Evolve Maternity Nursing Chap 6-8

Question 1

If exhibited by a pregnant woman, which of the following represents a positive sign of pregnancy?

a. Morning sickness
b. Quickening
c. Positive pregnancy test
d. Fetal heartbeat auscultated with Doppler/fetoscope

Answer 1

d. Fetal heartbeat auscultated with Doppler/fetoscope
* Detection of a fetal heartbeat, palpation of fetal movements and parts by an examiner, and detection of embryo/fetus with sonographic examination would be positive signs diagnostic of pregnancy.

Question 2

A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman’s current obstetric history, the nurse would record:

a. 4-1-2-0-2
b. 3-1-2-0-2
c. 4-2-1-0-1
d. 3-1-1-1-3

Answer 2

a. 4-1-2-0-2

*Gravida (the first number) is 4 because this woman is now pregnant and was pregnant three times before. Para (the next four numbers) represents the outcomes of the pregnancies and would be described as:
T: 1 = Term birth at 41 weeks of gestation (son)
P: 2 = Preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter)
A: 0 = Abortion: none occurred
L: 2 = Living children: her son and her daughter

Question 3

Which hematocrit (Hct) and hemoglobin (Hgb) results represent(s) the lowest acceptable values for a woman in the third trimester of pregnancy?

a. 38% Hct; 14 g/dl Hgb
b. 35% Hct; 13 g/dl Hgb
c. 33% Hct; 11 g/dl Hgb
d. 32% Hct; 10.5 g/dl Hgb

Answer 3

c. 33% Hct; 11 g/dl Hgb

* 33% Hct; 11 g/dl Hgb represents the lowest acceptable value during the first and the third trimesters.

Question 4

During a woman’s physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as:

a. Hegar’s sign.
b. McDonald’s sign.
c. Chadwick’s sign.
d. Goodell’s sign.

Answer 4

a. Hegar’s sign.
* At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called Hegar’s sign.

McDonald’s sign indicates a fast food restaurant.

Chadwick’s sign is the blue-violet coloring of the cervix caused by increased vascularity; this occurs around the fourth week of gestation.

Softening of the cervical tip is called Goodell’s sign, which may be observed around the sixth week of pregnancy.

Question 5

A number of changes in the integumentary system occur during pregnancy. What change persists after birth?

a. Epulis
b. Chloasma
c. Telangiectasia
d. Striae gravidarum

Answer 5

d. Striae gravidarum
* An epulis is a red, raised nodule on the gums that bleeds easily.

Chloasma, or mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually fades after the birth.

Telangiectasia, or vascular spiders, are tiny, star-shaped or branchlike, slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen. These usually disappear after birth.

Striae gravidarum, or stretch marks, reflect separation within the underlying connective tissue of the skin. After birth they usually fade, although they never disappear completely.

Question 6

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a:

a. Primipara.
b. Primigravida.
c. Multipara.
d. Nulligravida.

Answer 6

a. Primipara.
* A primipara is a woman who has completed one pregnancy with a viable fetus. To remember the meaning of terms, keep in mind that gravida is a pregnant woman; para comes from the word parity, meaning a viable fetus; primi means first; multi means many; and null means none.

A primigravida is a woman pregnant for the first time.

A multipara is a woman who has completed two or more pregnancies resulting in a viable fetus.

A nulligravida is a woman who has never been pregnant.

Question 7

To reassure and educate pregnant patients about changes in their breasts, nurses should be aware that:

a. The visibility of blood vessels that form an intertwining blue network indicates full function of Montgomery’s tubercles and possibly infection of the tubercles.
b. The mammary glands do not develop until 2 weeks before labor.
c. Lactation is inhibited until the estrogen level declines after birth.
d. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

Answer 7

c. Lactation is inhibited until the estrogen level declines after birth.
* The visible blue network of blood vessels is a normal outgrowth of a richer blood supply.

The mammary glands are functionally complete by midpregnancy.

Lactation is inhibited until after birth.

Colostrum is a creamy, white-to-yellow premilk fluid that can be expressed from the nipples before birth.

Question 8

A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The woman tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the woman that this type of contraction:

a. Is painless.
b. Increases with walking.
c. Causes cervical dilation.
d. Impedes oxygen flow to the fetus.

