Exam 1 - Chapter 14

Question 1

Ideally, when should prenatal care begin?

a. Before the first missed menstrual period
b. After the first missed menstrual period
c. After the second missed menstrual period
d. After the third missed menstrual period

Answer 1

B - Prenatal care should begin soon after the first missed menstrual period. This offers the greatest
opportunities to ensure the health of the expectant mother and her infant. Prenatal care before
missing the first menstrual period is too early. It is unlikely the woman is even aware of the
pregnancy. Ideally, prenatal visits should begin soon after the first period is missed. Beginning
prenatal care after the third missed menstrual period is too late. The woman will have completed
the first trimester by that time.

Question 2

A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was
February 14, 2015. What is the clients expected date of birth (EDB)?
a. September 17, 2015
b. November 7, 2015
c. November 21, 2015
d. December 17, 2015

Answer 2

C - Using the Ngeles rule, the EDB is calculated by subtracting 3 months from the month of the
LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14,
2015, her due date is November 21, 2015. September 17, 2015, is too short a period to complete
a normal pregnancy. Using the Ngeles rule, an EDB of November 7, 2015, is 2 weeks early.
December 17, 2015, is almost a month past the correct EDB.

Question 3

Which women should undergo prenatal testing for the human immunodeficiency virus
(HIV)?
a. All women, regardless of risk factors
b. Women who have had more than one sexual partner
c. Women who have had a sexually transmitted infection (STI)
d. Woman who are monogamous with one partner

Answer 3

A - An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal
transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who
test positive for HIV can then be treated.

Question 4

Which sign or symptom is considered a first-trimester warning sign and should be
immediately reported by the pregnant woman to her health care provider?
a. Nausea with occasional vomiting
b. Fatigue
c. Urinary frequency
d. Vaginal bleeding

Answer 4

D - Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on
urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of
complications of the pregnancy. Nausea with occasional vomiting is a normal first-trimester
complaint. Although it may be worrisome or annoying to the mother, it is not usually an
indication of a problem with the pregnancy

Question 5

Which client might be well advised to continue condom use during intercourse
throughout her pregnancy?
a. Unmarried pregnant women
b. Women at risk for acquiring or transmitting STIs
c. All pregnant women
d. Women at risk for candidiasis

Answer 5

B - The objective of safer sex is to provide prophylaxis against the acquisition and transmission of
STIs. Because these diseases may be transmitted to the woman and then to her fetus, condom use
is recommended throughout the pregnancy if the woman is at risk for acquiring an STI. Pregnant
women are encouraged to practice safer sex behaviors. An unmarried pregnant woman may be in
a monogamous relationship and not require the use of a condom. The client should be educated
as to what may place both herself and her fetus at risk. Any pregnant woman can develop
candidiasis, which is an infection not related to condom use

Question 6

Which condition is likely to be identified by the quadruple marker screen?

a. Down syndrome
b. Diaphragmatic hernia
c. Congenital cardiac abnormality
d. Anencephaly

Answer 6

A - The maternal serum level marker of alpha-fetoprotein is used to screen for Down syndrome,
trisomy 18, neural tube defects, and other chromosomal anomalies. The quadruple-marker screen
will not detect diaphragmatic hernia. Additional testing, such as ultrasonography, is required to
diagnose diaphragmatic hernia. Congenital cardiac abnormality will most likely be identified
during an ultrasound examination. The quadruple-marker screen will not detect anencephaly.

Question 7

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been
experiencing occasional backaches of mild-to-moderate intensity. Which intervention should the
nurse recommend?
a. Kegel exercises
b. Pelvic rock exercises
c. Softer mattress
d. Bed rest for 24 hours

Answer 7

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

Question 8

A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she does not
know what is happening; one minute she is happy that she is pregnant and the next minute she
cries for no reason. Which response by the nurse is most appropriate?
a. Dont worry about it; youll feel better in a month or so.
b. Have you talked to your husband about how you feel?
c. Perhaps you really dont want to be pregnant.
d. Hormone changes during pregnancy commonly result in mood swings.

