Chapter 11-Nursing Care of the Family During Pregnancy

Question 1

1. A nurse caring for a newly pregnant patient would advise them that ideally prenatal care should begin at what time?
   a. Prenatal care should begin before the first missed menstrual period.
   b. Prenatal care should begin after the first missed menstrual period.
   c. Prenatal care should begin after the second missed menstrual period.
   d. Prenatal care should begin after the third missed menstrual period.

Answer 1

ANS: B
Prenatal care ideally should begin soon after the first missed menstrual period. Regular prenatal visits offer opportunities to ensure the health of the expectant patient and their infant.

Question 2

A patient arrives at the clinic for a pregnancy test. The first day of their last menstrual period (LMP) was February 14, 2021. What would be the baby’s expected date of birth (EDB)?
a. May 21, 2022
b. November 7, 2021
c. November 21, 2021
d. May 2, 2022

Answer 2

ANS: C
Using Nägele’s rule, November 21, 2021, is the correct EDB. 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, 2021: February 14, 2021 – 3 months = November 14, 2020 + 7 days = November 21, 2020 + 1 year = November 21, 2021.

Question 3

For which pregnant patients would prenatal testing for the human immunodeficiency virus (HIV) be recommended?
a. All patients, regardless of risk factors
b. A patient who has had more than one sexual partner
c. A patient who has had a sexually transmitted infection
d. A patient who is monogamous with their partner

Answer 3

ANS: A
Testing for the antibody to HIV is strongly recommended for all pregnant patients, regardless of risk factors. With identification of HIV and prescribed antiretroviral medications, during pregnancy, the incidence of perinatal transmission from an HIV-positive mother to their fetus is less than 1%. Patients who test positive for HIV can then be treated.

Question 4

A nurse would teach that which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant patient to their health care provider?
a. Nausea with occasional vomiting
b. Fatigue
c. Urinary frequency
d. Vaginal bleeding

Answer 4

ANS: 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. Nausea with occasional vomiting, fatigue, and urinary frequency are normal first-trimester concerns. Although they may be worrisome or annoying to the pregnant patient, they usually are not indications of pregnancy problems.

Question 5

A pregnant patient at 10 weeks of gestation jogs three or four times per week. Which is true about exercise during pregnancy?
a. There is no need to modify exercise regimes at any time during pregnancy.
b. Exercising is contraindicated during the third trimester of pregnancy.
c. Exercise routines may need to be modified as pregnancy progresses.
d. Walking is recommended during pregnancy, not jogging.

Answer 5

ANS: C
Pregnant patients should be advised that they may have to modify their exercise later in pregnancy. The nurse should inform the patient that they may need to reduce their exercise level as the pregnancy progresses. Physical activity brings about a feeling of well-being in pregnant patients. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.

Question 6

A nurse would be most concerned about which blood pressure (BP) finding during the second trimester?
a. Baseline BP 120/80, current BP 126/85
b. Baseline BP 100/70, current BP 140/90
c. Baseline BP 140/85, current BP 130/80
d. Baseline BP 110/60, current BP 130/80

Answer 6

ANS: B
A systolic BP (SBP) of 140 mm Hg or more and a diastolic BP (DBP) of 90 mm Hg or more, based on the average of at least two measurements, suggest the presence of hypertension. A slight increase in BP of 126/85 does not meet the criteria for concern. 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. The increase to 130/80 from 110/60 would not be the most concerning.

Question 7

A nurse would teach a pregnant patient that which sign would be most concerning at 32 weeks of gestation?
a. Constipation
b. Alteration in the pattern of fetal movement
c. Heart palpitations
d. Edema in the ankles at the end of the day

Answer 7

ANS: B
An alteration in the pattern or amount of fetal movement may indicate fetal compromise. Constipation, heart palpitations, and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.

