening and thinning of the uterine segment that occurs at week 6.
Goodell’s sign or softening of the cervix that occurs at the beginning of the 2nd month
Chadwick’s sign or bluish coloration of the mucous membranes of the cervix, vagina and vulva. Occurs at week 6.
Ballottement or rebounding of the fetus against the examiner’s fingers of palpation
Braxton-Hicks contractions
Positive pregnancy test measuring for hCG.
Positive signs of pregnancy include:
Fetal Heart Rate detected by electronic device (doppler) at 10-12 weeks
Fetal Heart rate detected by nonelectronic device (fetoscope) at 20 weeks AOG
Active fetal movement palpable by the examiners
Outline of the fetus via radiography or ultrasound
Question 11
A nurse midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement?
A
Palpating the abdomen for fetal movement
B
Initiating a gentle upward tap on the cervix
C
Auscultating for fetal heart sounds
D
Assessing the cervix for thinning
Question 11 Explanation:
Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger.
Question 12
A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is:
A
G4 T3 P1 A1 L4
B
G4 T3 P2 A1 L4
C
G5 T2 P1 A1 L4
D
G5 T2 P2 A1 L4
Question 12 Explanation:
5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.
Question 13
At a prenatal visit at 36 weeks’ gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to:
A
Lie down until they stop
B
Time contraction for 30 minutes
C
Take 10 grains of aspirin for the discomfort
D
Walk around until they subside
Question 13 Explanation:
Ambulation relieves Braxton Hicks.
Question 14
A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell’s sign. The nurse determines this sign indicates:
A
The presence of fetal movement
B
The presence of hCG in the urine
C
A softening of the cervix
D
A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus.
Question 14 Explanation:
In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell’s sign.
Question 15
A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to:
A
Wear tight-fitting blouses or dresses to provide support
B
Wash the breasts with warm water and keep them dry
C
Wash the nipples and areola area daily with soap, and massage the breasts with lotion.
D
Avoid wearing a bra
Question 15 Explanation:
The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort.
Question 16
Clients with gestational diabetes are usually managed by which of the following therapies?
A
Oral hypoglycemic drugs
B
Oral hypoglycemic drugs and insulin
C
NPH insulin (long-acting)
D
Diet
Question 16 Explanation:
Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic agents are contraindicated in pregnancy. NPH isn’t usually needed for blood glucose control for GDM.
Question 17
The antagonist for magnesium sulfate should be readily available to any client receiving IV magnesium. Which of the following drugs is the antidote for magnesium toxicity?
A
RhoGAM
B
Hydralazine (Apresoline)
C
Calcium gluconate
D
Narcan
Question 17 Explanation:
Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium gluconate is given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients.
Question 18
A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)?
A
Negative urinary protein
B
Increased respirations
C
Facial edema
D
Elevated blood pressure
Question 18 Explanation:
The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia.
Question 19
A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician?
A
Urinary output has increased
B
The client complains of a headache and blurred vision
C
Dependent edema has resolved
D
Blood pressure reading is at the prenatal baseline
Question 19 Explanation:
If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening Preeclampsia.
Question 20
The developing cells are called a fetus from the:
A
Eighth week to the time of birth
B
Time the fetal heart is heard
C
Implantation of the fertilized ovum
D
End of the send week to the onset of labor
Question 20 Explanation:
In the first 7-14 days the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.
Question 21
The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is:
A
An increase in blood volume
B
A decrease in WBC’s
C
In increase in hematocrit
D
A decrease in sedimentation rate
Question 21 Explanation:
The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.
Question 22
A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps and is awakened by the cramps at night. To provide relief from the leg cramps, the nurse tells the client to:
A
Dorsiflex the foot while flexing the knee when the cramps occur
B
Dorsiflex the foot while extending the knee when the cramps occur
C
Plantar flex the foot while extending the knee when the cramps occur
D
Plantar flex the foot while flexing the knee when the cramps occur
Question 22 Explanation:
Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping.
Question 23
A prenatal nurse is providing instructions to a group of pregnant client regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions?
A
“I need to drink unpasteurized milk only.”
B
“I need to avoid contact with materials that are possibly contaminated with cat feces.”
C
“I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat.”
D
“I need to cook meat thoroughly.”
Question 23 Explanation:
All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption, and avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sandboxes, and garden soil.
Question 24
A 26-year old multigravida is 14 weeks’ pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, “What does the alpha-fetoprotein test indicate?” The nurse bases a response on the knowledge that this test can detect:
A
Cardiac defects
B
Urinary tract defects
C
Kidney defects
D
Neural tube defects
Question 24 Explanation:
The alpha-fetoprotein test detects neural tube defects and Down syndrome.
Question 25
The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as:
A
Chadwick’s sign
B
Hegar’s sign
C
Ladin’s sign
D
Goodell’s sign
Question 25 Explanation:
A purplish color results from the increased vascularity and blood vessel engorgement of the vagina.
Question 26
A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client.
A
Monitor renal function and cardiac function closely
B
Notify the physician if urinary output is less than 30 ml per hour.
C
Notify the physician if respirations are less than 18 per minute.
D
Keep calcium gluconate on hand in case of a magnesium sulfate overdose
E
Monitor maternal vital signs every 2 hours
F
Monitor deep tendon reflexes hourly
G
Monitor I and O’s hourly
Question 26 Explanation:
When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.
Question 27
After the first four months of pregnancy, the chief source of estrogen and progesterone is the:
A
Adrenal cortex
B
Corpus luteum
C
Placenta
D
Anterior hypophysis
Question 27 Explanation:
When placental formation is complete, around the 16th week of pregnancy; it produces estrogen and progesterone.