Answer 8

D - Explaining that hormone changes can result in mood swings is an accurate statement and the
most appropriate response by the nurse. Telling the woman not to worry dismisses her concerns
and is not the most appropriate response. Although the woman should be encouraged to share her
feelings, asking if she has spoken to her husband about them is not the most appropriate response
and does not provide her with a rationale for the psychosocial dynamics of her pregnancy.
Suggesting that the woman does not want to be pregnant is completely inappropriate and
deleterious to the psychologic well-being of the woman. Hormonal and metabolic adaptations
often cause mood swings in pregnancy. The womans responses are normal. She should be
reassured about her feelings.

Question 9

What is the primary role of the nonpregnant partner during pregnancy?

a. To provide financial support
b. To protect the pregnant woman from old wives tales
c. To support and nurture the pregnant woman
d. To make sure the pregnant woman keeps prenatal appointments

Answer 9

C - The partners primary role in pregnancy is to nurture the pregnant woman and respond to her
feelings of vulnerability. Although financial support is important, it is not the partners primary
role in pregnancy. Protecting the pregnant woman from old wives tales is not the partners role.
The womans partner can encourage the client to keep all appointments; however, this is not the
most important role during the pregnancy.

Question 10

During the first trimester, which of the following changes regarding her sexual drive
should a client be taught to expect?
a. Increased sexual drive, because of enlarging breasts
b. Decreased sexual drive, because of nausea and fatigue
c. No change in her sexual drive
d. Increased sexual drive, because of increased levels of female hormones

Answer 10

B - A pregnant woman usually experiences a decrease, not an increase, in libido during the first
trimester. Maternal physiologic changes, such as breast enlargement, nausea, fatigue, abdominal
changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses, may
affect sexuality and sexual expression. Libido may be depressed in the first trimester but often
increases during the second and third trimesters. During pregnancy, the breasts may become
enlarged and tender, which tends to interfere with coitus, thereby decreasing the desire to engage
in sexual activity.

Question 11

A 3-year-old girls mother is 6 months pregnant. What concern is this child most likely to 
verbalize?
a. How the baby will get out?
b. How will the baby eat?
c. Will you die having the baby?
d. What color eyes will the baby have?

Answer 11

B - By age 3 or 4 years, children like to be told the story of their own beginning and accept it being
compared with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby
move. Sometimes they worry about how the baby is being fed and what it will wear. School-age
children take a more clinical interest in their mothers pregnancy and may want to know How did
the baby get in there? and How will it get out? Whether the childs mother will die does not tend
to be the focus of her questions about the impending birth of a sibling. The babys eye color does
not tend to be the focus of childrens questions about the impending birth of a sibling

Question 12

In her work with pregnant women of different cultures, a nurse practitioner has observed
various practices that seemed unfamiliar. The nurse practitioner has learned that cultural rituals
and practices during pregnancy seem to have one purpose in common. Which statement best
describes that purpose?
a. To promote family unity
b. To ward off the evil eye
c. To appease the gods of fertility
d. To protect the mother and fetus during pregnancy

Answer 12

D - Although many cultures consider pregnancy normal, certain practices are expected of women of
all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural
proscriptions establish taboos. The purposes of these practices are to prevent maternal illness
resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus.
Promoting family unity is important, although not usually the premise for cultural rituals and
practices. Warding off the evil eye may be specific to one particular culture; however, it is not
the primary purpose of these practices. Appeasing the gods of fertility is not the impetus behind
cultural rituals.

