Exam 1 Flashcards
Most, very, or less effective birth control methods?
male and female sterilization
most effective
Most, very, or less effective birth control methods?
intrauterine contraception
most effective
Most, very, or less effective birth control methods?
implant (Nexplanon)
most effective
Most, very, or less effective birth control methods?
abstinence
most effective
Most, very, or less effective birth control methods?
injectable
very effective
Most, very, or less effective birth control methods?
contraceptive patch
very effective
Most, very, or less effective birth control methods?
male and female condoms
least effective
Most, very, or less effective birth control methods?
ring and pills
very effective
Most, very, or less effective birth control methods?
diaphragm
less effective
Most, very, or less effective birth control methods?
fertility awareness
less effective
Name the correct shunt.
connects the umbilical vein to the inferior vena cava
a. ductus venosus
b. ductus arteriosus
c. foramen ovale
a. ductus venosus
Name the correct shunt.
connects the main pulmonary artery to the aorta
a. ductus venosus
b. ductus arteriosus
c. foramen ovale
b. ductus arteriosus
Name the correct shunt.
anatomic opening between the right and left atria
a. ductus venosus
b. ductus arteriosus
c. foramen ovale
c. foramen ovale
A nurse is assessing the umbilical cord of a newborn immediately after birth. Which of the following findings indicates a normal umbilical cord structure?
A. One artery and one vein surrounded by Wharton’s jelly
B. Two arteries and two veins with no protective covering
C. One artery and two veins surrounded by Wharton’s jelly
D. Two arteries and one vein surrounded by Wharton’s jelly
D. Two arteries and one vein surrounded by Wharton’s jelly
Rationale: The normal umbilical cord contains two arteries that carry waste products away from the fetus and one vein that carries oxygenated blood and nutrients to the fetus. The vessels are surrounded by Wharton’s jelly, which provides cushioning and protection.
Which of the following statements best describes the function of Wharton’s jelly in the umbilical cord?
A. Provides a medium for nutrient absorption by the fetus
B. Protects the umbilical blood vessels from compression
C. Serves as a primary source of oxygenation for the fetus
D. Facilitates the exchange of waste between the fetus and mother
B. Protects the umbilical blood vessels from compression
Rationale: Wharton’s jelly is a gelatinous substance in the umbilical cord that surrounds and protects the umbilical vessels from compression, ensuring that blood flow between the mother and fetus is maintained.
During labor, the nurse notes that the umbilical cord is wrapped around the infant’s neck. Which of the following functions of the umbilical cord’s structure helps minimize the risk of compromised circulation in this situation?
A. The presence of two arteries
B. The length of the umbilical cord
C. Wharton’s jelly surrounding the vessels
D. The presence of only one vein
C. Wharton’s jelly surrounding the vessels
Rationale: Wharton’s jelly helps protect and cushion the umbilical vessels against compression and kinking. This cushioning effect is especially important if the cord becomes wrapped around the fetus, as it helps ensure continued blood flow.
The average length of a term umbilical cord is approximately:
A. 12 inches
B. 18 inches
C. 22 inches
D. 30 inches
C. 22 inches
Rationale: At term, the average length of the umbilical cord is approximately 22 inches, with a diameter of about 1 inch. This length allows adequate movement of the fetus without compromising circulation.
The nurse is reviewing fetal circulation with a student. Which of the following best describes the role of the umbilical vein?
A. Removes waste products from the fetus
B. Carries deoxygenated blood to the placenta
C. Carries oxygenated blood and nutrients to the fetus
D. Circulates blood within the amniotic sac
C. Carries oxygenated blood and nutrients to the fetus
Rationale: The umbilical vein carries oxygenated blood and essential nutrients from the placenta to the fetus. In contrast, the two umbilical arteries carry deoxygenated blood and waste products away from the fetus to the placenta.
A newborn’s umbilical cord is examined shortly after birth, and only one artery and one vein are noted. This finding most likely indicates:
A. A normal umbilical cord
B. An absence of Wharton’s jelly
C. Excessive cord length
D. An increased risk for congenital anomalies
D. An increased risk for congenital anomalies
Rationale: The normal umbilical cord has two arteries and one vein. A single umbilical artery is associated with a higher risk for congenital anomalies and warrants further evaluation.
The umbilical cord develops from which of the following embryonic structures?
A. Neural crest cells
B. Yolk sac and amnion
C. Chorionic villi
D. Trophoblast layer
B. Yolk sac and amnion
Rationale: The umbilical cord is derived from the yolk sac and amnion during embryonic development. These structures contribute to the formation of the cord that connects the fetus to the placenta.
When explaining umbilical cord circulation, the nurse should emphasize that the umbilical arteries:
A. Remove deoxygenated blood and waste products away from the fetus
B. Transport nutrients to the fetus
C. Are thicker than the umbilical vein
D. Do not play a role in fetal circulation
A. Remove deoxygenated blood and waste products away from the fetus
Rationale: The umbilical arteries carry deoxygenated blood and metabolic waste products away from the fetus to the placenta for exchange and removal.
In a term pregnancy, the average diameter of the umbilical cord is approximately:
A. 0.5 inches
B. 1 inch
C. 1.5 inches
D. 2 inches
B. 1 inch
Rationale: At term, the average umbilical cord diameter is about 1 inch. This thickness, along with the Wharton’s jelly, helps ensure protection of the blood vessels within the cord.
Which of the following is true regarding umbilical cord function?
A. The umbilical vein removes waste from the fetus
B. The two umbilical arteries carry oxygenated blood to the fetus
C. The umbilical vein carries oxygenated blood and nutrients to the fetus
D. Wharton’s jelly is responsible for nutrient exchange
C. The umbilical vein carries oxygenated blood and nutrients to the fetus
Rationale: The umbilical vein’s primary function is to carry oxygenated blood and nutrients from the placenta to the fetus. This ensures proper fetal growth and development. The two arteries remove waste products from the fetus.
Which of the following is the primary function of the placenta at term?
A. To transport maternal blood into fetal circulation
B. To serve as a protective barrier to maternal immune cells
C. To produce insulin for the fetus
D. To bring nutrients and oxygen to the fetus while removing waste products
D. To bring nutrients and oxygen to the fetus while removing waste products
Rationale: The placenta acts as the interface between the mother and developing fetus, facilitating the exchange of nutrients, oxygen, and waste products. It does not directly transport maternal blood into the fetus but allows for exchange via diffusion and active transport. Although it provides some immune protection and hormone production, nutrient exchange is a crucial primary function.
Where does the placenta most commonly develop in a healthy pregnancy?
A. Lower uterine segment
B. Cervical os
C. Fundus of the uterus
D. Posterior uterine wall
C. Fundus of the uterus
Rationale: The placenta most commonly develops in the fundus of the uterus, which is the upper portion. This location supports optimal fetal development and uterine contractions during delivery. Placental implantation near the cervix or lower uterine segment can lead to complications such as placenta previa.
Which hormone is primarily produced by the placenta to sustain pregnancy?
A. Follicle-stimulating hormone (FSH)
B. Estrogen
C. Human chorionic gonadotropin (hCG)
D. Insulin-like growth factor
C. Human chorionic gonadotropin (hCG)
Rationale: The placenta produces human chorionic gonadotropin (hCG) to maintain the corpus luteum, which secretes progesterone necessary for pregnancy maintenance in the early stages. While estrogen is also produced, hCG plays a critical early role.
Which function of the placenta contributes to immune tolerance during pregnancy?
A. Producing hormones for fetal growth
B. Preventing maternal antibodies from attacking fetal cells
C. Removing waste products from the fetal bloodstream
D. Acting as a site for nutrient exchange
B. Preventing maternal antibodies from attacking fetal cells
Rationale: The placenta provides immune tolerance by preventing maternal immune cells from attacking the genetically distinct fetus. This immunological protection ensures fetal development proceeds without rejection from the mother’s immune system.
During fetal development, what is the role of the placenta regarding fetal circulation given the collapsed state of the fetal lungs?
A. Providing oxygen and nutrients via the maternal blood supply
B. Transporting oxygen directly through the fetal lungs
C. Allowing the fetus to practice breathing movements
D. Preventing oxygenated blood from reaching the fetus
A. Providing oxygen and nutrients via the maternal blood supply
Rationale: The placenta functions as the site of nutrient and oxygen transfer from the mother to the fetus since the fetal lungs remain collapsed and non-functional for oxygen exchange during intrauterine life.
How does the placenta protect the fetus from maternal immune attack?
A. By increasing maternal antibody production
B. By creating a physical barrier to immune cells
C. By secreting immunosuppressive factors
D. By promoting early labor to avoid immune attack
C. By secreting immunosuppressive factors
Rationale: The placenta secretes immunosuppressive factors and hormones that help modulate the maternal immune system, reducing the risk of an immune attack against the fetus.
The placenta is capable of producing hormones needed for fetal growth. Which of these is primarily involved in fetal growth regulation?
A. Cortisol
B. Human placental lactogen (hPL)
C. Thyroid-stimulating hormone
D. Testosterone
B. Human placental lactogen (hPL)
Rationale: Human placental lactogen (hPL) is produced by the placenta and plays a significant role in fetal growth by modulating maternal metabolism, increasing nutrient availability to the fetus.
What is one of the critical functions of the placenta related to the developing fetus’s lungs?
A. It acts as a surrogate lung for oxygen exchange
B. It inflates the lungs with amniotic fluid
C. It prevents amniotic fluid from reaching the fetus
D. It matures fetal lung tissue in the first trimester
A. It acts as a surrogate lung for oxygen exchange
Rationale: The placenta acts as a surrogate lung for the fetus, allowing oxygen and carbon dioxide exchange while the fetal lungs remain collapsed and non-functional in utero.
Name this hormone.
Modulates fetal and maternal metabolism
a. Human placental lactogen (HPL)
b. Estrogen
c. Progesterone
d. Relaxin
a. Human placental lactogen (HPL)
Name this hormone.
Development of breast tissue
a. Human placental lactogen (HPL)
b. Estrogen
c. Progesterone
d. Relaxin
a. Human placental lactogen (HPL)
Name this hormone.
Decreases maternal glucose utilization, increases available glucose to fetus
a. Human placental lactogen (HPL)
b. Estrogen
c. Progesterone
d. Relaxin
a. Human placental lactogen (HPL)
Name this hormone.
Enlargement of maternal organs, stimulates contractions of uterus
a. Human placental lactogen (HPL)
b. Estrogen
c. Progesterone
d. Relaxin
b. Estrogen
Name this hormone.
Maintains endometrium, decreases contractility of uterus, stimulates maternal metabolism and breast development.
a. Human placental lactogen (HPL)
b. Estrogen
c. Progesterone
d. Relaxin
c. Progesterone
Name this hormone.
Acts synergistically with progesterone to maintain pregnancy, relaxation of pelvic ligaments, softens the cervix in preparation for birth.
a. Human placental lactogen (HPL)
b. Estrogen
c. Progesterone
d. Relaxin
d. Relaxin
Name this hormone.
preserves the corpus luteum and its progesterone production so that the endometrial lining of the uterus is maintained; this is the basis for pregnancy tests
a. Human chorionic gonadotropin (hCG)
b. Estrogen
c. Progesterone
d. Relaxin
a. Human chorionic gonadotropin (hCG)
_________ is the incidence or number of individuals who have died over a specific period.
mortality
__________ indicates any physical or mental diseased state or condition.
morbidity
A new mother in your postpartum unit is worried about her role transition to parenthood. She expresses anxiety over balancing her career and parental responsibilities. As the nurse, which intervention is the most appropriate?
A. Encourage the patient to avoid working for at least the first year.
B. Refer the patient to community support groups and parental counseling.
C. Suggest the patient rely on friends for childcare.
D. Discourage the patient from expressing negative emotions.
B. Refer the patient to community support groups and parental counseling.
Rationale: Transitioning into parental roles can be challenging. Providing support groups and parental counseling can help the mother feel less isolated and better equipped to handle her new responsibilities. Encouraging community support is effective in promoting adaptive coping mechanisms. Options A, C, and D either limit the patient’s choices or are inappropriate for fostering a supportive and adaptive environment.
A pregnant woman with a known genetic predisposition to cystic fibrosis asks about the potential impact on her unborn child. Which of the following is the nurse’s most appropriate response?
A. “Cystic fibrosis only affects males, so if you have a female child, she will not be affected.”
B. “Genetic counseling can help you better understand the risk and testing options available for your child.”
C. “There is no way to know if your child will have cystic fibrosis until they are born.”
D. “You should consider terminating the pregnancy, as there is a high risk of genetic disorders.”
B. “Genetic counseling can help you better understand the risk and testing options available for your child.”
Rationale: Genetic counseling is the most appropriate option for helping the patient understand genetic risks, inheritance patterns, and available tests. It respects the patient’s autonomy and helps in informed decision-making. Option A is incorrect as cystic fibrosis affects both genders. Option C is inaccurate as prenatal testing is possible, and Option D is not an appropriate response and fails to provide supportive guidance.
A nurse is conducting a health assessment for a woman living in a low-income community with high violence rates. Which factor should the nurse prioritize when developing a care plan?
A. Ensuring the patient has access to recreational activities.
B. Providing resources for community advocacy against violence.
C. Addressing immediate safety and providing referrals to shelters if needed.
D. Encouraging the patient to move out of the community.
C. Addressing immediate safety and providing referrals to shelters if needed.
Rationale: Patient safety is a priority when addressing healthcare needs in high-violence communities. Ensuring access to shelters or safety resources can protect the patient from harm. While community advocacy (Option B) and recreational activities (Option A) may have long-term value, immediate safety concerns must be prioritized. Option D is impractical and may not be a feasible solution for many patients.
A nurse is educating a women’s health support group on the influence of social roles and media on body image perception. Which statement by a participant would require further education?
A. “The media often sets unrealistic beauty standards that can impact self-esteem.”
B. “My social role as a caregiver makes it easier for me to prioritize self-care.”
C. “My socioeconomic status sometimes limits my access to self-improvement resources.”
D. “I feel pressured by media to adhere to certain beauty norms.”
B. “My social role as a caregiver makes it easier for me to prioritize self-care.”
Rationale: This statement requires further education, as caregiving roles often lead to challenges in self-care prioritization due to demanding responsibilities. Media and social roles can contribute to stressors and influence self-perception and body image, but caregivers often struggle to balance responsibilities with personal health needs.
T/F
Health screenings are an important component of primary prevention.
false; Health Screenings are part of Secondary Prevention
primary, secondary or tertiary prevention
involves preventing the disease or condition before it occurs through health promotion activities, environmental protection, and specific protection against disease or injury
primary prevention
primary, secondary or tertiary prevention
the early identification of people who have already developed a disease at an early stage in the disease’s natural history through screening and early intervention
secondary prevention
primary, secondary or tertiary prevention
designed to reduce or limit the progression of a permanent, irreversible disease or disability
tertiary prevention
the process of openness, self-awareness, egolessness, and self-reflection and critique after interacting with diverse culture individuals
cultural humility
no detectable variation around baseline
absent variability
> 25 bpm variation
marked variability
< 5 bpm variation around baseline
minimal variability
6-25 bmp variation around baseline
moderate variability
acme of 15 bmp above baseline with duration > 15 seconds but < 2 minutes
acceleration
a transient fall in fetal GR caused by stimulation of the parasympathetic nervous system
deceleration
The does the V in VEALCHOP stand for?
variable
The does the E in VEALCHOP stand for?
early
The does the A in VEALCHOP stand for?
acceleration
The does the L in VEALCHOP stand for?
late
The does the C in VEALCHOP stand for?
cord compression
The does the H in VEALCHOP stand for?
head compression
The does the O in VEALCHOP stand for?
oxygen or okay
The does the P in VEALCHOP stand for?
placental insufficiency
What does the L in LIONS stand for?
left side lying
What does the I in LIONS stand for?
IV fluid bolus (lactated Ringer’s 500)
What does the O in LIONS stand for?
oxygen
What does the N in LIONS stand for?
notifty provider
What does the S in LIONS stand for?
stop pitocin
the process by which clients or relatives at risk for an inherited disorder are advised of the consequences and nature of the disorder, the probability of developing or transmitting it, and the options open to them in management and family planning in order to prevent, avoid, or ameliorate it
genetic counseling
Women who are pregnant or planning to be after what age may benefit from genetic counseling?
35
Paternal age of _____ may benefit from genetic counseling.
50 years or older
A nurse is assessing the contraction pattern of a patient in active labor. Which finding indicates a normal uterine contraction pattern?
a. Contractions lasting 120 seconds every 10 minutes
b. Contractions lasting 40-90 seconds, occurring every 2-5 minutes
c. Contractions lasting 20-30 seconds, occurring every 15 minutes
d. Contractions lasting 100-120 seconds, occurring every 1-2 minutes
b. Contractions lasting 40-90 seconds, occurring every 2-5 minutes
rationale: In active labor, a normal contraction pattern includes contractions lasting 40-90 seconds with a frequency of 2-5 minutes. Patterns lasting too long or too frequent may indicate hyperstimulation, which can cause fetal distress.
A laboring client is being monitored, and her contraction intervals are occurring every 1 minute with a duration of 100 seconds. What is the nurse’s priority intervention?
a. Encourage the patient to bear down
b. Administer oxygen to the mother
c. Increase the infusion rate of oxytocin
d. Discontinue oxytocin and notify the healthcare provider
d. Discontinue oxytocin and notify the healthcare provider
Rationale: Contractions that occur every minute and last 100 seconds represent uterine tachysystole, which may compromise uteroplacental perfusion. Discontinuing oxytocin is a priority to reduce contraction frequency and prevent fetal compromise.
During labor, a nurse notices a patient’s contractions are lasting 70 seconds and occur every 6 minutes. What does this pattern indicate?
a. Adequate labor progression
b. Hyperstimulation of the uterus
c. Contractions too infrequent for effective labor
d. Signs of uterine rupture
a. Adequate labor progression
Rationale: In active labor, contractions lasting around 60-90 seconds and occurring every 2-5 minutes are typical. This pattern is adequate for effective labor.
A client in early labor reports contractions every 10 minutes. The nurse advises the client to:
a. Stay at home and time contractions
b. Come to the hospital immediately
c. Perform vigorous exercise to speed up labor
d. Lie flat on her back to conserve energy
a. Stay at home and time contractions
Rationale: Contractions every 10 minutes are typical of early labor. The client should be instructed to stay at home and monitor contraction timing and intensity until they become closer together and more regular.