Question 28
A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for:
A
Periods of fetal movement followed by quiet periods
B
Enlargement of the breasts
C
Any bleeding, such as in the gums, petechiae, and purpura.
D
Complaints of feeling hot when the room is cool
Question 28 Explanation:
Severe Preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.
Question 29
Which of the following terms applies to the tiny, blanched, slightly raised end arterioles found on the face, neck, arms, and chest during pregnancy?
A
Epulis
B
Telangiectasias
C
Linea nigra
D
Striae gravidarum
Question 29 Explanation:
The dilated arterioles that occur during pregnancy are due to the elevated level of circulating estrogen. The linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus during pregnancy.
Question 30
A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education?
A
“I will maintain strict bedrest throughout the remainder of pregnancy.”
B
“I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding.”
C
“I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad.”
D
“I will watch for the evidence of the passage of tissue.”
Question 30 Explanation:
Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.
Question 31
Gravida refers to which of the following descriptions?
A
A serious pregnancy
B
Number of children a female has delivered
C
Number of times a female has been pregnant
D
Number of term pregnancies a female has had.
Question 31 Explanation:
Gravida refers to the number of times a female has been pregnant, regardless of pregnancy outcome or the number of neonates delivered.
Question 32
In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must:
A
Make certain she receives RhoGAM on her first clinic visit
B
Administer RhoGAM within 72 hours
C
Not give RhoGAM, since it is not used with the birth of a stillborn
D
Make certain the client does not receive RhoGAM, since the gestation only lasted 12 weeks.
Question 32 Explanation:
RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.
Question 33
A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education?
A
“I need to avoid exercise because of the negative effects of insulin production.”
B
“I need to be aware of any infections and report signs of infection immediately to my health care provider.”
C
“I need to stay on the diabetic diet.”
D
“I will perform glucose monitoring at home.”
Question 33 Explanation:
Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood glucose level.
Question 34
When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased:
A
Supply of sodium chloride to the cells of the vagina
B
Functioning of the Bartholin glands
C
Metabolic rates
D
Production of estrogen
Question 34 Explanation:
The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells.
Question 35
A pregnant woman’s last menstrual period began on April 8, 2005, and ended on April 13. Using Naegele’s rule her estimated date of birth would be:
A
November 5, 2005
B
January 15, 2006
C
January 20, 2006
D
July 1, 2006
Question 35 Explanation:
Naegele’s rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman’s last menstrual period. When this rule, is used with April 8, 2005, the estimated date of birth is January 15, 2006.
Question 36
Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged?
A
Conception
B
32-34 weeks gestation
C
9 weeks’ gestation, when the fetal heart is well developed
D
maternal and fetal blood are never exchanged
Question 36 Explanation:
Only nutrients and waste products are transferred across the placenta. Blood exchange only occurs in complications and some medical procedures accidentally.
Question 37
Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include:
A
An increase of 500 calories a day
B
A decrease of 200 calories a day
C
A maintenance of her present caloric intake per day
D
An increase of 300 calories a day
Question 37 Explanation:
This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy.
Question 38
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?
A
Proteinuria of +3
B
Presence of deep tendon reflexes
C
Serum magnesium level of 6 mEq/L
D
Respirations of 10 per minute
Question 38 Explanation:
Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L. Proteinuria of +3 would be noted in a client with preeclampsia.
Question 39
A nursing instructor is conducting lecture and is reviewing the functions of the female reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Mark accurately responds by stating that:
A
FSH and LH are secreted by the corpus luteum of the ovary
B
FSH and LH stimulate the formation of milk during pregnancy.
C
FSH and LH are secreted by the adrenal glands
D
FSH and LH are released from the anterior pituitary gland.
Question 39 Explanation:
FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the graafian follicle, and production of progesterone.
Question 40
A 21-year old client, 6 weeks’ pregnant is diagnosed with hyperemesis gravidarum. This excessive vomiting during pregnancy will often result in which of the following conditions?
A
Pregnancy induced hypertension (PIH)
B
Bowel perforation
C
Electrolyte imbalance
D
Miscarriage
Question 40 Explanation:
Excessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid, electrolyte, and acid-base imbalances.
Question 41
In a lecture on sexual functioning, the nurse plans to include the fact that ovulation occurs when the:
A
Oxytocin is too high
B
Progesterone level is high
C
Blood level of LH is too high
D
Endometrial wall is sloughed off.
Question 41 Explanation:
It is the surge of LH secretion in mid cycle that is responsible for ovulation.
Question 42
A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse accurately tells the client that fetal circulation consists of:
A
Arteries carrying oxygenated blood to the fetus
B
Two umbilical veins and one umbilical artery
C
Veins carrying deoxygenated blood to the fetus
D
Two umbilical arteries and one umbilical vein
Question 42 Explanation:
Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus.
Question 43
Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy?
A
Physiologic anemia
B
Metabolic alkalosis
C
Mastitis
D
Respiratory acidosis
Question 43 Explanation:
Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production.
Question 44
During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines that the fetal heart rate is normal if which of the following is noted?
A
80 BPM
B
180 BPM
C
100 BPM
D
150 BPM
Question 44 Explanation:
The fetal heart rate depends in gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress.
Question 45
A pregnant woman at 32 weeks’ gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse’s initial response would be to:
A
Raise the woman’s legs
B
Have the woman breathe into a paper bag
C
Assess the woman’s blood pressure and pulse
D
Turn the woman on her side.
Question 45 Explanation:
During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure. Then vital signs can be assessed. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation.
