Final CH 11 & 12: Antepartum Flashcards

1
Q

__________ signs are those signs that the mother can perceive.

A

presumptive

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2
Q

__________ signs of pregnancy are those that can be detected on physical examination by a HCP.

A

probable

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3
Q

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

A

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.

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4
Q

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.

A

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.

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5
Q

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

A

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.

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6
Q

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

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.

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7
Q

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.

A

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.

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8
Q

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

A

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.

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9
Q

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.

A

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.

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10
Q

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

A

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.

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11
Q

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.”

A

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.

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12
Q

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

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.

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13
Q

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.”

A

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.

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14
Q

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

A

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.

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15
Q

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

A

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.

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16
Q

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

A

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.

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17
Q

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

A

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.

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18
Q

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

A

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.

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19
Q

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

A. Chadwick sign

Rationale: Chadwick sign refers to the bluish-purple discoloration of the cervix caused by increased vascularity during pregnancy.

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20
Q

A patient reports fatigue, nausea, and breast tenderness but is unsure if she is pregnant. Which of the following describes these symptoms?

a) Positive signs of pregnancy
b) Probable signs of pregnancy
c) Presumptive signs of pregnancy
d) Diagnostic signs of pregnancy

A

c) Presumptive signs of pregnancy

Rationale: Presumptive signs of pregnancy are subjective signs that a woman experiences, such as fatigue, nausea, and breast tenderness, but they are not definitive indicators of pregnancy.

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21
Q

A nurse is assessing a woman who reports amenorrhea and urinary frequency. Which explanation should the nurse provide about these symptoms?

a) “These are probable signs of pregnancy and confirm you are pregnant.”
b) “These are presumptive signs of pregnancy and may suggest you are pregnant.”
c) “These are diagnostic signs of pregnancy and confirm fetal development.”
d) “These are related to an infection and are not pregnancy-related.”

A

b) “These are presumptive signs of pregnancy and may suggest you are pregnant.”

Rationale: Amenorrhea and urinary frequency are subjective symptoms that indicate a possibility of pregnancy, but they are not definitive proof.

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22
Q

A pregnant patient at 12 weeks reports extreme fatigue. What is the nurse’s best response?

a) “Fatigue is uncommon in early pregnancy and should be evaluated further.”

b) “Fatigue is a probable sign of pregnancy and confirms fetal development.”

c) “Fatigue is a diagnostic sign and indicates pregnancy complications.”

d) “Fatigue is a presumptive sign of pregnancy and is expected around this time.”

A

d) “Fatigue is a presumptive sign of pregnancy and is expected around this time.”

Rationale: Fatigue is a common presumptive sign of pregnancy due to increased progesterone levels and higher metabolic demands, particularly by 12 weeks.

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23
Q

A nurse is educating a patient about breast tenderness in pregnancy. When should the patient expect this symptom to occur?

a) Between 3–4 weeks
b) Between 8–10 weeks
c) After 12 weeks
d) After 20 weeks

A

a) Between 3–4 weeks

Rationale: Breast tenderness is one of the earliest presumptive signs of pregnancy, typically starting around 3–4 weeks due to hormonal changes.

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24
Q

A woman reports feeling fetal movements at 18 weeks of gestation. How should the nurse document this finding?

a) Positive sign of pregnancy
b) Probable sign of pregnancy
c) Presumptive sign of pregnancy
d) Diagnostic sign of pregnancy

A

c) Presumptive sign of pregnancy

Rationale: Fetal movements, or quickening, are subjective sensations felt by the mother and are considered presumptive signs of pregnancy.

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25
Q

During a prenatal exam, the nurse notes uterine enlargement at 10 weeks gestation. How should this finding be classified?

a) Positive sign of pregnancy
b) Probable sign of pregnancy
c) Presumptive sign of pregnancy
d) Diagnostic sign of pregnancy

A

c) Presumptive sign of pregnancy

Rationale: Uterine enlargement is a subjective observation made by the patient or provider, and it is considered a presumptive sign of pregnancy.

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26
Q

What is the significance of a pregnancy test showing an hCG level higher than 25 mIU/mL?

a) It is considered positive for pregnancy.
b) It indicates an ectopic pregnancy.
c) It confirms multiple gestations.
d) It rules out other conditions like hydatidiform mole.

A

a) It is considered positive for pregnancy.

Rationale: An hCG level higher than 25 mIU/mL is considered a positive test for pregnancy, although further evaluation may be needed to confirm.

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27
Q

What is the clinical relevance of hCG doubling every 48 to 72 hours in early pregnancy?

a) It indicates a molar pregnancy.

b) It suggests normal pregnancy development.

c) It confirms multiple gestations.

d) It diagnoses ectopic pregnancy.

A

b) It suggests normal pregnancy development.

Rationale: In early pregnancy, hCG levels that double every 48 to 72 hours are a sign of a normal, progressing pregnancy.

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28
Q

What is one limitation of home pregnancy tests that nurses should communicate to patients?

a) They cannot detect hCG levels above 25 mIU/mL.

b) They are not affected by medications or blood contamination.

c) They have a high false-negative rate when performed early in pregnancy.

d) They are 100% reliable when instructions are followed.

A

c) They have a high false-negative rate when performed early in pregnancy.

Rationale: Home pregnancy tests may not detect early pregnancy due to low hCG levels, leading to false-negative results if performed too early.

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29
Q

What is a key characteristic of Hegar sign as a probable sign of pregnancy?

a) Softening of the lower uterine segment
b) Bluish discoloration of the vaginal mucosa
c) Fetal rebound felt during examination
d) Increased uterine size and shape

A

a) Softening of the lower uterine segment

Rationale: Hegar sign refers to the softening of the lower uterine segment or isthmus, typically detected during a physical examination.

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30
Q

Why is it important to begin prenatal care as soon as pregnancy is suspected?

a) To confirm a molar pregnancy early
b) To prevent pelvic congestion syndrome
c) To implement medication and lifestyle changes for a healthy pregnancy
d) To reduce the likelihood of Braxton Hicks contractions

A

c) To implement medication and lifestyle changes for a healthy pregnancy

Rationale: Early prenatal care ensures the implementation of necessary interventions to promote a healthy pregnancy, such as medication adjustments and lifestyle modifications.

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31
Q

Which of the following are considered positive signs of pregnancy? (Select all that apply)

a) Visualization of the fetus by ultrasound
b) Palpation of fetal movements by a health care provider
c) Hearing a fetal heartbeat via Doppler
d) Presence of Braxton Hicks contractions
e) A positive home pregnancy test

A

a) Visualization of the fetus by ultrasound
b) Palpation of fetal movements by a health care provider
c) Hearing a fetal heartbeat via Doppler

Rationale: Positive signs of pregnancy are objective findings that directly confirm the presence of a fetus in the uterus. Visualization of the fetus, palpation of fetal movements by a trained provider, and hearing a fetal heartbeat are definitive indicators of pregnancy. Braxton Hicks contractions (d) and a positive pregnancy test (e) are probable signs but do not confirm a pregnancy.

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32
Q

What is the earliest time that a positive sign of pregnancy, such as visualization of the fetus via ultrasound, can typically be observed?

a) 2 weeks after fertilization
b) 6 weeks’ gestation
c) 10 weeks’ gestation
d) 12 weeks’ gestation

A

b) 6 weeks’ gestation

Rationale: Visualization of the fetus by ultrasound can often confirm pregnancy as early as 6 weeks’ gestation. At this time, a gestational sac or fetal heartbeat may be detected, providing direct evidence of pregnancy.

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33
Q

Why are positive signs of pregnancy critical for confirming a pregnancy?

a) They differentiate pregnancy from conditions like hydatidiform mole or uterine tumors.
b) They are required for health insurance coverage of prenatal care.
c) They occur earlier than probable and presumptive signs.
d) They help diagnose complications like ectopic pregnancy.

A

a) They differentiate pregnancy from conditions like hydatidiform mole or uterine tumors.

Rationale: Positive signs of pregnancy, such as fetal movement, visualization, and heartbeat, provide definitive evidence that a fetus is present in the uterus. This distinguishes pregnancy from other conditions, such as a hydatidiform mole, which can produce similar symptoms and hCG levels.

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34
Q

During a prenatal visit, a health care provider confirms fetal movement through palpation. What should the nurse document?

a) Presumptive sign of pregnancy
b) Probable sign of pregnancy
c) Early pregnancy symptom
d) Positive sign of pregnancy

A

d) Positive sign of pregnancy

Rationale: Fetal movement palpated by an experienced health care provider is a positive sign of pregnancy, as it directly confirms the presence of a fetus.

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35
Q

A client is 8 weeks pregnant and asks why an ultrasound is being performed so early. What is the best response by the nurse?

a) “An ultrasound at this stage is used to detect Braxton Hicks contractions.”

b) “Ultrasound allows visualization of the fetus to confirm the pregnancy and estimate gestational age.”

c) “Ultrasound at this stage ensures the placenta is fully formed.”

d) “Ultrasound is necessary to confirm ovulation.”

A

b) “Ultrasound allows visualization of the fetus to confirm the pregnancy and estimate gestational age.”

Rationale: Early ultrasounds are used to confirm pregnancy, detect a fetal heartbeat, and estimate gestational age, ensuring accurate counseling and prenatal care. The placenta does not fully form until later in pregnancy, and Braxton Hicks contractions are not visible on ultrasound.

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36
Q

A client with a confirmed pregnancy via positive ultrasound asks about the purpose of early prenatal visits. Which of the following should the nurse include in her response? (Select all that apply)

a) Assessment of maternal and fetal health
b) Education on normal signs and symptoms of early pregnancy
c) Identification of gestational age for appropriate counseling
d) Initiation of fetal heart rate monitoring
e) Management of labor plans

A

a) Assessment of maternal and fetal health
b) Education on normal signs and symptoms of early pregnancy
c) Identification of gestational age for appropriate counseling

Rationale: Early prenatal visits focus on confirming pregnancy, assessing maternal and fetal health, providing education on pregnancy symptoms, and accurately determining gestational age. While fetal heart rate monitoring (d) is part of prenatal care, it is not typically initiated during early visits.

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37
Q

How do you calculate the estimated date of birth?

