Exam 1 - Chapter 13

Question 1

A womans obstetric history indicates that she is pregnant for the fourth time, and all of
her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins
were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is
her gravidity and parity using the GTPAL system?
a. 3-1-1-1-3
b. 4-1-2-0-4
c. 3-0-3-0-3
d. 4-2-1-0-3

Answer 1

B - Using the GTPAL system, 4-1-2-0-4 is the correct calculation of this womans gravidity and
parity. The numbers reflect the womans gravidity and parity information. Her information is
calculated as: G reflects the total number of times the woman has been pregnant; she is pregnant
for the fourth time. T indicates the number of pregnancies carried to term, not the number of
deliveries at term; only one of her pregnancies resulted in a fetus at term. P is the number of
pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she
delivered preterm. A signifies whether the woman has had any abortions or miscarriages before
the period of viability; she has not

Question 2

Which presumptive sign or symptom of pregnancy would a client experience who is 
approximately 10 weeks of gestation?
a. Amenorrhea
b. Positive pregnancy test
c. Chadwick sign
d. Hegar sign

Answer 2

A - Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt
by the woman. A positive pregnancy test and the presence of the Chadwick and Hegar signs are
all probable signs of pregnancy

Question 3

A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At
which level does the nurse expect to palpate the fundus?
a. Nonpalpable above the symphysis at 14 weeks of gestation
b. Slightly above the symphysis pubis
c. At the level of the umbilicus
d. Slightly above the umbilicus

Answer 3

B - In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the
symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows,
it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of
pregnancy. At 14 weeks, the uterus is not yet at the level of the umbilicus. The fundus is not
palpable above the umbilicus until 22 to 24 weeks of gestation.

Question 4

The musculoskeletal system adapts to the changes that occur throughout the pregnancy.
Which musculoskeletal alteration should the client expect?
a. Her center of gravity will shift backward.
b. She will have increased lordosis.
c. She will have increased abdominal muscle tone.
d. She will notice decreased mobility of her pelvic joints.

Answer 4

B - An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature
in the cervicodorsal region develops to help her maintain balance. The center of gravity shifts
forward. She will have decreased abdominal muscle tone and will notice increased mobility of
her pelvic joints.

Question 5

A 31-year-old woman believes that she may be pregnant. She took an over-the-counter
(OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her
assessment interview, the nurse inquires about the womans last menstrual period and asks
whether she is taking any medications. The client states that she takes medicine for epilepsy. She
has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms
that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?
a. The pregnancy test was taken too early.
b. Anticonvulsant medications may cause the false-positive test result.
c. The woman has a fibroid tumor.
d. She has been under considerable stress and has a hormone imbalance.

Answer 5

B - Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use 
enzyme-linked immunosorbent assay (ELISA) technology, which can yield positive results as 
soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the 
woman were pregnant, then she would be into her third week at this point (having missed her 
period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on human 
chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt normal hormone 
cycles (menstrual cycles), it does not affect hCG levels or produce positive pregnancy test 
results.

Question 6

A woman is in her seventh month of pregnancy. She has been complaining of nasal
congestion and occasional epistaxis. Which statement best describes why this may be happening
to this client?
a. This respiratory change is normal in pregnancy and caused by an elevated level of
estrogen.
b. This cardiovascular change is abnormal, and the nosebleeds are an ominous sign.
c. The woman is a victim of domestic violence and is being hit in the face by her partner.
d. The woman has been intranasally using cocaine.

Answer 6

A - Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which
may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal
stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in the lower
extremities. Domestic violence cannot be determined on the basis on the sparse facts provided. If
the woman had been hit in the face, then she most likely would have additional physical findings.
Cocaine use cannot be determined on the basis on the sparse facts provided.

Question 7

The nurse is providing education to a client regarding the normal changes of the breasts
during pregnancy. Which statement regarding these changes is correct?
a. The visibility of blood vessels that form an intertwining blue network indicates full
function of the Montgomery tubercles and possibly an infection of the tubercles.
b. The mammary glands do not develop until 2 weeks before labor.
c. Lactation is inhibited until the estrogen level declines after birth.
d. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

Answer 7

C - Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal
outgrowth of a richer blood supply. The mammary glands are functionally complete by
midpregnancy. Colostrum is a creamy white-to-yellow premilk fluid that can be expressed from
the nipples before birth.

