- A woman’s obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One child was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?
| a. | 3-1-1-1-3 |
| b. | 4-1-2-0-4 |
| c. | 3-0-3-0-3 |
| d. | 4-2-1-0-3 |
ANS: B
| Feedback |
| A | The numbers do not accurately reflect the woman’s gravidity and parity information. Using the GTPAL system, her information would be calculated as:
G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.
T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.
P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm.
A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not.
L: This number signifies the number of children born that currently are living; the woman has four children. |
| B | This is the correct calculation of this woman’s gravidity and parity. |
| C | The numbers do not accurately reflect the woman’s gravidity and parity information. Using the GTPAL system, her information would be calculated as:
G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.
T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.
P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm.
A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not.
L: This number signifies the number of children born that currently are living; the woman has four children. |
| D | The numbers do not accurately reflect the woman’s gravidity and parity information. Using the GTPAL system, her information would be calculated as:
G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.
T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.
P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm.
A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not.
L: This number signifies the number of children born that currently are living; the woman has four children. |
DIF: Cognitive Level: Comprehension REF: 169, 170
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis
- A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?
| a. | 2-0-0-1-1 |
| b. | 2-1-0-1-0 |
| c. | 3-1-0-1-0 |
| d. | 3-0-1-1-0 |
ANS: C
| Feedback |
| A | Using the GTPAL system explained in question 1, this patient’s gravidity and parity information would be calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time).
T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).
P: Number of pregnancies that resulted in a preterm birth (none).
A: Abortions or miscarriages before the period of viability (she has had one).
L: Number of children born who are currently living (she has no living children). |
| B | Using the GTPAL system explained in question 1, this patient’s gravidity and parity information would be calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time).
T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).
P: Number of pregnancies that resulted in a preterm birth (none).
A: Abortions or miscarriages before the period of viability (she has had one).
L: Number of children born who are currently living (she has no living children). |
| C | This is the correct calculation of this woman’s gravidity and parity. |
| D | Using the GTPAL system explained in question 1, this patient’s gravidity and parity information would be calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time).
T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).
P: Number of pregnancies that resulted in a preterm birth (none).
A: Abortions or miscarriages before the period of viability (she has had one).
L: Number of children born who are currently living (she has no living children). |
DIF: Cognitive Level: Comprehension REF: 169, 170
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis
- Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)?
| a. | Radioimmunoassay |
| b. | Radioreceptor assay |
| c. | Latex agglutination test |
| d. | Enzyme-linked immunosorbent assay (ELISA) |
ANS: D
| Feedback |
| A | The radioimmunoassay test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results. |
| B | The radioreceptor assay test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results. |
| C | The latex agglutination test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results. |
| D | ELISA technology is used in OTC pregnancy tests. |
DIF: Cognitive Level: Knowledge REF: 171
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment
- A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have:
| a. | Amenorrhea. |
| b. | Positive pregnancy test. |
| c. | Chadwick’s sign. |
| d. | Hegar’s sign. |
ANS: A
| Feedback |
| A | Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. |
| B | A positive pregnancy test would be a probable sign of pregnancy. |
| C | The presence of Chadwick’s sign would be a probable sign of pregnancy. |
| D | The presence of Hegar’s sign would be a probable sign of pregnancy. |
DIF: Cognitive Level: Comprehension REF: 172
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse’s instructions if she states that a positive sign of pregnancy is:
| a. | A positive pregnancy test. |
| b. | Fetal movement palpated by the nurse-midwife. |
| c. | Braxton Hicks contractions. |
| d. | Quickening. |
ANS: B
| Feedback |
| A | A positive pregnancy test would be a probable sign of pregnancy. |
| B | Positive signs of pregnancy are those that are attributed to the presence of a fetus such as hearing the fetal heartbeat or palpating fetal movement. |
| C | Braxton Hicks contractions would be a probable sign of pregnancy. |
| D | Quickening would be a presumptive sign of pregnancy. |
DIF: Cognitive Level: Comprehension REF: 172
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning
- A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?