Answer 8

a. Is painless.
* Soon after the fourth month of gestation, uterine contractions can be felt through the abdominal wall. Braxton Hicks contractions are regular and painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying.

Braxton Hicks contractions usually cease with walking or exercise.

Braxton Hicks contractions can be mistaken for true labor; however, they do not increase in intensity, frequency, or cause cervical dilation.

Braxton Hicks contractions facilitate uterine blood flow through the intervillous spaces of the placenta and thereby promote oxygen delivery to the fetus.

Question 9

____________________ occurs when the fetus begins to descend and drop into the pelvis.

Answer 9

*Lightening

Question 10

During the first trimester the pregnant woman would be most motivated to learn about:

a. Fetal development.
b. Impact of a new baby on family members.
c. Measures to reduce nausea and fatigue so she can feel better.
d. Location of childbirth preparation and breastfeeding classes.

Answer 10

c. Measures to reduce nausea and fatigue so she can feel better.
- Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement.

Impact of a new baby on the family would be appropriate topics for the second trimester when the fetus becomes “real” as its movements are felt and its heartbeat heard. During this trimester a woman works on the task of, “I am going to have a baby.”

During the first trimester a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy.

Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

Question 11

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. “One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?” The nurse’s best response would be:

a. “This is normal behavior and should begin to subside by the second trimester.”
b. “She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know.”
c. “This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant.”
d. “You seem impatient with her. Perhaps this is precipitating her behavior.”

Answer 11

c. “This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant.”
- Although it is appropriate to say the behavior is normal and will subside, this information does not answer the father’s question.

Mood swings are a normal finding in the first trimester; the woman does not need counseling.

Describing emotional liability and indicating that it will subside is the most appropriate response because it gives an explanation and a timeframe for when the mood swings may stop.

Telling the father he seems impatient is judgmental and not appropriate.

Question 12

An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. The nurse should tell the couple that:

a. Intercourse should be avoided if any spotting from the vagina occurs afterward.
b. Intercourse is safe until the third trimester.
c. Safer-sex practices should be used once the membranes rupture.
d. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

Answer 12

d. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.
- Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy.

Intercourse can continue as long as the pregnancy is progressing normally.

Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.

Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor.

Question 13

A pregnant woman demonstrates understanding of the nurse’s instructions regarding relief of leg cramps if she:

a. Wiggles and points her toes during the cramp.
b. Applies cold compresses to the affected leg.
c. Extends her leg and dorsiflexes her foot during the cramp.
d. Avoids weight bearing on the affected leg during the cramp.

Answer 13

c. Extends her leg and dorsiflexes her foot during the cramp.
- Pointing toes can aggravate rather than relieve the cramp.

Application of heat is recommended.

Extending the leg and dorsiflexing the foot is the appropriate relief for a leg cramp.

Bearing weight on the affected leg can help relieve the leg cramp, so it should not be avoided.

Question 14

A pregnant woman’s last menstrual period began on April 8, 2009, and ended on April 13. Using Nägele’s rule, her estimated date of birth would be:

a. January 15, 2010.
b. January 20, 2010.
c. December 15, 2009.
d. November 5, 2009.

Answer 14

a. January 15, 2010.
- Nägele’s rule requires subtracting 3 months and adding 7 days and 1 year, if appropriate, to the first day of a pregnant woman’s last menstrual period. When this rule is used with April 8, 2009, the estimated date of birth is January 15, 2010.

January 20, 2010 is not the correct date according to Nägele’s rule.

December 15, 2010 is not the correct date according to Nägele’s rule.

November 5, 2010 is not the correct date according to Nägele’s rule.

Question 15

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her:

a. “You don’t need to modify your exercising any time during your pregnancy.”
b. “Stop exercising because it will harm the fetus.”
c. “You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
d. “Jogging is too hard on your joints; switch to walking now.”

Answer 15

c. “You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
- The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses.

Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom.

Typically running should be replaced with walking around the seventh month of pregnancy.

Simple measures should be initiated to prevent injuries, such as performing warm-up and stretching exercises to prepare the joints for more strenuous exercise.

Question 16

A woman who is 32 weeks’ pregnant is informed by the nurse that a danger sign of pregnancy could be:

a. Constipation.
b. Alteration in the pattern of fetal movement.
c. Heart palpitations.
d. Edema in the ankles and feet at the end of the day.