A nurse is evaluating a laboring client whose contractions occur every 3 minutes and last for 45 seconds. How would the nurse document this finding?
a. Contractions with normal duration and frequency
b. Contractions that are inadequate for labor progress
c. Contractions indicative of uterine hypertonicity
d. Contractions requiring emergency intervention
a. Contractions with normal duration and frequency
Rationale: Contractions every 2-5 minutes, lasting 40-90 seconds, are expected during active labor. The documented pattern is within the normal range.
Which client scenario requires the nurse to immediately contact the healthcare provider?
a. Contractions occurring every 4 minutes and lasting 60 seconds
b. Contractions every 2 minutes lasting 120 seconds
c. Irregular contractions with a 10-minute interval
d. Contractions every 6 minutes lasting 50 seconds
b. Contractions every 2 minutes lasting 120 seconds
Rationale: Contractions lasting over 90 seconds and occurring every 2 minutes or less can lead to uterine hyperstimulation and fetal distress, requiring immediate intervention.
A patient in labor is experiencing contractions every 3 minutes that last 80 seconds. Which nursing action is most appropriate?
a. Reassess contraction pattern in 30 minutes
b. Position the patient in a supine position
c. Continue to monitor the client without intervention
d. Provide oxygen at 8-10 L/min via mask
c. Continue to monitor the client without intervention
Rationale: Contractions every 2-5 minutes, lasting 60-90 seconds, indicate effective labor progression and generally do not require immediate intervention unless there are signs of fetal or maternal distress.
A pregnant client is experiencing contractions every 8 minutes that last for 30 seconds. What phase of labor is she likely in?
a. Latent phase
b. Active phase
c. Transition phase
d. Second stage of labor
a. Latent phase
Rationale: In the latent phase of labor, contractions are less frequent (every 5-20 minutes) and shorter in duration (up to 30-45 seconds).
A nurse assesses a laboring patient and notes contractions that occur every 3 minutes, lasting for 60-70 seconds. The fetal heart rate is within normal limits. What is the appropriate nursing action?
a. Prepare the patient for an emergency cesarean delivery
b. Decrease oxytocin administration
c. Continue monitoring labor progress and fetal status
d. Apply fundal pressure to expedite labor
c. Continue monitoring labor progress and fetal status
Rationale: Contractions every 2-5 minutes, lasting 60-90 seconds, are typical for active labor, especially with a normal fetal heart rate. No intervention is required other than continued monitoring.
A nurse is constructing a pedigree for a patient undergoing genetic counseling. What is the primary purpose of developing a pedigree during this consultation?
A. To determine dietary needs of the patient
B. To assess for potential genetic disorders within the family
C. To evaluate the patient’s body mass index over time
D. To determine the patient’s risk of infectious diseases
B. To assess for potential genetic disorders within the family
Rationale: Constructing a pedigree focuses on tracing the family history across multiple generations to identify patterns that may suggest a hereditary genetic disorder. This is essential for genetic counseling, especially if there are known genetic disorders in the family.
A 42-year-old woman seeks genetic counseling due to her advanced maternal age. Why is genetic counseling particularly recommended for women of advanced maternal age?
A. They have an increased risk of spontaneous miscarriages due to uterine anomalies.
B. Older mothers often have more twins and triplets, which increase genetic risks.
C. Advanced maternal age significantly reduces the risk of all birth defects.
D. The chance of chromosomal abnormalities increases with maternal age.
D. The chance of chromosomal abnormalities increases with maternal age.
A patient with a history of six miscarriages comes for genetic counseling. What is the most appropriate next step in this patient’s care?
A. Recommend an immediate hysterectomy.
B. Counsel the patient on lifestyle changes to improve fertility.
C. Conduct genetic testing to determine possible hereditary causes for recurrent pregnancy loss.
D. Suggest that the patient avoid pregnancy in the future.
C. Conduct genetic testing to determine possible hereditary causes for recurrent pregnancy loss.
Rationale: Recurrent pregnancy loss (more than five miscarriages) may indicate an underlying genetic disorder. Genetic counseling and testing can help identify potential chromosomal or genetic issues that could be contributing factors.
During genetic counseling, a patient reports that several family members have a known genetic disorder. What is the most appropriate course of action for the nurse?
A. Document the information but advise no further follow-up.
B. Suggest that the patient inform their family members to avoid having children.
C. Provide education on genetic inheritance patterns and testing options for at-risk individuals.
D. Refer the patient to infectious disease control for evaluation.
C. Provide education on genetic inheritance patterns and testing options for at-risk individuals.
Rationale: Genetic counseling involves educating the patient about genetic inheritance, assessing risks, and offering testing options to those who may be at risk of passing or inheriting the genetic disorder. This enables informed decision-making regarding health and reproduction.
T/F
Down syndrome is an example of trisomy 21.
true
An amniocentesis is a diagnostic for what?
chromosomal abnormalities
Prader-Willi syndrome results from which genetic abnormality?
A. Mutation on the X chromosome
B. Deletion or imprinting defect on paternal chromosome 15
C. Extra chromosome 21
D. Defect in maternal chromosome 15
B. Deletion or imprinting defect on paternal chromosome 15
Rationale: Prader-Willi syndrome occurs due to a deletion or imprinting defect on the paternal chromosome 15 or when two maternal copies are present, leading to absent paternal genetic information.
Which population is affected by Prader-Willi syndrome?
A. Only males
B. Only females
C. Males more than females
D. Males and females equally
D. Males and females equally
Rationale: Prader-Willi syndrome affects males and females equally.
A nurse is caring for a child with Prader-Willi syndrome. Which of the following clinical manifestations is the nurse most likely to observe?
A. Excessive eating and obesity
B. Hypertonia
C. Low appetite in childhood
D. Aggressive behavior toward peers
A. Excessive eating and obesity
Rationale: Children with Prader-Willi syndrome often have excessive eating, leading to obesity, along with behavioral and compulsive challenges.
Which of the following is a common behavioral challenge seen in patients with Prader-Willi syndrome?
A. Passive behavior and low activity levels
B. Compulsive behaviors and tantrums
C. Aggressive tendencies in adolescence
D. Complete aversion to food
B. Compulsive behaviors and tantrums
Rationale: Patients with Prader-Willi syndrome often experience compulsive behaviors and behavioral challenges, including tantrums.
A genetic counselor is explaining inheritance patterns of Prader-Willi syndrome to a patient’s family. Which of the following is accurate?
A. It results from a deletion on maternal chromosome 15.
B. It may involve having two copies of chromosome 15 from the mother.
C. It only occurs due to a spontaneous mutation.
D. It is an X-linked recessive disorder.
B. It may involve having two copies of chromosome 15 from the mother.
Rationale: Prader-Willi syndrome can occur due to two copies of chromosome 15 being inherited from the mother (uniparental disomy), resulting in the absence of a functional paternal copy.
The prevalence of Prader-Willi syndrome is approximately:
A. 1 in 100 individuals
B. 1 in 100,000 to 1 in 15,000 individuals
C. 1 in 1,000 individuals
D. 1 in 10,000 to 1 in 15,000 individuals
D. 1 in 10,000 to 1 in 15,000 individuals
A child diagnosed with Prader-Willi syndrome exhibits hypotonia. What would the nurse expect to assess in this child?
A. Hyperactive reflexes
B. Increased muscle mass
C. Decreased muscle tone and poor muscle strength
D. Joint stiffness and rigidity
C. Decreased muscle tone and poor muscle strength
Rationale: Hypotonia, or decreased muscle tone, is a common symptom in Prader-Willi syndrome and often manifests as poor muscle strength and reduced tone.
Which of the following should be included in a nursing care plan for a child with Prader-Willi syndrome?
A. Encouraging unrestricted access to food
B. Focusing on weight management and balanced nutrition
C. Avoiding behavioral interventions
D. Limiting physical activity due to risk of injury
B. Focusing on weight management and balanced nutrition
Rationale: Children with Prader-Willi syndrome require a structured plan to prevent excessive eating and obesity, including weight management and balanced nutrition.
Which genetic testing method is most commonly used to confirm the diagnosis of Prader-Willi syndrome?
A. Karyotype analysis
B. Urinalysis
C. DNA methylation testing
D. Hemoglobin electrophoresis
C. DNA methylation testing
Rationale: DNA methylation testing is used to detect Prader-Willi syndrome by identifying abnormal methylation patterns associated with paternal chromosome 15.
Parents of a child with Prader-Willi syndrome ask why their child is constantly hungry. What is the best explanation by the nurse?
A. “It is due to an overproduction of digestive enzymes.”
B. “The disorder affects the brain’s ability to control hunger.”
C. “It is caused by genetic changes that lower metabolism.”
D. “Children with this syndrome burn more calories than average.”
B. “The disorder affects the brain’s ability to control hunger.”
Rationale: In Prader-Willi syndrome, the hypothalamus in the brain does not properly signal hunger and satiety, leading to constant hunger and excessive eating.
Which characteristic is most commonly associated with fragile X syndrome?
a) Hyperactivity and a large head
b) Seizures and short stature
c) Early onset Alzheimer’s disease
d) Immune system deficiency
a) Hyperactivity and a large head
Rationale: Fragile X syndrome often presents with hyperactivity, large head size, long face, and intellectual disability, among other features. Seizures and short stature, early Alzheimer’s, and immune deficiency are not the most characteristic features of fragile X syndrome.
Which of the following statements best describes the genetic transmission of fragile X syndrome?
a) Fragile X syndrome is inherited in an autosomal dominant pattern.
b) Females can be carriers and are typically mildly affected, while males exhibit the full effects of the syndrome.
c) Fragile X syndrome is a result of chromosomal deletion on chromosome 21.
d) It is inherited as a mitochondrial disorder.
b) Females can be carriers and are typically mildly affected, while males exhibit the full effects of the syndrome.
Rationale: Fragile X syndrome is an X-linked disorder; females are often carriers with milder symptoms due to their second normal X chromosome, while males with a single affected X chromosome tend to exhibit more severe symptoms.
A nurse is providing anticipatory guidance for a family with a child newly diagnosed with fragile X syndrome. Which therapy is most likely to be recommended?
a) Hormone replacement therapy
b) Gene therapy to correct chromosomal abnormalities
c) Occupational, speech, and physical therapy
d) Chemotherapy for symptomatic relief
c) Occupational, speech, and physical therapy
Rationale: There is no cure for fragile X syndrome, so treatment focuses on supportive therapies such as occupational, speech, and physical therapy to help manage developmental delays and improve quality of life.
Which behavior observed in a child might lead a nurse to suspect fragile X syndrome?
a) Perseverative speech and poor eye contact
b) Intolerance to dairy and gluten products
c) Early onset scoliosis
d) High intelligence quotient (IQ) with good social skills
a) Perseverative speech and poor eye contact
Rationale: Fragile X syndrome commonly manifests as perseverative speech (repeating words/phrases), poor eye contact, and other behaviors such as tactile defensiveness and hyperactivity, making it distinct from unrelated conditions.
A nurse working with a child who has fragile X syndrome should prioritize which nursing intervention?
a) Administering growth hormone therapy
b) Promoting speech and occupational therapy to address developmental delays
c) Restricting the child’s diet to manage digestive symptoms
d) Administering daily immunosuppressive therapy
b) Promoting speech and occupational therapy to address developmental delays
Rationale: Supporting therapies, including speech and occupational therapy, are critical interventions for children with fragile X syndrome to address developmental delays and enhance skills.
The nurse understands that fragile X syndrome typically does not impact which of the following aspects?
a) Lifespan of the individual
b) Development of intellectual disability
c) Behavioral and neuropsychological function
d) Risk for other genetic disorders
a) Lifespan of the individual
Rationale: Fragile X syndrome is associated with intellectual and behavioral disabilities but typically does not affect the lifespan.
When educating parents of a male child diagnosed with fragile X syndrome, the nurse explains that intellectual disability is most likely due to which underlying issue?
a) Fragile sites on the X chromosome causing breaks and gaps
b) Autoimmune system dysfunction
c) Viral infection during fetal development
d) Mutation of the 21st chromosome
a) Fragile sites on the X chromosome causing breaks and gaps
Rationale: Fragile X syndrome results from structural abnormalities on the X chromosome, such as breaks and gaps, which are associated with intellectual disability.
A parent asks why fragile X syndrome is not part of newborn screening panels in the U.S. The nurse’s best response would be:
a) “Fragile X syndrome cannot be detected in infants due to limited testing capabilities.”
b) “The disorder is not included because it does not meet established criteria for newborn screening recommendations.”
c) “It is a rare disorder that does not warrant public health screening.”
d) “Testing for fragile X syndrome is too expensive and ineffective.”
b) “The disorder is not included because it does not meet established criteria for newborn screening recommendations.”
Rationale: Fragile X syndrome does not meet the established criteria for inclusion in newborn screening panels, despite its impact, because of factors such as testing feasibility and public health implications.
Turner syndrome is a genetic condition that affects which population?
a) Both males and females equally
b) Mostly males, with occasional female cases
c) Males only
d) Females only
d) Females only
Rationale: Turner syndrome affects only females and results from a missing or partially missing X chromosome. Males are not affected by this condition.
Which of the following is a characteristic commonly associated with Turner syndrome?
a) Hyperactivity and intellectual disability
b) Infertility and underdeveloped sex organs
c) Immune system deficiency and short stature
d) Fragile bones and high blood pressure
b) Infertility and underdeveloped sex organs
Rationale: Turner syndrome commonly leads to infertility and underdevelopment of sex organs, including the failure to develop secondary sexual characteristics such as breasts and ovaries.
A nurse is caring for a girl diagnosed with Turner syndrome during adolescence. Which clinical manifestation would be expected?
a) Large hands and hyperactivity
b) Development of breasts and normal ovaries
c) Short stature and delayed puberty
d) Intellectual disability with autism-like behavior
c) Short stature and delayed puberty
Rationale: Girls with Turner syndrome often experience short stature, delayed puberty, and underdeveloped sex organs. Development of breasts and normal ovaries typically does not occur without intervention.
Turner syndrome is most often diagnosed in which manner?
a) During prenatal screening/testing
b) Based on presenting symptoms in adulthood
c) Through routine blood work
d) By diagnosing intellectual disability in early childhood
a) During prenatal screening/testing
Rationale: Turner syndrome can be identified during prenatal testing, as well as at other stages of development such as in childhood or adolescence, depending on symptom presentation.
The nurse understands that Turner syndrome is primarily caused by which chromosomal abnormality?
a) An extra Y chromosome
b) Trisomy of chromosome 21
c) A mutated mitochondrial gene
d) Absence or structural defect of one X chromosome
d) Absence or structural defect of one X chromosome
Rationale: Turner syndrome is caused by a missing or structurally altered X chromosome in females, leading to a range of developmental issues.
Which intervention is most appropriate for promoting the health and development of a girl with Turner syndrome?
a) Hormone replacement therapy
b) Gene therapy to repair the chromosome defect
c) Immunosuppressive drug therapy
d) Stem cell transplant
a) Hormone replacement therapy
Rationale: Hormone replacement therapy, such as estrogen therapy, is often used to promote secondary sexual characteristics and overall health in girls with Turner syndrome.
A mother of a child with Turner syndrome asks about possible health complications. Which potential complication should the nurse include?
a) Increased risk of intellectual disability
b) Immune deficiency disorders
c) Cardiovascular anomalies
d) Hearing impairment
c) Cardiovascular anomalies
Rationale: Girls with Turner syndrome may experience cardiovascular complications, such as congenital heart defects, in addition to other health issues like kidney malformations and hearing problems.
Which statement by a patient indicates a correct understanding of Turner syndrome and fertility?
a) “Girls with Turner syndrome usually have typical fertility without intervention.”
b) “I may need assisted reproductive technology due to infertility.”
c) “Turner syndrome does not affect my fertility at all.”
d) “The syndrome primarily causes immune deficiencies, not fertility issues.”
b) “I may need assisted reproductive technology due to infertility.”
Rationale: Turner syndrome can lead to infertility, and many women with the condition require assisted reproductive technology if they wish to conceive.
During a health check-up, the nurse observes that a young female patient with Turner syndrome has not experienced a growth spurt. What intervention might be indicated?
a) Physical therapy for joint stability
b) Vitamin supplementation to improve cognition
c) Restriction of physical activities
d) Growth hormone therapy to stimulate height
d) Growth hormone therapy to stimulate height
Rationale: Growth hormone therapy is commonly used to promote height and growth in children with Turner syndrome, as they typically experience short stature due to the condition.
Klinefelter syndrome results from which chromosomal pattern?
a) XYY
b) XYY
c) XXY
d) XYX
c) XXY
Rationale: Klinefelter syndrome occurs in males who have an extra X chromosome (XXY pattern), leading to the characteristic features of this condition.
The nurse is providing education to a family about Klinefelter syndrome. Which of the following is a characteristic commonly seen in affected males?
a) Short stature and high muscle mass
b) Tall stature with sparse body hair
c) Underdeveloped breasts and thick body hair
d) Early onset puberty and increased fertility
b) Tall stature with sparse body hair
Rationale: Males with Klinefelter syndrome often have tall stature, sparse body hair, and other features such as enlarged breasts (gynecomastia) and abnormal testicular development.
Which of the following is a common reproductive manifestation of Klinefelter syndrome?
a) High sperm count
b) Rapid onset of secondary sexual characteristics
c) High testosterone levels
d) Infertility due to abnormal testicular development
d) Infertility due to abnormal testicular development
Rationale: Infertility is common in males with Klinefelter syndrome due to the abnormal development of the testes, leading to decreased sperm production and low testosterone levels.
When is Klinefelter syndrome typically diagnosed?
a) In infancy due to physical characteristics
b) During adulthood after fertility concerns arise
c) At puberty, when physical symptoms such as gynecomastia may appear
d) Only through prenatal genetic testing
c) At puberty, when physical symptoms such as gynecomastia may appear
Rationale: Klinefelter syndrome is often diagnosed around puberty when signs like enlarged breasts (gynecomastia) and other developmental abnormalities become more apparent.