| a. | Not palpable above the symphysis at this time |
| b. | Slightly above the symphysis pubis |
| c. | At the level of the umbilicus |
| d. | Slightly above the umbilicus |
ANS: B
| Feedback |
| A | As the uterus grows, it may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy. |
| B | In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy. |
| C | The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation. |
| D | The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation. |
DIF: Cognitive Level: Comprehension REF: 173
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
| a. | Less audible heart sounds (S1, S2) |
| b. | Increased pulse rate |
| c. | Increased blood pressure |
| d. | Decreased red blood cell (RBC) production |
ANS: B
| Feedback |
| A | Splitting of S1 and S2 is more audible. |
| B | Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. |
| C | In the first trimester, blood pressure usually remains the same as at the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. |
| D | Production of RBCs accelerates during pregnancy. |
DIF: Cognitive Level: Comprehension REF: 177
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment
- The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?
| a. | Her center of gravity will shift backward. |
| b. | She will have increased lordosis. |
| c. | She will have increased abdominal muscle tone. |
| d. | She will notice decreased mobility of her pelvic joints. |
ANS: B
| Feedback |
| A | The center of gravity shifts forward. |
| B | An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain her balance. |
| C | She will have decreased muscle tone. |
| D | She will notice increased mobility of her pelvic joints. |
DIF: Cognitive Level: Comprehension REF: 185
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
- A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:
| a. | This is a normal respiratory change in pregnancy caused by elevated levels of estrogen. |
| b. | This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign. |
| c. | The woman is a victim of domestic violence and is being hit in the face by her partner. |
| d. | The woman has been using cocaine intranasally. |
ANS: A
| Feedback |
| A | Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract. This may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. |
| B | Cardiovascular changes in pregnancy may cause edema in lower extremities. |
| C | This determination cannot be made on the basis of the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings. |
| D | This determination cannot be made on the basis of the sparse facts provided. |
DIF: Cognitive Level: Application REF: 181
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is:
| a. | Estrogen. |
| b. | Human chorionic gonadotropin (hCG). |
| c. | Oxytocin. |
| d. | Progesterone. |
ANS: D
| Feedback |
| A | Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. |
| B | hCG levels rise at implantation but decline after 60 to 70 days. |
| C | Oxytocin stimulates uterine contractions. |
| D | Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage. |
DIF: Cognitive Level: Comprehension REF: 187
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- The nurse providing care to the pregnant woman should know that all are normal gastrointestinal changes in pregnancy except:
| a. | Ptyalism. |
| b. | Pyrosis. |
| c. | Pica. |
| d. | Decreased peristalsis. |
ANS: C
| Feedback |
| A | Ptyalism (excessive salivation) is a normal finding. |
| B | Pyrosis (heartburn) is a normal finding. |
| C | Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. |
| D | Decreased peristalsis is a normal finding. |
DIF: Cognitive Level: Analysis REF: 186
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- Appendicitis may be difficult to diagnose in pregnancy because the appendix is:
| a. | Displaced upward and laterally, high and to the right. |
| b. | Displaced upward and laterally, high and to the left. |
| c. | Deep at McBurney point. |
| d. | Displaced downward and laterally, low and to the right. |
ANS: A
| Feedback |
| A | The appendix is displaced high and to the right. |
| B | The appendix is displaced high and to the right. |
| C | The appendix is displaced beyond McBurney point. |
| D | The appendix is displaced high and to the right. |
DIF: Cognitive Level: Comprehension REF: 187
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis
- Which time-based description of a stage of development in pregnancy is accurate?