Question 13

A client has arrived for her first prenatal appointment. She asked the nurse to explain
exactly how long the pregnancy will be. What is the nurses best response?
a. Normal pregnancy is 10 lunar months.
b. Pregnancy is made up of four trimesters.
c. Pregnancy is considered term at 36 weeks.
d. Estimated date of delivery (EDD) is 40 completed weeks

Answer 13

A - Pregnancy spans 9 calendar months; but, health care providers prefer to use the lunar month of
28 days or 4 weeks. Pregnancy consists of three trimesters, each approximately 13 weeks long. A
pregnancy is considered term at 37 completed weeks; however, EDD is based upon 40 weeks of
gestation

Question 14

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

Answer 14

C- Love and support help a woman feel better about her pregnancy. The most important person to
the pregnant woman is usually the father of the child. Nurses can facilitate communication
between partners about sexual matters if, as is common, they are nervous about expressing their
worries and feelings to one another. The second trimester is the time when a womans sense of
well-being, along with certain physical changes, increases her desire for sex. Sexual desire is
down in the first and third trimesters.

Question 15

What represents a typical progression through the phases of a womans establishing a
relationship with the fetus?
a. Accepts the fetus as distinct from herself accepts the biologic fact of pregnancy has
feelings of caring and responsibility.
b. Fantasizes about the childs gender and personality views the child as part of
herself becomes introspective.
c. Views the child as part of herselfhas feelings of well-beingaccepts the biologic fact of the
pregnancy.
d. I am pregnantI am going to have a babyI am going to be a mother.

Answer 15

D - The woman first centers on herself as pregnant, then on the baby as an entity separate from
herself, and then on her responsibilities as a mother. The expressions I am pregnant, I am going
to have a baby, and I am going to be a mother sum up the progression through the three phases.
In phase one, the woman views the child as part of herself and not as a separate being. This is
only the first step of the progression through phases of attachment. Accepting the fetus as distinct
from herself occurs during the second phase of emotional attachment. Fantasizing about the
childs sex and personality based on fetal activity occurs during the third phase of attachment

Question 16

Who is most likely to experience the phenomenon of someone other than the mother-tobe having pregnancy-like symptoms such as nausea and weight gain?

a. Mother of the pregnant woman
b. Couples teenage daughter
c. Sister of the pregnant woman
d. Expectant father

Answer 16

D - An expectant fathers experiencing of his partners pregnancy-like symptoms is called the couvade
syndrome. The mother of the pregnant woman is unlikely to experience this phenomenon.

Question 17

During the initial visit with a client who is beginning prenatal care, which action should
be the highest priority for the nurse?
a. The first interview is a relaxed, get-acquainted affair during which the nurse gathers some
general impressions of his or her new client.
b. If the nurse observed handicapping conditions, he or she should be sensitive and not
inquire about them because the client will do that in her own time.
c. The nurse should be alert to the appearance of potential parenting problems, such as
depression or lack of family support.
d. Because of legal complications, the nurse should not ask about illegal drug use; that is
left to the physician.

Answer 17

C - Besides these potential problems, the nurse needs to be alert to the womans attitude toward
keeping regular health care appointments. If the client lacks insurance, then the nurse may be
able to direct her to resources that provide assistance for pregnant women (i.e., Women, Infants,
and Children [WIC]; Medicaid). The initial interview needs to be planned, purposeful, and
focused on specific content. A lot of ground must be covered. The nurse must be sensitive to
special problems; he or she should inquire because discovering individual needs is important. A
client with a chronic or handicapping condition might forget to mention it because she has
adapted to it. Obtaining information on drug use is important and can be confidentially done.
Actual testing for drug use requires the clients consent.

Question 18

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an
expectant parents class. Which aspect of their birth plan should be considered potentially
unrealistic and require further discussion with the nurse?
a. My husband and I have agreed that my sister will be my coach because he becomes
anxious with regard to medical procedures and blood. He will be nearby and check on me every
so often to make sure everything is okay.
b. We plan to use the techniques taught in the Lamaze classes to reduce the pain
experienced during labor.
c. We want the labor and birth to take place in a birthing room. My husband will come in
the minute the baby is born.
d. Regardless of the circumstances, we do not want the fetal monitor used during labor
because it will interfere with movement and doing effleurage.