Question 8

A patient who is 14 weeks pregnant tells a nurse that they always had a glass of wine with dinner before they became pregnant. They have abstained during her first trimester and would like to know if it is safe to have a drink at dinner now. What is the basis for the nurse’s response?
a. It is alright to have one drink with dinner after the first trimester.
b. Weekly alcohol intake is not to exceed three drinks per week during any month of pregnancy.
c. Alcohol intake in pregnancy is to be limited to beer or wine.
d. It is best to abstain from any alcohol intake during pregnancy

Answer 8

ANS: D
Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout the pregnancy. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.

Question 9

A pregnant patient at 18 weeks of gestation calls the clinic to report that they have been experiencing occasional backaches of mild-to-moderate intensity. What should a nurse recommend to the woman?
a. Do Kegel exercises.
b. Do pelvic rocking exercises.
c. Use a softer mattress.
d. Stay in bed for 24 hours.

Answer 9

ANS: B
Pelvic rocking exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain. Stretching and other exercises to relieve back pain should be performed several times a day.

Question 10

A nurse is aware that breastfeeding be contraindicated in which situation?
a. A pregnant patient has hepatitis B.
b. A pregnant patient has everted nipples.
c. A pregnant patient has a history of breast cancer 3 years ago.
d. A pregnant patient is human immunodeficiency virus (HIV) positive.

Answer 10

ANS: D
Patients who are HIV positive in developed countries are discouraged from breastfeeding because of the risk of HIV transmission. Although hepatitis B antigen has not been shown to be transmitted through breast milk, as an added precaution infants born to HBsAg-positive patients should receive the hepatitis B vaccine and immunoglobulin immediately after birth. Everted nipples are functional for breastfeeding. Newly diagnosed breast cancer would be a contraindication to breastfeeding.

Question 11

What is the pregnant person’s partner’s main role in the pregnancy?
a. Provide financial support.
b. Protect the pregnant person from “old wives’ tales.”
c. Support and nurture the pregnant person.
d. Make sure the pregnant person keeps prenatal appointments.

Answer 11

ANS: C
The partner’s main role in pregnancy is to nurture the pregnant person and respond to their feelings of vulnerability. In older societies the man enacted the ritual couvade.

Question 12

A nurse is aware that during the first trimester, a pregnant patient may expect which change in their sexual desire?
a. Their sexual desire is increased, related to enlarging breasts.
b. Their sexual desire is decreased, related to nausea and fatigue.
c. There is no change in sexual desire.
d. Their sexual desire is increased, related to increased levels of female hormones.

Answer 12

ANS: B
During the first trimester, the pregnant patient’s sexual desire may decrease, especially if they have breast tenderness, nausea, fatigue, or sleepiness. Libido may be depressed in the first trimester but often increases during the second trimester. During pregnancy the breasts may become enlarged and tender; this tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity. Physiological changes such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses may affect sexuality and sexual expression

Question 13

A nurse is aware that which behaviour indicates that a pregnant patient is “seeking safe passage” for themselves and their infant?
a. They keep all prenatal appointments.
b. They “eat for two.”
c. They drive their car slowly.
d. They wears only low-heeled shoes.

Answer 13

ANS: A
The goal of prenatal care is to foster a safe birth for the newborn and mother. Although eating properly, driving carefully, and using proper body mechanics are all healthy measures that a pregnant person can take, obtaining prenatal care is the optimal method for providing safety for both themselves and their baby.

Question 14

A nurse is teaching a multiparous patient about a 3-year-old child’s probable response during the pregnancy?
a. How the baby will “get out”?
b. What the baby will eat?
c. Whether their mother will die?
d. What colour eyes the baby has?

Answer 14

ANS: 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. 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?” Whether the mother will die does not tend to be the focus of a child’s questions about the impending birth of a sibling. The baby’s eye colour does not tend to be the focus of children’s questions about the impending birth of a sibling.

Question 15

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

Answer 15

ANS: D
Educators must build on cultural practices that promote the protection of the mother and fetus during pregnancy. Although many consider pregnancy normal, certain practices are expected of pregnant patients of all cultures to ensure a good outcome. Cultural prescriptions tell pregnant people 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.