| a. | Viability—22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight greater than 500 g) |
| b. | Term—pregnancy from the beginning of week 38 of gestation to the end of week 42 |
| c. | Preterm—pregnancy from 20 to 28 weeks |
| d. | Postdate—pregnancy that extends beyond 38 weeks |
ANS: B
| Feedback |
| A | Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since LMP. |
| B | Term is 38 to 42 weeks of gestation. |
| C | Preterm is 20 to 37 weeks of gestation. |
| D | Postdate or postterm is a pregnancy that extends beyond 42 weeks or what is considered the limit of full term. |
DIF: Cognitive Level: Knowledge REF: 170
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis
- Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and therefore the basis for many tests. A maternity nurse should be aware that:
| a. | hCG can be detected as early as 2½ weeks after conception. |
| b. | The hCG level increases gradually and uniformly throughout pregnancy. |
| c. | Much lower than normal increases in the level of hCG may indicate a postdate pregnancy. |
| d. | A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome. |
ANS: D
| Feedback |
| A | hCG can be detected as early as 7 to 10 days after conception. |
| B | The hCG level fluctuates during pregnancy: peaking, declining, stabilizing, and increasing again. |
| C | Abnormally slow increases may indicate impending miscarriage. |
| D | Higher levels also could be a sign of multiple gestation. |
DIF: Cognitive Level: Knowledge REF: 171
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis
- To reassure and educate pregnant patients about changes in the uterus, nurses should be aware that:
| a. | Lightening occurs near the end of the second trimester as the uterus rises into a different position. |
| b. | The woman’s increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening. |
| c. | Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise. |
| d. | The uterine souffle is the movement of the fetus. |
ANS: B
| Feedback |
| A | Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. |
| B | The softening of the lower uterine segment is called Hegar’s sign. |
| C | Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. |
| D | The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope. |
DIF: Cognitive Level: Comprehension REF: 173
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning
- When the nurse is providing education to the pregnant patient regarding changes in the cervix, vagina, and the position of the fetus, it is important to be aware that:
| a. | Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are much easier to evaluate. |
| b. | Quickening is a technique of palpating the fetus to engage it in passive movement. |
| c. | The deepening color of the vaginal mucosa and cervix (Chadwick’s sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor. |
| d. | Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester. |
ANS: D
| Feedback |
| A | These cervical changes make evaluation of abnormal Pap tests more difficult. |
| B | Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. |
| C | Chadwick’s sign appears from the sixth to eighth weeks. |
| D | Increased sensitivity and an increased interest in sex sometimes go together. This frequently occurs during the second trimester. |
DIF: Cognitive Level: Comprehension REF: 176
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning
- The mucous plug that forms in the endocervical canal is called:
| a. | The operculum. |
| b. | Leucorrhea. |
| c. | The funic souffle. |
| d. | Ballottement. |
ANS: A
| Feedback |
| A | The operculum protects against bacterial invasion. |
| B | Leucorrhea is the mucus that forms the endocervical plug (the operculum). |
| C | The funic souffle is the sound of blood flowing through the umbilical vessels. |
| D | Ballottement is a technique for palpating the fetus. |
DIF: Cognitive Level: Knowledge REF: 176
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment
- To reassure and educate pregnant patients about changes in their cardiovascular system, maternity nurses should be aware that:
| a. | A pregnant woman experiencing disturbed cardiac rhythm such as sinus arrhythmia requires close medical and obstetric observation, no matter how healthy she otherwise may appear. |
| b. | Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term. |
| c. | Palpitations are twice as likely to occur in twin gestations. |
| d. | All of the above changes likely will occur. |
ANS: B
| Feedback |
| A | A healthy woman with no underlying heart disease does not need any therapy. |
| B | These auscultatory changes should be discernible after 20 weeks of gestation. |
| C | The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double. |
| D | Auditory changes are discernible at 20 weeks. |
DIF: Cognitive Level: Comprehension REF: 177
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
- To reassure and educate their pregnant patients about changes in their blood pressure, maternity nurses should be aware that:
| a. | A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. |
| b. | Shifting the patient’s position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. |
| c. | The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. |
| d. | Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy. |
ANS: D
| Feedback |
| A | The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. |
| B | Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. |
| C | The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases. |
| D | This compression also leads to varicose veins in the legs and vulva. |
DIF: Cognitive Level: Comprehension REF: 178
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Planning, Implementation
- Some pregnant patients may complain of changes in their voice and impaired hearing. The nurse can tell these patients that these are common reactions to:
| a. | A decreased estrogen level. |
| b. | Displacement of the diaphragm, resulting in thoracic breathing. |
| c. | Congestion and swelling, which occur because the upper respiratory tract has become more vascular. |
| d. | Increased blood volume. |
ANS: C
| Feedback |
| A | Estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. |
| B | The diaphragm is displaced. However, the key is that estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. |
| C | Estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. |
| D | The volume of blood is increased. However, the key is that estrogen levels increase, causing the upper respiratory tract to become more vascular; this produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing. |
DIF: Cognitive Level: Comprehension REF: 181
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
- To reassure and educate pregnant patients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that:
| a. | Increased urinary output makes pregnant women less susceptible to urinary infection. |
| b. | Increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty. |
| c. | Renal (kidney) function is more efficient when the woman assumes a supine position. |
| d. | Using diuretics during pregnancy can help keep kidney function regular. |
ANS: B
| Feedback |
| A | A number of anatomic changes make a pregnant woman more susceptible to urinary tract infection. |
| B | First bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often. |
| C | Renal function is more efficient when the woman lies in the lateral recumbent position and less efficient when she is supine. |
| D | Diuretic use during pregnancy can overstress the system and cause problems. |
DIF: Cognitive Level: Comprehension REF: 182
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
- Which statement about a condition of pregnancy is accurate?