Answer 16

b. Alteration in the pattern of fetal movement.
- Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters.

An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy.

Heart palpitations are a normal discomfort of pregnancy that occurs in the second and third trimesters.

Edema is a normal discomfort of pregnancy that occurs in the second and third trimesters.

Question 17

If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner’s first pregnancy?

a. Views pregnancy with pride as a confirmation of his virility
b. Consistently changes the subject when the topic of the fetus/newborn is raised
c. Expresses concern that he might faint at the birth of his baby
d. Experiences nausea and fatigue, along with his partner, during the first trimester

Answer 17

b. Consistently changes the subject when the topic of the fetus/newborn is raised
- Being proud of the pregnancy is an expected view for an expectant father.

Persistent refusal to talk about the fetus-newborn may be a sign of a problem and should be assessed further.

Expressing concern about possibly fainting is an expected feeling for an expectant father.

Experiencing nausea and fatigue is an expected finding for expectant fathers.

Question 18

A woman who is 14 weeks’ pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her:

a. “Since you’re in your second trimester, there’s no problem with having one drink with dinner.”
b. “One drink every night is too much. One drink three times a week should be fine.”
c. “Since you’re in your second trimester, you can drink as much as you like.”
d. “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”

Answer 18

d. “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your 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.

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.

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.

Telling the mother that no one knows what amount of alcohol is safe and therefore it is best to abstain is an accurate statement.

Question 19

Which behavior indicates that a woman is “seeking safe passage” for herself and her infant?

a. She keeps all prenatal appointments.
b. She “eats for two.”
c. She drives her car slowly.
d. She wears only low-heeled shoes.

Answer 19

a. She keeps all prenatal appointments.
- The goal of prenatal care is to foster a safe birth for the infant and mother.

Although eating properly, driving carefully, and using proper body mechanics are all healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

Although eating properly, driving carefully, and using proper body mechanics are all healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

Although eating properly, driving carefully, and using proper body mechanics are all healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

Question 20

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that:

a. Nonacceptance of the pregnancy very often equates to rejection of the child.
b. Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.
c. Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers.
d. Conflicts that involve not wanting to be pregnant or be involved in childrearing and career-related decisions that relate to being pregnant need not be addressed during pregnancy, because they will resolve themselves naturally after birth.

Answer 20

b. Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes.
- A woman may dislike being pregnant, refuse to accept it, and still love and accept the child.

Mood swings are natural and are likely to affect every woman to some degree.

Ambivalent feelings about pregnancy are normal for mature or immature women, young or older.

Conflicts involving being pregnant, raising a child, and having a career need to be resolved. The birth of the baby ends the pregnancy but does not resolve the other issues.

Question 21

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? Choose all that apply.

a. Tetanus
b. Diphtheria
c. Chickenpox
d. Rubella
e. Hepatitis B

Answer 21

a. Tetanus
b. Diphtheria
e. Hepatitis B

Question 22

When planning a diet with a pregnant woman, the nurse’s first action would be to:

a. Review the woman’s current dietary intake.
b. Teach the woman about the food pyramid.
c. Caution the woman to avoid large doses of vitamins, especially those that are fat-soluble.
d. Instruct the woman to limit the intake of fatty foods.

Answer 22

a. Review the woman’s current dietary intake.
- Reviewing the woman’s dietary intake as the first step will help to establish whether she has a balanced diet or whether changes in the diet are required.

Teaching about the food pyramid is a correct action on the part of the nurse, but the first action should be to assess the woman’s current dietary pattern and practices because instruction should be geared to what she already knows and does.

Cautioning the woman to avoid large doses of vitamins is a correct action on the part of the nurse, but the first action should be to assess the woman’s current dietary pattern and practices because instruction should be geared to what she already knows and does.

Instructing the woman to limit intake of fatty foods is a correct action on the part of the nurse, but the first action should be to assess the woman’s current dietary pattern and practices because instruction should be geared to what she already knows and does.

Question 23

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how much weight she should be gaining during pregnancy. The nurse’s best response would be to tell the woman that her pattern of weight gain should be approximately:

a. A pound a week throughout pregnancy.
b. 2 to 5 pounds during the first trimester, then a pound each week until the end of pregnancy.
c. A pound a week during the first two trimesters, then 2 pounds per week during the third trimester.
d. A total of 25 to 35 pounds.