Question 16

A nurse understands that 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

Answer 16

ANS: B
A concern for modesty is a deterrent to many patients seeking prenatal care. For some patients exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a patient, some practices may conflict with their cultural beliefs and practices.

Question 17

A nurse teaches a patient which information about pregnancy?
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 is on bedrest.

Answer 17

ANS: A
A lunar month lasts 28 days, or 4 weeks. Pregnancy spans 9 calendar months but 10 lunar months. A trimester is one third of a normal pregnancy, or about 13 to 14 weeks. The prenatal period covers the full course of pregnancy (prenatal means before birth). The EDC is now called the EDB, or estimated date of birth. It has nothing to do with the duration of bedrest.

Question 18

Which should a nurse know to aid in understanding and guiding a patient through their acceptance of pregnancy?
a. Nonacceptance of the pregnancy very often equates to rejection of the child.
b. Mood swings most likely are the result of a changed lifestyle as well as profound
hormonal changes.
c. Ambivalent feelings usually are seen only in emotionally immature or very young
mothers.
d. Conflicts such as not wanting to be pregnant or child-rearing and career-related
decisions will resolve themselves naturally after birth.

Answer 18

ANS: B
Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for mature or immature women, young or older. Conflicts such as not wanting to be pregnant or child-rearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues.

Question 19

What would a nurse teach a patient with regards to reordering of personal relationships during pregnancy?
a. Because of the special motherhood bond, a pregnant patient’s relationship with
their mother is even more important than with the father of the child.
b. Nurses need not get involved in any sexual issues the couple has during
pregnancy, particularly if they have trouble communicating them to each other.
c. Pregnant patients usually express two major relationship needs during pregnancy:
feeling loved and valued and having the child be accepted by the partner.
d. The pregnant patient’s sexual desire is likely to be highest in the first trimester
because of the excitement and because intercourse is physically easier.

Answer 19

ANS: C
Love and support help a patient feel better about their pregnancy. The most important person to the pregnant patient is usually the father or partner. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings. The second trimester is the time when a pregnant patient’s sense of well-being, along with certain physical changes, increases their desire for sex. Desire is down in the first trimester.

Question 20

What represents a typical progression through the phases of a patient establishing a relationship with the fetus?
a. Accepts the fetus as distinct from themselves—accepts the biological 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
themselves—becomes introspective
c. Views the child as part of themselves—has feelings of well-being—accepts the
biological fact of pregnancy
d. Accepts they are pregnant—acknowledges that they are going to have a
baby—accepts they are going to be a mother

Answer 20

ANS: D
The patient first centres on themselves as pregnant, then on the baby as an entity separate from themself, and then on their 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.

Question 21

What should a nurse know with regard to the father’s acceptance of the pregnancy and preparation for childbirth?
a. For most men, pregnancy is a time of fantasy and intense learning.
b. The father’s attachment to the fetus cannot be as strong as that of the mother.
c. During 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.

Answer 21

ANS: A
For most partners, pregnancy is a time of preparation for the parental role, fantasy, great pleasure, and intense learning. The father– child attachment can be as strong as the mother–child relationship and can also begin during pregnancy. In the last 2 monthsof pregnancy many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant father’s ambivalence ends by the first trimester, and they progress to adjusting to the reality of the situation and then to focusing on their role.

Question 22

What should a nurse be aware of for the initial visit with a patient who is beginning prenatal care?
a. Maintain a relaxed, get-acquainted affair to gather general impressions.
b. Avoid assessing any handicap conditions until the second prenatal visit.
c. Be alert to the appearance of potential parenting problems, such as depression or
lack of family support.
d. Refrain from asking about illegal drug use; that is left to physicians.

Answer 22

ANS: C
Besides these potential problems, nurses need to be alert to the patient’s attitude toward health care. The initial inte rview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. While nurses must be sensitive to special problems, 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. Getting information on drug use is important and can be done confidentially. Actual testing for drug use requires the patient’s consent.