Question 46
An expected cardiopulmonary adaptation experienced by most pregnant women is:
A
Shortness of breath on exertion
B
Dyspnea at rest
C
Progression of dependent edema
D
Tachycardia
Question 46 Explanation:
This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm.
Question 47
A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if:
A
Seizures do not occur
B
The blood pressure decreases
C
Ankle clonus in noted
D
Scotomas are present
Question 47 Explanation:
For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.
Question 48
During a prenatal examination, the nurse draws blood from a young Rh negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for:
A
Respiratory distress syndrome
B
Physiologic hyperbilirubinemia
C
Protein metabolic deficiency
D
Acute hemolytic disease
Question 48 Explanation:
When an Rh negative mother carries an Rh positive fetus there is a risk for maternal antibodies against Rh positive blood; antibodies cross the placenta and destroy the fetal RBC’s.
Question 49
Which of the following symptoms occurs with a hydatidiform mole?
A
Fetal cardiac motion after 6 weeks gestation
B
Heavy, bright red bleeding every 21 days
C
Benign tumors found in the smooth muscle of the uterus
D
“Snowstorm” pattern on ultrasound with no fetus or gestational sac
Question 49 Explanation:
The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.
Question 50
A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele’s rule, the nurse determines the estimated date of confinement as:
A
July 26, 2013
B
June 12, 2014
C
June 26, 2014
D
July 12, 2014
Question 50 Explanation:
Accurate use of Naegele’s rule requires that the woman have a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract three months, and then add one year to that date.
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Maternal & Child Practice Exam 8 (Antepartum) EM
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Question 1
A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client.
A
Monitor deep tendon reflexes hourly
B
Notify the physician if respirations are less than 18 per minute.
C
Monitor renal function and cardiac function closely
D
Monitor I and O’s hourly
E
Notify the physician if urinary output is less than 30 ml per hour.
F
Monitor maternal vital signs every 2 hours
G
Keep calcium gluconate on hand in case of a magnesium sulfate overdose
Question 1 Explanation:
When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.
Question 2
Which of the following symptoms occurs with a hydatidiform mole?
A
Benign tumors found in the smooth muscle of the uterus
B
Fetal cardiac motion after 6 weeks gestation
C
“Snowstorm” pattern on ultrasound with no fetus or gestational sac
D
Heavy, bright red bleeding every 21 days
Question 2 Explanation:
The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.
Question 3
A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps and is awakened by the cramps at night. To provide relief from the leg cramps, the nurse tells the client to:
A
Plantar flex the foot while flexing the knee when the cramps occur
B
Plantar flex the foot while extending the knee when the cramps occur
C
Dorsiflex the foot while flexing the knee when the cramps occur
D
Dorsiflex the foot while extending the knee when the cramps occur
Question 3 Explanation:
Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping.
Question 4
A nurse midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement?
A
Palpating the abdomen for fetal movement
B
Initiating a gentle upward tap on the cervix
C
Assessing the cervix for thinning
D
Auscultating for fetal heart sounds
Question 4 Explanation:
Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger.
Question 5
An expected cardiopulmonary adaptation experienced by most pregnant women is:
A
Tachycardia
B
Dyspnea at rest
C
Shortness of breath on exertion
D
Progression of dependent edema
Question 5 Explanation:
This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm.
Question 6
Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include:
A
An increase of 500 calories a day
B
An increase of 300 calories a day
C
A maintenance of her present caloric intake per day
D
A decrease of 200 calories a day
Question 6 Explanation:
This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy.
Question 7
A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse’s first action is to:
A
Assess the blood pressure and fetal heart rate
B
Clean and maintain an open airway
C
Administer oxygen by face mask
D
Administer magnesium sulfate intravenously
Question 7 Explanation:
The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.
Question 8
A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education?
A
“I need to be aware of any infections and report signs of infection immediately to my health care provider.”
B
“I need to avoid exercise because of the negative effects of insulin production.”
C
“I will perform glucose monitoring at home.”
D
“I need to stay on the diabetic diet.”
Question 8 Explanation:
Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood glucose level.
Question 9
A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician?
A
Dependent edema has resolved
B
Blood pressure reading is at the prenatal baseline
C
The client complains of a headache and blurred vision
D
Urinary output has increased
Question 9 Explanation:
If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening Preeclampsia.
Question 10
A nurse is performing an assessment of a primipara who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing?
A
Fetal heart rate of 180 BPM
B
Consistent increase in fundal height
C
Braxton hicks contractions
D
Quickening
Question 10 Explanation:
The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected.
Question 11
A pregnant woman’s last menstrual period began on April 8, 2005, and ended on April 13. Using Naegele’s rule her estimated date of birth would be:
A
January 20, 2006
B
January 15, 2006
C
November 5, 2005
D
July 1, 2006
Question 11 Explanation:
Naegele’s rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman’s last menstrual period. When this rule, is used with April 8, 2005, the estimated date of birth is January 15, 2006.
Question 12
The chief function of progesterone is the:
A
Preparation of the uterus to receive a fertilized egg
B
Development of the female reproductive system
C
Establishment of secondary male sex characteristics
D
Stimulation of the follicles for ovulation to occur
Question 12 Explanation:
Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.
Question 13
The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is:
A
In increase in hematocrit
B
An increase in blood volume
C
A decrease in sedimentation rate
D
A decrease in WBC’s
Question 13 Explanation:
The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.
Question 14
A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse?
A
Fetal heart rate of 120 BPM
B
Respiratory rate of 10 BPM
C
Urinary output of 20 ml since the previous assessment
D
Deep tendon reflexes of 2+
Question 14 Explanation:
Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.