Answer 18

D - Because monitoring is essential to assess fetal well-being, fetal monitoring is not a factor that can
be determined by the couple. The nurse should fully explain its importance. The option for
intermittent electronic monitoring could be explored if this is a low-risk pregnancy and as long
as labor is normally progressing. The birth plan is a tool with which parents can explore their
childbirth options; however, the plan must be viewed as tentative. Having the womans sister as
her coach with her husband nearby is an acceptable request for a laboring woman. Using
breathing techniques to alleviate pain is a realistic part of a birth plan. Not all fathers are able to
be present during the birth; however, this couple has made a realistic plan that works for their
specific situation.

Question 19

During the physical examination of a client beginning prenatal care, which initial action
is most important for the nurse to perform?
a. Only women who show physical signs or meet the sociologic profile should be assessed
for physical abuse.
b. The client should empty her bladder before the pelvic examination.
c. The distribution, amount, and quality of body hair are of no particular importance.
d. The size of the uterus is discounted in the initial examination because it will be increasing
in size during the second trimester

Answer 19

B - The nurse should instruct the client to empty her bladder. An empty bladder facilitates the
examination and also provides an opportunity to obtain a urine sample for a number of tests. All
women should be assessed for a history of physical abuse, particularly because the likelihood of
abuse increases during pregnancy. Noting body hair is important because body hair reflects
nutritional status, endocrine function, and hygiene. Particular attention is paid to the size of the
uterus because it is an indication of the duration of gestation.

Question 20

A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant
other. To reassure the client regarding fetal well-being, which is the highest priority action for
the nurse to perform?
a. Assess the fetal heart tones with a Doppler stethoscope.
b. Measure the girth of the womans abdomen.
c. Complete an ultrasound examination (sonogram).
d. Offer the woman and her family the opportunity to listen to the fetal heart tones.

Answer 20

D - To provide the parents with the greatest sense of reassurance, the nurse should offer to have the
client and her significant other the chance to listen to their babys heartbeat. A fetoscope can
detect the fetal heart rate around 20 weeks of gestation. Doppler can detect the fetal heart rate
between 10 and 12 weeks and should be performed as part of routine fetal assessment.
Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an
important measure that should be determined with precision, with the same technique and
positioning of the client consistently used at every prenatal visit. Routine ultrasound
examinations are recommended in early pregnancy; they date the pregnancy and provide useful
information about the health of the fetus. However, they are not necessary at each prenatal visit

Question 21

What is the primary role of the doula during labor?
a. Helps the woman perform Lamaze breathing techniques and to provide support to the
woman and her partner
b. Checks the fetal monitor tracing for effects of the labor process on the fetal heart rate
c. Takes the place of the father as a coach and support provider
d. Administers pain medications as needed by the woman

Answer 21

A - A doula is professionally trained to provide labor support, including physical, emotional, and
informational support, to both the woman and her partner during labor and the birth. The doula
does not become involved with clinical tasks.

Question 22

A client at 34 weeks of gestation seeks guidance from the nurse regarding personal
hygiene. Which information should the nurse provide?
a. Tub bathing is permitted even in late pregnancy unless membranes have ruptured.
b. The perineum should be wiped from back to front.
c. Bubble bath and bath oils are permissible because they add an extra soothing and
cleansing action to the bath.
d. Expectant mothers should use specially treated soap to cleanse the nipples.

Answer 22

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

Question 23

The client is instructed to place her thumb and forefinger on the areola and gently press

inward. What is the purpose of this exercise?
a. To check the sensitivity of the nipples
b. To determine whether the nipple is everted or inverted
c. To calculate the adipose buildup in the abdomen
d. To see whether the fetus has become inactive

Answer 23

B - Sometimes known as the pinch test, this exercise is used to determine whether the nipple is
everted or inverted. Nipples must be everted to allow breastfeeding. The pinch does not
determine the level of sensitivity of the nipples, nor is it not used to determine the level of
adipose tissue in the abdomen. Fetal activity is not determined by using the pinch test.