What intervention may be indicated for managing gynecomastia in a male with Klinefelter syndrome?
a) Surgical removal of breast tissue
b) Estrogen therapy
c) Testosterone-suppressing medication
d) Chemotherapy
a) Surgical removal of breast tissue
Rationale: Surgical removal of breast tissue (mastectomy) is an option for males with Klinefelter syndrome who develop gynecomastia and wish to address this issue for cosmetic or health reasons.
A male adolescent presents with tall stature, sparse body hair, and learning difficulties. What condition should be considered during assessment?
a) Turner syndrome
b) Klinefelter syndrome
c) Down syndrome
d) Fragile X syndrome
b) Klinefelter syndrome
Rationale: The symptoms described, including tall stature, sparse body hair, and potential learning difficulties, align with features of Klinefelter syndrome, a condition affecting males with an extra X chromosome.
A nurse educating a patient with Klinefelter syndrome about treatment options should include which potential therapy?
a) Growth hormone therapy
b) Estrogen replacement therapy
c) Testosterone replacement therapy
d) Chemotherapy
c) Testosterone replacement therapy
Rationale: Testosterone replacement therapy is often used in males with Klinefelter syndrome to address symptoms related to low testosterone, such as sparse body hair, reduced muscle mass, and energy levels.
Which intellectual characteristic is common in individuals with Klinefelter syndrome?
a) Severe intellectual disability
b) No cognitive impact
c) Mild intellectual disabilities, such as learning difficulties
d) Superior academic abilities
c) Mild intellectual disabilities, such as learning difficulties
Rationale: Males with Klinefelter syndrome may experience mild intellectual disabilities, often manifesting as learning difficulties, language delays, or challenges with executive functioning, though severity can vary.
Which of the following best describes trisomy 21, the most common genetic variation of Down syndrome?
A. The presence of an extra chromosome 22 in all cells.
B. The translocation of chromosome 21 to another chromosome.
C. Three copies of chromosome 21 in all cells.
D. Mosaicism with only some cells having an extra chromosome 21.
C. Three copies of chromosome 21 in all cells.
Rationale: Trisomy 21 occurs when there are three copies of chromosome 21 in all cells, making it the most common cause of Down syndrome.
Which of the following is true about the risk of Down syndrome as maternal age increases?
A. Risk decreases after age 35.
B. Risk remains constant regardless of maternal age.
C. Risk increases with advancing maternal age.
D. Risk is highest at age 25.
C. Risk increases with advancing maternal age.
Rationale: The risk of having a baby with Down syndrome increases with maternal age, particularly after the age of 35.
What is a common physical characteristic of infants with Down syndrome?
A. Long limbs and a tall stature.
B. Small, low-set ears that may fold over at the pinna.
C. Absence of palmar creases.
D. Hypertonia with rigid muscle tone.
C. Absence of palmar creases.
Rationale: Small, low-set ears that may fold over at the pinna are among the characteristic features seen in individuals with Down syndrome.
A child with Down syndrome is being assessed for hypotonia. Which finding is consistent with this condition?
A. Increased muscle rigidity and tightness.
B. Poor muscle tone and flexibility.
C. Spastic movements.
D. Inability to extend the limbs.
B. Poor muscle tone and flexibility.
Rationale: Hypotonia, or poor muscle tone, is common in children with Down syndrome and often results in increased flexibility.
Which of the following describes a chromosomal translocation in Down syndrome?
A. The complete loss of chromosome 21 in some cells.
B. Part of chromosome 21 becoming attached to another chromosome.
C. The presence of three complete sets of chromosome 21 in every cell.
D. The absence of chromosome 21 in all cells.
B. Part of chromosome 21 becoming attached to another chromosome.
Rationale: A translocation involves part of chromosome 21 attaching to another chromosome, resulting in an extra piece of chromosome 21 in affected cells.
Which finding is associated with a simian crease?
A. A distinct loop pattern on the second digit.
B. An almond-shaped eye slant.
C. Hypertonic muscle rigidity.
D. A deep crease that runs across the palm.
D. A deep crease that runs across the palm.
Rationale: A simian crease is characterized by a single deep crease that runs across the palm and is commonly seen in individuals with Down syndrome.
Which statement reflects a correct understanding of the life expectancy for individuals with Down syndrome?
A. The average lifespan of individuals with Down syndrome is approaching 60 years.
B. Life expectancy has remained unchanged over the last century.
C. Most individuals with Down syndrome do not survive past their teenage years.
D. Life expectancy for individuals with Down syndrome is identical to those without chromosomal conditions.
A. The average lifespan of individuals with Down syndrome is approaching 60 years.
Rationale: The life expectancy of individuals with Down syndrome has increased significantly in recent years, with an average lifespan approaching 60 years.
Which intervention is most appropriate to promote developmental progress in a child with Down syndrome?
A. Isolate the child to reduce overstimulation.
B. Early intervention programs and special education.
C. Limit socialization opportunities.
D. Avoid any physical therapy exercises.
B. Early intervention programs and special education.
Rationale: Early intervention and special education programs play a crucial role in promoting cognitive and developmental progress for children with Down syndrome.
A pregnant woman at age 35 asks about her risk of having a baby with Down syndrome. Which is the correct response by the nurse?
A. “The risk is about one in 940.”
B. “Your risk is negligible; age is not a significant factor.”
C. “The risk is approximately one in 353.”
D. “The risk increases significantly only after age 40.”
C. “The risk is approximately one in 353.”
Rationale: The risk of having a baby with Down syndrome at age 35 is approximately one in 353.
Which of the following statements about trisomy 13 and trisomy 18 is accurate?
A. These conditions are more common than Down syndrome.
B. They frequently result in severe structural abnormalities.
C. Most affected individuals live well into adulthood.
D. These trisomies rarely affect physical structures.
B. They frequently result in severe structural abnormalities.
Rationale: Trisomy 13 and trisomy 18 result in severe structural abnormalities, which may include microcephaly, cleft lip/palate, and major heart defects, often detected during ultrasound examinations.
A nurse is educating a couple who received a prenatal diagnosis of trisomy 18. What is the most appropriate information to share regarding prognosis?
A. Most infants survive without significant health issues.
B. Infants typically have a high chance of reaching adulthood.
C. Survival beyond a few months is rare.
D. It can be managed with corrective surgeries in most cases.
C. Survival beyond a few months is rare.
Rationale: The prognosis for infants with trisomy 18 is poor, with most affected individuals not surviving beyond a few months.
During a prenatal ultrasound, the healthcare provider detects multiple structural abnormalities, including microcephaly and major heart defects. What is the patient most at risk of having?
A. Trisomy 13 or 18
B. Trisomy 21 (Down syndrome)
C. Turner syndrome
D. Klinefelter syndrome
A. Trisomy 13 or 18
Rationale: Trisomy 13 and trisomy 18 are associated with severe structural abnormalities, such as microcephaly, cleft lip/palate, and major heart defects, often detectable on ultrasound
Supportive care for an infant born with trisomy 13 typically focuses on:
A. Aggressive medical intervention to cure the condition.
B. Immediate corrective surgeries to fix all structural abnormalities.
C. Genetic therapy to eliminate chromosomal abnormalities.
D. Providing palliative care and managing symptoms for quality of life.
D. Providing palliative care and managing symptoms for quality of life.
Which of the following prenatal findings is commonly associated with trisomy 13?
A. Isolated cleft lip with normal brain structure
B. Microcephaly and major heart defects
C. High birth weight and rapid growth
D. Normal prenatal ultrasound findings
B. Microcephaly and major heart defects
Rationale: Common abnormalities associated with trisomy 13 include microcephaly and major heart defects, often detected during prenatal ultrasounds.
A pregnant patient is considering amniocentesis. What information about this procedure should the nurse provide?
A. It is typically performed at 10-12 weeks of pregnancy.
B. Amniocentesis carries a higher risk of pregnancy loss compared to chorionic villi sampling (CVS).
C. It is done between 15-20 weeks of pregnancy and has a lower risk of pregnancy loss compared to CVS.
D. Amniocentesis cannot provide a karyotype for genetic testing.
C. It is done between 15-20 weeks of pregnancy and has a lower risk of pregnancy loss compared to CVS.
Rationale: Amniocentesis is performed between 15-20 weeks of pregnancy and carries a lower risk of pregnancy loss compared to CVS, which is done earlier in the pregnancy.
A patient undergoing genetic counseling is considering chorionic villi sampling (CVS). Which statement correctly describes CVS?
A. It is performed at 15-20 weeks and poses a low risk of pregnancy loss.
B. CVS is performed early at 10-12 weeks but carries a higher risk of pregnancy loss compared to amniocentesis.
C. CVS cannot provide a karyotype for diagnosing genetic conditions.
D. This procedure is used to screen for, not diagnose, genetic conditions.
B. CVS is performed early at 10-12 weeks but carries a higher risk of pregnancy loss compared to amniocentesis.
Rationale: Chorionic villi sampling (CVS) is conducted at 10-12 weeks of pregnancy and has a higher risk of pregnancy loss compared to amniocentesis.
A nurse is explaining karyotyping to a patient during genetic counseling. Which statement best describes the purpose of a karyotype?
A. It diagnoses genetic conditions that microarrays cannot detect.
B. It only provides screening results without confirming a diagnosis.
C. It analyzes an individual’s chromosomes to detect genetic abnormalities.
D. It is exclusively used during labor.
C. It analyzes an individual’s chromosomes to detect genetic abnormalities.
Rationale: A karyotype is a laboratory test that analyzes an individual’s chromosomes to identify genetic abnormalities and confirm diagnoses.
Which genetic diagnostic test is recommended if karyotyping cannot provide a definitive diagnosis for a specific genetic condition?
A. Amniocentesis
B. Chorionic villi sampling (CVS)
C. Ultrasonograph
D. Microarray analysis
D. Microarray analysis
Rationale: Microarray analysis is used to diagnose genetic conditions that karyotyping alone cannot identify, offering more detailed genetic information.
A patient undergoing genetic counseling asks about the possibility of pregnancy termination following screening results. What is the appropriate nurse response?
A. “Termination decisions should be based solely on screening results.”
B. “Pregnancy should never be terminated based on screening results alone.”
C. “It depends on the results of a microarray analysis.”
D. “Termination is the only option if screening shows any abnormality.”
B. “Pregnancy should never be terminated based on screening results alone.”
Rationale: Screening results alone are not definitive and should not be used as the basis for terminating a pregnancy; diagnostic testing is required for confirmation.
Which of the following correctly describes the role of amniocentesis in genetic testing?
A. It only serves as a screening tool and cannot be diagnostic.
B. It is performed earlier than CVS and has a higher risk of pregnancy loss.
C. It provides a karyotype for diagnosing genetic abnormalities and is considered a diagnostic test.
D. It is only performed after 30 weeks of pregnancy.
C. It provides a karyotype for diagnosing genetic abnormalities and is considered a diagnostic test.
Rationale: Amniocentesis is used to obtain a karyotype for diagnosing genetic abnormalities and is considered a diagnostic test. It is performed between 15-20 weeks of pregnancy.
A patient wants to know the difference between screening and diagnostic tests in genetic counseling. Which statement should the nurse provide?
A. Diagnostic tests, such as karyotyping and microarray, confirm genetic conditions, whereas screening tests provide risk assessments.
B. Screening tests are more reliable than diagnostic tests for detecting genetic disorders.
C. Diagnostic tests have no risks and are always preferred over screening tests.
D. Screening tests can confirm a genetic diagnosis without further testing.
A. Diagnostic tests, such as karyotyping and microarray, confirm genetic conditions, whereas screening tests provide risk assessments.
Rationale: Diagnostic tests, such as karyotyping and microarray analysis, confirm the presence of genetic conditions, whereas screening tests assess the risk but do not provide a definitive diagnosis.
A nurse is counseling a 32-year-old pregnant woman about first trimester screening combined with second trimester screening (quad screen). Which of the following is true regarding this combined screening approach?
A. It is primarily recommended for women over 35 years old.
B. It provides a more comprehensive risk assessment for chromosomal abnormalities.
C. It only includes nuchal translucency measurement.
D. It can be performed any time after 10 weeks gestation.
B. It provides a more comprehensive risk assessment for chromosomal abnormalities.
Rationale: First trimester screening combined with second trimester screening (quad screen) is not limited to women over 35 years old and offers a comprehensive assessment by measuring multiple factors, including blood markers, enhancing the detection of chromosomal abnormalities.
Which genetic screening method is particularly suitable for women over 35 due to its high sensitivity and ability to use fetal DNA?
A. Nuchal translucency with blood markers
B. MSAFP alone
C. Cell-free DNA testing
D. First trimester combined with quad screening
C. Cell-free DNA testing
Rationale: Cell-free DNA testing is recommended for women over 35 and uses a sample of the mother’s blood to detect fetal DNA, providing accurate screening results for chromosomal conditions.
The maternal serum alpha-fetoprotein (MSAFP) test is part of the quad screen. Which of the following is a known limitation of the MSAFP test alone?
A. It can detect all trisomies with high accuracy.
B. Results are more accurate when used in isolation.
C. It may not be as accurate as combined screenings.
D. It uses cell-free DNA technology.
C. It may not be as accurate as combined screenings.
Rationale: MSAFP alone is less accurate compared to when it is part of combined screenings like the quad screen, which improves the detection of chromosomal abnormalities through additional blood markers.
A nurse explains to a patient that genetic screening can be time-sensitive. Which of the following best describes this aspect?
A. Optimal timing for accuracy varies between tests.
B. It can be performed at any point during pregnancy.
C. Results are unaffected by gestational age.
D. Timing only applies to cell-free DNA testing.
A. Optimal timing for accuracy varies between tests.
Rationale: Many genetic screening tests require specific timing during pregnancy to achieve accurate results. For example, the first trimester combined screening needs to be done within the appropriate gestational age window.
Which of the following tests can reveal the fetal gender with a high predictive value and detect certain chromosomal conditions like Trisomy 21?
A. Nuchal translucency
B. Cell-free DNA testing
C. MSAFP alone
D. First trimester combined screening
B. Cell-free DNA testing
Rationale: Cell-free DNA testing can accurately predict fetal gender and detect chromosomal conditions such as Trisomy 21 (Down syndrome) with a high level of predictive accuracy.
A pregnant patient at 12 weeks gestation asks when she can have a genetic screening test that uses fetal DNA. The most appropriate response is:
A. “This test can be performed any time after 10 weeks gestation.”
B. “It can only be performed in the third trimester.”
C. “You must wait until the second trimester for accurate results.”
D. “It cannot be used for detecting Trisomy 13.”
A. “This test can be performed any time after 10 weeks gestation.”
Rationale: Cell-free DNA testing can be done any time after 10 weeks gestation, making it an early option for detecting chromosomal abnormalities.
The nurse explains that nuchal translucency measurement as part of genetic screening is combined with:
A. Cell-free DNA to detect fetal gender
B. Maternal serum alpha-fetoprotein alone
C. Testing that provides predictive value for all chromosomal disorders
D. Blood markers to enhance detection of abnormalities
D. Blood markers to enhance detection of abnormalities
Rationale: Nuchal translucency measurement is combined with blood markers to provide a more accurate assessment of potential chromosomal abnormalities.
Which of the following statements about cell-free DNA testing is accurate?
A. It is used for all women regardless of age.
B. It detects a fetal fraction of DNA and has 99.7% predictive value for detecting certain chromosomal conditions.
C. It is less effective than MSAFP screening.
D. It cannot reveal fetal gender.
B. It detects a fetal fraction of DNA and has 99.7% predictive value for detecting certain chromosomal conditions.
Rationale: Cell-free DNA testing detects fetal DNA in the maternal bloodstream and has a high predictive value for conditions like Trisomy 21, 18, and 13, and can also reveal fetal gender.
Which hormone is primarily responsible for preparing the ovum for fertilization during the follicular phase?
A. Follicle Stimulating Hormone (FSH)
B. Luteinizing Hormone (LH)
C. Progesterone
D. Prostaglandins
A. Follicle Stimulating Hormone (FSH)
Rationale: FSH increases during the follicular phase, leading to the maturation of multiple follicles in the ovaries and preparing the ovum for potential fertilization
During ovulation, which characteristic change occurs in cervical mucus?
A. Becomes thick and opaque
B. Becomes thin, clear, and stretchy
C. Increases in viscosity
D. Dries up completely
B. Becomes thin, clear, and stretchy
Rationale: Cervical mucus changes to a thin, clear, and stretchy consistency during ovulation to facilitate the movement of sperm toward the ovum.
What triggers the luteinizing hormone (LH) surge that leads to ovulation?
A. High levels of estrogen produced by the mature follicle
B. Decreased levels of progesterone
C. Increased follicle-stimulating hormone (FSH)
D. High levels of prostaglandins
A. High levels of estrogen produced by the mature follicle
Rationale: A surge in LH is triggered by rising estrogen levels from the mature follicle, resulting in ovulation.
The luteal phase is characterized by increased production of which hormone to support potential implantation?
A. Estrogen
B. Follicle Stimulating Hormone (FSH)
C. Progesterone
D. Prostaglandins
C. Progesterone
Rationale: The corpus luteum produces progesterone during the luteal phase to prepare the endometrium for possible implantation of a fertilized ovum.
The absence of fertilization by day 23 results in which of the following?
A. Maintenance of high progesterone levels
B. Degeneration of the corpus luteum
C. Increase in LH secretion
D. Thickening of the endometrial lining
B. Degeneration of the corpus luteum
Rationale: Without fertilization, the corpus luteum degenerates, leading to a drop in ovarian hormones and triggering menstruation.
What phase follows the luteal phase if fertilization does not occur?
A. Proliferative phase
B. Ischemic phase
C. Ovulatory phase
D. Secretory phase
B. Ischemic phase
Rationale: If fertilization does not occur, a drop in estrogen and progesterone leads to the ischemic phase, resulting in the involution of the endometrium and the onset of menstruation.
What is the typical duration of menstrual bleeding?
A. 1-3 days
B. 3-7 days
C. 7-10 days
D. 10-14 days
B. 3-7 days
Which hormone primarily suppresses LH output during the menstrual cycle?
A. Estrogen and progesterone
B. Follicle Stimulating Hormone (FSH)
C. Prostaglandins
D. Oxytocin
A. Estrogen and progesterone
Rationale: High levels of estrogen and progesterone suppress LH secretion, maintaining the cycle’s hormonal balance until the corpus luteum’s cessation.