Question 15
A pregnant woman at 32 weeks’ gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse’s initial response would be to:
A
Assess the woman’s blood pressure and pulse
B
Have the woman breathe into a paper bag
C
Turn the woman on her side.
D
Raise the woman’s legs
Question 15 Explanation:
During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure. Then vital signs can be assessed. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation.
Question 16
A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for:
A
Enlargement of the breasts
B
Any bleeding, such as in the gums, petechiae, and purpura.
C
Periods of fetal movement followed by quiet periods
D
Complaints of feeling hot when the room is cool
Question 16 Explanation:
Severe Preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.
Question 17
During a prenatal examination, the nurse draws blood from a young Rh negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for:
A
Respiratory distress syndrome
B
Protein metabolic deficiency
C
Acute hemolytic disease
D
Physiologic hyperbilirubinemia
Question 17 Explanation:
When an Rh negative mother carries an Rh positive fetus there is a risk for maternal antibodies against Rh positive blood; antibodies cross the placenta and destroy the fetal RBC’s.
Question 18
A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is:
A
G4 T3 P2 A1 L4
B
G5 T2 P1 A1 L4
C
G4 T3 P1 A1 L4
D
G5 T2 P2 A1 L4
Question 18 Explanation:
5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.
Question 19
A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele’s rule, the nurse determines the estimated date of confinement as:
A
July 12, 2014
B
June 12, 2014
C
July 26, 2013
D
June 26, 2014
Question 19 Explanation:
Accurate use of Naegele’s rule requires that the woman have a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract three months, and then add one year to that date.
Question 20
A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell’s sign. The nurse determines this sign indicates:
A
A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus.
B
The presence of hCG in the urine
C
The presence of fetal movement
D
A softening of the cervix
Question 20 Explanation:
In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell’s sign.
Question 21
A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term?
A
“It is the irregular, painless contractions that occur throughout pregnancy.”
B
“It is the fetal movement that is felt by the mother.”
C
“It is the thinning of the lower uterine segment.”
D
“It is the soft blowing sound that can be heard when the uterus is auscultated.”
Question 21 Explanation:
Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar’s sign.
Question 22
In a lecture on sexual functioning, the nurse plans to include the fact that ovulation occurs when the:
A
Progesterone level is high
B
Oxytocin is too high
C
Endometrial wall is sloughed off.
D
Blood level of LH is too high
Question 22 Explanation:
It is the surge of LH secretion in mid cycle that is responsible for ovulation.
Question 23
After the first four months of pregnancy, the chief source of estrogen and progesterone is the:
A
Corpus luteum
B
Adrenal cortex
C
Anterior hypophysis
D
Placenta
Question 23 Explanation:
When placental formation is complete, around the 16th week of pregnancy; it produces estrogen and progesterone.
Question 24
Which of the following terms applies to the tiny, blanched, slightly raised end arterioles found on the face, neck, arms, and chest during pregnancy?
A
Telangiectasias
B
Linea nigra
C
Epulis
D
Striae gravidarum
Question 24 Explanation:
The dilated arterioles that occur during pregnancy are due to the elevated level of circulating estrogen. The linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus during pregnancy.
Question 25
When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased:
A
Supply of sodium chloride to the cells of the vagina
B
Functioning of the Bartholin glands
C
Production of estrogen
D
Metabolic rates
Question 25 Explanation:
The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells.
Question 26
The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as:
A
Goodell’s sign
B
Chadwick’s sign
C
Ladin’s sign
D
Hegar’s sign
Question 26 Explanation:
A purplish color results from the increased vascularity and blood vessel engorgement of the vagina.
Question 27
Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged?
A
Conception
B
9 weeks’ gestation, when the fetal heart is well developed
C
32-34 weeks gestation
D
maternal and fetal blood are never exchanged
Question 27 Explanation:
Only nutrients and waste products are transferred across the placenta. Blood exchange only occurs in complications and some medical procedures accidentally.
Question 28
A 21-year old client, 6 weeks’ pregnant is diagnosed with hyperemesis gravidarum. This excessive vomiting during pregnancy will often result in which of the following conditions?
A
Electrolyte imbalance
B
Miscarriage
C
Bowel perforation
D
Pregnancy induced hypertension (PIH)
Question 28 Explanation:
Excessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid, electrolyte, and acid-base imbalances.
Question 29
A nursing instructor is conducting lecture and is reviewing the functions of the female reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Mark accurately responds by stating that:
A
FSH and LH are released from the anterior pituitary gland.
B
FSH and LH are secreted by the adrenal glands
C
FSH and LH stimulate the formation of milk during pregnancy.
D
FSH and LH are secreted by the corpus luteum of the ovary
Question 29 Explanation:
FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the graafian follicle, and production of progesterone.
Question 30
A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to:
A
Avoid wearing a bra
B
Wash the breasts with warm water and keep them dry
C
Wear tight-fitting blouses or dresses to provide support
D
Wash the nipples and areola area daily with soap, and massage the breasts with lotion.
Question 30 Explanation:
The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort.
Question 31
In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must:
A
Make certain the client does not receive RhoGAM, since the gestation only lasted 12 weeks.
B
Not give RhoGAM, since it is not used with the birth of a stillborn
C
Administer RhoGAM within 72 hours
D
Make certain she receives RhoGAM on her first clinic visit
Question 31 Explanation:
RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.
Question 32
Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following?
A
Having Rh positive blood
B
Being affected by Rh incompatibility
C
Developing physiological jaundice
D
Developing a rubella infection
Question 32 Explanation:
Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the baby’s Rh positive blood can enter the maternal circulation, causing the woman’s immune system to form antibodies against Rh positive blood. Administration of Rho(D) immune globulin prevents the woman from developing antibodies against Rh positive blood by providing passive antibody protection against the Rh antigen.