| a. | Insufficient salivation (ptyalism) is caused by increases in estrogen. |
| b. | Acid indigestion (pyrosis) begins early but declines throughout pregnancy. |
| c. | Hyperthyroidism often develops (temporarily) because hormone production increases. |
| d. | Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial. |
ANS: D
| Feedback |
| A | Ptyalism is excessive salivation, which may be caused by a decrease in unconscious swallowing or stimulation of the salivary glands. |
| B | Pyrosis begins as early as the first trimester and intensifies through the third trimester. |
| C | Increased hormone production does not lead to hyperthyroidism in pregnant women. |
| D | Normal nausea and vomiting rarely produce harmful effects, and nausea and vomiting periods may be less likely to result in miscarriage or preterm labor. |
DIF: Cognitive Level: Application REF: 186
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
MULTIPLE RESPONSE
- The diagnosis of pregnancy is based on which positive signs of pregnancy? Choose all that apply.
| a. | Identification of fetal heartbeat |
| b. | Palpation of fetal outline |
| c. | Visualization of the fetus |
| d. | Verification of fetal movement |
| e. | Positive hCG test |
ANS: A, C, D
| Feedback |
| Correct | These are all positive, objective signs of pregnancy. |
| Incorrect | These are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests. |
DIF: Cognitive Level: Analysis REF: 172
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment, Diagnosis
- A woman is in for a routine prenatal checkup. You are assessing her urine for proteinuria. You know that which findings are considered normal? Choose all that apply.
| a. | Dipstick assessment of trace to +1 |
| b. | <300 mg/24 hours |
| c. | Dipstick assessment of +2 |
| d. | >300 mg/24 hours |
ANS: A, B
| Feedback |
| Correct | Small amounts of protein in the urine are acceptable during pregnancy. The presence of protein in greater amounts may indicate renal problems. |
| Incorrect | These are excessive amounts of protein in the urine and should be evaluated further. |
DIF: Cognitive Level: Application REF: 181
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
Lowdermilk: Maternity Nursing, 8th Edition
Chapter 07: Nursing Care of the Family during Pregnancy
Test Bank
MULTIPLE CHOICE
- The nurse caring for the newly pregnant woman would advise her that ideally prenatal care should begin:
| a. | Before the first missed menstrual period. |
| b. | After the first missed menstrual period. |
| c. | After the second missed menstrual period. |
| d. | After the third missed menstrual period. |
ANS: B
| Feedback |
| A | Regular prenatal visits, ideally beginning soon after the first missed menstrual period, offer opportunities to ensure the health of the expectant mother and her infant. |
| B | Prenatal care ideally should begin soon after the first missed menstrual period. |
| C | Regular prenatal visits, ideally beginning soon after the first missed menstrual period, offer opportunities to ensure the health of the expectant mother and her infant. |
| D | Regular prenatal visits, ideally beginning soon after the first missed menstrual period, offer opportunities to ensure the health of the expectant mother and her infant. |
DIF: Cognitive Level: Knowledge REF: 191
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning
- With regard to follow-up visits for women receiving prenatal care, nurses should be aware that:
| a. | The interview portions become more intensive as the visits become more frequent over the course of the pregnancy. |
| b. | Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. |
| c. | During the abdominal examination, the nurse should be alert for supine hypotension. |
| d. | For pregnant women a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive. |
ANS: C
| Feedback |
| A | The interview portion of follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. |
| B | Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. |
| C | The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in blood pressure and a feeling of faintness. |
| D | For pregnant women hypertension is defined as a systolic BP of 140 or higher and a diastolic BP of 90 or higher. |
DIF: Cognitive Level: Comprehension REF: 202
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment
- A woman arrives at the clinic for a pregnancy test. The first day of her last menstrual period (LMP) was February 14, 2010. Her expected date of birth (EDB) would be:
| a. | September 17, 2010. |
| b. | November 7, 2010. |
| c. | November 21, 2010. |
| d. | December 17, 2010. |
ANS: C
| Feedback |
| A | Using Nägele’s rule, the EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2010:
February 14, 2010 – 3 months = November 14, 2009 + 7 days = November 21, 2009 + 1 year = November 21, 2010 |
| B | Using Nägele’s rule, the EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2010:
February 14, 2010 – 3 months = November 14, 2009 + 7 days = November 21, 2009 + 1 year = November 21, 2010 |
| C | Using Nägele’s rule, this is the correct expected date of birth. |
| D | Using Nägele’s rule, the EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2010:
February 14, 2010 – 3 months = November 14, 2009 + 7 days = November 21, 2009 + 1 year = November 21, 2010 |
DIF: Cognitive Level: Knowledge REF: 192
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- Prenatal testing for the human immunodeficiency virus (HIV) is recommended for which women?