Which of the following is a sign of ovulation?
A. Decrease in basal body temperature
B. Increased progesterone levels
C. Thickening of cervical mucus
D. Left or right lower quadrant pain
D. Left or right lower quadrant pain
Rationale: Ovulation may present with signs such as localized lower abdominal pain, often referred to as mittelschmerz.
The proliferative phase is primarily regulated by which hormone?
A. Progesterone
B. Estrogen
C. Luteinizing Hormone (LH)
D. Prostaglandins
B. Estrogen
Rationale: Estrogen plays a key role in stimulating the proliferation of the endometrium during the follicular phase leading up to ovulation.
Which process occurs due to a drop in estrogen and progesterone levels during the ischemic phase?
A. Spasm of arterioles and involution of the endometrium
B. Thickening of the endometrial lining
C. Increase in cervical mucus viscosity
D. Rise in basal body temperature
A. Spasm of arterioles and involution of the endometrium
Rationale: The ischemic phase involves a drop in these hormones, causing endometrial involution, arteriolar spasms, and ultimately menstruation.
Which hormone surge directly precedes ovulation?
A. Estrogen
B. Follicle Stimulating Hormone (FSH)
C. Luteinizing Hormone (LH)
D. Progesterone
C. Luteinizing Hormone (LH)
Rationale: The surge in LH, triggered by high estrogen levels, directly precedes ovulation.
Gonadotropin-Releasing Hormone (GnRH) is secreted from which structure?
A. Anterior pituitary gland
B. Hypothalamus
C. Ovaries
D. Corpus luteum
B. Hypothalamus
Rationale: GnRH is secreted by the hypothalamus in a pulsatile manner to regulate the release of FSH and LH from the anterior pituitary gland.
The LH surge during the menstrual cycle is primarily responsible for which event?
A. Ovulation
B. Initiation of menstruation
C. Inhibition of FSH
D. Thickening of the endometrium
A. Ovulation
Rationale: The surge in LH levels leads to ovulation by triggering the rupture of the mature follicle.
Which event follows the establishment of the corpus luteum?
A. Decrease in progesterone levels
B. Decline in estrogen and progesterone output
C. Production of estrogen and progesterone by the corpus luteum
D. Suppression of FSH
C. Production of estrogen and progesterone by the corpus luteum
Rationale: After the corpus luteum is formed, it begins to secrete estrogen and progesterone to support the luteal phase
Lack of LH has what effect on the corpus luteum?
A. Stimulates growth
B. Causes degeneration
C. Promotes estrogen production
D. Increases endometrial thickness
B. Causes degeneration
Rationale: The absence of LH leads to the degeneration of the corpus luteum, resulting in a decline in estrogen and progesterone levels.
The secretion of FSH from the anterior pituitary is highest during which phase of the reproductive cycle?
A. Luteal phase
B. Ovulatory phase
C. Proliferative phase
D. The first week of the follicular phase
D. The first week of the follicular phase
Rationale: FSH secretion peaks during the first week of the follicular phase to promote follicular maturation.
The final maturation of preovulatory follicles is primarily dependent on which hormone?
A. Estrogen
B. Luteinizing Hormone (LH)
C. Progesterone
D. Prostaglandins
B. Luteinizing Hormone (LH)
Rationale: LH is essential for the final maturation and luteinization of preovulatory follicles.
Which hormone is predominant at the end of the proliferative phase?
A. Progesterone
B. Estrogen
C. FSH
D. LH
B. Estrogen
Rationale: Estrogen is predominant at the end of the proliferative phase, leading to endometrial proliferation and preparation for ovulation.
A decline in estrogen levels occurs when in relation to ovulation?
A. A day before ovulation
B. One week before ovulation
C. Immediately after ovulation begins
D. During the menstrual phase
A. A day before ovulation
Rationale: Estrogen levels drop just before ovulation as LH and progesterone become more dominant.
What effect does progesterone have on uterine contractions during the luteal phase?
A. Increases contractions
B. Inhibits contractions
C. Does not affect contractions
D. Stimulates irregular contractions
B. Inhibits contractions
Rationale: Progesterone is known as the hormone of pregnancy due to its calming effect, reducing uterine contractions to maintain a stable environment for potential pregnancy.
Which hormone induces the proliferation of endometrial glands?
A. Progesterone
B. Luteinizing Hormone (LH)
C. Follicle-Stimulating Hormone (FSH)
D. Estrogen
D. Estrogen
Rationale: Estrogen induces the proliferation of the endometrial glands and increases the size and weight of the uterus.
The decline of which hormones leads to the beginning of the menstrual cycle?
A. Estrogen and LH
B. Progesterone and FSH
C. Estrogen and progesterone
D. LH and FSH
C. Estrogen and progesterone
Rationale: The decline in ovarian hormones estrogen and progesterone leads to the end of the negative feedback loop on LH secretion, initiating a new menstrual cycle.
What triggers the decline in estrogen production after the LH surge?
A. Inhibition by FSH
B. Damage to estrogen-producing cells
C. Rising levels of progesterone
D. Prostaglandin synthesis
B. Damage to estrogen-producing cells
Rationale: The LH surge causes damage to estrogen-producing cells, leading to a decline in estrogen levels after ovulation.
Which phase is characterized by swelling and increased secretion of the endometrium?
A. Follicular phase
B. Proliferative phase
C. Ovulatory phase
D. Luteal phase
D. Luteal phase
Rationale: During the luteal phase, progesterone induces swelling and increased secretion of the endometrium, preparing it for potential implantation.
Which hormone suppresses the output of LH during the menstrual cycle?
A. Estrogen and FSH
B. Estrogen and progesterone
C. Progesterone only
D. FSH and LH
B. Estrogen and progesterone
Rationale: High levels of estrogen and progesterone suppress LH output as part of hormonal regulation during the menstrual cycle.
When do progesterone levels typically peak during the menstrual cycle?
A. During the follicular phase
B. A day before ovulation
C. 5-7 days after ovulation
D. At the start of menstruation
C. 5-7 days after ovulation
Rationale: Progesterone levels peak during the luteal phase, typically 5-7 days after ovulation, to support endometrial changes.
The corpus luteum primarily secretes which hormone(s)?
A. Estrogen and FSH
B. LH and progesterone
C. Estrogen and progesterone
D. FSH and LH
C. Estrogen and progesterone
Rationale: The corpus luteum produces estrogen and progesterone to maintain the luteal phase and prepare the endometrium for potential implantation.
Which hormone induces the release of FSH and LH to assist with ovulation?
A. GnRH
B. Estrogen
C. Progesterone
D. Prostaglandins
A. GnRH
Rationale: GnRH from the hypothalamus induces the anterior pituitary gland to release FSH and LH, which are crucial for ovulation.
Estrogen levels are highest during which phase of the reproductive cycle?
A. Follicular phase
B. Ovulatory phase
C. Luteal phase
D. Menstrual phase
B. Ovulatory phase
Rationale: Estrogen levels peak during the ovulatory phase, leading to the LH surge necessary for ovulation.
A pregnant client asks why folic acid is important in pregnancy. What is the nurse’s best response?
A. Folic acid improves maternal digestion during pregnancy.
B. It helps to prevent neural tube defects in the developing fetus.
C. Folic acid increases maternal appetite and weight gain.
D. It supports a rapid increase in red blood cell count only in the third trimester.
B. It helps to prevent neural tube defects in the developing fetus.
Rationale: Folic acid is critical in preventing neural tube defects such as spina bifida and anencephaly in the developing fetus. It is especially important during early pregnancy.
The recommended daily intake of folic acid for pregnant women is:
A. 200 micrograms
B. 400 micrograms
C. 600 micrograms
D. 1000 micrograms
C. 600 micrograms
Rationale: The recommended daily intake for folic acid during pregnancy is 600 micrograms to support fetal development and prevent neural tube defects.
A pregnant woman expresses concern about iron supplementation. Which statement by the nurse is accurate?
A. “Iron needs decrease during pregnancy because the fetus uses minimal iron.”
B. “Iron supplementation can help prevent anemia, which is common in pregnancy.”
C. “Excess iron intake during pregnancy has no impact on the baby.”
D. “You only need iron supplements if you have a history of anemia.”
B. “Iron supplementation can help prevent anemia, which is common in pregnancy.”
Rationale: Iron supplementation is important during pregnancy to prevent iron-deficiency anemia, which can lead to complications such as preterm delivery and low birth weight.
When teaching a pregnant client about iron-rich foods, which food should the nurse recommend?
A. Leafy green vegetables and red meat
B. Milk and cheese
C. Citrus fruits and whole grains
D. Potatoes and rice
A. Leafy green vegetables and red meat
Rationale: Iron-rich foods include leafy green vegetables and red meat. Vitamin C from citrus fruits can enhance iron absorption when consumed together.
What can pregnant women do to improve the absorption of iron supplements?
A. Take iron with milk or antacids.
B. Take iron supplements on an empty stomach with a glass of orange juice.
C. Combine iron supplements with calcium-rich foods.
D. Take iron supplements at bedtime with water.
B. Take iron supplements on an empty stomach with a glass of orange juice.
Rationale: Iron is best absorbed on an empty stomach, and the vitamin C in orange juice enhances iron absorption. Calcium and dairy products inhibit iron absorption.
Which statement about prenatal nutrition is correct?
A. Pregnant women should avoid all types of fish due to mercury risk.
B. High-fiber diets are discouraged in pregnancy.
C. A balanced diet with fruits, vegetables, and whole grains is essential.
D. Protein requirements decrease during pregnancy.
C. A balanced diet with fruits, vegetables, and whole grains is essential.
Rationale: A balanced diet including fruits, vegetables, whole grains, and protein supports maternal and fetal health. Fish low in mercury is also recommended.
Why is folic acid supplementation more critical during early pregnancy?
A. It only supports weight gain in the second trimester.
B. The fetal neural tube closes within the first month.
C. Folic acid levels rise naturally during late pregnancy.
D. It helps with the development of fetal bones.
B. The fetal neural tube closes within the first month.
Rationale: The neural tube forms and closes in the early weeks of pregnancy, making adequate folic acid intake crucial to reduce the risk of neural tube defects.
A nurse is educating a pregnant woman on constipation prevention due to iron supplementation. Which advice is appropriate?
A. Increase fiber intake and hydration.
B. Decrease water intake.
C. Stop taking iron supplements.
D. Avoid high-fiber foods.
A. Increase fiber intake and hydration.
Rationale: Iron supplements can lead to constipation. Increasing fiber intake and drinking more water can help manage this common side effect.
How does inadequate maternal iron intake affect the fetus?
A. It has no impact on fetal development.
B. It can lead to a high birth weight.
C. It may contribute to low birth weight and preterm birth.
D. It results in congenital malformations.
C. It may contribute to low birth weight and preterm birth.
Rationale: Inadequate maternal iron intake is linked to complications such as preterm birth and low birth weight due to maternal anemia.
Which guideline is recommended for healthy eating during pregnancy?
A. Fill half the plate with protein-rich foods.
B. Limit water intake to avoid swelling.
C. Fill half the plate with fruits and vegetables.
D. Focus primarily on refined grains.
C. Fill half the plate with fruits and vegetables.
Rationale: Healthy eating guidelines for pregnant women emphasize filling half of each plate with fruits and vegetables to ensure adequate intake of essential nutrients.
A client is taking iron supplements but finds them difficult to tolerate. What suggestion can the nurse make?
A. Switch to taking iron every other day.
B. Take iron at bedtime with a snack.
C. Combine iron with calcium supplements.
D. Stop taking iron entirely.
B. Take iron at bedtime with a snack.
Rationale: Taking iron supplements at bedtime with a small snack can help reduce gastrointestinal discomfort, which is a common side effect.
A pregnant woman asks about fish consumption. The nurse should emphasize which of the following?
A. Eat at least two servings of fish per week, avoiding high-mercury fish.
B. Avoid fish entirely during pregnancy.
C. Consume only shellfish for optimal nutrition.
D. Limit all sources of omega-3 fatty acids.
A. Eat at least two servings of fish per week, avoiding high-mercury fish.
Rationale: Pregnant women should consume fish to benefit from omega-3 fatty acids but must avoid fish high in mercury for the baby’s safety.
Which statement about folic acid is incorrect?
A. Folic acid helps reduce the risk of neural tube defects.
B. It must be taken with calcium to work effectively.
C. Folic acid can be found in leafy green vegetables.
D. Supplementation is especially important before and during early pregnancy.
B. It must be taken with calcium to work effectively.
Rationale: Folic acid does not need to be taken with calcium for effectiveness; its primary benefit is reducing the risk of neural tube defects.
What is a recommended strategy to ensure adequate folic acid intake in pregnancy?
A. Only rely on diet.
B. Combine supplements with folic acid-rich foods.
C. Avoid synthetic folic acid.
D. Only take folic acid supplements after 20 weeks gestation.
B. Combine supplements with folic acid-rich foods.
Rationale: Combining supplements with a diet rich in folic acid ensures adequate intake, supporting fetal development and reducing the risk of birth defects.
Which dietary recommendation helps pregnant women avoid constipation, especially when taking iron supplements?
A. Increase protein intake.
B. Reduce fiber intake.
C. Eat more high-fiber foods and drink water.
D. Limit water consumption.
C. Eat more high-fiber foods and drink water.
Rationale: High-fiber foods and adequate hydration help prevent constipation, a common side effect of iron supplementation during pregnancy.
__________ signs are those signs that the mother can perceive.
presumptive
__________ signs of pregnancy are those that can be detected on physical examination by a HCP.
probable
Name the endocrine hormone that matches the correct description during pregnancy.
slight enlargement; increased activity; increase in BMR
a. thyroid gland
b. pituitary gland
c. pancreas
d. adrenal gland
e. prostaglandin secretion
f. placental secretion
a. thyroid gland
Name the endocrine hormone that matches the correct description during pregnancy.
enlargement; decrease in TSH, GH; inhibition of FSH and LH; increase in prolactin, MSH; gradual increase in oxytocin with fetal maturation
a. thyroid gland
b. pituitary gland
c. pancreas
d. adrenal gland
e. prostaglandin secretion
f. placental secretion
b. pituitary gland
Name the endocrine hormone that matches the correct description during pregnancy.
insulin resistance due to hPL (antagonist against insulin) & other hormones in 2nd half of pregnancy, increased insulin
a. thyroid gland
b. pituitary gland
c. pancreas
d. adrenal gland
e. prostaglandin secretion
f. placental secretion
c. pancreas
Name the endocrine hormone that matches the correct description during pregnancy.
increase in cortisol and aldosterone secretion
a. thyroid gland
b. pituitary gland
c. pancreas
d. adrenal gland
e. prostaglandin secretion
f. placental secretion
d. adrenal gland
Name the endocrine hormone that matches the correct description during pregnancy.
help to thin the cervix
a. thyroid gland
b. pituitary gland
c. pancreas
d. adrenal gland
e. prostaglandin secretion
f. placental secretion
e. prostaglandin secretion
Name the endocrine hormone that matches the correct description during pregnancy.
hCG, hPL, relaxin, progesterone, estrogen
a. thyroid gland
b. pituitary gland
c. pancreas
d. adrenal gland
e. prostaglandin secretion
f. placental secretion
f. placental secretion
What hormone produces milk?
prolactin
How do you calculate the estimated date of birth?
add 7 days and 9 months from the LMP
G in GTPAL
(gravida): the total number of pregnancies, regardless if terminated or multiples(twins/triplets)
T in GTPAL
(term births): the number of pregnancies ending >37 weeks’ gestation, at term
P in GTPAL
(preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks
A in GTPAL
(abortions): the number of pregnancies ending before 20 weeks or viability
L in GTPAL
L (living children): number of children currently living
Couvade syndrome
dad is experiencing the same symptoms as mom
A nurse is educating a pregnant woman about the importance of sleep and rest during pregnancy. Which of the following suggestions is most appropriate for promoting restful sleep during the second trimester?
A) “Try sleeping on your back to avoid back pain and improve circulation.”
B) “Take long naps during the day to avoid feeling tired at night.”
C) “Sleep on your left side to improve blood flow to the placenta and kidneys.”
D) “Limit your water intake in the evening to avoid nighttime urination.”
C) “Sleep on your left side to improve blood flow to the placenta and kidneys.”
Rationale: Sleeping on the left side improves blood flow to the placenta and kidneys, promoting better oxygen and nutrient supply to the fetus. It also helps reduce the risk of swelling and improves circulation. Sleeping on the back in the second and third trimesters can compress major blood vessels, leading to reduced blood flow and discomfort.
A pregnant woman in her second trimester asks the nurse about the safety of sexual activity during pregnancy. Which of the following is the best response?
A) “Sexual activity should be avoided during pregnancy due to the risk of miscarriage.”
B) “Sexual activity is safe as long as there are no complications like bleeding or preterm labor.”
C) “Sexual activity is only safe during the first trimester but should be avoided after that.”
D) “You can continue sexual activity as long as it doesn’t cause discomfort, but avoid orgasm.”
B) “Sexual activity is safe as long as there are no complications like bleeding or preterm labor.”
Rationale: Sexual activity is generally safe during pregnancy unless complications, such as vaginal bleeding, preterm labor, or ruptured membranes, are present. It’s important to have open communication with the healthcare provider if there are any concerns.
A nurse is advising a pregnant woman who plans to continue working throughout her pregnancy. Which of the following recommendations is most important to ensure a healthy work-life balance?
A) “Limit the amount of time spent sitting and take short breaks to stretch and move around.”
B) “Avoid taking breaks at work to ensure that you complete tasks on time.”
C) “Stop working after 20 weeks to prevent any pregnancy-related complications.”
D) “Make sure to work as long as possible to maintain a normal routine.”
A) “Limit the amount of time spent sitting and take short breaks to stretch and move around.”
Rationale: To promote self-care, pregnant women should avoid prolonged periods of sitting or standing. Taking frequent breaks to stretch and move around helps reduce the risk of complications such as swelling, varicosities, and back pain. It is generally safe to work throughout pregnancy unless advised otherwise by a healthcare provider.
A pregnant woman in her third trimester is planning to travel by car for a long distance. Which of the following is the best advice the nurse can offer to ensure her safety and comfort during the trip?
A) “Traveling by car is not recommended in the third trimester, as it increases the risk of preterm labor.”