A

add 7 days and 9 months from the LMP

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38
Q

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.”

A

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.

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39
Q

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.

A

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.

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40
Q

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

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.

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41
Q

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

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.

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42
Q

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

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.

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43
Q

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.

A

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.

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44
Q

Which strategies can help manage urinary frequency during the first trimester? (Select all that apply)

a) Decreasing fluid intake during the day
b) Limiting fluid intake 2–3 hours before bedtime
c) Performing Kegel exercises
d) Avoiding caffeinated beverages
e) Using a urinary catheter as needed

A

b) Limiting fluid intake 2–3 hours before bedtime
c) Performing Kegel exercises
d) Avoiding caffeinated beverages

Rationale: Urinary frequency in the first trimester is caused by the growing uterus compressing the bladder. Managing fluid intake near bedtime, avoiding caffeine, and strengthening pelvic muscles with Kegel exercises can help reduce this discomfort. Decreasing overall fluid intake (a) is not advised as hydration is essential during pregnancy, and urinary catheters (e) are not appropriate for routine management.

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45
Q

What is the primary cause of fatigue during the first trimester of pregnancy?

a) Decreased progesterone levels
b) Increased oxygen consumption and metabolic demands
c) Compression of the bladder by the uterus
d) Reduced physical activity levels

A

b) Increased oxygen consumption and metabolic demands

Rationale: Fatigue in the first trimester results from increased oxygen consumption, metabolic demands, and hormonal changes such as elevated levels of progesterone and relaxin.

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46
Q

What dietary changes can alleviate first-trimester nausea and vomiting? (Select all that apply)

a) Eating small, frequent meals throughout the day
b) Consuming high-fat foods
c) Eating dry crackers or cheese before getting out of bed
d) Avoiding strong food odors
e) Drinking liquids only during meals

A

a) Eating small, frequent meals throughout the day
c) Eating dry crackers or cheese before getting out of bed
d) Avoiding strong food odors

Rationale: Small, frequent meals prevent an empty stomach, while bland foods like crackers can help reduce nausea. Avoiding strong food odors minimizes triggers. High-fat foods (b) and drinking liquids during meals (e) may exacerbate symptoms.

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47
Q

A pregnant woman reports persistent first-trimester nausea. Which FDA-approved medication should the nurse suggest?

a) Promethazine (Phenergan) and doxylamine (Diclegis)
b) Ondansetron (Zofran) and doxylamine (Diclegis)
c) Vitamin B6 and doxylamine (Diclegis)
d) Dimenhydrinate (Dramamine) and doxylamine (Diclegis)

A

c) Vitamin B6 and doxylamine (Diclegis)

Rationale: The FDA has approved vitamin B6 and doxylamine for treating nausea and vomiting during pregnancy. Other medications (a, b, d) may be used but are not the first line of treatment.

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48
Q

What is the most common cause of constipation in pregnancy?

a) Increased iron in prenatal vitamins
b) Decreased physical activity
c) High levels of progesterone slowing gastrointestinal motility
d) Mechanical compression by the enlarging uterus

A

c) High levels of progesterone slowing gastrointestinal motility

Rationale: Progesterone causes decreased gastrointestinal contractility, slowing transit time and leading to constipation. Iron in prenatal vitamins (a) and uterine compression (d) may contribute, but hormonal changes are the primary cause.

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49
Q

Which recommendations are most effective for relieving constipation during pregnancy? (Select all that apply)

a) Increasing fluid intake
b) Adding more fresh fruits and vegetables to the diet
c) Taking stimulant laxatives daily
d) Eating whole-grain cereals and breads
e) Engaging in regular physical activity

A

a) Increasing fluid intake
b) Adding more fresh fruits and vegetables to the diet
d) Eating whole-grain cereals and breads
e) Engaging in regular physical activity

Rationale: Hydration, fiber from fruits, vegetables, and whole grains, and physical activity all promote regular bowel movements. Stimulant laxatives (c) are not recommended unless prescribed by a provider.

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50
Q

What causes nasal stuffiness and nosebleeds during the first trimester of pregnancy?

a) Low estrogen levels
b) High levels of vitamin B6
c) Reduced blood flow to the nasal passages
d) Edema of the mucous membranes due to increased estrogen

A

d) Edema of the mucous membranes due to increased estrogen

Rationale: Increased estrogen levels cause vascular changes, leading to swelling in the nasal mucosa and susceptibility to nosebleeds.

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51
Q

A pregnant woman asks how to manage leukorrhea during the first trimester. Which advice should the nurse provide? (Select all that apply)

a) Use cotton underwear.
b) Avoid douching and tampon use.
c) Wear tight nylon clothing to control discharge.
d) Wash the perineal area with mild soap and water daily.
e) Use a deodorant spray to mask odors.

A

a) Use cotton underwear.
b) Avoid douching and tampon use.
d) Wash the perineal area with mild soap and water daily.

Rationale: Cotton underwear, avoiding irritants like douches, and practicing good hygiene help manage leukorrhea. Tight nylon clothing (c) and deodorants (e) can worsen symptoms.

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52
Q

What does pica during pregnancy most commonly indicate?

a) A craving for salty foods
b) A dietary deficiency of vitamins or minerals
c) A hormonal imbalance
d) A sign of gestational diabetes

A

b) A dietary deficiency of vitamins or minerals

Rationale: Pica, the craving for non-food substances, may indicate deficiencies such as iron or zinc.

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53
Q

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.

A

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.

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54
Q

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

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.

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55
Q

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.

A

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.

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56
Q

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

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.

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57
Q

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.”

A

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.

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58
Q

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

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.

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59
Q

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.

A

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.

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60
Q

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

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.

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61
Q

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.”

A

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.

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62
Q

a positive result on a pregnancy test is a __________ sign of pregnancy.

Presumptive
Probable
Positive
Negative

A

Probable

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63
Q

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

A

e. prostaglandin secretion

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64
Q

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

A

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.

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65
Q

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.

A

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.

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66
Q

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.

A

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.

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67
Q

What role do prostaglandins play during early pregnancy?

a) They inhibit uterine contractions to maintain pregnancy.

b) They promote uterine smooth muscle contractions to prepare for labor.

c) They aid in the implantation of the fertilized ovum.

d) They increase maternal blood flow to the uterus and placenta.

A

c) They aid in the implantation of the fertilized ovum.

Rationale: Prostaglandins are critical during early pregnancy to promote the successful implantation of the fertilized ovum into the uterine lining by increasing endometrial receptivity.

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68
Q

How do prostaglandins contribute to maintaining pregnancy in the first trimester?

a) By inhibiting progesterone synthesis.

b) By increasing uterine blood flow and vascular tone.

c) By preventing luteolysis of the corpus luteum.

d) By stimulating uterine contractions to support placental attachment.

A

b) By increasing uterine blood flow and vascular tone.

Rationale: Prostaglandins help maintain pregnancy by regulating uterine blood flow and ensuring proper vascular tone to support the developing fetus and placenta during the first trimester.

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69
Q

Which of the following describes a key function of prostaglandins in the placenta during pregnancy? (Select all that apply)

a) Regulating vascular tone to ensure adequate placental perfusion.

b) Stimulating the production of surfactant in the fetal lungs.

c) Contributing to the remodeling of uterine spiral arteries.

d) Promoting cervical dilation throughout the pregnancy.

e) Supporting the maintenance of the amniotic sac integrity.

A

a) Regulating vascular tone to ensure adequate placental perfusion.

c) Contributing to the remodeling of uterine spiral arteries.

Rationale: Prostaglandins play a key role in regulating vascular tone and remodeling the uterine spiral arteries to optimize placental perfusion. This ensures the fetus receives adequate oxygen and nutrients. They are not directly involved in fetal lung surfactant production (b) or cervical dilation during pregnancy (d).

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70
Q

A gravida 2 para 1 client in the 10th week of her pregnancy says to the nurse, Ive never urinated as often as I have for the past three weeks. Which response would be most appropriate for the nurse to make?

A) Having to urinate so often is annoying. I suggest that you watch how much fluid you are drinking and limit it.

B) You shouldn’t be urinating this frequently now; it usually stops by the time youre eight weeks pregnant. Is there anything else bothering you?

C) By the time you are 12 weeks pregnant, this frequent urination should no longer be a problem, but it is likely to return toward the end of your pregnancy.

D) Women having their second child generally don’t have frequent urination. Are you experiencing any burning sensations?

A

C) By the time you are 12 weeks pregnant, this frequent urination should no longer be a problem, but it is likely to return toward the end of your pregnancy.

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71
Q

In a clients seventh month of pregnancy, she reports feeling dizzy, like I’m going to pass out, when I lie down flat on my back. The nurse integrates which of the following in to the explanation?

A) Pressure of the gravid uterus on the vena cava

B) A 50% increase in blood volume

C) Physiologic anemia due to hemoglobin decrease

D) Pressure of the presenting fetal part on the diaphragm

A

A) Pressure of the gravid uterus on the vena cava

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72
Q

A primiparous client is being seen in the clinic for her first prenatal visit. It is determined that she is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what she will most likely experience during this period. Which of the following would the nurse include?

A) Ankle edema

B) Urinary frequency

C) Backache

D) Hemorrhoids

A

B) Urinary frequency

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73
Q

A woman comes to the prenatal clinic suspecting that she is pregnant, and assessment reveals probable signs of pregnancy. Which of the following would be included as part of this assessment? (Select all that apply.)

A) Positive pregnancy test

B) Ultrasound visualization of the fetus

C) Auscultation of a fetal heartbeat

D) Ballottement

E) Absence of menstruation

F) Softening of the cervix

A

A) Positive pregnancy test

D) Ballottement

F) Softening of the cervix

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74
Q

A woman suspecting she is pregnant asks the nurse about which signs would confirm her pregnancy. The nurse would explain that which of the following would confirm the pregnancy?

A) Absence of menstrual period

B) Abdominal enlargement

C) Palpable fetal movement

D) Morning sickness

A

C) Palpable fetal movement

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75
Q

A woman in her second trimester comes for a follow-up visit and says to the nurse, I feel like I’m on an emotional roller-coaster. Which response by the nurse would be most appropriate?

A) How often has this been happening to you?

B) Maybe you need some medication to level things out.

