BN Ch. 65 Normal Pregnancy

Question 1

During pregnancy, women develop an inward curve of the lower back, known as _____.

Answer 1

Lordosis

Question 2

The zygote divides rapidly to form a ball of about 16 identical cells, which is called a/an _____.

Answer 2

Morula

Question 3

The fetus’ chorionic villi eventually meet with an area of uterine tissue to form the ______.

Answer 3

Placenta

Question 4

The _____ is the inner membrane surrounding the fetus.

Answer 4

Amnion

Question 5

_____ is the most common method used to evaluate dental size.

Answer 5

Ultrasound

Question 6

What changes take place in the fetal circulation with the newborn’s first few respirations?

Answer 6

With the newborn’s first few respirations, the lungs expand as soon as the pressure within the chest alters. The foramen ovale closes, and the ductus arteriosus and ductus venosus shrivel up and become fibrous ligaments.

Question 7

How is fetal circulation different from adult circulation?

Answer 7

In fetal circulation, the placenta returns deoxygenated blood from the fetus to the mother through the two umbilical arteries. The placenta returns oxygenated blood to the fetus via a single vessel, the umbilical vein. In adult circulation, all arteries carry oxygenated blood, and all veins carry deoxygenated blood.

Question 8

Period of time from the moment the sperm fertilizes the ovum until the birth of the newborn.

Answer 8

Gestation

Question 9

Union of two cells, the ovur and the sperm, which occurs in the outer third of the Fallopian tube (oviduct)

Answer 9

Fertilization

Question 10

Distinct 3-month periods that pregnancy is divided into, during which fetal development takes place.

Answer 10

Trimester

Question 11

Burrowing in and attachment of the blastocyst to the endometrium (or the decidua)

Answer 11

Implantation

Question 12

Total number of pregnancies a woman has had, including the present one if she is pregnant

Answer 12

Gravidia

Question 13

Write the correct sequence of steps for determining the estimated date of delivery by applying Nägele rule.

1. Determine the date of the first day of the last normal menstrual period.
2. The resulting date is the expected date of delivery.
3. Confirm that her last menstrual period was normal and on time.
4. Add 7 days and subtract 3 months from the date obtained.

Answer 13

-Confirm that her last menstrual period was normal and on time.
-Determine the date of the first day of the last normal menstrual period.
-Add 7 days and subtract 3 months from the date obtained.
-The resulting date is the expected date of delivery.

Question 14

What is hyperemesis gravidarum?

Answer 14

Nausea or vomiting during pregnancy may happen at any time during the day. If this condition lasts beyond the fourth month, results in a weight loss of 8 pounds or more, or affects the woman’s general health, it is considered a complication of pregnancy known as hyperemesis gravidarum.

Question 15

What is quickening, and when is it first experienced?

Answer 15

The first fetal movements that the pregnant woman feels are called quickening. The woman usually experiences quickening between 18 and 20 weeks of gestation, but it may occur a week or two earlier in a multigravida.

Question 16

Which pigment changes are seen during pregnancy?

Answer 16

Pregnancy causes some skin changes. A suntanned, bronzed masking may appear across the face of dark-haired women. This is known as melasma (or chloasma gravidarum), or the “mask of pregnancy.” A line of darker pigmentation, known as the linea nigra, often appears on the lower abdomen and extends from the umbilicus to the pubic bone.

Question 17

Why does ballottement occur?

Answer 17

After about 16 to 18 weeks of pregnancy, gently tapping one side of the pregnant woman’s abdomen will cause the fetus to “bounce” in the amniotic fluid. This is because the fetus is small compared with the amount of fluid. The examiner can feel this rebound tap against the hand. This procedure is known as ballottement.

Question 18

Why are beverages and foods that contain caffeine avoided during pregnancy?

Answer 18

Beverages and foods that contain caffeine can be harmful to the pregnant woman. Caffeine may contribute to mastitis, an inflammation and swelling of breast tissue in the woman that can cause irritability in the fetus, especially if the mother is breastfeeding. Caffeine also crosses the placenta during pregnancy.

Question 19

A client in their eighth month of pregnancy is expecting their first child and is being prepared for childbirth.

a. What is the goal of childbirth preparation?

Answer 19

The goal of childbirth is to have a healthy mother and baby.

Question 20

What are the common methods of childbirth preparation?

Answer 20

Common methods of childbirth preparation include:

• Progressive relaxation and abdominal breathing techniques taught to the expectant mother and her partner.

• Hypnosis, a combination of relaxation and conditioned
reflexes. It uses a normal breathing pattern. A healthcare provider trained in hypnosis and childbirth works with the mother and her significant other.

Question 21

What is the Lamaze method of childbirth preparation?

Answer 21

The Lamaze method is the most well-known model for childbirth preparation. The two components of this method are education and training, using the theory of conditioned reflex. Expectant women are trained in toning exercises, relaxation exercises, and breathing techniques, which use three levels of chest breathing for different stages of labor.

Question 22

A primigravid client who plans to breastfeed is being educated about basics of infant care and preparations for infant feeding.

a. Which information would the client education regarding general infant care include?