B) “It’s best to avoid travel in the third trimester, as it can cause preterm labor or complications.”
C) “Make sure to take breaks every 1-2 hours to stretch your legs and avoid deep vein thrombosis (DVT).”
D) “It is fine to travel, but avoid drinking any liquids during the trip to prevent frequent urination.”
C) “Make sure to take breaks every 1-2 hours to stretch your legs and avoid deep vein thrombosis (DVT).”
Rationale: Traveling by car during the third trimester is generally safe, but long trips should include regular breaks every 1-2 hours to stretch and improve circulation. This helps prevent the development of deep vein thrombosis (DVT) and relieves discomfort. It’s important to stay hydrated and wear a seatbelt properly for safety.
A nurse is reviewing the use of medications and immunizations during pregnancy with a woman who is in her first trimester. Which of the following statements by the nurse is most appropriate regarding the use of over-the-counter medications?
A) “You can use any over-the-counter medications as long as they are not for pain.”
B) “Always consult your healthcare provider before using any medications, including over-the-counter drugs.”
C) “It’s safe to use over-the-counter medications as long as they do not contain aspirin.”
D) “You should avoid all medications during pregnancy, even those that are over-the-counter.”
B) “Always consult your healthcare provider before using any medications, including over-the-counter drugs.”
Rationale: Many over-the-counter medications are not recommended during pregnancy due to potential risks to the developing fetus. It is important for pregnant women to consult their healthcare provider before taking any medications to ensure safety for both the mother and the fetus.
A 26-year-old woman presents to the clinic with amenorrhea for two months, nausea, fatigue, breast tenderness, and urinary frequency. Which of the following is the best explanation for these findings?
A. Definitive diagnosis of pregnancy
B. Probable signs of pregnancy
C. Presumptive signs of pregnancy
D. Positive signs of pregnancy
C. Presumptive signs of pregnancy
Rationale: Presumptive signs of pregnancy are subjective signs that the woman reports, such as amenorrhea, nausea, fatigue, breast tenderness, and urinary frequency. They are the least reliable indicators because these signs can be attributed to other conditions, such as endocrine dysfunction, stress, or infections.
A patient reports missing her menstrual period for two months and experiencing breast tenderness and fatigue. She is concerned she may be pregnant. Which of the following should the nurse inform the patient about presumptive signs?
A. They conclusively confirm pregnancy.
B. They may indicate pregnancy but are not definitive.
C. They indicate hormonal imbalance.
D. They are signs of early menopause.
B. They may indicate pregnancy but are not definitive.
Rationale: Presumptive signs are subjective changes that may suggest pregnancy but are not conclusive as they can be caused by a variety of conditions. Definitive confirmation requires probable or positive signs.
A nurse is educating a group of women on the signs of pregnancy. Which of the following is an example of a presumptive sign of pregnancy?
A. Positive pregnancy test
B. Bluish discoloration of the cervix and vagina (Chadwick’s sign)
C. Palpation of fetal movement by a healthcare provider
D. Nausea and vomiting
D. Nausea and vomiting
Rationale: Nausea and vomiting are considered a presumptive sign because they can be experienced by pregnant women but may also be due to gastrointestinal disturbances, infections, or other conditions. Positive pregnancy tests, Chadwick’s sign, and palpable fetal movement are more definitive indicators.
A patient presents with urinary frequency. Which of the following additional assessments would best help the nurse determine if this could be related to pregnancy?
A. History of recent sexual activity and missed periods
B. Positive laboratory test for urinary infection
C. Family history of urinary tract disorders
D. Recent changes in diet and fluid intake
A. History of recent sexual activity and missed periods
Rationale: Urinary frequency is a presumptive sign that can be related to pregnancy, but it is important to assess other factors, such as missed menstrual periods and sexual history. This can provide more context for the possibility of pregnancy.
A client with amenorrhea and fatigue expresses anxiety about possibly being pregnant. The nurse explains that presumptive signs of pregnancy are not definitive because:
A. Pregnancy tests have 100% accuracy in confirming pregnancy.
B. Many presumptive signs can be explained by other medical or physiological conditions.
C. Only probable signs of pregnancy are subjective.
D. Presumptive signs only occur in non-pregnant individuals.
B. Many presumptive signs can be explained by other medical or physiological conditions.
Rationale: Presumptive signs, such as amenorrhea and fatigue, may occur for reasons unrelated to pregnancy, including stress, endocrine disorders, or nutritional deficiencies. Thus, they are not definitive indicators of pregnancy on their own.
A nurse is performing a pelvic examination on a client and notes softening of the cervix. Which of the following probable signs of pregnancy is this known as?
A. Chadwick sign
B. Hegar sign
C. Ballottement
D. Goodell sign
D. Goodell sign
Rationale: The softening of the cervix is referred to as Goodell sign and is a probable sign of pregnancy. Chadwick sign is a bluish-purple coloration of the cervix and vaginal mucosa, Hegar sign refers to the softening of the lower uterine segment, and ballottement is the rebounding of the fetus when pushed during an exam.
Which of the following statements is true regarding human chorionic gonadotropin (hCG) and pregnancy detection?
A. hCG levels decrease steadily after conception.
B. hCG levels lower than 25 mIU/mL are considered positive for pregnancy.
C. hCG levels double every 48 to 72 hours during early pregnancy.
D. hCG is detectable in the serum of less than 1% of clients by day 11 after conception.
C. hCG levels double every 48 to 72 hours during early pregnancy.
Rationale: In early pregnancy, hCG levels typically double every 48 to 72 hours, making it an important biochemical marker for pregnancy detection. Levels below 5 mIU/mL are considered negative for pregnancy, while levels above 25 mIU/mL are considered positive. hCG is detectable in the serum of over 98% of clients by day 11 after conception.
During a prenatal visit, a healthcare provider notes a bluish-purple coloration of the vaginal mucosa and cervix. This is documented as which probable sign of pregnancy?
A. Goodell sign
B. Braxton Hicks contractions
C. Chadwick sign
D. Hegar sign
C. Chadwick sign
Rationale: Chadwick sign is a probable sign of pregnancy characterized by a bluish-purple coloration of the vaginal mucosa and cervix due to increased blood flow. Goodell sign refers to cervical softening, and Hegar sign refers to softening of the lower uterine segment. Braxton Hicks contractions are irregular uterine contractions that can occur during pregnancy.
A nurse is educating a client on the reliability of home pregnancy tests. Which of the following statements by the client indicates a need for further teaching?
A. “These tests detect the presence of hCG to determine pregnancy.”
B. “The accuracy of the test can be influenced by how far along I am in the pregnancy.”
C. “A positive test result can be caused by conditions other than pregnancy.”
D. “Home pregnancy tests are always 100% accurate and reliable.”
D. “Home pregnancy tests are always 100% accurate and reliable.”
Rationale: Home pregnancy tests are not 100% accurate, as their results can be affected by factors such as specimen concentration, the presence of blood, certain drugs, and medical conditions like ovarian cancer or hydatidiform mole. While they detect hCG, false positives and negatives are possible.
A provider performs a pelvic examination and feels a rebound from the floating fetus when pushing against the cervix. This assessment finding is known as:
A. Ballottement
B. Hegar sign
C. Braxton Hicks contractions
D. Chadwick sign
A. Ballottement
Rationale: Ballottement is a probable sign of pregnancy where, during a pelvic examination, the examiner pushes against the cervix and feels a rebound movement of the fetus. It indicates a floating fetus but is not a definitive sign of pregnancy.
A client with suspected pregnancy undergoes a blood test for hCG levels. The results show hCG levels of 30 mIU/mL. Which of the following statements by the nurse is appropriate?
A. “This level suggests you are not pregnant.”
B. “This level is considered negative for pregnancy.”
C. “Your hCG level suggests a positive pregnancy result.”
D. “The level of hCG does not matter for pregnancy detection.”
C. “Your hCG level suggests a positive pregnancy result.”
Rationale: An hCG level higher than 25 mIU/mL is considered a positive indication of pregnancy. Levels lower than 5 mIU/mL are negative. hCG testing is based on detecting and measuring this glycoprotein in serum or urine to establish probable pregnancy.
A nurse is assessing a pregnant client. Which of the following findings is considered a positive sign of pregnancy?
A. Nausea and vomiting
B. Positive urine pregnancy test
C. Softening of the cervix (Goodell sign)
D. Visualization of the fetus by ultrasound
D. Visualization of the fetus by ultrasound
Rationale: Positive signs of pregnancy are those that provide definitive confirmation of a fetus growing in the uterus and include visualizing the fetus via ultrasound, palpating fetal movements, and hearing the fetal heartbeat. Nausea, a positive urine test, and cervical softening are presumptive or probable signs and are not definitive.
The nurse hears a fetal heartbeat during a routine prenatal visit using a Doppler device. This is classified as which type of pregnancy sign?
A. Presumptive sign
B. Probable sign
C. Positive sign
D. Subjective sign
C. Positive sign
Rationale: Hearing the fetal heartbeat is a positive sign of pregnancy, as it directly confirms the presence of a fetus. Presumptive signs are subjective symptoms reported by the mother, and probable signs are objective but not definitive.
Which of the following is considered a positive sign of pregnancy that confirms fetal presence?
A. Abdominal enlargement
B. Braxton Hicks contractions
C. Palpation of fetal movements by a health care provider
D. A positive serum hCG test
C. Palpation of fetal movements by a health care provider
Rationale: Palpation of fetal movements by a health care provider is a positive sign of pregnancy. This directly confirms the presence of a fetus. Abdominal enlargement, Braxton Hicks contractions, and positive hCG tests are probable signs but do not conclusively confirm a pregnancy.
A woman at 10 weeks gestation expresses concern that her pregnancy may not be viable. The nurse explains that which of the following findings confirms a viable intrauterine pregnancy?
A. Bluish coloration of the cervix and vaginal mucosa
B. Visualization of the fetus by ultrasound
C. Persistent nausea and vomiting
D. Softening of the lower uterine segment
B. Visualization of the fetus by ultrasound
Rationale: Visualization of the fetus by ultrasound is a positive sign that confirms a viable intrauterine pregnancy. Other findings listed (bluish coloration, persistent nausea, and softening of the uterine segment) are either presumptive or probable signs and do not definitively establish viability.
Which physiological change of the uterus during pregnancy is primarily responsible for its increased size and weight?
A. Hyperplasia of myometrial cells throughout the entire pregnancy
B. Hypertrophy of uterine muscle fibers after mid-gestation
C. Shortening of blood vessels to reduce pressure
D. Increased contraction of uterine muscles
B. Hypertrophy of uterine muscle fibers after mid-gestation
Rationale: Uterine growth after mid-gestation is primarily due to the hypertrophy (increase in size) of existing muscle fibers, while hyperplasia (increase in number) occurs early in pregnancy. The growth accommodates the growing fetus and increases uterine size and weight.
During a prenatal visit, a client reports increased urinary frequency. The nurse explains that this symptom during early pregnancy is due to:
A. Hormonal changes causing excessive fluid retention
B. Compression of the bladder by the expanding uterus
C. Increased urine production due to elevated blood volume
D. Reduced blood flow to the kidneys
B. Compression of the bladder by the expanding uterus
Rationale: In early pregnancy, the expanding uterus exerts pressure on the bladder, resulting in increased urinary frequency. Hormonal changes and blood volume elevation also occur but do not directly cause bladder compression.
At 20 weeks’ gestation, the nurse would expect the fundus of the uterus to be located at which anatomical landmark?
A. Xiphoid process
B. Just above the pubic symphysis
C. Midway between the pubic symphysis and the umbilicus
D. At the level of the umbilicus
D. At the level of the umbilicus
Rationale: At 20 weeks’ gestation, the fundus is typically at the level of the umbilicus, and it corresponds with a fundal height of approximately 20 cm.
A pregnant woman complains of dizziness and light-headedness when lying on her back. The nurse recognizes this as a symptom of:
A. Vena cava compression syndrome
B. Orthostatic hypotension
C. Gestational hypertension
D. Dehydration due to increased metabolic demands
A. Vena cava compression syndrome
Rationale: The heavy gravid uterus in the supine position can compress the inferior vena cava, reducing venous return and cardiac output, leading to dizziness, light-headedness, and other symptoms associated with decreased blood flow.
A nurse explains to a pregnant woman that Braxton Hicks contractions are:
A. Painful contractions that require medical intervention
B. Irregular, painless contractions that occur throughout pregnancy
C. Associated with cervical dilation during early pregnancy
D. Predictive of the exact timing of labor onset
B. Irregular, painless contractions that occur throughout pregnancy
Rationale: Braxton Hicks contractions are irregular, painless contractions that begin early in pregnancy and help prepare the uterus for labor. They are not predictive of the timing of labor onset.
A client in her third trimester reports experiencing shortness of breath. The nurse attributes this symptom to:
A. Hormonal imbalances causing respiratory changes
B. Compression of the diaphragm by the expanding uterus
C. Reduced lung expansion due to excess amniotic fluid
D. Fluid accumulation in the chest cavity
B. Compression of the diaphragm by the expanding uterus
Rationale: As the uterus expands upward, it presses against the diaphragm, reducing lung capacity and resulting in shortness of breath. This is common in late pregnancy.
Lightening, which often occurs in the last weeks of pregnancy, is best described as:
A. Fetal head descending into the pelvis
B. Onset of strong uterine contractions
C. Rapid weight gain during the third trimester
D. Increase in uterine blood flow
A. Fetal head descending into the pelvis
Rationale: Lightening refers to the fetal head descending into the pelvis, typically occurring about two weeks before labor in first-time pregnancies and at the onset of labor in subsequent pregnancies.
Which intervention is appropriate for a pregnant woman experiencing supine hypotensive syndrome?
A. Instruct her to lie flat with legs elevated
B. Encourage her to sit or stand up quickly
C. Position her in a side-lying position
D. Administer diuretics to reduce fluid volume
C. Position her in a side-lying position
Rationale: Supine hypotensive syndrome is managed by positioning the woman on her side to relieve pressure on the vena cava, thereby restoring blood flow and alleviating symptoms.
The softening of the cervix between weeks 6 and 8 of pregnancy due to vasocongestion and hormonal influences is known as which sign?
A. Hegar sign
B. Chadwick sign
C. Goodell sign
D. Ballottement
C. Goodell sign
Rationale: Goodell sign refers to the softening of the cervix caused by increased vascularization and estrogen influence, typically seen around weeks 6 to 8 of pregnancy.
Which hormone is responsible for the formation of the thick mucus plug that blocks the cervical os during pregnancy?
A. Estrogen
B. Oxytocin
C. Progesterone
D. Relaxin
C. Progesterone
Rationale: Progesterone stimulates the formation of a thick mucus plug that serves to protect the cervical opening from bacterial invasion during pregnancy.
Increased vascularization of the cervix during early pregnancy leads to a bluish-purple discoloration known as:
A. Chadwick sign
B. Goodell sign
C. Braxton Hicks contractions
D. Lightening
A. Chadwick sign
Rationale: Chadwick sign refers to the bluish-purple discoloration of the cervix caused by increased vascularity during pregnancy.
Which change occurs to the vaginal secretions during pregnancy?
A. They become more alkaline
B. They become more acidic and white
C. They reduce in volume
D. They become yellow and purulent
B. They become more acidic and white
Rationale: During pregnancy, vaginal secretions increase in volume, become more acidic, and appear white due to increased estrogen influence and pelvic congestion.
During pregnancy, which of the following changes in the vagina is NOT typical?
A. Thickening of the vaginal mucosa
B. Increased vaginal length
C. Decrease in vascularity
D. Smooth muscle hypertrophy
C. Decrease in vascularity
Rationale: During pregnancy, there is an increase, not a decrease, in vaginal vascularity to prepare for childbirth.
A pregnant client reports increased vaginal discharge with itching and irritation. Which condition is likely and should be assessed for?
A. Vulvovaginal candidiasis
B. Bacterial vaginosis
C. Pelvic inflammatory disease
D. Urinary tract infection
A. Vulvovaginal candidiasis
Rationale: The glycogen-rich environment of the vagina during pregnancy can lead to vulvovaginal candidiasis, which often presents with itching, irritation, and increased discharge.
Which statement about ovarian function during pregnancy is correct?
A. The ovaries continue to release eggs until the 12th week of gestation
B. Ovulation ceases due to elevated estrogen and progesterone levels
C. The ovaries stop producing hormones immediately after conception
D. Ovaries are palpable throughout pregnancy
B. Ovulation ceases due to elevated estrogen and progesterone levels
Rationale: Elevated levels of estrogen and progesterone during pregnancy inhibit the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), resulting in the cessation of ovulation.
The corpus luteum remains active in hormone production until which time in pregnancy?
A. 4th week of gestation
B. 12th week of gestation
C. Throughout the entire pregnancy
D. 6th to 7th week of gestation
D. 6th to 7th week of gestation
Rationale: The corpus luteum is responsible for hormone production until about weeks 6 to 7, after which the placenta assumes this role.
Which of the following changes to the breasts during pregnancy helps prepare them for lactation?
A. Reduction in size of areola
B. Decreased vascularization
C. Prominence of Montgomery’s tubercles
D. Lightening of nipple pigmentation
C. Prominence of Montgomery’s tubercles
Rationale: Montgomery’s tubercles become more prominent to help lubricate the nipples in preparation for breastfeeding.
What is the primary function of colostrum during late pregnancy and the early postpartum period?
A. It provides nourishment for the newborn during the first few days after birth
B. It acts as a lubricant for the mother’s nipples
C. It reduces nipple sensitivity during breastfeeding
D. It prevents infections by forming a protective plug
A. It provides nourishment for the newborn during the first few days after birth
Rationale: Colostrum, the yellowish fluid produced by the breasts, provides essential nutrients and antibodies for the newborn during the first few days after birth.
Which of the following changes occur in the connective tissue of the breasts during pregnancy?
A. Reduction in elasticity
B. Formation of pink to purple striae
C. Constriction of blood vessels
D. Decrease in size of the breasts
B. Formation of pink to purple striae
Rationale: Changes in breast size and connective tissue can lead to the formation of stretch marks (striae), which are initially pink to purple and later fade to a silver color.