Question 33
The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine position can:
A
Interfere with free movement of the coccyx
B
Unduly prolong labor
C
Cause decreased placental perfusion
D
Lead to transient episodes of hypotension
Question 33 Explanation:
This is because impedance of venous return by the gravid uterus, which causes hypotension and decreased systemic perfusion.
Question 34
During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines that the fetal heart rate is normal if which of the following is noted?
A
180 BPM
B
80 BPM
C
150 BPM
D
100 BPM
Question 34 Explanation:
The fetal heart rate depends in gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress.
Question 35
A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse accurately tells the client that fetal circulation consists of:
A
Arteries carrying oxygenated blood to the fetus
B
Two umbilical veins and one umbilical artery
C
Two umbilical arteries and one umbilical vein
D
Veins carrying deoxygenated blood to the fetus
Question 35 Explanation:
Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus.
Question 36
Clients with gestational diabetes are usually managed by which of the following therapies?
A
Oral hypoglycemic drugs
B
NPH insulin (long-acting)
C
Diet
D
Oral hypoglycemic drugs and insulin
Question 36 Explanation:
Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic agents are contraindicated in pregnancy. NPH isn’t usually needed for blood glucose control for GDM.
Question 37
A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if:
A
Ankle clonus in noted
B
Scotomas are present
C
Seizures do not occur
D
The blood pressure decreases
Question 37 Explanation:
For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.
Question 38
The antagonist for magnesium sulfate should be readily available to any client receiving IV magnesium. Which of the following drugs is the antidote for magnesium toxicity?
A
RhoGAM
B
Narcan
C
Hydralazine (Apresoline)
D
Calcium gluconate
Question 38 Explanation:
Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium gluconate is given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients.
Question 39
A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education?
A
“I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad.”
B
“I will watch for the evidence of the passage of tissue.”
C
“I will maintain strict bedrest throughout the remainder of pregnancy.”
D
“I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding.”
Question 39 Explanation:
Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.
Question 40
The pituitary hormone that stimulates the secretion of milk from the mammary glands is:
A
Prolactin
B
Progesterone
C
Estrogen
D
Oxytocin
Question 40 Explanation:
Prolactin is the hormone from the anterior pituitary gland that stimulates mammary gland secretion. Oxytocin, a posterior pituitary hormone, stimulates the uterine musculature to contract and causes the “let down” reflex.
Question 41
A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy.
A
Outline of the fetus via radiography or ultrasound
B
Ballottement
C
Fetal heart rate detected by nonelectric device
D
Uterine enlargement
E
Braxton Hicks contractions
F
Chadwick’s sign
Question 41 Explanation:
The probable signs of pregnancy include:
Uterine Enlargement
Hegar’s sign or softening and thinning of the uterine segment that occurs at week 6.
Goodell’s sign or softening of the cervix that occurs at the beginning of the 2nd month
Chadwick’s sign or bluish coloration of the mucous membranes of the cervix, vagina and vulva. Occurs at week 6.
Ballottement or rebounding of the fetus against the examiner’s fingers of palpation
Braxton-Hicks contractions
Positive pregnancy test measuring for hCG.
Positive signs of pregnancy include:
Fetal Heart Rate detected by electronic device (doppler) at 10-12 weeks
Fetal Heart rate detected by nonelectronic device (fetoscope) at 20 weeks AOG
Active fetal movement palpable by the examiners
Outline of the fetus via radiography or ultrasound
Question 42
A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)?
A
Increased respirations
B
Negative urinary protein
C
Elevated blood pressure
D
Facial edema
Question 42 Explanation:
The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia.
Question 43
Gravida refers to which of the following descriptions?
A
A serious pregnancy
B
Number of children a female has delivered
C
Number of term pregnancies a female has had.
D
Number of times a female has been pregnant
Question 43 Explanation:
Gravida refers to the number of times a female has been pregnant, regardless of pregnancy outcome or the number of neonates delivered.
Question 44
The developing cells are called a fetus from the:
A
End of the send week to the onset of labor
B
Time the fetal heart is heard
C
Implantation of the fertilized ovum
D
Eighth week to the time of birth
Question 44 Explanation:
In the first 7-14 days the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.
Question 45
Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy?
A
Mastitis
B
Respiratory acidosis
C
Physiologic anemia
D
Metabolic alkalosis
Question 45 Explanation:
Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production.
Question 46
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year old child that was delivered at 37 weeks and tells the nurse that she doesn’t have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as:
A
G = 3, T = 2, P = 0, A = 0, L =1
B
G = 1, T = 1. P = 1, A = 0, L = 1
C
G = 2, T = 0, P = 0, A = 0, L = 1
D
G = 2, T = 0, P = 1, A = 0, L =1
Question 46 Explanation:
Pregnancy outcomes can be described with the acronym GTPAL.
“G” is Gravidity, the number of pregnancies.
“T” is term births, the number of born at term (38 to 41 weeks).
“P” is preterm births, the number born before 38 weeks gestation.
“A” is abortions or miscarriages, included in “G” if before 20 weeks gestation, included in parity if past 20 weeks AOE.
“L” is live births, the number of births of living children.
Therefore, a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 37 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1.
Question 47
At a prenatal visit at 36 weeks’ gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to:
A
Take 10 grains of aspirin for the discomfort
B
Time contraction for 30 minutes
C
Lie down until they stop
D
Walk around until they subside
Question 47 Explanation:
Ambulation relieves Braxton Hicks.
Question 48
A prenatal nurse is providing instructions to a group of pregnant client regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions?
A
“I need to avoid contact with materials that are possibly contaminated with cat feces.”