Answer 22

Client education regarding general infant care should include:

• The range of normal physical characteristics of newborns
• Neonatal and infant response: adjusting to the needs expressed by the infant (attunement), sleep/wake patterns, vision, hearing, startle reflex
• Holding the infant
• Skin care and bathing
• Care of the umbilicus
• Diapering options
• Infant stool patterns
• Newborn and infant safety, including the importance of using a car seat

Question 23

What are the exceptions for breastfeeding?

Answer 23

There is widespread agreement that breast milk is the best milk for a baby. The only exceptions are women who might transmit a disease (such as human immunodeficiency virus [HIV] infection) or a medication (such as lithium) through the breast milk.

Question 24

Which topics regarding lactation should the nurse discuss with the client?

Answer 24

Generally, new mothers need information on the following topics regarding lactation:

• Nutrition and hydration during lactation
• Supply and demand concept
• Nipple care
• Let-down reflex
• Appearance of breast milk
• Positions for breastfeeding
• Expressing/pumping and storing milk

Question 25

At a preconceptional visit, a client whose spouse’s family has a history of a genetic defect says they are planning to have a baby.

Which response by the nurse is best?

a. Reassure them that it is not a cause of concern.

b. Refer the couple for genetic testing and counseling.

c. Tell them that their spouse’s family history is unrelated to their pregnancy.

d. Tell them that it is unadvisable to have a baby.

Answer 25

b. Refer the couple for genetic testing and counseling.

*Rationale: If the client or her partner has a family history of genetic problems, a referral for genetic counseling and testing should be given to the couple. It is a cause for concern, because it may affect her pregnancy and the baby. The nurse is in no position to advise the client against having a baby, because this can be decided only after genetic counseling and testing

Question 26

A primigravid client opts to formula-feed their infant after birth. Which action would the nurse take?

a. Educate them about formula preparation and storage.
b. Tell them not to formula-feed their infant.
c. Insist to them that only breastfeeding should be done.
d. Tell them that it is a complicated decision and they should reconsider.

Answer 26

a. Educate them about formula preparation and storage.

Rationale: A woman who opts to formula-feed her infant may have educational needs about formula preparation and storage. The nurse should respect each woman’s decision and not impose breastfeeding on her or tell her not to formula feed her infant, nor should she ask her to reconsider her decision.

Question 27

During the first trimester, a client experiences many physiologic changes. Which changes would the nurse assure the client are normal for an 8-week pregnancy?

a. Nausea and vomiting
b. Dependent edema
c. Colostrum production
d. Visual changes

Answer 27

a. Nausea and vomiting

Rationale: Nausea and vomiting are normal during the first trimester of pregnancy. Nausea may begin soon after the first missed menstrual period and usually disappears after the third month of pregnancy. Approximately half of all pregnant women experience some nausea or vomiting, usually due to hormonal changes. The woman’s breasts begin to produce colostrum by the 14th week. Visual changes are not physiologic and may be a sign of pregnancy induced hypertension. Dependent edema may occur in the third trimester of pregnancy due to an increase in venous pressure and a decrease in venous return.

Question 28

A pregnant client has had two previous pregnancies. They had a miscarriage at 6 weeks the first time. The client also has a 4-year-old daughter, who was born at 40 weeks of gestation. How would the pregnancy history best be summarized?

a. G3, PO
b. G2, P1
c. G3. P1
d. G3, P2

Answer 28

c. G3. P1

Rationale: Gravida, represented as G, is the total number of pregnancies a female client has had, including the present one. The client has had two previous pregnancies; therefore, she is G3 and not G2. Para, represented as P, is the number of babies born at 20 or more weeks of gestation. She had a miscarriage at 6 weeks the first time. She also has a 4-year-old daughter who was born at 40 weeks of gestation; therefore, she is P1 and not P0 or P2.

Question 29

At which gestational age does the fetal stage begin?

a. 2 weeks
b. 5 weeks
c. 7 weeks
d. 9 weeks

Answer 29

d. 9 weeks

Rationale: The fetal stage lasts from the beginning of the 9th week after fertilization through birth, which is usually at about the end of the 40th week of pregnancy. The second, fifth, and seventh week are all in the embryonic stage.

Question 30

A nurse is educating a 22-year-old primigravid client about the danger signs of pregnancy. Which symptom is a danger sign of pregnancy?

a. Morning sickness
b. Vaginal bleeding
c. Shortness of breath
d. Vaginal discharge

Answer 30

b. Vaginal bleeding

Rationale: Vaginal bleeding at any time during pregnancy is a danger sign and should be immediately reported to the practitioner. Morning sickness, shortness of breath, and vaginal discharge are common discomforts of pregnancy due to the anatomic and physiologic changes taking place in the pregnant woman.

Question 31

A nurse is auscultating a 22-week pregnant client with a fetoscope. What does the detection of the fetal heartbeat (fetal heart tones) by use of the fetoscope mean?

a. Possible sign of pregnancy
b. Probable sign of pregnancy
c. Presumptive sign of pregnancy
d. Positive sign of pregnancy

Answer 31

d. Positive sign of pregnancy

Rationale: Detection of the fetal heartbeat (fetal heart tones) with a fetoscope is a positive sign of pregnancy, because it provides proof that there is a developing fetus. It is not a possible, probable, or presumptive sign, as such symptoms could indicate a condition other than pregnancy.