Question 23

What should a nurse be aware of with regard to the initial physical examination of a patient beginning prenatal care?
a. Only patients who show physical signs or meet the sociological profile should be
assessed for physical abuse.
b. The patient should empty their bladder before the pelvic examination is
performed.
c. The distribution, amount, and quality of body hair are of no particular importance.
d. The size of the uterus is discounted in the initial examination because it is just
going to get bigger soon.

Answer 23

ANS: B
An empty bladder facilitates the examination; this is also an opportunity to get a urine sample easily for a number of tests. All pregnant patients should be assessed for a history of physical abuse, particularly because the likelihood of abuse increases during pregnancy. Noting body hair is important because body hair reflects nutritional status, endocrine function, and hygiene. Particular attention is paid to the size of the uterus because it is an indication of the duration of gestation.

Question 24

Which should a nurse be aware of to care for patients receiving prenatal care?
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 patients a systolic blood pressure (BP) of 130 and a diastolic BP of
80 is sufficient to be considered hypertensive.

Answer 24

ANS: C
The pregnant patient lies on their 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. The interview portion of follow-up examinations is less extensive than in the initial prenatal visits, during which much new information must be gathered. 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. For pregnant patients hypertension is defined as a systolic BP of 140 or higher and a diastolic BP of 90 or higher.

Question 25

What should a nurse teach the mother to properly promote personal hygiene?
a. Tub bathing is permitted even in late pregnancy unless membranes have ruptured.
b. The perineum should be wiped from back to front.
c. Bubble bath and bath oils are permissible because they add an extra soothing and
cleansing action to the bath.
d. Expectant mothers should use specially treated soap to cleanse the nipples.

Answer 25

ANS: A
The main danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

Question 26

Why would a nurse perform the pinch test?
a. To check the sensitivity of the nipples
b. To determine whether the nipple is everted or inverted
c. To calculate the adipose buildup in the abdomen
d. To see whether the fetus has become inactive

Answer 26

ANS: B
The pinch test is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding.

Question 27

Which should a nurse teach a pregnant patient with regards to dental care during pregnancy?
a. Dental care need not be a priority because the patient is getting a lot of calcium
anyway.
b. Dental surgery, in particular, is contraindicated because of psychological stress.
c. The pregnant patient will be most comfortable with dental treatment in the second
trimester.
d. Dental care interferes with the need to practice conscious relaxation

Answer 27

ANS: C
The second trimester is best for dental treatment because that is when the patient will be able to sit most comfortably in the dental chair. Dental care such as brushing with fluoride toothpaste is especially important during pregnancy because nausea during pregnancy may lead to poor oral hygiene. Emergency dental surgery is permissible, but the patient must clearly understand the risks and benefits. Conscious relaxation is useful, and it may even help the patient get through any dental appointments; it is not a reason to avoid them.

Question 28

Which should a nurse teach a pregnant patient with regards to work and travel during pregnancy?
a. Patients should sit for as long as possible and cross their legs at the knees from
time to time for exercise.
b. Patients 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 patient
passes through them a number of times.
d. While working or travelling in a car or on a plane, patients should arrange to walk
around at least every hour or so.

Answer 28

ANS: D
Periodic walking helps prevent thrombophlebitis. Pregnant patients should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant patients must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

Question 29

Which should a nurse be aware of with regard to medications, herbs, immunizations, and other substances during pregnancy?
a. Both prescription and over-the-counter (OTC) drugs that otherwise are harmless
can become 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 second-hand smoke is potentially dangerous
to the fetus.

Answer 29

ANS: A
Both prescription and OTC drugs that otherwise are harmless can become hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of medication-caused developmental defects exists in the interval from fertilization through the first trimester, when a patient may not realize that they are pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Second-hand smoke is associated with fetal growth restriction and increases in infant mortality.