A nurse assesses a pregnant client and notes larger, more erect nipples with deeper pigmentation of the areola. This change is primarily influenced by:
A. Relaxin and nitric oxide
B. Progesterone and oxytocin
C. Estrogen and progesterone
D. Cortisol and adrenaline
C. Estrogen and progesterone
Rationale: Estrogen and progesterone contribute to breast changes during pregnancy, including increased vascularization, nipple size, and pigmentation of the areola.
When assessing a pregnant woman, the nurse explains that leukorrhea during pregnancy is considered normal unless it is accompanied by:
A. Itching and irritation
B. Thick, white color without odor
C. Increase in volume during late pregnancy
D. Slightly acidic pH
A. Itching and irritation
Rationale: While an increase in vaginal discharge (leukorrhea) is normal during pregnancy, itching and irritation may indicate infection, such as candidiasis.
Which anatomical structure increases vascularity to prepare for birth during pregnancy?
A. Cervical os
B. Vaginal vault
C. Ovarian follicles
D. Endometrial lining
B. Vaginal vault
Rationale: The vaginal vault, along with other structures, experiences increased vascularity in preparation for the stretching and distention required for birth.
What is the role of prostaglandins in cervical ripening as labor approaches?
A. They inhibit cervical dilation
B. They induce uterine contractions
C. They promote softening and increased distensibility of the cervix
D. They decrease blood supply to the cervix
C. They promote softening and increased distensibility of the cervix
Rationale: Prostaglandins, along with other factors, contribute to cervical ripening by softening the cervix and increasing its distensibility in preparation for labor.
A pregnant client at 30 weeks gestation has a fundal height measuring 28 cm. What is the nurse’s next best action?
A. Reassure the client that this is a normal finding.
B. Schedule an ultrasound to assess fetal growth.
C. Instruct the client to increase fluid intake.
D. Document the finding and continue with routine care.
A. Reassure the client that this is a normal finding.
Rationale: A fundal height measurement that is within 1-2 cm of the number of weeks gestation is considered within normal limits (WNL). No immediate intervention is required unless other concerns arise.
Which of the following scenarios would most likely require an ultrasound to accurately assess fetal growth?
A. A fundal height measuring 25 cm at 25 weeks in a healthy-weight patient.
B. A fundal height measuring 30 cm at 32 weeks in an obese patient.
C. A fundal height that matches exactly with the weeks of gestation in an underweight patient.
D. A fundal height that measures 1 cm larger than the gestational age.
B. A fundal height measuring 30 cm at 32 weeks in an obese patient.
Rationale: Fundal height measurements may not be accurate in obese patients due to excess adipose tissue, making ultrasound assessment necessary for accurate evaluation of fetal growth.
At 32 weeks gestation, a client’s fundal height is measured at 35 cm. What potential complication should the nurse suspect?
A. Oligohydramnios
B. Fetal growth restriction
C. Polyhydramnios or a multiple pregnancy
D. Normal variation
C. Polyhydramnios or a multiple pregnancy
Rationale: A larger-than-expected fundal height may indicate conditions such as polyhydramnios or multiple pregnancies. Further assessment, such as an ultrasound, is warranted.
Why is it important to monitor fundal height during pregnancy?
A. To accurately predict the baby’s birth weight.
B. To ensure maternal weight gain is sufficient.
C. To measure maternal hydration status.
D. To monitor fetal growth and detect potential complications.
D. To monitor fetal growth and detect potential complications.
Rationale: Monitoring fundal height helps assess fetal growth patterns and detect potential complications such as growth restriction or macrosomia.
A nurse is caring for a pregnant client at 29 weeks whose fundal height is 26 cm. Which of the following could be a potential reason for this finding?
A. Maternal obesity
B. Multiple pregnancy
C. Fetal growth restriction or oligohydramnios
D. Incorrect dating of pregnancy
C. Fetal growth restriction or oligohydramnios
Rationale: A smaller-than-expected fundal height may indicate fetal growth restriction or a reduced amount of amniotic fluid (oligohydramnios). Further evaluation is recommended.
A nurse is assessing a pregnant client at 28 weeks gestation. Which cardiovascular change should the nurse expect?
A. Decreased blood volume
B. Reduced plasma volume after 24 weeks
C. Increased blood volume starting around 6 weeks of gestation
D. Decrease in red blood cell volume
C. Increased blood volume starting around 6 weeks of gestation
Rationale: Blood volume increases starting around 6 weeks of gestation and continues to rise throughout pregnancy. This is necessary to support fetal development and accommodate maternal physiological changes.
A pregnant client asks why she feels more fatigued even though her hemoglobin levels are considered “low-normal.” What is the most appropriate response by the nurse?
A. “Your body is working harder to pump blood through your system.”
B. “This could be a sign of anemia and needs further testing.”
C. “This is due to the physiologic anemia of pregnancy caused by increased plasma volume.”
D. “You might not be consuming enough iron-rich foods.”
C. “This is due to the physiologic anemia of pregnancy caused by increased plasma volume.”
Rationale: During pregnancy, plasma volume increases more than red blood cell volume, causing hemodilution, known as physiologic anemia. This is normal and not a sign of true anemia in a healthy pregnancy.
When counseling a pregnant client about changes in blood components, which statement is accurate?
A. Red blood cell volume decreases slightly to compensate for increased plasma.
B. Hematocrit levels increase during pregnancy.
C. Increased plasma volume can lead to a drop in hemoglobin concentration.
D. Blood volume decreases as the pregnancy progresses past 32 weeks.
C. Increased plasma volume can lead to a drop in hemoglobin concentration.
Rationale: The increase in plasma volume relative to red blood cell volume can cause a dilutional drop in hemoglobin concentration, often referred to as physiologic anemia of pregnancy.
What cardiovascular change is primarily responsible for the increased risk of anemia in pregnant women?
A. Rapid increase in plasma volume compared to red blood cell volume
B. Decreased iron absorption from the gastrointestinal tract
C. Higher metabolic demand from the fetus
D. Decreased red blood cell production
A. Rapid increase in plasma volume compared to red blood cell volume
Rationale: The plasma volume increases more rapidly and to a greater extent than red blood cell volume, leading to a relative decrease in hemoglobin concentration, which contributes to physiologic anemia.
At which point in pregnancy does the plasma volume reach its peak?
A. At 8 weeks gestation
B. Around 32 weeks gestation
C. Around 20 weeks gestation
D. By the end of the first trimester
B. Around 32 weeks gestation
Rationale: Plasma volume begins increasing at 6-8 weeks gestation and peaks around 32 weeks, helping to meet the demands of the developing fetus and expanding maternal circulation.
Which physiological change during pregnancy helps ensure adequate oxygen delivery to both the mother and fetus?
A. Reduction in red blood cell production
B. Increase in blood and plasma volume
C. Decrease in plasma volume after 24 weeks
D. Vasoconstriction of maternal blood vessels
B. Increase in blood and plasma volume
Rationale: The increase in blood and plasma volume helps support the growing needs of the fetus by enhancing oxygen and nutrient delivery while also preparing the mother for potential blood loss during childbirth.
During pregnancy, blood volume increases by approximately how much above pre-pregnant levels?
A. 20%
B. 30%
C. 50%
D. 70%
C. 50%
Rationale: Blood volume during pregnancy increases by about 50% above pre-pregnancy levels to support the growing fetus, placenta, and maternal tissues.
A pregnant client at 24 weeks gestation reports feeling lightheaded when lying on her back. What is the most likely cause?
A. Physiologic anemia
B. Increased venous return
C. Hypercoagulable state
D. Supine hypotensive syndrome
D. Supine hypotensive syndrome
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses the inferior vena cava, decreasing venous return and causing dizziness or hypotension when the woman lies on her back.
What cardiovascular adaptation is primarily responsible for protecting a pregnant woman from hemorrhage during childbirth?
A. Increased heart rate
B. Increased fibrinogen and clotting factors
C. Decreased blood pressure
D. Hemodilution
B. Increased fibrinogen and clotting factors
Rationale: The increase in fibrinogen and clotting factors during pregnancy prepares the body to form clots quickly, reducing the risk of excessive bleeding during delivery.
Why is iron supplementation often necessary during pregnancy?
A. To prevent increased blood pressure
B. To support fetal skeletal development
C. To meet increased iron demands and prevent anemia
D. To maintain a hypercoagulable state
C. To meet increased iron demands and prevent anemia
Rationale: Pregnancy increases the demand for iron due to increased red blood cell production. Supplementation helps prevent iron deficiency anemia.
During pregnancy, what happens to cardiac output?
A. Decreases due to increased blood viscosity
B. Remains unchanged
C. Decreases due to lower venous return
D. Increases due to higher blood volume and venous return
D. Increases due to higher blood volume and venous return
Rationale: Cardiac output increases during pregnancy as a result of increased blood volume and venous return, supporting the metabolic demands of the fetus and mother.
What cardiovascular change is expected in a healthy pregnant woman by mid-pregnancy?
A. Increase in blood pressure above pre-pregnant levels
B. Stable blood pressure throughout pregnancy
C. Slight decline in blood pressure, returning to pre-pregnancy levels later
D. Immediate return of blood pressure to pre-pregnancy levels
C. Slight decline in blood pressure, returning to pre-pregnancy levels later
Rationale: Blood pressure typically declines slightly during mid-pregnancy due to hormonal and vascular changes, then returns to pre-pregnancy levels in the third trimester.
Which of the following is a characteristic of physiologic anemia in pregnancy?
A. Hemoconcentration due to increased red blood cell volume
B. Increased plasma volume relative to red blood cell volume
C. Anemia caused by decreased plasma volume
D. Reduced oxygen-carrying capacity of blood
B. Increased plasma volume relative to red blood cell volume
Rationale: Physiologic anemia in pregnancy is due to a greater increase in plasma volume compared to red blood cell volume, causing hemodilution.
Which physiological adaptation increases the risk of varicosities and hemorrhoids during pregnancy?
A. Hypercoagulability
B. Increased cardiac output
C. Pooling of blood in the veins of the legs, vulva, and rectum
D. Decreased iron levels
C. Pooling of blood in the veins of the legs, vulva, and rectum
Rationale: Pooling of blood in deep and superficial veins during pregnancy, particularly in the legs, vulva, and rectum, increases the risk of varicosities and hemorrhoids.
Which of the following statements best describes the hypercoagulable state of pregnancy?
A. It reduces the risk of thromboembolic events.
B. It occurs due to decreased fibrinogen levels.
C. It offers protection from hemorrhage but increases clotting risks.
D. It is a result of decreased cardiac output.
C. It offers protection from hemorrhage but increases clotting risks.
Rationale: The hypercoagulable state in pregnancy increases the ability to form clots, offering protection from hemorrhage during childbirth but raising the risk of thrombosis.
During pregnancy, blood flow to which organ increases by 50%?
A. Liver
B. Lungs
C. Kidneys
D. Brain
C. Kidneys
Rationale: Blood flow to the kidneys increases significantly during pregnancy to accommodate increased metabolic waste and fluid volume.
Which cardiovascular change helps dissipate heat in pregnant women?
A. Increased blood flow to the kidneys
B. Increased blood flow to the skin
C. Increased cardiac output
D. Increased red blood cell volume
B. Increased blood flow to the skin
Rationale: Increased blood flow to the skin during pregnancy helps dissipate heat generated by the increased metabolic activity.
A nurse is counseling a pregnant woman on why her breasts feel swollen and engorged. The nurse explains that this is primarily due to which cardiovascular change?
A. Pooling of blood in the lower extremities
B. Increased plasma fibrinogen
C. Reduced venous return
D. Doubling or tripling of blood flow to the breasts
D. Doubling or tripling of blood flow to the breasts
Rationale: Blood flow to the breasts increases significantly during pregnancy, often doubling or tripling, leading to engorgement.
Why is pregnancy considered a hypercoagulable state?
A. To protect against hemorrhage during labor and delivery
B. To reduce cardiac output demands
C. To decrease maternal heart rate
D. To prevent hemodilution
A. To protect against hemorrhage during labor and delivery
Rationale: Pregnancy induces a hypercoagulable state to help protect against hemorrhage during childbirth, but it also increases the risk of thrombotic events.
Which of the following changes is seen with increased blood flow during pregnancy?
A. Increased oxygen demand leading to maternal anemia
B. Pooling of blood in the uterine arteries only
C. Increased metabolic waste from the fetus, causing greater kidney activity
D. Reduced blood flow to the skin
C. Increased metabolic waste from the fetus, causing greater kidney activity
Rationale: Increased blood flow and metabolic activity during pregnancy lead to higher levels of metabolic waste, requiring greater kidney function.
What physiological change in pregnancy contributes to an increased risk of thromboembolism?
A. Decreased fibrinogen levels
B. Decreased red blood cell production
C. Increased clotting factors and fibrinogen
D. Reduced cardiac output
C. Increased clotting factors and fibrinogen
Rationale: Pregnancy leads to an increase in fibrinogen and other clotting factors, raising the risk of thromboembolic events.
Which statement about the cardiovascular system in pregnancy is true?
A. Blood flow to the skin remains constant.
B. The heart rate remains the same as pre-pregnancy levels.
C. Cardiac output increases due to increased blood volume.
D. Iron demand decreases during pregnancy.
C. Cardiac output increases due to increased blood volume.
Rationale: Cardiac output increases during pregnancy due to an increase in blood volume and venous return, which supports the maternal and fetal circulation.
What adaptation occurs to ensure adequate oxygen and nutrient delivery to the fetus?
A. Increase in cardiac output and blood volume
B. Decrease in red blood cell volume
C. Decrease in plasma fibrinogen levels
D. Reduction in metabolic activity
A. Increase in cardiac output and blood volume
Rationale: An increase in cardiac output and blood volume ensures adequate oxygen and nutrient delivery to the growing fetus.
A pregnant woman asks why her blood pressure slightly decreased in mid-pregnancy. The nurse should explain that this change is due to:
A. Decreased blood volume
B. Increased peripheral vascular resistance
C. Hormonal changes causing vasodilation
D. Reduced cardiac output
C. Hormonal changes causing vasodilation
Rationale: Hormonal changes during pregnancy cause vasodilation, which may lead to a slight decrease in blood pressure during mid-pregnancy.
Which hormone is primarily responsible for the softening and stretching of ligaments, particularly at the sacroiliac joints and pubic symphysis during pregnancy?
A. Progesterone
B. Estrogen
C. Human chorionic gonadotropin (hCG)
D. Relaxin
D. Relaxin
Rationale: Relaxin is a hormone that helps prepare the pelvis for childbirth by softening and stretching the ligaments, leading to increased flexibility in the sacroiliac joints and pubic symphysis.
A pregnant patient reports low back pain and pelvic discomfort. The nurse explains that these symptoms are likely due to:
A. Decreased progesterone levels
B. Increased production of relaxin and changes in ligament flexibility
C. Decreased fluid retention
D. Reduced pelvic mobility
B. Increased production of relaxin and changes in ligament flexibility
Rationale: Increased levels of relaxin during pregnancy lead to the softening and stretching of ligaments, contributing to pelvic discomfort and low back pain.
Which of the following postural changes is commonly observed in pregnant women?
A. Lordosis, characterized by an increased lumbosacral curve
B. Decrease in lumbosacral curve
C. Flattening of the spine
D. Backward shifting of the center of gravity
A. Lordosis, characterized by an increased lumbosacral curve
Rationale: Lordosis, or an increased curvature of the lumbosacral spine, is common in pregnant women due to changes in the center of gravity and the weight of the growing uterus.
A nurse is teaching a prenatal class about changes in gait during pregnancy. Which description is most accurate?
A. Pregnant women develop a waddle gait due to pelvic bone fusion.
B. A waddle gait occurs because of the widening of the pelvic joints and altered balance.
C. Gait changes are related to decreased mobility of the hip joints.
D. Waddle gait is caused by increased cardiovascular load.
B. A waddle gait occurs because of the widening of the pelvic joints and altered balance.
Rationale: The widening of the pelvic joints due to relaxin and changes in the center of gravity contribute to the characteristic “waddle gait” seen in pregnant women.
Pregnant women have a higher risk of falls due to:
A. Forward shifting of the center of gravity and postural changes
B. Reduced ligament flexibility
C. Decreased venous return
D. Lowered blood pressure
A. Forward shifting of the center of gravity and postural changes
Rationale: The forward shift in the center of gravity and postural adaptations, including swayback and changes in gait, increase the risk of falls in pregnant women.
The ideal sleeping position for a pregnant woman to maximize placental blood flow is:
A. Supine position
B. Right lateral side
C. Left lateral side
D. Semi-sitting position
C. Left lateral side
Rationale: The left lateral position is recommended as it optimizes placental blood flow, enhances cardiac output, and improves kidney function, reducing swelling in the lower extremities.
A pregnant woman in her third trimester expresses discomfort when sleeping. The nurse advises her to avoid lying on her back because it:
A. Increases the risk of premature labor
B. Compresses the great vessels, potentially reducing placental blood flow
C. Causes fetal movements to decrease
D. Increases maternal oxygenation
B. Compresses the great vessels, potentially reducing placental blood flow
Rationale: Lying on the back can compress the inferior vena cava and aorta, potentially reducing blood flow to the heart and placenta, which may compromise fetal circulation.
Research has suggested that sleeping on the back during the later stages of pregnancy may be associated with:
A. An increased risk of stillbirth after 28 weeks of gestation
B. Higher birth weights in newborns
C. Improved fetal movements at night
D. Reduced maternal leg cramps
A. An increased risk of stillbirth after 28 weeks of gestation
Rationale: Studies indicate that sleeping on the back during late pregnancy may be linked to an increased risk of stillbirth due to impaired blood flow to the placenta.
A nurse is educating a group of pregnant women about sleep hygiene during pregnancy. Which recommendation is most appropriate?
A. Lying in the supine position is best to maintain spinal alignment.
B. The right lateral position is superior to the left for all trimesters.
C. Left lateral positioning promotes optimal blood flow to the placenta and fetus.
D. Sleeping upright reduces the risk of complications more than any other position.
C. Left lateral positioning promotes optimal blood flow to the placenta and fetus.
Rationale: The left lateral position is recommended during pregnancy as it enhances placental blood flow and reduces the risk of vena cava compression compared to the supine position.
According to current guidelines, what is the recommended total weight gain for a woman with a prepregnancy BMI of 24?