Question 32

A client in their 10th week of pregnancy with suspected pregnancy-induced hypertension has sudden development of edema. Which symptoms may be signs of pregnancy induced hypertension? Select all that apply.

a. Visual changes
b. Epigastric pain
c. Lordosis
d. Severe headache
e. Breast enlargement

Answer 32

a. Visual changes
b. Epigastric pain
d. Severe headache

*Rationale: Visual changes, epigastric pain, and severe headache are all signs of pregnancy-induced hypertension. Lordosis and breast enlargement are normal changes during pregnancy.

Question 33

Many clients do not keep an accurate record of their menstrual periods or may not have regular periods for many different reasons.
How is the estimated date of delivery determined?

A. Using the gestational wheel
B. Applying Nägele rule
C. Estimating fetal age by ultrasound examination
D. Adding 40 weeks to the date of detection

Answer 33

C. Estimating fetal age by ultrasound examination

Rationale: Many women do not keep an accurate record of their menstrual periods or may not have regular periods for many different reasons. In these cases, the practitioner determines the estimated date of delivery, also called the estimated date of confinement, based on the size of the uterus during the physical examination and/or an ultrasound estimate of fetal age. Only when you have an accurate date for the last period can the due date for the baby be determined through either a gestational wheel or Nägele rule. Adding 40 weeks to the date of pregnancy detection is incorrect.

Question 34

A nurse is auscultating for fetal heart tones in client who is 20 weeks’ pregnant. Given below are the steps for listening to fetal hearts using Doppler equipment in random order. Arrange the steps in the correct order.

A. Count the fetal heart tones for 15 s and multiply by 4 to get the rate per minute.
B. Exert a little pressure and place the Instrument immediately above the pubic sone.
C. Ask the client to lie down on their back (Supine Position)
D. Slowly rotate the Doppler instrument by 360 until you hear the baby’s heartbeat.

Answer 34

C. Ask the client to lie down on their back (Supine Position)
B. Exert a little pressure and place the Instrument immediately above the pubic sone.
D. Slowly rotate the Doppler instrument by 360 until you hear the baby’s heartbeat.
A. Count the fetal heart tones for 15 s and multiply by 4 to get the rate per minute.

*Rationale: Ask the woman to lie down on her back (supine position). If she is more than
28 weeks’ pregnant, place a small rolled towel under one hip to tilt her slightly to one side. If Doppler equipment is being used, apply a small amount of gel to the end of the instrument. Exert a little pressure when placing the instrument immediately above the pubic bone. Slowly rotate it 360 degrees until you hear the baby’s heartbeat. Count the fetal heart tones for 15 seconds, and multiply by 4 to get the rate per minute.

Question 35

A client in their 19th week of gestation informs the nurse that they have been experiencing light, “fluttery” sensations,
which they refer to as fetal movements. The nurse knows that this sensation should be documented as which term?

Select all that apply.
a. Feeling of life
b. Confirmed pregnancy
c. Quickening
d. Morning sickness
e. Presumptive sign of pregnancy

Answer 35

a. Feeling of life
c. Quickening
e. Presumptive sign of pregnancy

• Rationale: The nurse should document the light, “fluttery” sensation experienced by the client as a feeling of life, quickening, and a presumptive sign of pregnancy. The first fetal movements that the pregnant woman feels are called quickening. Women describe it as a light, “fluttery” sensation. This “feeling of life” is considered a presumptive sign of pregnancy, because it cannot be confirmed objectively by anyone other than the woman herself. Pregnancy is not confirmed until the existence of a fetus can be proved. Nausea or vomiting, caused by hormonal changes in early pregnancy, is called morning sickness.

Question 36

A 30-year-old client has missed their menstrual period and is eager to know if they are pregnant. Which sign ensures that the client is pregnant?

a. Positive home pregnancy test
b. Goodell sign
c. Hearing a fetal heartbeat
d. Braxton Hicks contractions

Answer 36

c. Hearing a fetal heartbeat

*Rationale: Visualizing the fetus by ultrasound, palpating for fetal movements, and hearing a fetal heartbeat are all signs that ensure that the client is pregnant. A positive home pregnancy test, softening of the cervix (Goodell sign), and Braxton Hicks contractions are the probable signs of pregnancy; they do not make the diagnosis of pregnancy a certainty.

Question 37

A client in the first trimester visits the prenatal clinic. Which pattern would the nurse inform the client is the pattern for future visits?

a. Once every week for the first 28 weeks
b. Once every 2 weeks for the first 28 weeks
c. Once every 3 weeks for the first 28 weeks
d. Once every 4 weeks for the first 28 weeks

Answer 37

d. Once every 4 weeks for the first 28 weeks

Answer: d

*Rationale: The nurse should inform the client that future visits to the prenatal clinic should be once every 4 weeks until the 28th week, after which the frequency of visit increases to once every 2 weeks until the 36th week and then weekly until birth.