| a. | All women, regardless of risk factors |
| b. | A woman who has had more than one sexual partner |
| c. | A woman who has had a sexually transmitted infection |
| d. | A woman who is monogamous with her partner |
ANS: A
| Feedback |
| A | Testing for the antibody to HIV is strongly recommended for all pregnant women. |
| B | An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. |
| C | An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. |
| D | An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. |
DIF: Cognitive Level: Comprehension REF: 202
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning
- With regard to work and travel during pregnancy, nurses should be aware that:
| a. | Women should sit for as long as possible and cross their legs at the knees from time to time for exercise. |
| b. | Women should avoid seat belts and shoulder restraints in the car, because they press on the fetus. |
| c. | Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. |
| d. | While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so. |
ANS: D
| Feedback |
| A | Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. |
| B | Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. |
| C | Metal detectors at airport security checkpoints do not harm fetuses. |
| D | Periodic walking helps prevent thrombophlebitis. |
DIF: Cognitive Level: Comprehension REF: 216
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning
- Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider?
| a. | Nausea with occasional vomiting |
| b. | Fatigue |
| c. | Urinary frequency |
| d. | Vaginal bleeding |
ANS: D
| Feedback |
| A | This is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it usually is not an indication of a problem with the pregnancy. |
| B | This is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it usually is not an indication of a problem with the pregnancy. |
| C | This is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it usually is not an indication of a problem with the pregnancy. |
| D | Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of potential complications of the pregnancy. |
DIF: Cognitive Level: Comprehension REF: 205
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
- Which blood pressure (BP) finding during the second trimester indicates a risk for pregnancy-induced hypertension?
| a. | Baseline BP 120/80, current BP 126/85 |
| b. | Baseline BP 100/70, current BP 130/85 |
| c. | Baseline BP 140/85, current BP 130/80 |
| d. | Baseline BP 110/60, current BP 110/60 |
ANS: B
| Feedback |
| A | An increase in the systolic BP of 30 mm Hg or more over the baseline pressure or an increase in the diastolic BP of 15 mm Hg or more over the baseline pressure is a significant finding, regardless of the absolute values. This slight increase in BP does not meet the criteria for concern. |
| B | An increase in the systolic BP of 30 mm Hg or more over the baseline pressure or an increase in the diastolic BP of 15 mm Hg or more over the baseline pressure is a significant finding, regardless of the absolute values. This current BP indicates that such increases have occurred in both the diastolic and systolic pressures. |
| C | Although the baseline BP is worrisome (an absolute systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher suggests hypertension), the subsequent pressures have decreased, not increased. |
| D | This BP is within normal limits for both values and is not a concern. |
DIF: Cognitive Level: Knowledge REF: 204
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis
- The quadruple marker test is used to assess the fetus for which condition?
| a. | Down syndrome |
| b. | Diaphragmatic hernia |
| c. | Congenital cardiac abnormality |
| d. | Anencephaly |
ANS: A
| Feedback |
| A | The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosome anomalies. |
| B | The quadruple marker test would not detect this fetal anomaly. Additional testing such as ultrasonography and amniocentesis would be required to diagnose it. |
| C | The quadruple marker test would not detect this fetal anomaly. Additional testing such as ultrasonography and amniocentesis would be required to diagnose it. |
| D | The quadruple marker test would not detect this fetal anomaly. Additional testing such as ultrasonography and amniocentesis would be required to diagnose it. |
DIF: Cognitive Level: Knowledge REF: 203
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that:
| a. | Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. |
| b. | The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. |
| c. | Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. |
| d. | No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus. |
ANS: A
| Feedback |
| A | This is especially true for new medications and combinations of drugs. |
| B | The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. |
| C | Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. |
| D | Secondhand smoke is associated with fetal growth restriction and increases in infant mortality. |
DIF: Cognitive Level: Comprehension REF: 217
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she:
| a. | Do Kegel exercises. |
| b. | Do pelvic rock exercises. |
| c. | Use a softer mattress. |
| d. | Stay in bed for 24 hours. |
ANS: B
| Feedback |
| A | Kegel exercises increase the tone of the pelvic area, not the back. |
| B | Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. |
| C | A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. |
| D | Stretching and other exercises to relieve back pain should be performed several times a day. |
DIF: Cognitive Level: Application REF: 213
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- For what reason would breastfeeding be contraindicated?