Answer 23

b. 2 to 5 pounds during the first trimester, then a pound each week until the end of pregnancy.
- A pound a week is not the correct guideline during pregnancy.

A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 pounds or about 2 to 5 pounds in the first trimester and about 1 pound per week during the second and third trimesters.

A pound per week the first two trimesters and 2 pounds per week the third trimester are not accurate guidelines for weight gain during pregnancy.

The total weight gain of 25 to 35 pounds is correct, but the pattern of weight gain needs to be explained.

Question 24

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman:

a. Drink warm fluids with each of her meals.
b. Eat a high-protein snack before going to bed.
c. Keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed.
d. Schedule three meals and one mid-afternoon snack a day.

Answer 24

b. Eat a high-protein snack before going to bed.
- Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine.

A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea.

Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Adding peanut butter would not be helpful.

Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

Question 25

A pregnant woman’s diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this woman’s intake of:

a. Calcium.
b. Protein
c. Vitamin B12 .
d. Folic acid.

Answer 25

c. Vitamin B12 .
- This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.

This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.

This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.

This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.

Question 26

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned that during and after tennis matches this woman consumes:

a. Several glasses of fluid.
b. Extra protein sources such as peanut butter.
c. Salty foods to replace lost sodium.
d. Easily digested sources of carbohydrate.

Answer 26

a. Several glasses of fluid.
- If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor.

The woman’s calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. Extra protein would not be needed.

The woman’s calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. It would not be necessary to replace lost sodium.

The woman’s calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. Adding easily digested carbohydrate sources would not be necessary.

Question 27

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with:

a. Spina bifida.
b. Intrauterine growth restriction.
c. Diabetes mellitus.
d. Down syndrome.

Answer 27

b. Intrauterine growth restriction.
- Spina bifida is not associated with inadequate maternal weight gain.

Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction.

Diabetes mellitus is not associated with inadequate maternal weight gain.

Down syndrome is not associated with inadequate maternal weight gain.

Question 28

Which minerals and vitamins usually are recommended to supplement a pregnant woman’s diet?

a. Fat-soluble vitamins A and D
b. Water-soluble vitamins C and B6
c. Iron and folate
d. Calcium and zinc

Answer 28

c. Iron and folate
- Fat-soluble vitamins should be supplemented as a medical prescription, because vitamin D might be needed for lactose-intolerant women.

Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet.

Iron generally should be supplemented during pregnancy, and folic acid supplements often are needed because folate is so important to the growing fetus.

Zinc is sometimes supplemented during pregnancy. Most women get enough calcium.

Question 29

With regard to nutritional needs during lactation, a maternity nurse should be aware that:

a. The mother’s intake of vitamin C, zinc, and protein can be lower than during pregnancy.
b. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.
c. Critical iron and folic acid levels, higher than during pregnancy, must be maintained to ensure the health of the infant.
d. Lactating women can go back to their prepregnant calorie intake.

Answer 29

b. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.
- Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy.

A lactating woman needs to avoid consuming too much caffeine.

The recommendations for iron and folic acid are somewhat lower during lactation.

Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

Question 30

When counseling a patient about getting enough iron in her diet, the maternity nurse should tell her that:

a. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron.
b. Iron absorption is inhibited by a diet rich in vitamin C.
c. Iron supplements are permissible for children in small doses.
d. Constipation is common with iron supplements.

Answer 30

d. Constipation is common with iron supplements.
- The beverages listed inhibit iron absorption when consumed at the same time as iron.

Vitamin C promotes iron absorption.

Children who ingest iron can get very sick and even die.

Constipation can be a problem when iron intake is increased.

Question 31

After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy?

a. “Protein will help my baby grow.”
b. “Eating protein will prevent me from becoming anemic.”
c. “Eating protein will make my baby have strong teeth after he is born.”
d. “Eating protein will prevent me from being diabetic.”

Answer 31

a. “Protein will help my baby grow.”
- Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid.

Iron intake prevents anemia.

Calcium intake is needed for fetal bone and tooth development.

Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

Question 32

Obstetricians today are seeing more morbidly obese pregnant women (those that weigh 400 pounds or greater). A new medical subspecialty referred to as ______________ obstetrics has subsequently arisen.

Answer 32

Bariatric