B
“I need to cook meat thoroughly.”
C
“I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat.”
D
“I need to drink unpasteurized milk only.”
Question 48 Explanation:
All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption, and avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sandboxes, and garden soil.
Question 49
A 26-year old multigravida is 14 weeks’ pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, “What does the alpha-fetoprotein test indicate?” The nurse bases a response on the knowledge that this test can detect:
A
Cardiac defects
B
Urinary tract defects
C
Neural tube defects
D
Kidney defects
Question 49 Explanation:
The alpha-fetoprotein test detects neural tube defects and Down syndrome.
Question 50
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?
A
Respirations of 10 per minute
B
Proteinuria of +3
C
Serum magnesium level of 6 mEq/L
D
Presence of deep tendon reflexes
Question 50 Explanation:
Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L. Proteinuria of +3 would be noted in a client with preeclampsia.
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1. A nursing instructor is conducting lecture and is reviewing the functions of the female reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Mark accurately responds by stating that:
FSH and LH are released from the anterior pituitary gland.
FSH and LH are secreted by the corpus luteum of the ovary
FSH and LH are secreted by the adrenal glands
FSH and LH stimulate the formation of milk during pregnancy.
2. A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse accurately tells the client that fetal circulation consists of:
Two umbilical veins and one umbilical artery
Two umbilical arteries and one umbilical vein
Arteries carrying oxygenated blood to the fetus
Veins carrying deoxygenated blood to the fetus
3. During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines that the fetal heart rate is normal if which of the following is noted?
80 BPM
100 BPM
150 BPM
180 BPM
4. A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele’s rule, the nurse determines the estimated date of confinement as:
July 26, 2013
June 12, 2014
June 26, 2014
July 12, 2014
5. A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year old child that was delivered at 37 weeks and tells the nurse that she doesn’t have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as:
G = 3, T = 2, P = 0, A = 0, L =1
G = 2, T = 0, P = 1, A = 0, L =1
G = 1, T = 1. P = 1, A = 0, L = 1
G = 2, T = 0, P = 0, A = 0, L = 1
6. A nurse is performing an assessment of a primipara who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing?
Consistent increase in fundal height
Fetal heart rate of 180 BPM
Braxton hicks contractions
Quickening
7. A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell’s sign. The nurse determines this sign indicates:
A softening of the cervix
A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus.
The presence of hCG in the urine
The presence of fetal movement
8. A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term?
“It is the irregular, painless contractions that occur throughout pregnancy.”
“It is the soft blowing sound that can be heard when the uterus is auscultated.”
“It is the fetal movement that is felt by the mother.”
“It is the thinning of the lower uterine segment.”
9. A nurse midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement?
Auscultating for fetal heart sounds
Palpating the abdomen for fetal movement
Assessing the cervix for thinning
Initiating a gentle upward tap on the cervix
10. A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy.
Uterine enlargement
Fetal heart rate detected by nonelectric device
Outline of the fetus via radiography or ultrasound
Chadwick’s sign
Braxton Hicks contractions
Ballottement
11. A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps and is awakened by the cramps at night. To provide relief from the leg cramps, the nurse tells the client to:
Dorsiflex the foot while extending the knee when the cramps occur
Dorsiflex the foot while flexing the knee when the cramps occur
Plantar flex the foot while flexing the knee when the cramps occur
Plantar flex the foot while extending the knee when the cramps occur.
12. A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to:
Avoid wearing a bra
Wash the nipples and areola area daily with soap, and massage the breasts with lotion.
Wear tight-fitting blouses or dresses to provide support
Wash the breasts with warm water and keep them dry
13. A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for:
Any bleeding, such as in the gums, petechiae, and purpura.
Enlargement of the breasts
Periods of fetal movement followed by quiet periods
Complaints of feeling hot when the room is cool
14. A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education?
“I will maintain strict bedrest throughout the remainder of pregnancy.”
“I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding.”
“I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad.”
“I will watch for the evidence of the passage of tissue.”
15. A prenatal nurse is providing instructions to a group of pregnant client regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions?
“I need to cook meat thoroughly.”
“I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat.”
“I need to drink unpasteurized milk only.”
“I need to avoid contact with materials that are possibly contaminated with cat feces.”
16. A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician?
Blood pressure reading is at the prenatal baseline
Urinary output has increased
The client complains of a headache and blurred vision
Dependent edema has resolved
17. A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education?
“I need to stay on the diabetic diet.”
“I will perform glucose monitoring at home.”
“I need to avoid exercise because of the negative effects of insulin production.”
“I need to be aware of any infections and report signs of infection immediately to my health care provider.”
18. A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse?
Urinary output of 20 ml since the previous assessment
Deep tendon reflexes of 2+
Respiratory rate of 10 BPM
Fetal heart rate of 120 BPM
19. A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse’s first action is to:
Administer magnesium sulfate intravenously
Assess the blood pressure and fetal heart rate
Clean and maintain an open airway
Administer oxygen by face mask
20. A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)?
Elevated blood pressure
Negative urinary protein
Facial edema
Increased respirations
21. Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following?
Being affected by Rh incompatibility
Having Rh positive blood
Developing a rubella infection
Developing physiological jaundice
22. A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?
Presence of deep tendon reflexes
Serum magnesium level of 6 mEq/L
Proteinuria of +3
Respirations of 10 per minute
23. A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if:
Ankle clonus in noted
The blood pressure decreases
Seizures do not occur
Scotomas are present
24. A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client.
Monitor maternal vital signs every 2 hours
Notify the physician if respirations are less than 18 per minute.