| a. | Hepatitis B |
| b. | Everted nipples |
| c. | History of breast cancer 3 years ago |
| d. | Human immunodeficiency virus (HIV) positive |
ANS: D
| Feedback |
| A | Although hepatitis B antigen has not been shown to be transmitted through breast milk, as an added precaution infants born to HBsAg-positive women should receive the hepatitis B vaccine and immune globulin immediately after birth. |
| B | Everted nipples are functional for breastfeeding. |
| C | Newly diagnosed breast cancer would be a contraindication to breastfeeding. |
| D | Women who are HIV positive are discouraged from breastfeeding. |
DIF: Cognitive Level: Comprehension REF: 203
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she doesn’t know what is happening; one minute she’s happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate?
| a. | “Don’t worry about it; you’ll feel better in a month or so.” |
| b. | “Have you talked to your husband about how you feel?” |
| c. | “Perhaps you really don’t want to be pregnant.” |
| d. | “Hormonal changes during pregnancy commonly result in mood swings.” |
ANS: D
| Feedback |
| A | This statement dismisses the patient’s concerns and is not the most appropriate response. |
| B | Although women should be encouraged to share their feelings, this is not the most appropriate response and does not provide the patient with a rationale for the psychosocial dynamics of her pregnancy. |
| C | This response is completely inappropriate and deleterious to the psychologic well-being of the woman. Hormonal and metabolic adaptations often cause mood swings in pregnancy. The woman’s responses are normal. She should be reassured about her feelings. |
| D | This is an accurate statement and the most appropriate response by the nurse. |
DIF: Cognitive Level: Application REF: 192
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Diagnosis
- The nurse should be aware that the partner’s main role in pregnancy is to:
| a. | Provide financial support. |
| b. | Protect the pregnant woman from “old wives’ tales.” |
| c. | Support and nurture the pregnant woman. |
| d. | Make sure the pregnant woman keeps prenatal appointments. |
ANS: C
| Feedback |
| A | In older societies the man enacted the ritual couvade. Changing cultural and professional attitudes have encouraged fathers’ participation in the birth experience over the past 30 years. |
| B | In older societies the man enacted the ritual couvade. Changing cultural and professional attitudes have encouraged fathers’ participation in the birth experience over the past 30 years. |
| C | The partner’s main role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability. |
| D | In older societies the man enacted the ritual couvade. Changing cultural and professional attitudes have encouraged fathers’ participation in the birth experience over the past 30 years. |
DIF: Cognitive Level: Comprehension REF: 196
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment
- During the first trimester a woman can expect which of the following changes in her sexual desire?
| a. | An increase, because of enlarging breasts |
| b. | A decrease, because of nausea and fatigue |
| c. | No change |
| d. | An increase, because of increased levels of female hormones |
ANS: B
| Feedback |
| A | During pregnancy the breasts may become enlarged and tender; this tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity. |
| B | Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. |
| C | Libido may be depressed in the first trimester but often increases during the second and third trimesters. |
| D | Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression. |
DIF: Cognitive Level: Comprehension REF: 194
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis
- A 3-year-old girl’s mother is 6 months pregnant. What concern is this child likely to verbalize?
| a. | How the baby will “get out” |
| b. | What the baby will eat |
| c. | Whether her mother will die |
| d. | What color eyes the baby has |
ANS: B
| Feedback |
| A | School-age children take a more clinical interest in their mother’s pregnancy and may want to know, “How did the baby get in there?” and “How will it get out?” |
| B | By age 3 or 4, children like to be told the story of their own beginning and accept its comparison with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it wears. |
| C | Whether her mother will die does not tend to be the focus of a child’s questions about the impending birth of a sibling. |
| D | The baby’s eye color does not tend to be the focus of children’s questions about the impending birth of a sibling |
DIF: Cognitive Level: Comprehension REF: 197
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose?