A. 28–40 lb
B. 25–35 lb
C. 15–25 lb
D. 11–20 lb
B. 25–35 lb
Rationale: A woman with a prepregnancy BMI of 18.5–24.9 (normal weight) should aim for a total weight gain of 25–35 lb during pregnancy to support fetal growth and development.
A pregnant woman with a prepregnancy BMI of 31 asks for advice on weight gain during her pregnancy. What would the nurse advise?
A. “You should aim for a total weight gain of 11–20 lb.”
B. “Try to avoid gaining any weight during your pregnancy.”
C. “Gaining 40 lbs would be ideal to support the pregnancy.”
D. “Weight gain recommendations are not applicable to you.”
A. “You should aim for a total weight gain of 11–20 lb.”
Rationale: For obese women (BMI of 30 or higher), the recommended total weight gain during pregnancy is 11–20 lb to minimize risks while still ensuring necessary fetal and maternal health support.
Which statement accurately describes the weight gain pattern for an underweight pregnant woman in the second and third trimesters?
A. Gain slightly more than 1 lb per week
B. Gain approximately 1 lb per week
C. Gain 2/3 lb per week
D. No weight gain is necessary
A. Gain slightly more than 1 lb per week
Rationale: For underweight women, weight gain during the second and third trimesters should be slightly more than 1 lb per week to promote healthy fetal growth and maternal health.
What potential complication is a pregnant woman with a prepregnancy BMI greater than 25 at risk for?
A. Low-birth-weight infant
B. Cephalopelvic disproportion and high-birth-weight infant
C. Spontaneous miscarriage
D. Preterm labor without complications
B. Cephalopelvic disproportion and high-birth-weight infant
Rationale: Women who are overweight (BMI greater than 25 to 29) have an increased risk of having a high-birth-weight infant, potentially leading to cephalopelvic disproportion and an increased likelihood of surgical birth.
Which of the following best explains why dieting during pregnancy is never recommended, even for obese women?
A. It increases maternal weight gain beyond recommendations.
B. It prevents sufficient uterine blood flow.
C. It leads to excessive nutrient absorption by the fetus.
D. Severe caloric restriction can lead to a decrease in birth weight and inadequate fetal development.
D. Severe caloric restriction can lead to a decrease in birth weight and inadequate fetal development.
Rationale: Dieting during pregnancy can lead to insufficient calorie intake, which may reduce fetal and placental development, resulting in lower birth weight and other complications.
A pregnant woman whose prepregnancy BMI was 20 asks how much weight she should gain during her first trimester. What is the recommended range?
A. About 3.5 to 5 lb
B. About 2 lb
C. About 10 lb
D. No weight gain is necessary
A. About 3.5 to 5 lb
Rationale: For women whose prepregnancy weight falls within the normal BMI range, the recommended weight gain during the first trimester is approximately 3.5 to 5 lb, mainly due to uterine growth and blood volume expansion.
During follow-up visits for a pregnant woman up to 28 weeks’ gestation, which routine assessments should be conducted?
A. Fundal height, fetal heart rate, weight, and screening for gestational diabetes
B. Weight, blood pressure, fundal height, fetal heart rate, and urine testing for protein and glucose
C. Edema assessment, glucose tolerance test, and Rh titer evaluation
D. Blood pressure, weight, and hemoglobin levels
B. Weight, blood pressure, fundal height, fetal heart rate, and urine testing for protein and glucose
Rationale: During visits up to 28 weeks’ gestation, it is standard practice to assess weight, blood pressure, fundal height, fetal heart rate, and perform urine testing for protein and glucose.
At what gestational age is screening for gestational diabetes typically recommended for low-risk pregnancies?
A. 12-16 weeks
B. 20-22 weeks
C. 24-28 weeks
D. 32-36 weeks
C. 24-28 weeks
Rationale: Screening for gestational diabetes is recommended between 24 and 28 weeks’ gestation, as insulin resistance increases at this point in pregnancy, leading to a higher rate of abnormal test results.
What finding during an assessment of edema in the third trimester would be considered abnormal and should be reported?
A. Edema of the hands and periorbital edema
B. Dependent edema of the lower extremities
C. Swelling that decreases with rest
D. Mild swelling of the ankles after standing
A. Edema of the hands and periorbital edema
Rationale: Periorbital edema, edema of the hands, and pretibial edema are abnormal findings that may indicate gestational hypertension and require further evaluation.
A nurse is counseling a pregnant woman who is Rh-negative. At 28 weeks’ gestation, which intervention is recommended to prevent isoimmunization?
A. Administration of Rh-positive red cells
B. RhoGAM injection
C. Frequent hemoglobin testing
D. Administration of iron supplements
B. RhoGAM injection
Rationale: RhoGAM is administered to Rh-negative women at 28 weeks’ gestation to prevent the development of antibodies to Rh-positive red cells, especially if fetal cells enter the maternal circulation.
Which of the following is a common sign or symptom of preterm labor that the nurse should ask about during a follow-up visit?
A. Increased fetal movements
B. Sudden weight loss
C. Uterine contractions and a feeling of pressure in the pelvic area
D. Decreased vaginal discharge
C. Uterine contractions and a feeling of pressure in the pelvic area
Rationale: Symptoms such as uterine contractions, a feeling of pressure in the pelvic area, dull backache, or increased vaginal discharge may indicate preterm labor.
When screening for gestational diabetes between 24 and 28 weeks, what is the next step if a woman’s 1-hour plasma glucose level is above 140 mg/dL after a 50-g oral glucose load?
A. Immediate insulin therapy
B. No further testing is needed
C. 3-hour 100-g glucose tolerance test
D. Daily blood sugar monitoring
C. 3-hour 100-g glucose tolerance test
Rationale: If the 1-hour plasma glucose level is above 140 mg/dL, further testing with a 3-hour 100-g glucose tolerance test is warranted to confirm the diagnosis of gestational diabetes.
A nurse is educating a pregnant woman between 29 and 36 weeks’ gestation about edema. Which advice is appropriate?
A. Dependent edema is common, but swelling in the hands and face should be reported.
B. Edema of the lower legs is always a cause for concern.
C. All forms of edema in pregnancy are harmless.
D. Reducing fluid intake will prevent edema.
A. Dependent edema is common, but swelling in the hands and face should be reported.
Rationale: Dependent edema of the lower extremities is common due to vascular compression by the gravid uterus, but edema of the hands and face (periorbital edema) could indicate gestational hypertension and should be reported.
During prenatal visits, why is daily fetal movement monitoring emphasized?
A. It is the primary indicator of maternal well-being.
B. It helps monitor maternal weight gain.
C. It helps regulate maternal blood pressure.
D. It is a critical indicator of fetal well-being.
D. It is a critical indicator of fetal well-being.
Rationale: Daily fetal movement monitoring is emphasized because it is an important indicator of fetal well-being. A decrease in movements may indicate a need for further evaluation.
A nurse is educating a pregnant woman about routine laboratory tests. Which of the following tests is typically included in the initial screening for all pregnant women?
A. Glucose tolerance test
B. Hepatitis B surface antibody antigen
C. Rubeola screening
D. Genetic screening for Down syndrome
B. Hepatitis B surface antibody antigen
Rationale: Hepatitis B surface antigen is a routine screening test for pregnant women to assess for the presence of hepatitis B. Other tests like glucose tolerance and genetic screening are typically ordered later based on risk factors or patient history, not universally for all pregnant women.
A nurse is explaining the ethical principle of autonomy to a couple during their prenatal care visit. Which of the following actions reflects this principle?
A. The nurse explains the benefits and risks of additional testing, then supports the couple’s decision regardless of their choice.
B. The nurse insists the couple undergo genetic screening to prevent a hereditary disease.
C. The nurse suggests the couple choose genetic testing to avoid potential health problems for the baby.
D. The nurse arranges genetic testing for the couple without discussing their preferences.
A. The nurse explains the benefits and risks of additional testing, then supports the couple’s decision regardless of their choice.
Rationale: Autonomy involves respecting a patient’s right to make decisions about their own health care. The nurse should provide the couple with information, respect their decisions, and support them in making informed choices, even if their choice differs from the nurse’s personal beliefs.
A nurse is conducting a prenatal visit and orders a blood test for a pregnant woman. Which of the following laboratory studies is most commonly included in the initial blood work?
A. HIV testing
B. Complete blood count (CBC)
C. Urinalysis for glucose and ketones
D. Cervical smear for STIs
B. Complete blood count (CBC)
Rationale: A complete blood count (CBC) is a standard laboratory test for pregnant women to assess hemoglobin, hematocrit, red and white blood cell counts, and platelets. HIV testing and STI screenings are also common but are often secondary to a CBC in the initial screening.
Which of the following laboratory tests is used to validate an intrauterine pregnancy and assess early fetal growth?
A. Complete blood count (CBC)
B. Hepatitis B surface antigen test
C. Ultrasound
D. Rubeola screening
C. Ultrasound
Rationale: Ultrasound is routinely used during the early stages of pregnancy to confirm the presence of an intrauterine pregnancy and assess fetal growth. It is not a blood or urine test, unlike the other options listed.
A nurse is educating a pregnant woman about additional laboratory tests that can be offered. Which test would be appropriate for a woman with a history of high-risk pregnancies and current risk factors for genetic diseases?
A. Complete blood count (CBC)
B. Rubeola screening
C. Genetic screening
D. HIV testing
C. Genetic screening
Rationale: Genetic screening is often recommended for women with risk factors for genetic diseases or a history of high-risk pregnancies. This test is tailored to the individual’s specific risks, unlike routine screening like CBC or HIV testing.
A nurse is discussing the rationale for testing a pregnant woman for HIV and other sexually transmitted infections (STIs). Which of the following statements is the most accurate?
A. HIV and STIs are only tested if the woman shows symptoms.
B. Testing for HIV and STIs is a routine part of prenatal care to prevent transmission to the baby.
C. HIV testing is optional for all pregnant women, regardless of risk.
D. STIs are only tested if the woman has a history of multiple sexual partners.
B. Testing for HIV and STIs is a routine part of prenatal care to prevent transmission to the baby.
Rationale: Routine testing for HIV and STIs is recommended during pregnancy to prevent transmission to the baby and to manage the health of the mother. Testing is not based on the presence of symptoms or a history of multiple partners. It is a standard practice in prenatal care.
At what gestational age is a detailed anatomy scan typically performed via ultrasonography to assess fetal development?
A. 8-10 weeks
B. 11-13 weeks
C. 18-20 weeks
D. 30-32 weeks
C. 18-20 weeks
Rationale: A detailed anatomy scan is typically performed between 18-20 weeks of gestation to evaluate fetal growth, development, and structural anatomy.
Which of the following tests evaluates fetal blood flow and is often used when there is concern about placental function or fetal well-being?
A. Amniocentesis
B. Nuchal translucency screening
C. Doppler flow studies
D. Alpha-fetoprotein analysis
C. Doppler flow studies
Rationale: Doppler flow studies use ultrasound to evaluate fetal blood flow, particularly through the umbilical artery, to assess placental function and detect any signs of compromised circulation.
A nurse is discussing alpha-fetoprotein (AFP) analysis with a pregnant woman. Which of the following conditions can be detected by an elevated maternal serum AFP (MSAFP) level?
A. Down syndrome
B. Neural tube defects such as spina bifida
C. Fetal lung maturity
D. Rh isoimmunization
B. Neural tube defects such as spina bifida
Rationale: Elevated levels of MSAFP can indicate the presence of neural tube defects such as spina bifida or anencephaly in the fetus.
A nuchal translucency screening is performed during which trimester to assess for chromosomal abnormalities?
A. First trimester
B. Second trimester
C. Third trimester
D. Postpartum
A. First trimester
Rationale: Nuchal translucency screening is performed during the first trimester (around 11-14 weeks) to measure the fluid-filled space at the back of the fetus’s neck, which can help identify chromosomal abnormalities.
Which fetal assessment procedure involves obtaining a sample of amniotic fluid to test for chromosome abnormalities, fetal lung maturity, or Rh isoimmunization status?
A. Doppler flow study
B. Marker screening test
C. Amniocentesis
D. Ultrasonography
C. Amniocentesis
Rationale: Amniocentesis involves extracting a sample of amniotic fluid, which can be tested for chromosomal abnormalities, fetal lung maturity (at later gestation), or Rh isoimmunization status.
When is amniocentesis typically performed for evaluating fetal lung maturity?
A. Around 10-12 weeks of gestation
B. At 24 weeks gestation
C. In the third trimester, around 32-34 weeks or later if needed
D. Only in the first trimester
C. In the third trimester, around 32-34 weeks or later if needed
Rationale: Amniocentesis for evaluating fetal lung maturity is typically performed during the third trimester (around 32-34 weeks) to assess the readiness of the fetal lungs for birth.
Which of the following tests can be used in the first trimester to screen for genetic abnormalities?
A. Doppler flow studies
B. Nuchal translucency screening
C. Amniocentesis for fetal lung maturity
D. Detailed anatomy scan
B. Nuchal translucency screening
Rationale: Nuchal translucency screening is performed in the first trimester to assess the risk of chromosomal abnormalities such as Down syndrome.
A pregnant woman is scheduled for an ultrasound to confirm early pregnancy. At which point is this typically done?
A. 1 week of gestation
B. 6-8 weeks of gestation
C. 18-20 weeks of gestation
D. 28-30 weeks of gestation
B. 6-8 weeks of gestation
Rationale: An early ultrasound for pregnancy confirmation is typically performed around 6-8 weeks of gestation to verify fetal heartbeat and viability.
Marker screening tests during pregnancy are used to:
A. Evaluate maternal kidney function
B. Detect chromosomal and genetic conditions
C. Determine the fetal position
D. Assess placental blood flow
B. Detect chromosomal and genetic conditions
Rationale: Marker screening tests, such as multiple marker screening, can help detect chromosomal abnormalities and other genetic conditions in the developing fetus.
Why is it important to conduct Rh isoimmunization testing during pregnancy?
A. To determine fetal lung maturity
B. To evaluate the possibility of neural tube defects
C. To prevent the development of antibodies in an Rh-negative mother
D. To measure the fetal heart rate
C. To prevent the development of antibodies in an Rh-negative mother
Rationale: Rh isoimmunization testing and treatment with RhoGAM are performed to prevent the development of antibodies in an Rh-negative mother that could harm an Rh-positive fetus.
During the first and third trimesters, many pregnant women experience increased urinary frequency and urgency. Which of the following best explains this phenomenon?
A. Decreased blood flow to the kidneys
B. The expanding uterus places pressure on the bladder
C. Hormonal changes suppress the need to urinate
D. The baby’s head engages in the pelvis during the second trimester
B. The expanding uterus places pressure on the bladder
Rationale: In the first and third trimesters, the growing uterus exerts pressure on the bladder, leading to increased urinary frequency and urgency. This is exacerbated in the third trimester by the phenomenon of “lightening,” when the baby’s head engages in the pelvis.
A pregnant woman at 24 weeks gestation reports a decrease in urinary urgency compared to her first trimester. The nurse explains that this is likely due to:
A. Decreased blood flow to the kidneys
B. Increased physical activity
C. The uterus moving into the abdominal cavity, relieving bladder pressure
D. Reduced fluid intake
C. The uterus moving into the abdominal cavity, relieving bladder pressure
Rationale: During the second trimester, the uterus moves upward into the abdominal cavity, relieving pressure on the bladder and decreasing urinary urgency.
What is “lightening” in the context of pregnancy, and how does it affect urinary symptoms?
A. It refers to hormonal changes that cause increased thirst.
B. It is when the baby drops into the pelvis, increasing urinary frequency in the third trimester.
C. It describes a decrease in fetal movements.
D. It involves increased uterine contractions.
B. It is when the baby drops into the pelvis, increasing urinary frequency in the third trimester.
Rationale: “Lightening” refers to the baby descending into the pelvis toward the end of the third trimester, which often increases urinary frequency due to added pressure on the bladder.
Why do hormonal changes contribute to urinary changes in pregnancy?
A. They reduce blood flow to the bladder.
B. Hormones cause relaxation of smooth muscle, including the bladder and ureters.
C. They decrease kidney function during pregnancy.
D. Hormones limit the sensation of fullness
B. Hormones cause relaxation of smooth muscle, including the bladder and ureters.
Rationale: Hormonal changes, particularly increased levels of progesterone, cause smooth muscle relaxation, including in the bladder and ureters, which can lead to urinary frequency and incomplete bladder emptying.
A pregnant client in her second trimester is less likely to experience urinary urgency compared to the first trimester. This is because:
A. The baby is too small to exert pressure on the bladder.
B. Hormonal levels stabilize, reducing the need to urinate.
C. The uterus has shifted into the abdominal cavity, relieving bladder pressure.
D. The kidneys produce less urine during this period.
C. The uterus has shifted into the abdominal cavity, relieving bladder pressure.
Rationale: As the uterus grows and moves into the abdominal cavity during the second trimester, it reduces pressure on the bladder, leading to a decrease in urinary urgency.
Increased urinary frequency during the third trimester can contribute to:
A. Reduced fluid intake due to fear of nocturia
B. Increased bladder capacity
C. Improved sleep due to decreased discomfort
D. Increased risk of urinary tract infections (UTIs)
D. Increased risk of urinary tract infections (UTIs)
Rationale: Increased urinary frequency and hormonal changes during pregnancy can lead to incomplete emptying of the bladder, increasing the risk of urinary tract infections (UTIs) during the third trimester.
A pregnant woman asks about the dark line appearing on her abdomen during pregnancy. The nurse explains that this line is known as:
A. Striae gravidarum
B. Linea alba
C. Linea nigra
D. Vascular spider
C. Linea nigra
Rationale: Linea nigra is the dark line that forms on the abdomen during pregnancy, running from the symphysis pubis to the top of the fundus due to hormonal changes and increased melanin production.
What causes hyperpigmentation changes, such as the “mask of pregnancy” or melasma, during pregnancy?
A. Increased blood circulation
B. Changes in connective tissue
C. Hormonal changes, particularly increased estrogen and progesterone
D. Poor diet during pregnancy
C. Hormonal changes, particularly increased estrogen and progesterone
Rationale: Hyperpigmentation, including melasma, is caused by hormonal changes during pregnancy, primarily increased levels of estrogen and progesterone, which stimulate melanin production.