Question 24

Dental care during pregnancy is an important component of good prenatal care. Which
instruction regarding dental health should the nurse provide?
a. Regular brushing and flossing may not be necessary during early pregnancy because it
may stimulate the woman who is already nauseated to vomit. A cleaning is all that is necessary.
b. Dental surgery, in particular, is contraindicated during pregnancy and should be delayed
until after delivery.
c. If dental treatment is necessary, then the woman will be most comfortable with it in the
second trimester.
d. If a woman has dental anxiety, then dental care may interfere with the expectant mothers
need to practice conscious relaxation and to prepare for labor

Answer 24

C - The second trimester is the best time for dental treatment because the woman will be able to sit
most comfortably in the dental chair. Dental care, such as brushing with a fluoride toothpaste, is
especially important during pregnancy. Periodontal disease has been linked to both preterm labor
and low-birth-weight (LBW) infants. Emergency dental surgery is permissible; however, the
mother must clearly understand the risks and benefits. Conscious relaxation is useful and may
even help the woman get through any dental appointments, but it is not a reason to avoid them.

Question 25

Many pregnant women have questions regarding work and travel during pregnancy.
Which education is a priority for the nurse to provide?
a. Women should sit for as long as possible and cross their legs at the knees from time to
time for exercise.
b. Women should avoid seat belts and shoulder restraints in the car because they press on
the fetus.
c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes
through them a number of times.
d. While working or traveling in a car or on an airplane, women should arrange to walk
around at least every hour or so.

Answer 25

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

Question 26

Which statement accurately describes the centering model of care?

a. Group sessions begin with the first prenatal visit.
b. Blood pressure (BP), weight, and urine dipsticks are obtained by the nurse at each visit.
c. Approximately 8 to 12 women are placed in each gestational-age cohort group.
d. Outcomes are similar to traditional prenatal care.

Answer 26

C - Gestational-age cohorts comprise the groups, with approximately 8 to 12 women in each group.
The groups remain intact throughout the pregnancy

Question 27

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is
concerned about the effect of the exercise on the fetus. Which guidance should the nurse
provide?
a. You dont need to modify your exercising any time during your pregnancy.
b. Stop exercising because it will harm the fetus.
c. You may find that you need to modify your exercise to walking later in your pregnancy,
around the seventh month.
d. Jogging is too hard on your joints; switch to walking now.

Answer 27

C - Typically, running should be replaced with walking around the seventh month of pregnancy. The
nurse should inform the woman that she may need to reduce her exercise level as the pregnancy
progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves
circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be
initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for
more strenuous exercise.

Question 28

Which sign of a potential complication is the most important for the nurse to share with
the client?
a. Constipation
b. Alteration in the pattern of fetal movement
c. Heart palpitations
d. Edema in the ankles and feet at the end of the day

Answer 28

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

Question 29

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine
with dinner before she became pregnant. She has abstained during her first trimester and would
like to know if it is safe for her to have a drink with dinner now. Which guidance should the
nurse provide?
a. Since youre in your second trimester, theres no problem with having one drink with
dinner.
b. One drink every night is too much. One drink three times a week should be fine.
c. Since youre in your second trimester, you can drink as much as you like.
d. Because no one knows how much or how little alcohol it takes to cause fetal problems,
the best course is to abstain throughout your pregnancy.

Answer 29

D - The statement Because no one knows how much or how little alcohol it takes to cause fetal
problems, the best course is to abstain throughout your pregnancy is accurate

Question 30

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

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

Answer 30

A - The goal of prenatal care is to foster a safe birth for the infant and mother. Although properly
eating, carefully driving, and using proper body mechanics all are healthy measures that a mother
can take, obtaining prenatal care is the optimal method for providing safety for both herself and
her baby

Question 31

What type of cultural concern is the most likely deterrent to many women seeking 
prenatal care?
a. Religion
b. Modesty
c. Ignorance
d. Belief that physicians are evil

Answer 31

B - A concern for modesty is a deterrent to many women seeking prenatal care. For some women,
exposing body parts, especially to a man, is considered a major violation of their modesty. Many
cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a
woman, some practices may conflict with the beliefs and practices of a subculture group to
which she belongs.