C) Mood swings are completely normal during pregnancy.

D) Have you been experiencing any thoughts of harming yourself?

A

C) Mood swings are completely normal during pregnancy.

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76
Q

A group of students are reviewing the signs of pregnancy. The students demonstrate understanding of the information when they identify which as presumptive signs? (Select all that apply.)

A) Amenorrhea

B) Nausea

C) Abdominal enlargement

D) Braxton-Hicks contractions

E) Fetal heart sounds

A

A) Amenorrhea

B) Nausea

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77
Q

Which of the following describes the most significant change in the uterus during pregnancy?

A. Increase in size, weight, and volume
B. Shift from an ovoid to a pear shape
C. Enhanced uterine contractility and Braxton Hicks contractions
D. Ascension of the uterus from the pelvic cavity to the abdomen

A

A. Increase in size, weight, and volume

Rationale: The most significant change in the uterus during pregnancy is its increase in size, weight, length, width, depth, volume, and overall capacity, which is essential to accommodate the growing fetus. The other options describe specific effects of these changes.

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78
Q

At what point in pregnancy does the uterus typically ascend from the pelvic cavity into the abdomen?

A. After the first 3 months
B. At 20 weeks’ gestation
C. After the first trimester
D. By 36 weeks’ gestation

A

A. After the first 3 months

Rationale: After the first 3 months, the uterus ascends from the pelvic cavity into the abdomen as it grows to accommodate the developing fetus.

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79
Q

Which of the following are characteristics of uterine changes during pregnancy? (Select all that apply.)

A. Enhanced uterine contractility
B. Increase in uterine volume
C. Shift from ovoid to pear shape
D. Fundal height is at the level of the umbilicus by 20 weeks
E. Hegar’s sign becomes negative after 12 weeks

A

A. Enhanced uterine contractility
B. Increase in uterine volume
D. Fundal height is at the level of the umbilicus by 20 weeks

Rationale:
* A (Enhanced uterine contractility): Uterine contractility increases, leading to Braxton Hicks contractions.
* B (Increase in uterine volume): The uterus grows to accommodate the fetus, increasing in size, weight, and volume.

  • D (Fundal height at the level of the umbilicus by 20 weeks): At 20 weeks, the fundal height is usually at the level of the umbilicus, which is useful in determining gestational age.
  • C (Shift from ovoid to pear shape): This change is part of the uterine adaptations, but it is not the most notable characteristic.
  • E (Hegar’s sign): Hegar’s sign remains positive, indicating softening of the lower uterine segment early in pregnancy.
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80
Q

When can fundal height be reliably used to determine gestational age until 36 weeks?

A. 12 weeks’ gestation
B. 20 weeks’ gestation
C. 24 weeks’ gestation
D. 36 weeks’ gestation

A

B. 20 weeks’ gestation

Rationale: Fundal height at 20 weeks’ gestation is typically at the level of the umbilicus and is a reliable indicator for determining gestational age until 36 weeks.

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81
Q

Which of the following is a reliable method for estimating gestational age up until 36 weeks?

A. Ultrasound imaging
B. Urine pregnancy test
C. Maternal weight gain
D. Fundal height measurement

A

D. Fundal height measurement

Rationale: Fundal height measurement is a reliable method for estimating gestational age until 36 weeks. After 36 weeks, other factors, like fetal position and growth patterns, may make fundal height less accurate.

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82
Q

Which of the following is the primary cause of myometrial growth in the uterus during pregnancy after mid-gestation?

A. Hyperplasia of smooth muscle cells
B. Hypertrophy of smooth muscle cells
C. Elongation of blood vessels
D. Increase in uterine blood flow

A

B. Hypertrophy of smooth muscle cells

Rationale: After mid-gestation, the major component of uterine growth is the hypertrophy (increase in size) of smooth muscle cells in the myometrium, which is stimulated by mechanical stretch from the growing fetus.

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83
Q

At what point in pregnancy does the uterus begin to ascend from the pelvic cavity into the abdomen?

A. After the first trimester
B. At 16 weeks
C. By 12 weeks
D. By 36 weeks

A

A. After the first trimester

Rationale: The uterus remains in the pelvic cavity for the first three months of pregnancy. After that, it ascends into the abdomen as the fetus grows.

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84
Q

Which of the following contribute to increased urinary frequency in early pregnancy? (Select all that apply.)

A. Increased pressure on the bladder from the enlarging uterus
B. Decreased blood flow to the bladder
C. Exaggerated uterine anteflexion
D. Uterine contractions
E. Hormonal changes influencing kidney function

A

A. Increased pressure on the bladder from the enlarging uterus
C. Exaggerated uterine anteflexion

Rationale:
* A (Increased pressure on the bladder): The growing uterus exerts pressure on the bladder, leading to increased urinary frequency.
* C (Exaggerated uterine anteflexion): This pressure on the bladder also causes urinary frequency, particularly during the early months of pregnancy due to exaggerated anteflexion of the uterus.

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85
Q

Which of the following physiological changes occurs due to the increase in uterine blood flow during pregnancy?

A. The diameter of the main uterine artery decreases
B. The uterine blood flow supports only the myometrium
C. 80% to 90% of uterine blood flow goes to the placenta
D. The uterine walls become thicker and less vascular

A

C. 80% to 90% of uterine blood flow goes to the placenta

Rationale: During pregnancy, the majority of uterine blood flow (80-90%) is directed to the placenta to support fetal growth, with the remainder going to the myometrium and endometrium.

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86
Q

What is the function of Braxton Hicks contractions during pregnancy?

A. To strengthen uterine muscle tone
B. To begin cervical dilation
C. To initiate labor contractions
D. To thin out the cervix before birth

A

A. To strengthen uterine muscle tone

Rationale: Braxton Hicks contractions are irregular, painless contractions that occur throughout pregnancy. They help to strengthen the uterine muscles and prepare the body for labor, although they do not directly initiate labor.

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87
Q

What is the purpose of measuring fundal height during pregnancy?

A. To detect fetal heart tones
B. To assess fetal position
C. To estimate gestational age
D. To assess uterine blood flow

A

C. To estimate gestational age

Rationale: Fundal height is a reliable method for estimating gestational age, particularly between 18 and 32 weeks. It is measured in centimeters and corresponds to the number of weeks of gestation.

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88
Q

What is the primary factor that interferes with the accuracy of fundal height measurement as a marker for gestational age?

A. Maternal age
B. Obesity, hydramnios, and uterine fibroids
C. Fetal heart rate
D. Maternal weight

A

B. Obesity, hydramnios, and uterine fibroids

Rationale: Conditions like obesity, hydramnios (excess amniotic fluid), and uterine fibroids can interfere with the accuracy of fundal height measurements, making them less reliable as indicators of gestational age.

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89
Q

What is the typical cause of “supine hypotensive syndrome” during pregnancy?

A. Uterus compression of the inferior vena cava
B. Increased cardiac output
C. Decreased blood flow to the brain
D. Excessive uterine blood flow

A

A. Uterus compression of the inferior vena cava

Rationale: Supine hypotensive syndrome occurs when the enlarged uterus compresses the inferior vena cava in the supine position, reducing venous return, cardiac output, and blood pressure. This causes symptoms like dizziness, nausea, and lightheadedness.

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90
Q

When does the uterus reach its highest level during pregnancy?

A. At 20 weeks
B. At 36 weeks
C. At 38-40 weeks
D. At 12 weeks

A

B. At 36 weeks

Rationale: By approximately 36 weeks, the uterus reaches its highest level, near the xiphoid process. After this, it may descend as the fetus begins to engage in the pelvis.

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91
Q

Which of the following occurs when the uterus reaches its highest point at 36 weeks?

A. Fundal height decreases
B. Fetal heart rate becomes more difficult to detect
C. Increased pressure on the bladder
D. The woman experiences fewer Braxton Hicks contractions

A

C. Increased pressure on the bladder

Rationale: When the uterus reaches its highest point at 36 weeks, it may begin to press down on the bladder again, leading to increased urinary frequency.

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92
Q

What happens to the fundal height between 38 and 40 weeks of pregnancy?

A. It remains constant
B. It increases due to fetal growth
C. It stabilizes at the xiphoid process
D. It decreases as the fetus engages in the pelvis

A

D. It decreases as the fetus engages in the pelvis

Rationale: Between 38 and 40 weeks, the fundal height typically decreases as the fetus begins to descend and engage in the pelvis, a process known as “lightening.” This reduces pressure on the diaphragm and makes breathing easier for the mother.

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93
Q

Which of the following is a typical cervical change that occurs during pregnancy?

A. Decreased mucus production
B. Increased mucus production
C. Thickening of cervical tissue
D. Formation of cervical polyps

A

B. Increased mucus production

Rationale: During pregnancy, there is an increase in mucus production by the cervix, which leads to the formation of a mucus plug that helps protect the uterus from infections.

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94
Q

What is the role of the increased cervical mucus production during pregnancy?

A. To enhance cervical dilation
B. To prevent infection by forming a protective mucus plug
C. To promote uterine contractions
D. To facilitate cervical effacement

A

B. To prevent infection by forming a protective mucus plug

Rationale: The increased mucus production during pregnancy forms a mucus plug that seals the cervix, providing a barrier against infections and protecting the fetus.

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95
Q

What is the primary cause of the cervical softening (Goodell sign) during early pregnancy?

A. Hormonal influence of estrogen
B. Decreased blood flow
C. Increased muscle tone
D. Cervical infection

A

A. Hormonal influence of estrogen

Rationale: Estrogen causes vasocongestion and softening of the cervix between weeks 6 and 8 of pregnancy, which is a key sign of early pregnancy known as Goodell sign.

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96
Q

What is the role of the cervical mucus plug formed during pregnancy?

A. To assist in cervical dilation
B. To stimulate uterine contractions
C. To block the cervical os and prevent bacterial invasion
D. To increase uterine blood flow

A

C. To block the cervical os and prevent bacterial invasion

Rationale: The cervical mucus plug, formed under the influence of progesterone, seals the cervical os and helps protect the uterus from bacterial infection during pregnancy.

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97
Q

At what stage of pregnancy does cervical ripening, which includes softening, effacement, and increased distensibility, begin?