Question 30

Which statement about multifetal pregnancy is accurate?
a. The expectant mother rarely develops anemia because the fetuses have a greater
supply of iron.
b. Twin pregnancies come to term with the same frequency as single pregnancies.
c. The mother should be counselled to increase their nutritional intake and gain
more weight.
d. Backache and varicose veins often are less pronounced.

Answer 30

ANS: C
The mother should be counselled to increase their nutritional intake and gain more weight. Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. A patient with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counselling is needed to help them adjust to these condition

Question 31

What is the name of the phenomenon of the expectant father experiencing pregnancy-like symptoms such as nausea?
a. Hyperemesis
b. Couvade
c. Identification syndrome
d. Psychological bingeing

Answer 31

ANS: B
An expectant father’s experiencing of his partner’s pregnancy-like symptoms is called the couvade syndrome.

Question 32

Which sign or symptom should a nurse teach a pregnant patient to report immediately to their health care provider?
a. Vaginal mucous discharge
b. Decreased libido
c. Urinary frequency
d. Heartburn accompanied by severe headache

Answer 32

ANS: D
Severe headache is a sign of potential complications in pregnancy. Patients should be advised to report this sign to their health care provider. It is normal to have a vaginal mucous discharge. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

Question 33

A nurse would teach a pregnant patient that which immunization is safe to administer during pregnancy?
a. Tetanus
b. Mumps
c. Chickenpox
d. Rubella

Answer 33

ANS: A
Immunization with live or attenuated live viruses is contraindicated during pregnancy because of its potential teratogenicity. Vaccines consisting of killed viruses may be used. Those that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, rabies vaccines, and most influenza vaccines. Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps and are contraindicated during pregnancy.

Question 34

The most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant is
a. genetic changes and anomalies.
b. extensive central nervous system damage.
c. fetal addiction to the substance inhaled.
d. intrauterine growth restriction.

Answer 34

ANS: D
The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes normally will not cause genetic changes or extensive central nervous system damage. Addiction to tobacco is not a usual concern related to the neonate.

Question 35

A patient is 3 months pregnant. At their prenatal visit, they tell a nurse that they do not know what is happening; one minute they are happy that they are pregnant, and the next minute they cry 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 partner about how you feel?”
c. “Perhaps you really don’t want to be pregnant.”
d. “Hormonal changes during pregnancy commonly result in mood swings.”

Answer 35

ANS: D
The statement “Hormonal changes during pregnancy commonly result in mood swings” is accurate and the most appropriate response by the nurse. The statement “Don’t worry about it; you’ll feel better in a month or so” dismisses the patient’s concerns and is not the most appropriate response. Although patients should be encouraged to share their feelings, “Have you talked to your partner about how you feel” is not the most appropriate response and does not provide the patient with a rationale for the psychosocial dynamics of their pregnancy. “Perhaps you really don’t want to be pregnant” is completely inappropriate and deleterious to the psychological well-being of the patient. Hormonal and metabolic adaptations often cause mood swings in pregnancy. The patient’s responses are normal and they should be reassured about their feelings.

Question 36

While a nurse is assessing the vital signs of a pregnant patient in the third trimester, the patient states they are feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?
a. Have the patient stand up and retake their blood pressure.
b. Have the patient sit down and hold their arm in a dependent position.
c. Have the patient lie supine for 5 minutes and recheck their blood pressure on both arms.
d. Have the patient turn to her left side and recheck their blood pressure in 5 minutes.

Answer 36

ANS: D
Blood pressure is affected by maternal position during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant patient to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

Question 37

Where is the emphasis placed in the current practice of childbirth preparation?
a. The Dick-Read (natural) childbirth method
b. The Lamaze (psychoprophylactic) method
c. The Bradley (husband-coached) method
d. Attend childbirth preparation in any or no specific method

Answer 37

ANS: D
Getting expectant parents to class is most important, because preparation increases a woman’s confidence and thus her ability to cope with labour and birth.