Question 8

Which hormone is essential for maintaining pregnancy?

a. Estrogen
b. hCG
c. Oxytocin
d. Progesterone

Answer 8

D - Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles,
which reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy,
but it is not the primary hormone for maintaining pregnancy. hCG levels rise at implantation but
decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

Question 9

Which clinical finding in a primiparous client at 32 weeks of gestation might be an 
indication of anemia?
a. Ptyalism
b. Pyrosis
c. Pica
d. Decreased peristalsis

Answer 9

C - Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be

evaluated. Cravings include ice, clay, and laundry starch. Ptyalism (excessive salivation), pyrosis
(heartburn) , and decreased peristalsis are normal findings.

Question 10

Why might it be more difficult to diagnose appendicitis during pregnancy?

a. The appendix is displaced upward and laterally, high and to the right.
b. The appendix is displaced upward and laterally, high and to the left.
c. The appendix is deep at the McBurneys point.
d. The appendix is displaced downward and laterally, low and to the right.

Answer 10

A - The appendix is displaced high and to the right, not to the left. It is displaced beyond the
McBurneys point and is not displaced in a downward direction.

Question 11

The nurse is providing health education to a pregnant client regarding the cardiovascular
system. Which information is correct and important to share?
a. A pregnant woman experiencing disturbed cardiac rhythm, such as sinus arrhythmia,
requires close medical and obstetric observation no matter how healthy she may appear
otherwise.
b. Changes in heart size and position and increases in blood volume create auditory changes
from 20 weeks of gestation to term.
c. Palpitations are twice as likely to occur in twin gestations.
d. All of the above changes will likely occur.

Answer 11

B - These auscultatory changes should be discernible after 20 weeks of gestation. A healthy woman
with no underlying heart disease does not need any therapy. The maternal heart rate increases in
the third trimester, but palpitations may not necessarily occur, let alone double. Auditory changes
are discernible at 20 weeks of gestation.

Question 12

Which statement regarding the probable signs of pregnancy is most accurate?

a. Determined by ultrasound
b. Observed by the health care provider
c. Reported by the client
d. Confirmed by diagnostic tests

Answer 12

B - Probable signs are those detected through trained examination. Fetal visualization is a positive
sign of pregnancy. Presumptive signs are those reported by the client. The term diagnostic tests
is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs
of pregnancy.

Question 13

Which time-based description of a stage of development in pregnancy is correct?
a. Viability22 to 37 weeks of gestation since the last menstrual period (assuming a fetal
weight greater than 500 g)
b. Term pregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks of
gestation
c. Preterm pregnancy from 20 to 28 weeks of gestation
d. Postdate pregnancy that extends beyond 38 weeks of gestation

Answer 13

B - Term is 38 to 42 weeks of gestation. Viability is the ability of the fetus to live outside the uterus
before coming to term, or 22 to 24 weeks since the last menstrual period. Preterm is 20 to 37
weeks of gestation. Postdateor postterm is a pregnancy that extends beyond 42 weeks of
gestation or what is considered the limit of full term

Question 14

hCG is an important biochemical marker for pregnancy and therefore the basis for many
tests. Which statement regarding hCG is true?
a. hCG can be detected as early as weeks after conception.
b. hCG levels gradually and uniformly increase throughout pregnancy.
c. Significantly lower-than-normal increases in the levels of hCG may indicate a postdate
pregnancy.
d. Higher-than-normal levels of hCG may indicate an ectopic pregnancy or Down
syndrome.

Answer 14

D - Higher hCG levels also could be a sign of a multiple gestation. hCG can be detected as early as 7
to 10 days after conception. The hCG levels fluctuate during pregnancy, peaking, declining,
stabilizing, and then increasing again. Abnormally slow increases may indicate impending
miscarriage.