A. 12 weeks
B. 20 weeks
C. 36 weeks
D. 4 weeks before birth

A

D. 4 weeks before birth

Rationale: Cervical ripening begins about 4 weeks before birth and prepares the cervix for labor by softening, effacing, and increasing its distensibility.

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98
Q

Which of the following is a key physiological change that contributes to the cervical ripening process in preparation for labor?

A. Increased blood flow to the uterus
B. Inflammation and cervical stretch
C. Thickening of the cervical mucus
D. Decrease in uterine contractility

A

B. Inflammation and cervical stretch

Rationale: Inflammation, cervical stretch, pressure from the fetal presenting part, and hormonal release contribute to cervical ripening, making the cervix more elastic and distensible in preparation for labor.

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99
Q

What is the significance of the Chadwick sign observed in early pregnancy?

A. It indicates a potential infection of the cervix
B. It signifies softening of the cervix
C. It refers to the bluish-purple discoloration of the cervix due to increased vascularization
D. It marks the formation of the mucus plug

A

C. It refers to the bluish-purple discoloration of the cervix due to increased vascularization

Correct Answer: C. It refers to the bluish-purple discoloration of the cervix due to increased vascularization

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100
Q

What causes the increase in vaginal vascularity during pregnancy?

A. Progesterone
B. Estrogen
C. Human chorionic gonadotropin (hCG)
D. Relaxin

A

B. Estrogen

Rationale: Estrogen increases vaginal vascularity during pregnancy, leading to pelvic congestion and hypertrophy of the vagina in preparation for birth.

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101
Q

Which of the following is true about the vaginal changes that occur during pregnancy?

A. Vaginal mucosa becomes thinner and less elastic
B. The vaginal vault shortens in preparation for birth
C. Smooth muscle hypertrophy occurs in the vagina
D. Vaginal secretions become less acidic

A

C. Smooth muscle hypertrophy occurs in the vagina

Rationale: The smooth muscle of the vagina hypertrophies during pregnancy, contributing to the structural changes that prepare the vagina for the distention needed during birth.

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102
Q

Which condition is most likely to cause vaginal itching and irritation during pregnancy?

A. Leukorrhea
B. Vulvovaginal candidiasis
C. Chlamydia infection
D. Bacterial vaginosis

A

B. Vulvovaginal candidiasis

Rationale: Vulvovaginal candidiasis, a fungal infection, is common during pregnancy due to the glycogen-rich environment and can cause symptoms of itching and irritation.

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103
Q

What is the typical presentation of oral thrush in neonates, which can result from a mother’s vulvovaginal candidiasis?

A. White patches on the mucous membranes of the mouth
B. Red, irritated skin around the mouth
C. Difficulty feeding due to mouth pain
D. Fever and lethargy

A

A. White patches on the mucous membranes of the mouth

Rationale: Neonates who contract thrush from a mother’s vulvovaginal candidiasis present with white patches on the mucous membranes of their mouths.

104
Q

How does the vaginal discharge during pregnancy change?

A. It becomes less acidic and more watery
B. It becomes white, thick, and more acidic
C. It decreases significantly in volume
D. It becomes greenish and foul-smelling

A

B. It becomes white, thick, and more acidic

Rationale: Vaginal discharge during pregnancy typically becomes more acidic, white, and thick, a condition known as leukorrhea, which is normal unless accompanied by itching or irritation.

105
Q

Which of the following is a common complication that can result from vulvovaginal candidiasis in pregnant women?

A. Pelvic inflammatory disease
B. Preterm labor
C. Urinary tract infection
D. Neonatal oral thrush

A

D. Neonatal oral thrush

Rationale: Vulvovaginal candidiasis in pregnant women can result in neonatal oral thrush, which is a fungal infection characterized by white patches in the neonate’s mouth.

106
Q

What causes the ovaries to enlarge during the first 12 to 14 weeks of pregnancy?

A. Increased blood supply to the ovaries
B. Hormonal changes due to the placenta
C. Enlargement of the corpus luteum
D. Increased secretion of follicle-stimulating hormone (FSH)

A

A. Increased blood supply to the ovaries

Rationale: The increased blood supply to the ovaries causes them to enlarge until approximately the 12th to 14th week of gestation.

107
Q

Why do the ovaries become non-palpable after the first 12 to 14 weeks of pregnancy?

A. The ovaries are absorbed by the growing fetus
B. The uterus fills the pelvic cavity
C. Elevated levels of progesterone shrink the ovaries
D. The ovaries no longer produce hormones

A

B. The uterus fills the pelvic cavity

Rationale: As the uterus enlarges during pregnancy, it fills the pelvic cavity and pushes the ovaries out of reach, making them non-palpable after approximately 12 to 14 weeks of gestation.

108
Q

What hormonal changes lead to the cessation of ovulation during pregnancy?

A. Elevated levels of estrogen and progesterone
B. Increased secretion of luteinizing hormone (LH)
C. Decreased blood flow to the ovaries
D. Increased secretion of follicle-stimulating hormone (FSH)

A

A. Elevated levels of estrogen and progesterone

Rationale: Elevated levels of estrogen and progesterone during pregnancy block the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), leading to the cessation of ovulation.

109
Q

When does the corpus luteum regress during pregnancy, and what takes over its role?

A. The corpus luteum regresses by week 4, and the ovaries take over hormone production
B. The corpus luteum persists throughout pregnancy, continuously producing progesterone
C. The corpus luteum regresses by week 12, and the anterior pituitary begins producing progesterone
D. The corpus luteum regresses by week 6 to 7, and the placenta takes over progesterone production

A

D. The corpus luteum regresses by week 6 to 7, and the placenta takes over progesterone production

Rationale: The corpus luteum regresses around weeks 6 to 7 of pregnancy, at which point the placenta takes over the major production of progesterone to support the pregnancy.

110
Q

Which of the following hormones is primarily responsible for the growth of mammary ductal tissue during pregnancy?

A. Progesterone
B. Estrogen
C. Prolactin
D. Human chorionic gonadotropin (hCG)

A

B. Estrogen

Rationale: Estrogen stimulates the growth of the mammary ductal tissue in preparation for lactation.

111
Q

What is the role of progesterone in breast development during pregnancy?

A. Stimulates the growth of mammary ductal tissue
B. Increases the production of colostrum
C. Promotes the growth of lobes, lobules, and alveoli
D. Enhances nipple pigmentation

A

C. Promotes the growth of lobes, lobules, and alveoli

Rationale: Progesterone promotes the growth of lobes, lobules, and alveoli in the breasts, preparing them for lactation.

112
Q

When can colostrum typically be expressed during pregnancy?

A. After 8 weeks of pregnancy
B. After 12 weeks of pregnancy
C. After 20 weeks of pregnancy
D. After delivery

A

B. After 12 weeks of pregnancy

Rationale: Colostrum, a yellow, antibody-rich fluid, can be expressed after 12 weeks of pregnancy and is a precursor to mature milk.

113
Q

Which of the following describes the characteristics of colostrum produced during pregnancy?

A. Thin and clear fluid, high in fat
B. Yellow, antibody-rich fluid
C. Sweet-tasting fluid rich in lactose
D. Thick, white fluid high in protein

A

B. Yellow, antibody-rich fluid

Rationale: Colostrum is a yellow, antibody-rich fluid produced during pregnancy, which is essential for newborn immunity.

114
Q

Which of the following breast changes is primarily due to estrogen during pregnancy?

A. Increase in nipple size, becoming more erect and pigmented
B. Production of colostrum
C. Enlargement of lobes, lobules, and alveoli
D. Nodularity of the breast tissue

A

A. Increase in nipple size, becoming more erect and pigmented

Rationale: Estrogen is responsible for the increase in nipple size, becoming more erect and pigmented, as part of the breast preparation for lactation.

115
Q

What happens to the production of colostrum after delivery?

A. It is replaced by mature milk
B. It continues throughout the entire pregnancy
C. It decreases significantly and is replaced by milk from the placenta
D. It converts into mature milk within the first month postpartum

A

A. It is replaced by mature milk

Rationale: After delivery, colostrum transitions into mature milk to meet the nutritional needs of the newborn.

116
Q

Which of the following hormonal influences is primarily responsible for the increase in breast fullness and tenderness during pregnancy?

A. Prolactin
B. Estrogen and progesterone
C. Oxytocin
D. Human chorionic gonadotropin (hCG)

A

B. Estrogen and progesterone

Rationale: Estrogen and progesterone are responsible for the increase in breast fullness, tenderness, and enlargement throughout pregnancy.

117
Q

What is the primary role of the tubercles of Montgomery during pregnancy?

A. To enlarge the nipple area
B. To provide nourishment to the fetus
C. To lubricate the nipple for breastfeeding
D. To increase the size of the areola

A

C. To lubricate the nipple for breastfeeding

Rationale: The tubercles of Montgomery, which are sebaceous glands, secrete oils to keep the nipples lubricated, aiding in the breastfeeding process.

118
Q

What is the appearance of striae (stretch marks) in pregnancy?

A. White, thin lines that disappear after pregnancy
B. Pink to purple lines that eventually fade to silver
C. Red, raised lines that remain visible
D. Dark, pigmented lines that disappear after breastfeeding

A

B. Pink to purple lines that eventually fade to silver

Rationale: Striae typically appear as pink to purple lines and gradually fade to a silver color after pregnancy but never completely disappear.

119
Q

When can colostrum, a yellowish breast fluid, typically be expressed from the breast during pregnancy?

A. By the end of the first trimester
B. By the third trimester
C. After delivery
D. After 6 weeks postpartum

A

B. By the third trimester

Rationale: Colostrum, a creamy, yellowish fluid, can typically be expressed from the breast by the third trimester and provides nourishment to the newborn in the first days of life.

120
Q

What causes the visible veins on the breasts during pregnancy?

A. Increased levels of prolactin
B. Increased vascularity due to estrogen
C. Pressure from the growing uterus
D. Enlargement of the Montgomery glands

A

B. Increased vascularity due to estrogen

Rationale: Estrogen increases vascularity in the breasts, which makes the veins more visible under the skin.

121
Q

What is the significance of the pigmentation changes in the nipples and areola during pregnancy?