Question 32

The nurse working with pregnant clients must seek to gain understanding of the process
whereby women accept their pregnancy. Which statement regarding this process is most
accurate?
a. Nonacceptance of the pregnancy very often equates to a rejection of the child.
b. Mood swings are most likely the result of worries about finances and a changed lifestyle,
as well as profound hormonal changes.
c. Ambivalent feelings during pregnancy are usually only expressed in emotionally
immature or very young mothers.
d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions
need not be addressed during pregnancy because they will naturally resolve themselves after
birth.

Answer 32

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

Question 33

What is important for the nurse to recognize regarding the new father and his acceptance
of the pregnancy and preparation for childbirth?
a. The father goes through three phases of acceptance of his own.
b. The fathers attachment to the fetus cannot be as strong as that of the mother because it
does not start until after the birth.
c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of
their established lifestyle and resist making changes to the home.
d. Typically, men remain ambivalent about fatherhood right up to the birth of their child.

Answer 33

A - A father typically goes through three phases of development to reach acceptance of fatherhood:
the announcement phase, the moratorium phase, and the focusing phase. The father-child
attachment can be as strong as the mother-child relationship and can also begin during
pregnancy. During the last 2 months of the pregnancy, many expectant fathers work hard to
improve the environment of the home for the child. Typically, the expectant fathers ambivalence
ends by the first trimester, and he progresses to adjusting to the reality of the situation and then
to focusing on his role.

Question 34

Which consideration is essential for the nurse to understand regarding follow-up prenatal
care visits?
a. The interview portions become more intensive as the visits become more frequent over
the course of the pregnancy.
b. Monthly visits are scheduled for the first trimester, every 2 weeks for the second
trimester, and weekly for the third trimester.
c. During the abdominal examination, the nurse should be alert for supine hypotension.
d. For pregnant women, a systolic BP of 130 mm Hg and a diastolic BP of 80 mm Hg is
sufficient to be considered hypertensive.

Answer 34

C - The woman lies on her back during the abdominal examination, possibly compressing the vena
cava and aorta, which can cause a decrease in BP and a feeling of faintness. The interview
portion of the follow-up examinations is less extensive than in the initial prenatal visits, during
which so much new information must be gathered. Monthly visits are routinely scheduled for the
first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at
week 36. For pregnant women, hypertension is defined as a systolic BP of 140 mm Hg or higher
and a diastolic BP of 90 mm Hg or higher.

Question 35

With regard to medications, herbs, boosters, and other substances normally encountered
by pregnant women, what is important for the nurse to be aware of?
a. Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be
made hazardous by metabolic deficiencies of the fetus.
b. The greatest danger of drug-caused developmental deficits in the fetus is observed in the
final trimester.
c. Killed-virus vaccines (e.g., tetanus) should not be administered during pregnancy, but
live-virus vaccines (e.g., measles) are permissible.
d. No convincing evidence exists that secondhand smoke is potentially dangerous to the
fetus.

Answer 35

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

Question 36

Which statement regarding multifetal pregnancy is incorrect?
a. The expectant mother often develops anemia because the fetuses have a greater demand
for iron.
b. Twin pregnancies come to term with the same frequency as single pregnancies.
c. The mother should be counseled to increase her nutritional intake and gain more weight.
d. Backache and varicose veins often are more pronounced with a multifetal pregnancy.

Answer 36

B - Twin pregnancies often end in prematurity. Serious efforts should be made to bring the
pregnancy to term. A woman with a multifetal pregnancy often develops anemia, suffers more or
worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these
conditions.

Question 37

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

Answer 37

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

Question 38

Which signs and symptoms should a woman immediately report to her health care 
provider?
(Select all that apply.)
a. Vaginal bleeding
b. Rupture of membranes
c. Heartburn accompanied by severe headache
d. Decreased libido
e. Urinary frequency

Answer 38

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

Question 39

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

Answer 39

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