Question 15

Of which physiologic alteration of the uterus during pregnancy is it important for the
nurse to alert the patient?
a. Lightening occurs near the end of the second trimester as the uterus rises into a different
position.
b. Womans increased urinary frequency in the first trimester is the result of exaggerated
uterine antireflexion caused by softening.
c. Braxton Hicks contractions become more painful in the third trimester, particularly if the
woman tries to exercise.
d. Uterine souffle is the movement of the fetus.

Answer 15

B - The softening of the lower uterine segment is called the Hegar sign. In this position, the uterine
fundus presses on the bladder, causing urinary frequency that is a normal change of pregnancy.
Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks
contractions become more defined in the final trimester but are not painful. Walking or exercise
usually causes them to stop. The uterine souffle is the sound made by blood in the uterine
arteries; it can be heard with a fetal stethoscope.

Question 16

What is the correct term used to describe the mucous plug that forms in the endocervical 
canal?
a. Operculum
b. Leukorrhea
c. Funic souffle
d. Ballottement

Answer 16

A - The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the
endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the
umbilical vessels. Ballottement is a technique for palpating the fetus.

Question 17

Some pregnant clients may complain of changes in their voice and impaired hearing.
What should the nurse explain to the client concerning these findings?
a. Voice changes are caused by decreased estrogen levels.
b. Displacement of the diaphragm results in thoracic breathing.
c. Voice changes and impaired hearing are due to the results of congestion and swelling of
the upper respiratory tract.
d. Increased blood volume causes changes in the voice.

Answer 17

C - Although the diaphragm is displaced and the volume of blood is increased, neither causes
changes in the voice nor impairs hearing. The key is that estrogen levels increase, not decrease,
which causes the upper respiratory tract to become more vascular, which produces swelling and
congestion in the nose and ears and therefore voice changes and impaired hearing.

Question 18

Which renal system adaptation is an anticipated anatomic change of pregnancy?
a. Increased urinary output makes pregnant women less susceptible to urinary infections.
b. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus
result in the urge to urinate even when the bladder is almost empty.
c. Renal (kidney) function is more efficient when the woman assumes a supine position.
d. Using diuretic agents during pregnancy can help keep kidney function regular.

Answer 18

B - Bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate
more often, even when the bladder is almost empty. A number of anatomic changes in pregnancy
make a woman more susceptible to urinary tract infections. Renal function is more efficient
when the woman lies in the lateral recumbent position and is less efficient when she is supine.
Diuretic use during pregnancy can overstress the system and cause problems.

Question 19

A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring
over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition
related to hormonal changes. What is the correct term for this integumentary finding?
a. Melasma
b. Linea nigra
c. Striae gravidarum
d. Palmar erythema

Answer 19

A - Melasma, (also called chloasma, the mask of pregnancy), usually fades after birth. This
hyperpigmentation of the skin is more common in women with a dark complexion. Melasma
appears in 50% to 70% of pregnant women. Linea nigra is a pigmented line that runs vertically
up the abdomen. Striae gravidarum are also known as stretch marks. Palmar erythema is
signified by pinkish red blotches on the hands.

Question 20

Which gastrointestinal alteration of pregnancy is a normal finding?

a. Insufficient salivation (ptyalism) is caused by increases in estrogen.
b. Acid indigestion (pyrosis) begins early but declines throughout pregnancy.
c. Hyperthyroidism often develops (temporarily) because hormone production increases.
d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial

Answer 20

D - Normal nausea and vomiting rarely produce harmful effects and may be less likely to result in
miscarriage or preterm labor. Ptyalism is excessive salivation that may be caused by a decrease
in unconscious swallowing or by stimulation of the salivary glands. Pyrosis begins as early as the
first trimester and intensifies through the third trimester. Increased hormone production does not
lead to hyperthyroidism in pregnant women.

Question 21

A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal
visit. The client tells the nurse that she is afraid that she is going into premature labor because
she is beginning to have regular contractions. The nurse explains that these are Braxton Hicks
contractions. What other information is important for the nurse to share?
a. Braxton Hicks contractions should be painless.
b. They may increase in frequency with walking.
c. These contractions might cause cervical dilation.
d. Braxton Hicks contractions will impede oxygen flow to the fetus.