A. They help the breasts become more sensitive for breastfeeding
B. They signal the onset of labor
C. They increase attractiveness for the partner
D. They provide contrast for the newborn to latch onto the breast

A

D. They provide contrast for the newborn to latch onto the breast

Rationale: The darkening of the nipples and areola during pregnancy helps provide contrast, making it easier for the newborn to latch onto the breast for breastfeeding.

122
Q

Fundal height measurements typically correlate with which of the following?

A. Maternal weight
B. Number of weeks of gestation
C. Fetal heart rate
D. Placental position

A

B. Number of weeks of gestation

Rationale: Fundal height measurements generally correspond with the number of weeks of gestation in centimeters, which helps to estimate fetal growth and development.

123
Q

A difference of 1-2 cm in fundal height measurement is considered:

A. A sign of fetal growth restriction
B. Outside the normal limits (WNL)
C. Within normal limits (WNL)
D. Indicative of preterm labor

A

C. Within normal limits (WNL)

Rationale: A 1-2 cm difference in fundal height measurement is generally considered within normal limits and does not necessarily indicate any complications.

124
Q

In which of the following cases would an ultrasound be most necessary for accurate fetal growth assessment?

A. Fundal height is measured at 30 cm at 28 weeks of gestation
B. The patient is obese
C. The patient is experiencing swelling in the lower extremities
D. The fundal height corresponds with the gestational age

A

B. The patient is obese

Rationale: Obese patients may have less accurate fundal height measurements, requiring an ultrasound to more reliably assess fetal growth, especially after 28 weeks.

125
Q

Why is it important to monitor fundal height during pregnancy?

A. To determine fetal lung maturity
B. To estimate the fetal weight
C. To monitor fetal growth and detect potential complications
D. To assess the placental location

A

C. To monitor fetal growth and detect potential complications

Rationale: Monitoring fundal height helps track fetal growth and development, and deviations may indicate potential complications such as growth restriction or excessive amniotic fluid.

126
Q

Which of the following is true about fundal height measurements after 28 weeks of pregnancy?

A. Fundal height is a reliable indicator of fetal weight
B. Fundal height measurement is always accurate in obese patients
C. Fundal height measurements should always be interpreted alongside ultrasound after 28 weeks
D. Fundal height becomes less important for monitoring fetal development after 28 weeks

A

C. Fundal height measurements should always be interpreted alongside ultrasound after 28 weeks

Rationale: After 28 weeks, fundal height measurements may become less reliable, especially in obese patients, so ultrasound is needed to confirm fetal growth.

127
Q

A patient at 30 weeks of gestation has a fundal height of 27 cm. What is the likely interpretation?

A. The fetus is experiencing intrauterine growth restriction (IUGR)
B. The pregnancy is progressing normally within the expected range
C. The fetus is likely larger than expected for gestational age
D. There is a likely complication, and the patient needs immediate intervention

A

B. The pregnancy is progressing normally within the expected range

Rationale: A fundal height of 27 cm at 30 weeks gestation is within a 1-2 cm range of normal, which generally indicates the pregnancy is progressing well. However, continued monitoring is necessary.

128
Q

At what point during pregnancy does red blood cell volume increase by 20-30%?

A. 4-6 weeks of gestation
B. 6-8 weeks of gestation
C. 12-16 weeks of gestation
D. 20-32 weeks of gestation

A

B. 6-8 weeks of gestation

Rationale: Red blood cell volume increases by 20-30% during the early stages of pregnancy, starting from around 6-8 weeks of gestation.

129
Q

Which of the following is the primary cause of physiologic anemia during pregnancy?

A. Increased red blood cell volume
B. Increased plasma volume
C. Decreased oxygen demand
D. Decreased erythropoiesis

A

B. Increased plasma volume

Rationale: Physiologic anemia in pregnancy is caused by the greater increase in plasma volume compared to red blood cell volume, which leads to dilution of hemoglobin levels.

130
Q

What is the peak plasma volume increase during pregnancy?

A. 24 weeks of gestation
B. 28 weeks of gestation
C. 32 weeks of gestation
D. 36 weeks of gestation

A

C. 32 weeks of gestation

Rationale: Plasma volume increases steadily from 6-8 weeks and reaches its peak around 32 weeks of gestation.

131
Q

Which of the following changes is most likely to occur in the cardiovascular system during pregnancy?

A. A decrease in blood volume
B. An increase in red blood cell production
C. A greater increase in plasma volume than in red blood cell volume
D. A decrease in cardiac output

A

C. A greater increase in plasma volume than in red blood cell volume

Rationale: During pregnancy, plasma volume increases significantly more than red blood cell volume, contributing to physiologic anemia.

132
Q

Which of the following changes in the cardiovascular system occurs during pregnancy?

A. Decrease in cardiac output
B. Decrease in blood volume
C. Increase in heart rate
D. Decrease in venous return

A

C. Increase in heart rate

Rationale: During pregnancy, cardiac output increases, which is partially due to an increased heart rate to meet the increased demands of the body.

133
Q

What is the primary cause of physiologic anemia in pregnancy?

A. Increase in red blood cell production
B. Decrease in iron levels
C. Decrease in cardiac output
D. Increase in plasma volume

A

D. Increase in plasma volume

Rationale: Physiologic anemia in pregnancy occurs due to a greater increase in plasma volume compared to red blood cell volume, leading to hemodilution.

134
Q

At what point in pregnancy does blood pressure typically decline before returning to pre-pregnancy levels?

A. Early pregnancy
B. Mid-pregnancy
C. Late pregnancy
D. Postpartum

A

B. Mid-pregnancy

Rationale: Blood pressure generally declines slightly during the first half of pregnancy and then returns to pre-pregnancy levels as the pregnancy progresses.

135
Q

Which of the following blood components increases during pregnancy to support the increased clotting needs?

A. Fibrinogen levels
B. Hemoglobin levels
C. Platelet count
D. White blood cell count

A

A. Fibrinogen levels

Rationale: Fibrinogen and other clotting factors increase during pregnancy to support the body’s heightened need for blood clotting in the event of labor or postpartum hemorrhage.

136
Q

Which of the following is a direct consequence of increased cardiac output during pregnancy?

A. Decreased venous return
B. Decreased blood volume
C. Increased heart rate
D. Increased blood pressure

A

C. Increased heart rate

Rationale: Increased cardiac output during pregnancy leads to an increase in heart rate to meet the demands of the growing fetus and the mother’s body.

137
Q

Which of the following is true about the increase in blood volume during pregnancy?

A. Plasma volume increases more than red blood cell volume
B. Red blood cell volume increases more than plasma volume
C. The increase in blood volume is solely due to red blood cell production
D. Blood volume remains unchanged throughout pregnancy

A

A. Plasma volume increases more than red blood cell volume

Rationale: During pregnancy, plasma volume increases more than red blood cell volume, leading to hemodilution and physiologic anemia.

138
Q

Which of the following is true regarding clotting factors during pregnancy?

A. Clotting factors decrease during pregnancy
B. All components of clotting factors increase during pregnancy
C. Only fibrinogen increases during pregnancy
D. Clotting factors remain unchanged during pregnancy

A

B. All components of clotting factors increase during pregnancy

Rationale: Pregnancy is a hypercoagulable state, which means all components of clotting factors increase to protect against hemorrhage during childbirth.

139
Q

Why is pregnancy considered a hypercoagulable state?

A. It decreases the risk of clot formation
B. It causes a decrease in fibrinogen levels
C. It reduces platelet count
D. It increases the ability to form clots

A

D. It increases the ability to form clots

Rationale: Pregnancy is considered a hypercoagulable state because the body increases clotting factors to prevent excessive bleeding during childbirth, but this also increases the risk of clot formation.

140
Q

Which of the following is the primary reason for the increase in fibrinogen during pregnancy?

A. To prevent infection
B. To aid in wound healing
C. To prepare for potential blood loss during delivery
D. To reduce the risk of hemorrhage

A

C. To prepare for potential blood loss during delivery

Rationale: Fibrinogen increases during pregnancy to anticipate and manage blood loss that may occur during delivery.

141
Q

What is the most likely reason for iron supplementation during pregnancy?

A. To increase platelet production
B. To manage increased fibrinogen levels
C. To support the increased volume of red blood cells and prevent anemia
D. To prevent clotting disorders

A

C. To support the increased volume of red blood cells and prevent anemia

Rationale: Iron supplementation is often necessary during pregnancy to meet the increased demand for red blood cell production and prevent iron deficiency anemia.

142
Q

What is the primary risk associated with the hypercoagulable state in pregnancy?

A. Increased risk of deep vein thrombosis (DVT)
B. Increased risk of bleeding disorders
C. Decreased risk of clot formation
D. Decreased wound healing after delivery

A

A. Increased risk of deep vein thrombosis (DVT)

Rationale: The hypercoagulable state in pregnancy increases the risk of clot formation, including deep vein thrombosis (DVT), which can be dangerous for both the mother and fetus.

143
Q

Which of the following changes is most likely to occur in the clotting system during pregnancy?

A. A decrease in the number of platelets
B. An increase in fibrinogen and clotting factors
C. A decrease in fibrinogen levels
D. A decrease in the number of red blood cells

A

B. An increase in fibrinogen and clotting factors

Rationale: Pregnancy leads to an increase in fibrinogen and other clotting factors, preparing the body for potential blood loss during delivery.

144
Q

Which of the following is an important consideration when prescribing iron supplementation during pregnancy?

A. Iron supplementation should be avoided to prevent clotting
B. Iron supplementation can help prevent anemia due to increased red blood cell volume
C. Iron supplementation is unnecessary since clotting factors already increase
D. Iron supplementation should only be used after delivery

A

B. Iron supplementation can help prevent anemia due to increased red blood cell volume

Rationale: Iron supplementation is essential to prevent anemia, which can result from the increased volume of red blood cells and the body’s increased iron requirements during pregnancy.

145
Q

What is the main reason for the increase in blood flow to the skin during pregnancy?

A. To provide nutrients to the skin cells
B. To enhance the absorption of vitamins and minerals
C. To help dissipate heat due to increased metabolic activity
D. To prepare for delivery and increased body temperature

A

C. To help dissipate heat due to increased metabolic activity

Rationale: During pregnancy, increased metabolic activity generates more heat, and the increased blood flow to the skin helps dissipate that heat to regulate body temperature.