Monitor renal function and cardiac function closely
Keep calcium gluconate on hand in case of a magnesium sulfate overdose
Monitor deep tendon reflexes hourly
Monitor I and O’s hourly
Notify the physician if urinary output is less than 30 ml per hour.
25. In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must:
Administer RhoGAM within 72 hours
Make certain she receives RhoGAM on her first clinic visit
Not give RhoGAM, since it is not used with the birth of a stillborn
Make certain the client does not receive RhoGAM, since the gestation only lasted 12 weeks.
26. In a lecture on sexual functioning, the nurse plans to include the fact that ovulation occurs when the:
Oxytocin is too high
Blood level of LH is too high
Progesterone level is high
Endometrial wall is sloughed off.
27. The chief function of progesterone is the:
Development of the female reproductive system
Stimulation of the follicles for ovulation to occur
Preparation of the uterus to receive a fertilized egg
Establishment of secondary male sex characteristics
28. The developing cells are called a fetus from the:
Time the fetal heart is heard
Eighth week to the time of birth
Implantation of the fertilized ovum
End of the send week to the onset of labor
29. After the first four months of pregnancy, the chief source of estrogen and progesterone is the:
Placenta
Adrenal cortex
Corpus luteum
Anterior hypophysis
30. The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is:
A decrease in WBC’s
In increase in hematocrit
An increase in blood volume
A decrease in sedimentation rate
31. The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as:
Ladin’s sign
Hegar’s sign
Goodell’s sign
Chadwick’s sign
32. A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is:
G4 T3 P2 A1 L4
G5 T2 P2 A1 L4
G5 T2 P1 A1 L4
G4 T3 P1 A1 L4
33. An expected cardiopulmonary adaptation experienced by most pregnant women is:
Tachycardia
Dyspnea at rest
Progression of dependent edema
Shortness of breath on exertion
34. Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include:
A decrease of 200 calories a day
An increase of 300 calories a day
An increase of 500 calories a day
A maintenance of her present caloric intake per day
35. During a prenatal examination, the nurse draws blood from a young Rh negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for:
Acute hemolytic disease
Respiratory distress syndrome
Protein metabolic deficiency
Physiologic hyperbilirubinemia
36. When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased:
Metabolic rates
Production of estrogen
Functioning of the Bartholin glands
Supply of sodium chloride to the cells of the vagina
37. A 26-year old multigravida is 14 weeks’ pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, “What does the alpha-fetoprotein test indicate?” The nurse bases a response on the knowledge that this test can detect:
Kidney defects
Cardiac defects
Neural tube defects
Urinary tract defects
38. At a prenatal visit at 36 weeks’ gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to:
Lie down until they stop
Walk around until they subside
Time contraction for 30 minutes
Take 10 grains of aspirin for the discomfort
39. The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine position can:
Unduly prolong labor
Cause decreased placental perfusion
Lead to transient episodes of hypotension
Interfere with free movement of the coccyx
40. The pituitary hormone that stimulates the secretion of milk from the mammary glands is:
Prolactin
Oxytocin
Estrogen
Progesterone
41. Which of the following symptoms occurs with a hydatidiform mole?
Heavy, bright red bleeding every 21 days
Fetal cardiac motion after 6 weeks gestation
Benign tumors found in the smooth muscle of the uterus
“Snowstorm” pattern on ultrasound with no fetus or gestational sac
42. Which of the following terms applies to the tiny, blanched, slightly raised end arterioles found on the face, neck, arms, and chest during pregnancy?
Epulis
Linea nigra
Striae gravidarum
Telangiectasias
43. Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy?
Mastitis
Metabolic alkalosis
Physiologic anemia
Respiratory acidosis
44. A 21-year old client, 6 weeks’ pregnant is diagnosed with hyperemesis gravidarum. This excessive vomiting during pregnancy will often result in which of the following conditions?
Bowel perforation
Electrolyte imbalance
Miscarriage
Pregnancy induced hypertension (PIH)
45. Clients with gestational diabetes are usually managed by which of the following therapies?
Diet
NPH insulin (long-acting)
Oral hypoglycemic drugs
Oral hypoglycemic drugs and insulin
46. The antagonist for magnesium sulfate should be readily available to any client receiving IV magnesium. Which of the following drugs is the antidote for magnesium toxicity?
Calcium gluconate
Hydralazine (Apresoline)
Narcan
RhoGAM
47. Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged?
Conception
9 weeks’ gestation, when the fetal heart is well developed
32-34 weeks gestation
maternal and fetal blood are never exchanged
48. Gravida refers to which of the following descriptions?
A serious pregnancy
Number of times a female has been pregnant
Number of children a female has delivered
Number of term pregnancies a female has had.
49. A pregnant woman at 32 weeks’ gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse’s initial response would be to:
Assess the woman’s blood pressure and pulse
Have the woman breathe into a paper bag
Raise the woman’s legs
Turn the woman on her side.
50. A pregnant woman’s last menstrual period began on April 8, 2005, and ended on April 13. Using Naegele’s rule her estimated date of birth would be:
January 15, 2006
January 20, 2006
July 1, 2006
November 5, 2005
Answers and Rationales
Answer:A. FSH and LH are released from the anterior pituitary gland. FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the graafian follicle, and production of progesterone.
Answer:B. Two umbilical arteries and one umbilical vein. Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus.
Answer: C. 150 BPM. The fetal heart rate depends in gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress.
Answer: C. June 26, 2014. Accurate use of Naegele’s rule requires that the woman have a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract three months, and then add one year to that date.
Answer:B. G = 2, T = 0, P = 1, A = 0, L =1. Pregnancy outcomes can be described with the acronym GTPAL.