A pregnant woman expresses concern about the reddish, raised veins on her legs. The nurse identifies these as:
A. Striae gravidarum
B. Linea nigra
C. Varicosities (varicose veins)
D. Pruritus
C. Varicosities (varicose veins)
Rationale: Varicosities, or varicose veins, are common during pregnancy due to increased blood volume, hormonal effects on vessel walls, and poor circulation from prolonged standing.
Striae gravidarum, commonly known as stretch marks, are caused by:
A. Increased melanin production
B. Connective tissue changes and stretching of the skin
C. Hormonal changes only
D. Excessive vitamin intake during pregnancy
B. Connective tissue changes and stretching of the skin
Rationale: Stretch marks, or striae gravidarum, occur due to changes in the connective tissue and stretching of the skin as the body grows during pregnancy.
The presence of vascular spiders (spider veins) during pregnancy is related to:
A. Increased levels of estrogen causing dilation of small blood vessels
B. Compression of the inferior vena cava
C. Reduced vascular blood flow
D. Increased abdominal pressure
A. Increased levels of estrogen causing dilation of small blood vessels
Rationale: Vascular spiders, or spider veins, are small, dilated blood vessels caused by elevated levels of estrogen, which promote dilation of capillaries.
During pregnancy, some women experience redness of the palms known as palmar erythema. This change is primarily due to:
A. Increased melanin levels
B. Changes in connective tissue elasticity
C. Increased blood flow and hormonal changes
D. Deficiency in iron
C. Increased blood flow and hormonal changes
Rationale: Palmar erythema, or redness of the palms, is common in pregnancy due to increased blood flow and hormonal changes that cause capillary dilation.
A nurse explains to a pregnant client that pruritus, specifically related to PUPPP (pruritic urticarial papules and plaques of pregnancy), is:
A. Caused by excess sweating
B. A harmless but itchy skin rash seen late in pregnancy
C. An indication of an allergic reaction
D. A rare skin condition that occurs only after delivery
B. A harmless but itchy skin rash seen late in pregnancy
Rationale: PUPPP is a benign skin condition that causes intense itching and a rash, typically developing late in pregnancy, and resolves after delivery.
Intrahepatic cholestasis of pregnancy (ICP) is a condition associated with:
A. Hormonal changes causing increased pigmentation
B. Liver dysfunction leading to severe itching without a rash
C. Excessive sweating during pregnancy
D. Poor blood circulation in the lower limbs
B. Liver dysfunction leading to severe itching without a rash
Rationale: ICP is a liver condition in pregnancy that causes severe itching without a rash due to elevated bile acids and requires careful monitoring due to potential risks to the fetus.
Increased hair and nail growth during pregnancy is attributed to:
A. Decreased estrogen levels
B. Increased levels of androgens
C. Enhanced blood flow and hormonal changes
D. Poor diet during the first trimester
C. Enhanced blood flow and hormonal changes
Rationale: Hormonal changes and increased blood flow during pregnancy often lead to increased hair and nail growth, although changes may reverse after delivery.
What factor primarily contributes to the development of varicosities in pregnant women?
A. Decreased fluid intake
B. Connective tissue elasticity changes
C. Increased blood volume and poor circulation due to standing
D. Lack of exercise during pregnancy
C. Increased blood volume and poor circulation due to standing
Rationale: Varicosities are caused by increased blood volume and poor circulation, especially when standing for long periods, as well as hormonal influences that affect the veins.
A pregnant woman expresses conflicting feelings about her upcoming baby, stating she is both excited and anxious. This emotional response is best described as:
A. Mood swings
B. Introversion
C. Ambivalence
D. Acceptance
C. Ambivalence
Rationale: Ambivalence refers to mixed or contradictory feelings, which is common in early pregnancy as women adjust to the impending arrival of a baby and the changes it brings.
Which emotional response is characterized by a pregnant woman’s increased focus on her own body and physical changes?
A. Acceptance
B. Mood swings
C. Ambivalence
D. Introversion
D. Introversion
Rationale: Introversion is common during pregnancy, involving a heightened focus on the woman’s body and physical changes as she adapts to pregnancy.
As pregnancy progresses and a woman becomes more accustomed to the idea of becoming a mother, her emotional response is best described as:
A. Introversion
B. Acceptance
C. Ambivalence
D. Mood swings
B. Acceptance
Rationale: Acceptance occurs as a woman adapts to the reality of pregnancy and prepares for her role as a mother, reflecting a positive adjustment to her changing situation.
A nurse is educating a pregnant woman who reports frequent mood swings. The nurse explains that these mood swings are primarily due to:
A. Stress from financial concerns
B. Hormonal influences related to pregnancy
C. Lack of adequate nutrition
D. Physical inactivity
B. Hormonal influences related to pregnancy
Rationale: Mood swings during pregnancy are largely influenced by hormonal changes that can cause fluctuations in emotional states, which is normal and expected.
A nurse is educating a pregnant woman in her third trimester about the role of prostaglandins in labor. Which of the following statements by the nurse is most accurate regarding prostaglandins during labor?
A) Prostaglandins inhibit uterine contractions to prolong pregnancy.
B) Prostaglandins enhance the sensitivity of the uterus to oxytocin, promoting uterine contractions.
C) Prostaglandins decrease the secretion of progesterone, leading to early labor.
D) Prostaglandins are responsible for the softening and dilation of the cervix before labor.
B) Prostaglandins enhance the sensitivity of the uterus to oxytocin, promoting uterine contractions.
Rationale: Prostaglandins play a key role in initiating labor by increasing the uterus’ sensitivity to oxytocin, which enhances uterine contractions. They also aid in cervical ripening and softening, preparing the cervix for delivery.
A pregnant patient at 39 weeks gestation is receiving prostaglandin gel as part of her induction of labor. The nurse understands that prostaglandins in this context primarily function to:
A) Increase the production of estrogen to stimulate labor.
B) Stimulate uterine contractions by enhancing oxytocin activity.
C) Increase progesterone production to maintain pregnancy.
D) Relax the uterine muscles to prevent preterm labor.
B) Stimulate uterine contractions by enhancing oxytocin activity.
Rationale: Prostaglandins are used in labor induction because they increase the uterus’ responsiveness to oxytocin, stimulating uterine contractions and promoting cervical ripening. This action is critical for initiating labor.
A nurse is monitoring a client who has received prostaglandin E2 (dinoprostone) for cervical ripening prior to labor induction. Which of the following is the most important to assess for in the immediate postpartum period?
A) Hyperthermia
B) Tachycardia
C) Uterine hyperstimulation
D) Hypoglycemia
C) Uterine hyperstimulation
Rationale: Prostaglandins, such as dinoprostone, can cause uterine hyperstimulation, which is excessive uterine contractions that can lead to fetal distress or uterine rupture. Close monitoring for this complication is essential.
A pregnant woman in her first trimester is experiencing frequent urination. Which of the following is the best explanation for this symptom?
A) The growing uterus is compressing the bladder, causing increased frequency.
B) Increased blood volume is leading to more urine production.
C) Hormonal changes increase kidney filtration, causing excess urine production.
D) Urinary tract infections are common in early pregnancy and should be investigated.
A) The growing uterus is compressing the bladder, causing increased frequency.
Rationale: During early pregnancy, hormonal changes and the growing uterus put pressure on the bladder, leading to increased urinary frequency. This symptom typically resolves in the second trimester as the uterus rises out of the pelvic cavity.
A woman at 10 weeks gestation reports feeling extremely fatigued. Which of the following is the most appropriate response by the nurse?
A) “Fatigue is usually a sign of anemia, so you should schedule an iron supplement.”
B) “Fatigue is a common symptom during the first trimester due to hormonal changes.”
C) “You may need to decrease your physical activity to avoid fatigue.”
D) “Fatigue should resolve once the placenta takes over progesterone production.”
B) “Fatigue is a common symptom during the first trimester due to hormonal changes.”
Rationale: Fatigue is a common discomfort in the first trimester of pregnancy, typically due to rising levels of progesterone and other hormonal changes. It usually improves in the second trimester.
A pregnant woman in her first trimester is experiencing nausea and vomiting. What is the nurse’s primary recommendation for managing these symptoms?
A) Avoiding eating at all to prevent triggering nausea.
B) Eating small, frequent meals and avoiding greasy foods.
C) Taking over-the-counter anti-nausea medications daily.
D) Lying down immediately after eating to avoid vomiting.
B) Eating small, frequent meals and avoiding greasy foods.
Rationale: Nausea and vomiting, often referred to as “morning sickness,” are common in the first trimester. It is helpful to eat small, frequent meals, avoid greasy and spicy foods, and keep a light snack available in the morning to manage symptoms.
A 9-week pregnant woman is complaining of tender and swollen breasts. The nurse recognizes that this symptom is most likely due to:
A) Increased blood flow and hormonal changes preparing the breasts for lactation.
B) Excessive weight gain early in pregnancy.
C) A possible infection of the mammary glands.
D) A result of a high-fat diet causing hormonal fluctuations.
A) Increased blood flow and hormonal changes preparing the breasts for lactation.
Rationale: Breast tenderness and swelling during the first trimester are common due to hormonal changes, particularly increased estrogen and progesterone, which prepare the breasts for lactation.
A pregnant woman at 12 weeks gestation asks the nurse about managing constipation, which she has been experiencing. The nurse’s best advice would be to:
A) Increase intake of fiber-rich foods and drink plenty of water.
B) Use over-the-counter laxatives regularly for relief.
C) Limit the intake of dairy products to prevent constipation.
D) Avoid exercise and rest to reduce pressure on the intestines.
A) Increase intake of fiber-rich foods and drink plenty of water.
Rationale: Constipation is common during pregnancy, especially in the first trimester, due to hormonal changes that slow down the digestive system. Increasing fiber intake, drinking water, and staying active can help alleviate constipation.
A pregnant woman in her first trimester is experiencing nasal stuffiness, bleeding gums, and occasional nosebleeds. Which of the following would be the nurse’s most appropriate response?
A) “These symptoms are typical in pregnancy due to hormonal changes and increased blood flow.”
B) “You should see a dentist for the bleeding gums and start a nasal decongestant immediately.”
C) “These symptoms are a sign of an underlying infection that needs medical treatment.”
D) “Nosebleeds are abnormal in pregnancy, and you should report them to your healthcare provider.”
A) “These symptoms are typical in pregnancy due to hormonal changes and increased blood flow.”
Rationale: Nasal stuffiness, bleeding gums, and nosebleeds are common due to increased blood volume and hormonal changes during pregnancy. They typically resolve as the pregnancy progresses.
A 10-week pregnant woman reports experiencing cravings for certain foods. The nurse understands that cravings during pregnancy are most commonly caused by:
A) Nutritional deficiencies that the body tries to correct through cravings.
B) Emotional stress and anxiety during pregnancy.
C) Hormonal changes and the body’s need for additional calories.
D) Excessive weight gain causing an increased appetite for comfort foods.
C) Hormonal changes and the body’s need for additional calories.
Rationale: Food cravings in pregnancy are thought to be caused by hormonal changes, particularly the increase in hCG and progesterone, and the body’s increased nutritional demands, although they are often not tied to actual deficiencies.
A woman in her first trimester reports noticing a white vaginal discharge that is odorless and not irritating. The nurse understands that this is most likely:
A) A sign of a vaginal infection that requires immediate treatment.
B) A normal symptom due to increased blood flow and hormonal changes.
C) A sign of a miscarriage and requires urgent evaluation.
D) Caused by dehydration and requires fluid replacement.
B) A normal symptom due to increased blood flow and hormonal changes.
Rationale: Leukorrhea, a thin, white vaginal discharge, is common in pregnancy due to hormonal changes and increased blood flow. As long as it is odorless and non-irritating, it is considered normal and does not typically require treatment.
A pregnant woman in her second trimester complains of lower back pain. Which of the following interventions is most appropriate for relieving her backache?
A) Encourage the woman to avoid lifting any objects to prevent straining her back.
B) Recommend wearing a back support belt and practicing good posture.
C) Advise strict bed rest to reduce pressure on the back.
D) Suggest taking hot baths and applying cold compresses to the back.
B) Recommend wearing a back support belt and practicing good posture.
Rationale: Lower back pain in pregnancy is common due to the growing uterus and changes in posture. Using a back support belt and practicing proper posture can alleviate strain. Bed rest is not typically recommended, and alternating heat or cold may provide temporary relief but does not address the root cause.
A woman in her second trimester reports developing varicosities in the vulva and legs. What should the nurse advise her to do to manage this discomfort?
A) Avoid prolonged standing and elevate the legs when sitting or lying down.
B) Wear tight-fitting stockings to prevent further varicosities.
C) Apply heat packs to the legs and vulva to promote blood circulation.
D) Increase physical activity and avoid sitting to prevent swelling.
A) Avoid prolonged standing and elevate the legs when sitting or lying down.
Rationale: Varicosities during pregnancy are caused by increased blood volume and pressure on the veins. Elevating the legs and avoiding prolonged standing or sitting can help reduce swelling and discomfort. Tight-fitting stockings should be avoided unless specifically recommended by a healthcare provider.
A woman at 24 weeks gestation complains of hemorrhoids, which are causing pain and discomfort. Which of the following interventions should the nurse recommend to manage this discomfort?
A) Encourage the woman to perform deep breathing exercises to relax.
B) Suggest warm sitz baths and the use of hemorrhoid cream or witch hazel.
C) Recommend increasing physical activity to relieve constipation.
D) Advise using laxatives to soften stools and avoid further straining.
B) Suggest warm sitz baths and the use of hemorrhoid cream or witch hazel.
Rationale: Hemorrhoids are common during pregnancy due to increased blood volume and pressure from the growing uterus. Warm sitz baths and topical treatments like hemorrhoid creams or witch hazel can relieve discomfort. Constipation management through dietary changes is also beneficial but should be done without over-relying on laxatives.
A pregnant woman in her second trimester reports flatulence and bloating. Which of the following is the most likely cause of these symptoms?
A) Hormonal changes causing gastrointestinal motility to slow down.
B) The uterus compressing the intestines and decreasing digestion.
C) A vitamin deficiency leading to an upset stomach and bloating.
D) Excessive intake of fiber-rich foods causing increased gas production.
A) Hormonal changes causing gastrointestinal motility to slow down.
Rationale: Flatulence and bloating in pregnancy are commonly caused by hormonal changes, particularly increased progesterone, which slows gastrointestinal motility and leads to more gas buildup. The growing uterus can also contribute to these symptoms by putting pressure on the intestines.
A pregnant woman in her third trimester complains of experiencing the return of nausea and vomiting, similar to what she experienced during the first trimester. Which of the following is the most appropriate response by the nurse?
A) “This is a sign of a serious complication, and you should seek immediate medical care.”
B) “Morning sickness can return in the third trimester due to increased progesterone levels.”
C) “You are likely experiencing food poisoning, and it is best to avoid eating for 24 hours.”
D) “The return of nausea and vomiting in the third trimester is unusual and should be investigated further.”
B) “Morning sickness can return in the third trimester due to increased progesterone levels.”
Rationale: Although nausea and vomiting are most common in the first trimester, some women experience a return of symptoms in the third trimester due to increased progesterone levels and the pressure of the growing uterus on the stomach.
A 34-week pregnant woman reports shortness of breath and dyspnea. Which of the following is the most likely cause of this symptom in the third trimester?
A) The growing uterus is putting pressure on the diaphragm, reducing lung expansion.
B) The increase in circulating blood volume is causing fluid accumulation in the lungs.
C) Decreased hemoglobin levels due to pregnancy are causing hypoxia.
D) Hormonal changes are leading to restricted airways and difficulty breathing.
A) The growing uterus is putting pressure on the diaphragm, reducing lung expansion.
Rationale: Shortness of breath and dyspnea in the third trimester are commonly caused by the growing uterus pressing against the diaphragm, which limits lung expansion and decreases respiratory capacity.
A pregnant woman in her third trimester reports frequent heartburn and indigestion. Which of the following interventions should the nurse recommend?
A) Taking over-the-counter antacids as needed for relief.
B) Eating large meals throughout the day to ensure proper digestion.
C) Avoiding foods that are spicy, acidic, or fatty, and eating smaller meals.
D) Lying down immediately after meals to help with digestion.
C) Avoiding foods that are spicy, acidic, or fatty, and eating smaller meals.
Rationale: Heartburn and indigestion are common in the third trimester due to the growing uterus pressing on the stomach and slowing digestion. Eating smaller meals, avoiding trigger foods (such as spicy, acidic, or fatty foods), and not lying down immediately after eating can help alleviate these symptoms.
A 36-week pregnant woman is experiencing dependent edema in her legs and feet. Which of the following interventions should the nurse recommend to alleviate this discomfort?
A) Keeping the legs elevated and avoiding prolonged standing or sitting.
B) Applying tight stockings to reduce swelling in the legs.
C) Increasing salt intake to reduce the fluid retention in the legs.
D) Engaging in intense exercise to increase circulation and reduce swelling.
A) Keeping the legs elevated and avoiding prolonged standing or sitting.
Rationale: Dependent edema in pregnancy is caused by increased blood volume and pressure from the growing uterus. Elevating the legs and avoiding prolonged standing or sitting helps reduce swelling by promoting better circulation and reducing fluid retention.
A pregnant woman at 38 weeks gestation reports experiencing Braxton Hicks contractions. Which of the following is the most appropriate explanation the nurse should provide?
A) “These are early signs of labor, and you should go to the hospital immediately.”
B) “Braxton Hicks contractions are irregular and typically occur as the body prepares for labor.”
C) “You should monitor the contractions carefully, as they may indicate preterm labor.”
D) “These contractions are a result of too much physical activity, and you should rest more.”
B) “Braxton Hicks contractions are irregular and typically occur as the body prepares for labor.”
Rationale: Braxton Hicks contractions, also known as “practice contractions,” are irregular and painless contractions that occur in the third trimester. They are a normal part of pregnancy and help the body prepare for labor. They do not indicate true labor or preterm labor unless they become regular and painful.
a positive result on a pregnancy test is a __________ sign of pregnancy.
Presumptive
Probable
Positive
Negative
Probable
What cranial nerve causes Bell Palsy during pregnancy?
cranial nerve VII
What viruses cause Bell Palsy during pregnancy?
Can be caused by HSV or other viral infections, varicella, Epstein-barr