146
Q

What is the cause of varicosities and hemorrhoids during pregnancy?

A. Decreased blood volume
B. Increased blood pressure in the upper body
C. Pooling of blood in the veins of the legs, vulva, and rectum
D. Hormonal changes causing vasoconstriction

A

C. Pooling of blood in the veins of the legs, vulva, and rectum

Rationale: The pooling of blood in the deep and superficial veins, due to increased blood volume and pressure from the growing uterus, leads to varicosities and hemorrhoids in pregnancy.

147
Q

What is a common outcome of the increased blood flow to the breasts during pregnancy?

A. Decreased blood circulation to the breasts
B. Decreased breast sensitivity
C. Breast engorgement
D. Atrophy of mammary glands

A

C. Breast engorgement

Rationale: The increase in blood flow to the breasts during pregnancy (2-3 times normal) results in breast engorgement, preparing the body for lactation.

148
Q

How does the increase in blood flow to the maternal kidneys affect kidney function during pregnancy?

A. The kidneys become less efficient in removing waste
B. The kidneys become larger and more active
C. The kidneys stop producing urine
D. The kidneys become unable to filter blood properly

A

B. The kidneys become larger and more active

Rationale: Due to the increased blood flow, the kidneys become larger and more active to manage the increased metabolic waste produced during pregnancy.

149
Q

Why do pregnant women experience varicosities and hemorrhoids more frequently?

A. Decreased blood flow and hormonal changes
B. Decreased blood volume and uterine pressure
C. Pooling of blood in veins and increased venous pressure
D. Increased platelet count and coagulation

A

C. Pooling of blood in veins and increased venous pressure

Rationale: Varicosities and hemorrhoids are commonly caused by the pooling of blood in veins, especially in the legs, vulva, and rectum, due to increased venous pressure and blood volume during pregnancy.

150
Q

Why does pregnancy lead to physiologic anemia?

A. Increased RBC production due to hormonal factors
B. Decreased RBC production as a result of low iron intake
C. A greater increase in plasma volume compared to RBC volume
D. Overproduction of clotting factors in the blood

A

C. A greater increase in plasma volume compared to RBC volume

Rationale: Pregnancy leads to physiologic anemia because plasma volume increases more than the red blood cell (RBC) volume, causing hemodilution, which lowers hemoglobin and hematocrit levels.

151
Q

What triggers the rise in erythropoietin during the second and third trimesters of pregnancy?

A. High levels of progesterone, prolactin, and human placental lactogen
B. Low blood pressure and vascular changes
C. Increased iron supplementation
D. Increased blood volume

A

A. High levels of progesterone, prolactin, and human placental lactogen

Rationale: Erythropoietin levels rise during pregnancy due to hormonal stimulation from progesterone, prolactin, and human placental lactogen, which promotes RBC production.

152
Q

Which of the following best explains why pregnant women are at increased risk for venous thrombosis?

A. Elevated levels of fibrin and plasma fibrinogen, combined with venous stasis
B. Decreased cardiac output and venous return
C. Increased red blood cell mass leading to hypercoagulability
D. Reduced blood pressure leading to poor circulation

A

A. Elevated levels of fibrin and plasma fibrinogen, combined with venous stasis

Rationale: Pregnancy is a hypercoagulable state, with increased fibrin and fibrinogen levels, alongside venous stasis from the pressure of the growing uterus, which raises the risk for venous thrombosis.

153
Q

Which change in the cardiovascular system most commonly leads to a decrease in blood pressure during pregnancy?

A. Peripheral vasodilation due to progesterone
B. Increased blood volume
C. Increased heart rate and cardiac output
D. Reduced blood flow to the kidneys

A

A. Peripheral vasodilation due to progesterone

Rationale: Progesterone causes peripheral vasodilation, which leads to a slight decrease in blood pressure, particularly in the second trimester.

154
Q

Which of the following changes occurs in the cardiovascular system during pregnancy?

A. A decrease in venous return
B. A decrease in stroke volume
C. An increase in heart rate by 10–15 beats per minute
D. A decrease in cardiac output

A

C. An increase in heart rate by 10–15 beats per minute

Rationale: Heart rate increases by 10 to 15 bpm between 14 and 20 weeks’ gestation and persists throughout pregnancy, contributing to increased cardiac output.

155
Q

When does blood pressure typically reach its lowest point during pregnancy?

A. First trimester
B. Second trimester
C. Third trimester
D. At term

A

B. Second trimester

Rationale: Blood pressure typically decreases by 5-10 mmHg during the second trimester due to peripheral vasodilation, reaching its lowest point before returning to prepregnancy levels in the third trimester.

156
Q

Which of the following best describes the relationship between blood volume and fetal weight during pregnancy?

A. Blood volume decreases as fetal weight increases
B. Blood volume remains constant regardless of fetal weight
C. Blood volume decreases in the third trimester to compensate for fetal growth
D. Blood volume increases directly in correlation with fetal weight

A

D. Blood volume increases directly in correlation with fetal weight

Rationale: The increase in blood volume during pregnancy correlates directly with fetal weight, highlighting the placenta’s role as an arteriovenous shunt.

157
Q

What is the role of erythropoietin in pregnancy?

A. Stimulates the production of red blood cells to meet increased oxygen demands
B. Regulates blood pressure during pregnancy
C. Controls blood glucose levels in the mother
D. Prevents blood clots during pregnancy

A

A. Stimulates the production of red blood cells to meet increased oxygen demands

Rationale: Erythropoietin stimulates the production of red blood cells, which is essential during pregnancy to meet the increased oxygen needs of the mother and fetus.

158
Q

A nurse is assessing a pregnant woman at her prenatal visit. The nurse understands that the transition to motherhood involves a combination of physiological, psychological, and social changes. Which of the following is an example of a psychosocial change during pregnancy?

A) Increased heart rate due to pregnancy
B) Changes in social status due to becoming a mother
C) Changes in the structure of the uterus
D) Increase in blood volume

A

B) Changes in social status due to becoming a mother

Rationale: Psychosocial changes during pregnancy involve changes in the woman’s social role and relationships. The transition to motherhood often results in a shift in social status, as the woman moves into a new role as a mother.

159
Q

A nurse is conducting a prenatal assessment and inquires about a woman’s emotional well-being. Why is it important for the nurse to address psychosocial adaptations during pregnancy?

A) To provide accurate information about the woman’s physical health
B) To ensure the woman is meeting all physical milestones of pregnancy
C) To identify any physical discomforts the woman may be experiencing
D) To assess how the woman is coping with changes in her body and life

A

D) To assess how the woman is coping with changes in her body and life

Rationale: Psychosocial adaptations are crucial during pregnancy because they impact the woman’s emotional well-being and her ability to cope with the dramatic physical and social changes. Nurses must assess emotional well-being at each visit to provide appropriate support and interventions.

160
Q

A nurse is counseling a pregnant woman and her partner, emphasizing the dramatic changes in the woman’s body and appearance during pregnancy. Which of the following is an example of a psychological change the woman may experience during pregnancy?

A) Increased weight gain
B) Adjustments in body image and self-esteem
C) Changes in heart rate
D) Increased blood flow to the uterus

A

B) Adjustments in body image and self-esteem

Rationale: Pregnancy brings about significant changes in a woman’s body and appearance, which may lead to psychological adjustments. A woman may experience altered body image and changes in self-esteem as she navigates these changes.

161
Q

Which of the following best describes the role of the nurse in assessing psychosocial adaptations during pregnancy?

A) To focus primarily on physical changes and complications
B) To address emotional well-being and assess role and lifestyle changes
C) To provide counseling regarding labor and delivery options
D) To manage the woman’s physical discomfort during pregnancy

A

B) To address emotional well-being and assess role and lifestyle changes

Rationale: The nurse plays a crucial role in assessing the emotional and psychosocial well-being of the pregnant woman. This includes addressing the emotional and social adjustments related to changes in role and lifestyle during pregnancy, as these factors can significantly impact the woman’s overall well-being.

162
Q

Which of the following hormones contributes to the softening and stretching of ligaments during pregnancy?

A. Estrogen
B. Progesterone
C. Relaxin
D. Prolactin

A

C. Relaxin

Rationale: Relaxin is the hormone primarily responsible for softening and stretching the ligaments during pregnancy, particularly those in the pelvic region, to facilitate childbirth.

163
Q

What is the primary reason for the increased mobility of the sacroiliac joints and pubis symphysis during pregnancy?

A. Hormonal influence for joint relaxation
B. Increased fetal movement
C. Weight gain causing added pressure
D. Alterations in the woman’s posture

A

A. Hormonal influence for joint relaxation

Rationale: Hormones like relaxin and progesterone cause the sacroiliac joints and pubis symphysis to soften and become more mobile, facilitating the widening of the pelvic cavity for childbirth.

164
Q

Which postural change is commonly seen during pregnancy?

A. Increase in cervical lordosis
B. Flattening of the lumbar curve
C. Forward pelvic tilt
D. Increased swayback and upper spine extension

A

D. Increased swayback and upper spine extension

Rationale: The increased swayback and extension of the upper spine help to compensate for the enlarging abdomen and shifting center of gravity during pregnancy.

165
Q

What is a likely consequence of the relaxation of the sacroiliac joints during pregnancy?

A. Enhanced spinal stability
B. Increased risk of lower back pain
C. Improved posture alignment
D. Decreased weight gain

A

B. Increased risk of lower back pain

Rationale: The relaxation of the sacroiliac joints and changes in posture can lead to lower back pain, a common discomfort experienced by pregnant women.

166
Q

Which of the following is a common compensatory mechanism for the changing center of gravity during pregnancy?

A. Increased lumbar lordosis
B. Decreased cervicodorsal curve
C. Decreased body weight
D. Reduced pelvic mobility

A

A. Increased lumbar lordosis

Rationale: To compensate for the shifting center of gravity, an increased lumbosacral curve (lordosis) develops, aiding in balance during pregnancy.

167
Q

What contributes to the “waddle” gait often seen in late pregnancy?