Answer 21

A - Soon after the fourth month of gestation, uterine contractions can be felt through the abdominal
wall. Braxton Hicks contractions are regular and painless and continue throughout the
pregnancy. Although they are not painful, some women complain that they are annoying. This
type of contraction usually ceases with walking or exercise. Braxton Hicks contractions can be
mistaken for true labor; however, they do not increase in intensity, frequency, or cause cervical
dilation. These contractions facilitate uterine blood flow through the intervillous spaces of the
placenta and thereby promote oxygen delivery to the fetus.

Question 22

Pregnancy hormones prepare the vagina for stretching during labor and birth. Which
change related to the pelvic viscera should the nurse share with the client?
a. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are
easier to evaluate.
b. Quickening is a technique of palpating the fetus to engage it in passive movement.
c. The deepening color of the vaginal mucosa and cervix (Chadwick sign) usually appears
in the second trimester or later as the vagina prepares to stretch during labor.
d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of
arousal, especially in the second trimester

Answer 22

D - Increased sensitivity and an increased interest in sex sometimes go together and frequently occur
during the second trimester. These cervical changes make evaluation of abnormal Pap tests more
difficult. Quickening is the first recognition of fetal movements by the mother. Ballottement is a
technique used to palpate the fetus. The Chadwick sign appears from the 6 to 8 weeks of
gestation.

Question 23

Numerous changes in the integumentary system occur during pregnancy. Which change 
persists after birth?
a. Epulis
b. Chloasma
c. Telangiectasia
d. Striae gravidarum

Answer 23

D - Striae gravidarum, or stretch marks, reflect a separation within the underlying connective tissue
of the skin. They usually fade after birth, although they never completely disappear. An epulis is
a red, raised nodule on the gums that easily bleeds; it disappears or shrinks after giving birth.
Chloasma, or the mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the
cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually
fades after the birth. Telangiectasia, or vascular spiders, are tiny, star-shaped or branchlike,
slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They
occur as a result of elevated levels of circulating estrogen and usually disappear after birth

Question 24

What is the correct term for a woman who has completed one pregnancy with a fetus (or

fetuses) reaching the stage of fetal viability?
a. Primipara
b. Primigravida
c. Multipara
d. Nulligravida

Answer 24

A - A primipara is a woman who has completed one pregnancy with a viable fetus. To help
remember the terms: gravida is a pregnant woman; para comes from parity, meaning a viable
fetus; primi means first; multi means many; and null means none. Therefore, a primigravida is a
woman pregnant for the first time; a multipara is a woman who has completed two or more
pregnancies with a viable fetus; and a nulligravida is a woman who has never been pregnant

Question 25

To reassure and educate their pregnant clients regarding changes in their blood pressure,
nurses should be cognizant of what?
a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is
too large produces a reading that is too high.
b. Shifting the clients position and changing from arm to arm for different measurements
produces the most accurate composite blood pressure reading at each visit.
c. Systolic blood pressure slightly increases as the pregnancy advances; diastolic pressure
remains constant.
d. Compression of the iliac veins and inferior vena cava by the uterus contributes to
hemorrhoids in the later stage of a term pregnancy.

Answer 25

D - Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in
the later stage of a term pregnancy. This compression also leads to varicose veins in the legs and
vulva. The tightness of a blood pressure cuff that is too small produces a reading that is too high;
similarly, the looseness of a cuff that is too large results in a reading that is too low. Because
maternal positioning affects readings, blood pressure measurements should be obtained in the
same arm and with the woman in the same position. The systolic blood pressure generally
remains constant but may decline slightly as the pregnancy advances. The diastolic blood
pressure first decreases and then gradually increases

Question 26

Which finding in the urinalysis of a pregnant woman is considered a variation of normal?

a. Proteinuria
b. Glycosuria
c. Bacteria in the urine
d. Ketones in the urine

Answer 26

B - Small amounts of glucose may indicate physiologic spilling. The presence of protein could
indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in
the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an
inadequate fluid and food intake.