| a. | To promote family unity |
| b. | To ward off the “evil eye” |
| c. | To appease the gods of fertility |
| d. | To protect the mother and fetus during pregnancy |
ANS: D
| Feedback |
| A | Although many consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus. |
| B | Although many consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus. |
| C | Although many consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus. |
| D | The purpose of all cultural practices is to protect the mother and fetus during pregnancy. |
DIF: Cognitive Level: Comprehension REF: 226
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Planning
- What type of cultural concern is the most likely deterrent to many women seeking prenatal care?
| a. | Religion |
| b. | Modesty |
| c. | Ignorance |
| d. | Belief that physicians are evil |
ANS: B
| Feedback |
| A | Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs. |
| B | A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. |
| C | Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs. |
| D | Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs. |
DIF: Cognitive Level: Analysis REF: 226
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Evaluation
- Which statement about pregnancy is accurate?
| a. | A normal pregnancy lasts about 10 lunar months. |
| b. | A trimester is one third of a year. |
| c. | The prenatal period extends from fertilization to conception. |
| d. | The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth. |
ANS: A
| Feedback |
| A | A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months. |
| B | A trimester is one third of a normal pregnancy, or about 13 to 14 weeks. |
| C | The prenatal period covers the full course of pregnancy (prenatal means before birth). |
| D | The EDC is now called the EDB, or estimated date of birth. It has nothing to do with the duration of bed rest. |
DIF: Cognitive Level: Knowledge REF: 191
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- What represents a typical progression through the phases of a woman’s establishing a relationship with the fetus?
| a. | Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has a feeling of caring and responsibility |
| b. | Fantasizes about the child’s gender and personality—views the child as part of herself—becomes introspective |
| c. | Views the child as part of herself—has feelings of well-being—accepts the biologic fact of pregnancy |
| d. | “I am pregnant.”—“I am going to have a baby.”—“I am going to be a mother.” |
ANS: D
| Feedback |
| A | The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions, “I am pregnant,” “I am going to have a baby,” and “I am going to be a mother” sum up the progression through the three phases. |
| B | The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions, “I am pregnant,” “I am going to have a baby,” and “I am going to be a mother” sum up the progression through the three phases. |
| C | The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions, “I am pregnant,” “I am going to have a baby,” and “I am going to be a mother” sum up the progression through the three phases. |
| D | The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions, “I am pregnant,” “I am going to have a baby,” and “I am going to be a mother” sum up the progression through the three phases. |
DIF: Cognitive Level: Application REF: 194
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Diagnosis
- With regard to the father’s acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that:
| a. | The father goes through three phases of acceptance of his own. |
| b. | The father’s attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth. |
| c. | In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. |
| d. | Typically men remain ambivalent about fatherhood right up to the birth of their child. |
ANS: A
| Feedback |
| A | A father typically goes through three phases of acceptance: accepting the biologic fact, adjusting to the reality, and focusing on his role. |
| B | The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy. |
| C | In the last 2 months of pregnancy, many expectant fathers work hard to improve the environment of the home for the child. |
| D | Typically the expectant father’s ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role. |
DIF: Cognitive Level: Comprehension REF: 195
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Diagnosis
- With regard to the initial visit with a patient who is beginning prenatal care, nurses should be aware that:
| a. | The first interview is a relaxed, get-acquainted affair in which nurses gather some general impressions. |
| b. | If nurses observe handicapping conditions, they should be sensitive and not inquire about them because the patient will do that in her own time. |
| c. | Nurses should be alert to the appearance of potential parenting problems such as depression or lack of family support. |
| d. | Because of legal complications, nurses should not ask about illegal drug use; that is left to physicians. |
ANS: C
| Feedback |
| A | The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. |
| B | Nurses must be sensitive to special problems, but they do need to inquire because discovering individual needs is important. People with chronic or handicapping conditions forget to mention them because they have adapted to them. |
| C | Besides these potential problems, nurses need to be alert to the woman’s attitude toward health care. |
| D | Getting information on drug use is important and can be done confidentially. Actual testing for drug use requires the patient’s consent. |
DIF: Cognitive Level: Comprehension REF: 201