A. Hormonal relaxation of the joints and increased mobility
B. Decreased weight gain and decreased center of gravity shift
C. Increased muscle tone in the pelvic region
D. Tightening of the sacroiliac joints

A

A. Hormonal relaxation of the joints and increased mobility

Rationale: The “waddle” gait is caused by the relaxation of the pelvic joints (due to hormones like relaxin), leading to increased mobility and instability in the pelvic area.

168
Q

Which of the following factors is most likely to exacerbate the discomfort caused by postural changes during pregnancy?

A. Increased weight gain
B. Decreased hormone levels
C. Higher levels of physical activity
D. Lack of fetal growth

A

A. Increased weight gain

Rationale: Increased weight gain during pregnancy accentuates the postural changes and exacerbates discomfort, particularly in the lumbar and dorsal curves.

169
Q

Which of the following hormonal changes occurs in the pituitary gland during pregnancy?

A. Increased secretion of TSH and GH
B. Increased secretion of FSH and LH
C. Decreased secretion of prolactin
D. Increased secretion of prolactin and MSH

A

D. Increased secretion of prolactin and MSH

Rationale: During pregnancy, the pituitary gland experiences increased secretion of prolactin and melanocyte-stimulating hormone (MSH), which are essential for lactation and pigmentation changes.

170
Q

Which gland is responsible for the increased secretion of cortisol and aldosterone during pregnancy?

A. Pituitary gland
B. Thyroid gland
C. Adrenal glands
D. Placenta

A

C. Adrenal glands

Rationale: The adrenal glands secrete increased levels of cortisol and aldosterone during pregnancy, which help with stress response and fluid balance, respectively.

171
Q

What is the primary effect of hPL (human placental lactogen) on the pancreas during pregnancy?

A. Stimulates insulin production
B. Increases insulin resistance
C. Decreases insulin secretion
D. Enhances glucose utilization

A

B. Increases insulin resistance

Rationale: hPL acts as an antagonist to insulin, increasing insulin resistance during the second half of pregnancy, which allows more glucose to be available for the fetus.

172
Q

What hormonal change is associated with the enlargement of the thyroid gland during pregnancy?

A. Increased BMR due to thyroid activity
B. Decreased basal metabolic rate (BMR)
C. Decreased production of thyroid hormones
D. Decreased secretion of prolactin

A

A. Increased BMR due to thyroid activity

Rationale: The thyroid gland undergoes slight enlargement and increased activity during pregnancy, leading to an increase in basal metabolic rate (BMR).

173
Q

Which hormone gradually increases with fetal maturation to facilitate labor?

A. Prolactin
B. Oxytocin
C. Progesterone
D. Relaxin

A

B. Oxytocin

Rationale: Oxytocin levels gradually increase as pregnancy progresses, particularly towards fetal maturation, and it plays a key role in initiating labor by stimulating uterine contractions.

174
Q

Which of the following is a result of the increased activity of the thyroid gland during pregnancy?

A. Decreased metabolism
B. Increased energy levels
C. Decreased basal metabolic rate
D. Increased blood pressure

A

B. Increased energy levels

Rationale: Increased thyroid activity during pregnancy elevates the basal metabolic rate (BMR), which often leads to increased energy levels.

175
Q

Which of the following is a key role of human chorionic gonadotropin (hCG) during pregnancy?

A. Promotes uterine contractions
B. Inhibits lactation
C. Stimulates the corpus luteum to secrete progesterone
D. Reduces insulin production

A

C. Stimulates the corpus luteum to secrete progesterone

Rationale: hCG stimulates the corpus luteum to continue secreting progesterone, which is essential for maintaining the uterine lining and preventing menstruation during pregnancy.

176
Q

Which of the following is true regarding insulin secretion in the second half of pregnancy?

A. Insulin resistance decreases due to placental hormones
B. Insulin secretion is inhibited by hPL
C. Insulin resistance is eliminated during pregnancy
D. Increased insulin production compensates for insulin resistance

A

D. Increased insulin production compensates for insulin resistance

Rationale: During pregnancy, insulin resistance increases in the second half, and the pancreas compensates by producing more insulin to maintain normal blood glucose levels.

177
Q

Which of the following hormones is responsible for the slight enlargement of the thyroid gland during pregnancy?

A. Estrogen
B. Progesterone
C. Thyroid-stimulating hormone (TSH)
D. Human chorionic gonadotropin (hCG)

A

C. Thyroid-stimulating hormone (TSH)

Rationale: During pregnancy, the thyroid gland slightly enlarges due to the increased levels of TSH, which stimulate thyroid hormone production and are important for metabolic regulation.

178
Q

What is the role of aldosterone secretion during pregnancy?

A. Decreases sodium retention to manage blood pressure
B. Increases sodium retention to help manage fluid balance
C. Stimulates uterine contractions during labor
D. Regulates glucose metabolism during pregnancy

A

B. Increases sodium retention to help manage fluid balance

Rationale: Aldosterone secretion increases during pregnancy to help the body retain sodium, thereby regulating fluid balance and supporting increased blood volume and circulation.

179
Q

Which of the following is an effect of the increased secretion of human placental lactogen (hPL) during pregnancy?

A. Increases maternal insulin sensitivity
B. Reduces maternal glucose levels
C. Increases maternal insulin resistance
D. Stimulates prolactin production

A

C. Increases maternal insulin resistance

Rationale: Human placental lactogen (hPL) increases maternal insulin resistance in the second half of pregnancy to ensure more glucose is available for the fetus. This leads to a rise in maternal blood glucose levels.

180
Q

Which of the following hormones from the thyroid gland increases during pregnancy and is important for fetal brain development?

A. Thyroid-stimulating hormone (TSH)
B. Prolactin
C. Growth hormone (GH)
D. Thyroxine (T4)

A

D. Thyroxine (T4)

Rationale: Thyroxine (T4) from the thyroid gland plays a crucial role in fetal brain development during pregnancy. It is transferred from the mother to the fetus early on when the fetal thyroid is not yet producing sufficient amounts.

181
Q

Which hormone is thought to decrease the need for growth hormone (GH) during pregnancy?

A. Prolactin
B. Human placental lactogen (hPL)
C. Progesterone
D. Oxytocin

A

B. Human placental lactogen (hPL)

Rationale: Human placental lactogen (hPL) acts as an antagonist to growth hormone (GH), reducing the need for GH during pregnancy by promoting maternal insulin resistance and facilitating nutrient supply to the fetus.

182
Q

Which hormone is primarily responsible for stimulating uterine contractions during labor?

A. Prolactin
B. Estrogen
C. Oxytocin
D. Relaxin

A

C. Oxytocin

Rationale: Oxytocin is the key hormone responsible for stimulating uterine contractions during labor. It also plays a role in milk ejection during breastfeeding.

183
Q

Which hormone is released in response to suckling by the newborn, stimulating milk production?

A. Prolactin
B. Estrogen
C. Human chorionic gonadotropin (hCG)
D. Relaxin

A

A. Prolactin

Rationale: Prolactin is released from the anterior pituitary in response to suckling, and it stimulates milk production and breast development.

184
Q

Which of the following hormones does not cross the placenta to affect the fetus directly?

A. Glucose
B. Insulin
C. Oxygen
D. Amino acids

A

B. Insulin

Rationale: Insulin does not cross the placenta. Therefore, the fetus must produce its own insulin to maintain glucose regulation, while nutrients like glucose and amino acids can cross to the fetus.

185
Q

What is the role of the pancreas in pregnancy?

A. To produce insulin to meet the demands of pregnancy
B. To regulate blood pressure through aldosterone secretion
C. To secrete human chorionic gonadotropin (hCG)
D. To produce progesterone for pregnancy maintenance

A

A. To produce insulin to meet the demands of pregnancy

Rationale: The pancreas secretes insulin to meet the increased demand for glucose during pregnancy, ensuring the growing fetus receives adequate nutrients.

186
Q

Which hormone produced by the adrenal glands helps in the regulation of sodium and water balance during pregnancy?

A. Cortisol
B. Aldosterone
C. Progesterone
D. Estrogen

A

B. Aldosterone

Rationale: Aldosterone helps regulate sodium and water balance during pregnancy, contributing to plasma volume expansion and supporting fetal growth.

187
Q

During which trimester is urinary frequency and urgency most commonly experienced due to physical and hormonal changes?

A. First trimester
B. Second trimester
C. Third trimester
D. Both first and third trimesters

A

D. Both first and third trimesters

Rationale: Urinary frequency and urgency are common in the first and third trimesters, primarily due to physical and hormonal changes.

188
Q

What is the primary reason for urinary frequency and urgency during the first and third trimesters of pregnancy?

A. Increased fluid intake
B. Hormonal changes and physical pressure from the growing uterus
C. Increased kidney filtration
D. Decreased renal blood flow

A

B. Hormonal changes and physical pressure from the growing uterus

Rationale: Urinary frequency and urgency in the first and third trimesters are due to hormonal changes and the physical pressure exerted by the enlarging uterus on the bladder.

189
Q

What event in the third trimester contributes to reduced pressure on the bladder and urinary urgency?

A. Increased urine production
B. Decreased blood flow to the kidneys
C. Lightening
D. Increased uterine size

A

C. Lightening

Rationale: Lightening, which occurs when the fetus descends into the pelvis, reduces pressure on the bladder, thus lessening urinary urgency in the third trimester.

190
Q

Which of the following is most likely to cause decreased urinary urgency during the second trimester?

A. Increased renal blood flow
B. Lightening
C. The uterus shifting into the abdominal cavity
D. Increased progesterone levels

A

C. The uterus shifting into the abdominal cavity

Rationale: During the second trimester, the uterus moves into the abdominal cavity, reducing pressure on the bladder and leading to decreased urgency.

191
Q

What causes the frequent need to urinate during the first trimester of pregnancy?

A. Increased blood volume
B. Physical pressure on the bladder from the uterus
C. Decreased renal function
D. Hormonal changes affecting bladder muscle tone

A

D. Hormonal changes affecting bladder muscle tone

Rationale: Hormonal changes during the first trimester, particularly increased progesterone, cause bladder muscle relaxation and lead to increased frequency and urgency of urination.

192
Q

Which of the following factors contributes to increased urinary frequency in the first trimester of pregnancy?