Question 27

Cardiac output increases from 30% to 50% by the 32nd week of pregnancy. What is the
rationale for this change?
a. To compensate for the decreased renal plasma flow
b. To provide adequate perfusion of the placenta
c. To eliminate metabolic wastes of the mother
d. To prevent maternal and fetal dehydration

Answer 27

B - The primary function of increased vascular volume is to transport oxygen and nutrients to the
fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling
metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular
volume.

Question 28

Which statement best describes the rationale for the physiologic anemia that occurs
during pregnancy?
a. Physiologic anemia involves an inadequate intake of iron.
b. Dilution of hemoglobin concentration occurs in pregnancy with physiologic anemia.
c. Fetus establishes the iron stores.
d. Decreased production of erythrocytes occur.

Answer 28

B - When blood volume expansion is more pronounced and occurs earlier than the increase in red
blood cells, the woman has physiologic anemia, which is the result of the dilution of hemoglobin
concentration rather than inadequate hemoglobin. An inadequate intake of iron may lead to true
anemia. The production of erythrocytes increases during pregnancy.

Question 29

A patient in her first trimester complains of nausea and vomiting. She asks, Why does
this happen? What is the nurses best response?
a. Nausea and vomiting are due to an increase in gastric motility.
b. Nausea and vomiting may be due to changes in hormones.
c. Nausea and vomiting are related to an increase in glucose levels.
d. Nausea and vomiting are caused by a decrease in gastric secretions.

Answer 29

B - Nausea and vomiting are believed to be caused by increased levels of hormones, decreased
gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels
decrease in the first trimester. Although gastric secretions decrease, these secretions are not the
primary cause of the nausea and vomiting.

Question 30

The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all 
that apply.)
a. Identification of fetal heartbeat
b. Palpation of fetal outline
c. Visualization of the fetus
d. Verification of fetal movement
e. Positive hCG test

Answer 30

A,C,D - Identification of a fetal heartbeat, the visualization of the fetus, and verification of fetal
movement are all positive, objective signs of pregnancy

Question 31

A woman is in for a routine prenatal checkup. The nurse is assessing her urine for
glycosuria and proteinuria. Which findings are considered normal? (Select all that apply.)
a. Dipstick assessment of trace to +1
b. <300 mg/24 hours
c. Dipstick assessment of +2 glucose
d. >300 mg/24 hours
e. Albumin < 30 mg/24 hours

Answer 31

A,B,E - Small amounts of protein in the urine are acceptable during pregnancy. The presence of protein
in greater amounts may indicate renal problems. A dipstick assessment of +2 and proteinuria
>300 mg/24 hours, and albuminuria greater than 30 mg/24 hours are excessive and should be
further evaluated.

Question 32

During pregnancy, many changes occur as a direct result of the presence of the fetus.
Which of these adaptations meet this criterion? (Select all that apply.)
a. Leukorrhea
b. Development of the operculum
c. Quickening
d. Ballottement
e. Lightening

Answer 32

C,D,E - Quickening is the first recognition of fetal movements or feeling life. Quickening is often
described as a flutter and is felt earlier in the multiparous woman than in the primiparous
woman. Passive movement of the unengaged fetus is referred to as ballottement. Lightening
occurs when the fetus begins to descend into the pelvis and occurs 2 weeks before labor in the
nulliparous woman and at the start of labor in the multiparous woman. Leukorrhea is a white or
slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and
progesterone. Mucus fills the cervical canal creating a plug otherwise known as the operculum.
The operculum acts as a barrier against bacterial invasion during the pregnancy.

Question 33

Pregnancy is a hypercoagulable state in which women are at a fivefold to sixfold
increased risk for thromboembolic disease. The tendency for blood to clot is greater, attributable
to an increase in various clotting factors. Which of these come into play during pregnancy?
(Select all that apply.)
a. Factor VII
b. Factor VIII
c. Factor IX
d. Factor XIII
e. Fibrinogen

Answer 33

A,B,C,E - Factors VII, VIII, IX, X, and fibrinogen increase in pregnancy. Factors that inhibit coagulation
decrease. Fibrinolytic activity (dissolving of a clot) is depressed during pregnancy and the early
postpartum period to protect the women from postpartum hemorrhage