“G” is Gravidity, the number of pregnancies.
“T” is term births, the number of born at term (38 to 41 weeks).
“P” is preterm births, the number born before 38 weeks gestation.
“A” is abortions or miscarriages, included in “G” if before 20 weeks gestation, included in parity if past 20 weeks AOE.
“L” is live births, the number of births of living children.
Therefore, a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 37 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1.
Answer:B. Fetal heart rate of 180 BPM. The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected.
Answer:A. A softening of the cervix. In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell’s sign.
Answer: C. “It is the fetal movement that is felt by the mother.” Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar’s sign.
Answer:D. Initiating a gentle upward tap on the cervix. Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger.
Answers: A, D, E, and F.
The probable signs of pregnancy include:
Uterine Enlargement
Hegar’s sign or softening and thinning of the uterine segment that occurs at week 6.
Goodell’s sign or softening of the cervix that occurs at the beginning of the 2nd month
Chadwick’s sign or bluish coloration of the mucous membranes of the cervix, vagina and vulva. Occurs at week 6.
Ballottement or rebounding of the fetus against the examiner’s fingers of palpation
Braxton-Hicks contractions
Positive pregnancy test measuring for hCG.
Positive signs of pregnancy include:
Fetal Heart Rate detected by electronic device (doppler) at 10-12 weeks
Fetal Heart rate detected by nonelectronic device (fetoscope) at 20 weeks AOG
Active fetal movement palpable by the examiners
Outline of the fetus via radiography or ultrasound
Answer:A. Dorsiflex the foot while extending the knee when the cramps occur. Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping.
Answer: D. Wash the breasts with warm water and keep them dry. The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort.
Answer: A. Any bleeding, such as in the gums, petechiae, and purpura. Severe Preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.
Answer: A. “I will maintain strict bedrest throughout the remainder of pregnancy.” Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.
Answer: C. “I need to drink unpasteurized milk only.” All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption, and avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sandboxes, and garden soil.
Answer: C. The client complains of a headache and blurred vision. If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening Preeclampsia.
Answer: C. “I need to avoid exercise because of the negative effects of insulin production.” Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood glucose level.
Answer: C. Respiratory rate of 10 BPM. Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.
Answer: C. Clean and maintain an open airway. The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.
Answers: A Elevated blood pressure and 3 Facial edema. The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia.
Answer: A. Being affected by Rh incompatibility. Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the baby’s Rh positive blood can enter the maternal circulation, causing the woman’s immune system to form antibodies against Rh positive blood. Administration of Rho(D) immune globulin prevents the woman from developing antibodies against Rh positive blood by providing passive antibody protection against the Rh antigen.
Answer: D. Respirations of 10 per minute. Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L. Proteinuria of +3 would be noted in a client with preeclampsia.
Answer: C. Seizures do not occur. For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.
Answers: C, D, E, F, and G. When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.
Answer: A. Administer RhoGAM within 72 hours. RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.
Answer: B. Blood level of LH is too high. It is the surge of LH secretion in mid cycle that is responsible for ovulation.
Answer: C. Preparation of the uterus to receive a fertilized egg. Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.
Answer: B. Eighth week to the time of birth. In the first 7-14 days the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.
Answer: A. Placenta. When placental formation is complete, around the 16th week of pregnancy; it produces estrogen and progesterone.
Answer: C. An increase in blood volume. The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.
Answer: D. Chadwick’s sign. A purplish color results from the increased vascularity and blood vessel engorgement of the vagina.
Answer: C. G5 T2 P1 A1 L4. 5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.
Answer: D. Shortness of breath on exertion. This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm.
Answer: B. An increase of 300 calories a day. This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy.
Answer: A. Acute hemolytic disease. When an Rh negative mother carries an Rh positive fetus there is a risk for maternal antibodies against Rh positive blood; antibodies cross the placenta and destroy the fetal RBC’s.
Answer: B. Production of estrogen. The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells.
Answer: C. Neural tube defects. The alpha-fetoprotein test detects neural tube defects and Down syndrome.
Answer: B. Walk around until they subside. Ambulation relieves Braxton Hicks.
Answer: B. Cause decreased placental perfusion. This is because impedance of venous return by the gravid uterus, which causes hypotension and decreased systemic perfusion.
Answer: A. Prolactin. Prolactin is the hormone from the anterior pituitary gland that stimulates mammary gland secretion. Oxytocin, a posterior pituitary hormone, stimulates the uterine musculature to contract and causes the “let down” reflex.
Answer: D. “Snowstorm” pattern on ultrasound with no fetus or gestational sac. The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.
Answer: D. Telangiectasias. The dilated arterioles that occur during pregnancy are due to the elevated level of circulating estrogen. The linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus during pregnancy.
Answer: C. Physiologic anemia. Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production.
Answer: B. Electrolyte imbalance. Excessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid, electrolyte, and acid-base imbalances.
Answer: A. Diet. Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic agents are contraindicated in pregnancy. NPH isn’t usually needed for blood glucose control for GDM.
Answer: A. Calcium gluconate. Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium gluconate is given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients.
Answer: D. maternal and fetal blood are never exchanged. Only nutrients and waste products are transferred across the placenta. Blood exchange only occurs in complications and some medical procedures accidentally.
Answer: B. Number of times a female has been pregnant. Gravida refers to the number of times a female has been pregnant, regardless of pregnancy outcome or the number of neonates delivered.
Answer: D. Turn the woman on her side. During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure. Then vital signs can be assessed. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation.
Answer: A. January 15, 2006. Naegele’s rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman’s last menstrual period. When this rule, is used with April 8, 2005, the estimated date of birth is January 15, 2006.