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment
- The nurse should be aware that the pinch test is used to:
| a. | Check the sensitivity of the nipples. |
| b. | Determine whether the nipple is everted or inverted. |
| c. | Calculate the adipose buildup in the abdomen. |
| d. | See whether the fetus has become inactive. |
ANS: B
| Feedback |
| A | The pinch test is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. |
| B | The pinch test is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. |
| C | The pinch test is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. |
| D | The pinch test is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. |
DIF: Cognitive Level: Knowledge REF: 210
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- With regard to dental care during pregnancy, maternity nurses should be aware that:
| a. | Dental care can be dropped from the priority list because the woman has enough to worry about and is getting a lot of calcium anyway. |
| b. | Dental surgery, in particular, is contraindicated because of the psychologic stress it engenders. |
| c. | If dental treatment is necessary, the woman will be most comfortable with it in the second trimester. |
| d. | Dental care interferes with the expectant mother’s need to practice conscious relaxation. |
ANS: C
| Feedback |
| A | Dental care such as brushing with a fluoride toothpaste is especially important during pregnancy because nausea during pregnancy may lead to poor oral hygiene. |
| B | Emergency dental surgery is permissible, but the mother must clearly understand the risks and benefits. |
| C | The second trimester is best for dental treatment because that is when the woman will be able to sit most comfortably in the dental chair. |
| D | Conscious relaxation is useful, and it may even help the woman get through any dental appointments; it is not a reason to avoid them. |
DIF: Cognitive Level: Comprehension REF: 210
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
- Which statement about multifetal pregnancy is NOT accurate?
| a. | The expectant mother often develops anemia because the fetuses have a greater demand for iron. |
| b. | Twin pregnancies come to term with the same frequency as single pregnancies. |
| c. | The mother should be counseled to increase her nutritional intake and gain more weight. |
| d. | Backache and varicose veins often are more pronounced. |
ANS: B
| Feedback |
| A | A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions. |
| B | Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. |
| C | A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions. |
| D | A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions. |
DIF: Cognitive Level: Comprehension REF: 230
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment
- The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the:
| a. | Mother of the pregnant woman. |
| b. | Couple’s teenage daughter. |
| c. | Sister of the pregnant woman. |
| d. | Expectant father. |
ANS: D
| Feedback |
| A | An expectant father’s experiencing of pregnancy-like symptoms similar to those of his partner is called the couvade syndrome. |
| B | An expectant father’s experiencing of pregnancy-like symptoms similar to those of his partner is called the couvade syndrome. |
| C | An expectant father’s experiencing of pregnancy-like symptoms similar to those of his partner is called the couvade syndrome |
| D | An expectant father’s experiencing of his partner’s pregnancy-like symptoms is called the couvade syndrome. |
DIF: Cognitive Level: Knowledge REF: 195
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Diagnosis
- In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement would accurately apply to the centering model of care?
| a. | Group sessions begin with the first prenatal visit. |
| b. | At each visit blood pressure, weight, and urine dipsticks are obtained by the nurse. |
| c. | Eight to 12 women are placed in gestational-age cohort groups. |
| d. | Outcomes are similar to those of traditional prenatal care. |
ANS: C
| Feedback |
| A | Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Before group sessions the patient has an individual assessment, physical examination, and history. |
| B | At the beginning of each group meeting, patients measure their own blood pressure, weight, and urine dips and enter these in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. |
| C | Gestational age cohorts comprise the groups, with approximately 8 to 12 women in each group. This group remains intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. |
| D | Results evaluating this approach have been very promising. In a recent study of adolescent patients, there was a decrease in low-birth-weight infants and an increase in breastfeeding rates. |
DIF: Cognitive Level: Application REF: 199
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Implementation
MULTIPLE RESPONSE
- Signs and symptoms that a woman should report immediately to her health care provider include (choose all that apply):
| a. | Vaginal bleeding. |
| b. | Rupture of membranes. |
| c. | Heartburn accompanied by severe headache. |
| d. | Decreased libido. |
| e. | Urinary frequency. |
ANS: A, B, C
| Feedback |
| Correct | Vaginal bleeding, rupture of membranes, and severe headaches are all signs of potential complications in pregnancy. Patients should be advised to report these signs to their health care provider. |
| Incorrect | Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions. |
DIF: Cognitive Level: Analysis REF: 205
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Planning, Implementation