Question 38

Which infections can be identified for pregnant women through laboratory analysis of a vaginal or rectal smear? (Select all that apply.)
a. Gonorrhea
b. HIV
c. Chlamydia
d. Group B streptococcus (GBS)
e. Syphilis
f. Human papillomavirus (HPV)

Answer 38

ANS: A, C, D, F
A vaginal or rectal smear can screen for Neisseria gonorrhoeae, chlamydia, HPV, and GBS. A VDRL test is used to screen for women with untreated syphilis. An HIV antibody screen is used to screen for HIV.

Question 39

Which tests will be conducted in the prenatal period to identify fetus(es) at risk for developing erythroblastosis fetalis or hyperbilirubinemia in the newborn period? (Select all that apply.)
a. Blood type
b. Rh
c. Hemoglobin
d. Hematocrit
e. Differential
f. WBC
g. Presence of antibodies

Answer 39

ANS: A, B, G
Blood type, Rh, and the presence of antibodies is used in the prenatal period to identify fetus(es) at risk for developing erythroblastosis fetalis or hyperbilirubinemia in the neonatal period.

Question 40

A nurse is aware that pregnant patients should have serum testing completed at their first prenatal visit for which sexually transmitted infection (STI)? (Select all that apply.)
a. Chlamydia
b. Syphilis
c. Gonorrhea
d. Hepatitis B virus (HBV)
e. Herpes simplex virus (HSV)
f. Human papillomavirus (HPV)

Answer 40

ANS: B, D
All pregnant patients should have serum testing for HBV and syphilis at the first prenatal visit, and if they are considered to be high risk, blood testing should be repeated later in pregnancy or on admission for labour and birth. Although chlamydia and gonorrhea should be screened for during the initial prenatal visit, these are done via cervical cultures and not serum testing. HPV and HSV are also recommended for screening but are done via a rectal or vaginal smear and not serum testing.

Question 41

A nurse would teach a pregnant patient to report which signs and symptoms immediately to their health care provider? (Select all that apply.)
a. Vaginal bleeding
b. Rupture of membranes
c. Heartburn accompanied by severe headache
d. Decreased libido
e. Urinary frequency

Answer 41

ANS: A, B, C
Vaginal bleeding, rupture of membranes, and severe headaches all are signs of potential complications in pregnancy. Patients should be advised to report these signs to the health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

Question 42

A woman has just moved to Canada from a refugee camp in Somalia. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, a nurse discovers that she has not had any immunizations. Which immunizations should the patient receive at this point in her pregnancy? (Select all that apply.)
a. Tetanus
b. Diphtheria
c. Chickenpox
d. Rubella
e. Hepatitis B

Answer 42

ANS: A, B, E
Immunization with live or attenuated live viruses is contraindicated during pregnancy because of potential teratogenicity. Vaccines consisting of killed viruses may be used. Immunizations that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines. Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps.

Question 43

A patient arrives at the clinic for a pregnancy test. The first day of their last menstrual period (LMP) was September 10, 2020. Their expected date of birth (EDB) would be .

Answer 43

ANS:June 17, 2021
Using Nägele’s rule, June 17, 2021, is the correct EDB. 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 September 10, 2020:
September 10, 2020 – 3 months = June 10, 2020 + 7 days = June 17, 2020 + 1 year = June 17, 2021

Question 44

All pregnant patient should be instructed to recognize and report potential complications for each trimester of pregnancy. Match the sign or symptom with a possible cause.
a. Severe vomiting in early pregnancy
b. Epigastric pain in late pregnancy
c. Severe backache and flank pain
d. Decreased fetal movement
e. Glycosuria

1. Fetal compromise or intrauterine fetal death
2. Kidney infection or stones
3. Gestational diabetes
4. Hyperemesis gravidarum
5. Hypertension, preeclampsia

Answer 44

1 ANS: D
2. ANS: C
3. ANS: E
4. ANS: A
5. ANS: B