A. Increased glomerular filtration rate (GFR)
B. Increased blood pressure
C. Enlargement of the uterus in the pelvic cavity
D. Increased production of antidiuretic hormone (ADH)

A

A. Increased glomerular filtration rate (GFR)

Rationale: The increase in GFR during the first trimester leads to more urine production, contributing to urinary frequency.

193
Q

During the third trimester, what effect does lightening have on the bladder?

A. Increases bladder pressure and frequency of urination
B. Relieves pressure on the bladder, reducing urgency
C. Causes urinary retention
D. Increases renal blood flow, causing excessive urination

A

B. Relieves pressure on the bladder, reducing urgency

Rationale: Lightening, the descent of the fetus into the pelvis, reduces pressure on the bladder, which decreases urinary urgency during the third trimester.

194
Q

Which of the following best describes the urinary changes that occur in the second trimester of pregnancy?

A. Increased frequency and urgency of urination due to hormonal changes
B. Decreased urgency as the uterus moves out of the pelvic cavity
C. Increased urinary retention as a result of hormonal shifts
D. Increased bladder pressure as the uterus grows

A

B. Decreased urgency as the uterus moves out of the pelvic cavity

Rationale: In the second trimester, the uterus rises out of the pelvic cavity, reducing bladder pressure and resulting in decreased urgency.

195
Q

Why are pregnant women more prone to urinary tract infections (UTIs)?

A. Decreased urine production
B. Increased urine flow
C. Partial obstruction of urine flow due to uterine pressure
D. Increased glomerular filtration rate (GFR)

A

C. Partial obstruction of urine flow due to uterine pressure

Rationale: During pregnancy, the growing uterus partially obstructs the flow of urine through the ureters, leading to urinary stasis and increased risk of UTIs.

196
Q

Which of the following is a major consequence of urinary stasis in pregnant women?

A. Decreased risk of pyelonephritis
B. Increased risk of urinary tract infections (UTIs)
C. Increased renal clearance
D. Increased glomerular filtration rate (GFR)

A

B. Increased risk of urinary tract infections (UTIs)

Rationale: Urinary stasis provides an environment conducive to bacterial growth, increasing the risk of UTIs during pregnancy.

197
Q

What is a common result of the pressure exerted by the uterus on the urinary system during pregnancy?

A. Increased urine output
B. Increased bladder control
C. Partial obstruction of the ureters
D. Decreased risk of bacteriuria

A

C. Partial obstruction of the ureters

Rationale: The growing uterus can exert pressure on the ureters, leading to partial obstruction, which contributes to urinary stasis and an increased risk of infections.

198
Q

Which condition is pregnant women at a higher risk of developing due to urinary tract infections (UTIs) during pregnancy?

A. Urinary retention
B. Bladder cancer
C. Cystitis
D. Pyelonephritis

A

D. Pyelonephritis

Rationale: Pregnant women are at an increased risk of developing pyelonephritis due to ascending infections from UTIs, which can lead to more severe complications.

199
Q

What is the main reason for the loss of bladder control during pregnancy?

A. Decreased fluid intake
B. Hormonal changes affecting bladder tone
C. Increased blood volume
D. Decreased kidney function

A

B. Hormonal changes affecting bladder tone

Rationale: Hormonal changes, particularly the increase in progesterone, cause relaxation of the bladder muscles, leading to decreased bladder control.

200
Q

Which of the following best describes the condition of bacteriuria in pregnant women?

A. It is always symptomatic and easy to treat.
B. It may be asymptomatic and requires screening.
C. It causes immediate kidney failure.
D. It occurs only in the first trimester.

A

B. It may be asymptomatic and requires screening.

Rationale: Bacteriuria can be asymptomatic in pregnant women, which is why routine screening is necessary to detect and treat it before it leads to more severe conditions like pyelonephritis.

201
Q

What is the primary hormonal influence causing renal system changes during pregnancy?

A. Progesterone
B. Estrogen
C. Relaxin
D. Thyroid hormone

A

A. Progesterone

Rationale: Progesterone causes changes in the renal system, such as dilation of the renal pelvis and ureters, by relaxing smooth muscle.

202
Q

What is the effect of increased glomerular filtration rate (GFR) during pregnancy?

A. Decreased urine flow and volume
B. Increased filtration and excretion of waste products
C. Decreased renal perfusion
D. Lowered blood pressure

A

B. Increased filtration and excretion of waste products

Rationale: The increased GFR during pregnancy leads to enhanced filtration and excretion of waste products, including urea, uric acid, and creatinine.

203
Q

Why is the right ureter more affected than the left during pregnancy?

A. It is compressed by the growing fetus.
B. It has a longer length compared to the left ureter.
C. Progesterone relaxes the smooth muscle more on the right side.
D. It is influenced more by the position of the uterus.

A

D. It is influenced more by the position of the uterus.

Rationale: The right ureter is more commonly affected during pregnancy due to its anatomical position and the pressure from the growing uterus.

204
Q

What physiological change occurs when a pregnant woman lies on her side?

A. Decreased renal perfusion
B. Increased pressure on the vena cava
C. Decreased cardiac output
D. Increased renal perfusion and glomerular filtration

A

D. Increased renal perfusion and glomerular filtration

Rationale: Lying on her side relieves pressure on the vena cava, improving venous return and subsequently increasing renal perfusion and glomerular filtration.

205
Q

What is the effect of progesterone on the renal system during pregnancy?

A. Increases smooth muscle tone
B. Increases renal blood flow
C. Relaxes smooth muscle, causing renal and ureter dilation
D. Decreases glomerular filtration rate (GFR)

A

C. Relaxes smooth muscle, causing renal and ureter dilation

Rationale: Progesterone relaxes smooth muscle, leading to dilation of the renal pelvis and ureters, which is a significant structural change during pregnancy.

206
Q

Which of the following skin changes is commonly referred to as the “mask of pregnancy”?

A. Striae Gravidarum
B. Linea Nigra
C. Varicosities
D. Melasma

A

D. Melasma

Rationale: Melasma, also known as the “mask of pregnancy,” is characterized by darkened patches of skin, usually on the face, due to increased melanin production during pregnancy.

207
Q

What is the primary cause of the development of striae gravidarum during pregnancy?

A. Hormonal changes leading to skin elasticity loss
B. Increased blood circulation to the skin
C. Increased pigmentation of the skin
D. Excessive weight gain

A

A. Hormonal changes leading to skin elasticity loss

Rationale: Striae gravidarum (stretch marks) occur due to hormonal changes during pregnancy that affect skin elasticity, particularly when the skin is stretched rapidly by fetal growth and weight gain.

208
Q

Which of the following best describes the linea nigra?

A. A dark line that extends from the navel to the pubis symphysis
B. A stretch mark that appears on the abdomen
C. A birthmark that develops on the face during pregnancy
D. A dark line that extends from the symphysis pubis to the top of the fundus

A

D. A dark line that extends from the symphysis pubis to the top of the fundus

Rationale: The linea nigra is a dark vertical line that appears on the abdomen during pregnancy, extending from the pubis symphysis to the top of the fundus.

209
Q

Which of the following is a common manifestation of varicosities during pregnancy?

A. Swelling in the hands and feet
B. Enlarged veins, typically in the legs
C. Yellowish discoloration of the skin
D. Itchy rashes over the abdomen

A

B. Enlarged veins, typically in the legs

Rationale: Varicosities, or varicose veins, often appear in the legs during pregnancy due to increased blood volume, pressure from the uterus, and hormonal changes affecting vascular tone.

210
Q

Which of the following integumentary system changes is typically seen as a result of the hormonal changes in pregnancy that influence connective tissue?

A. Melasma
B. Striae Gravidarum
C. Linea Nigra
D. Varicosities

A

B. Striae Gravidarum

Rationale: Striae gravidarum (stretch marks) are commonly caused by hormonal changes that affect the elasticity of the connective tissue, leading to visible stretch marks as the skin is stretched during pregnancy.

211
Q

What is the most likely cause of hyperpigmentation in the skin during pregnancy?

A. Increased blood volume
B. Higher levels of progesterone and estrogen
C. Increased collagen production
D. Hormonal changes affecting melanin production

A

D. Hormonal changes affecting melanin production

Rationale: Hormonal changes during pregnancy, particularly increased levels of estrogen and progesterone, can cause increased melanin production, leading to hyperpigmentation such as melasma.

212
Q

Which of the following vascular-related skin changes is commonly seen in pregnant women due to poor circulation from standing for extended periods?

A. Palmar erythema
B. Vascular spiders
C. Varicosities
D. Pruritus

A

C. Varicosities

Rationale: Varicosities (varicose veins) develop in pregnancy due to increased blood volume, hormonal changes, and pressure from the uterus, leading to poor circulation, particularly in the legs.

213
Q

Which of the following conditions is characterized by intensely itchy skin and is associated with pregnancy?

A. PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)
B. Intrahepatic cholestasis of Pregnancy (ICP)
C. Palmar erythema
D. Vascular spiders

A

A. PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)

Rationale: PUPPP is a pregnancy-related skin condition characterized by pruritus (itching), usually around the abdomen, and presents as papules and plaques. It is most commonly seen in the third trimester.

214
Q

Which of the following vascular-related skin changes can cause the appearance of small, red, spider-like veins on the skin surface?

A. Vascular spiders
B. Varicosities
C. Palmar erythema
D. Pruritus

A

A. Vascular spiders

Rationale: Vascular spiders (spider veins) are small, red, or purple veins that appear as a network of fine lines on the skin surface, often due to hormonal changes during pregnancy.

215
Q

Palmar erythema during pregnancy is characterized by:

A. Reddening of the palms of the hands
B. Increased hair growth on the hands
C. Swelling of the fingers
D. A rash on the palms of the hands

A

A. Reddening of the palms of the hands

Rationale: Palmar erythema is the reddening of the palms, a vascular-related change often associated with increased estrogen levels during pregnancy.

216
Q

Which condition is characterized by the build-up of bile acids due to impaired liver function, leading to pruritus and jaundice in pregnant women?

A. Vascular spiders
B. Intrahepatic cholestasis of Pregnancy (ICP)
C. Striae gravidarum
D. Varicosities

A

B. Intrahepatic cholestasis of Pregnancy (ICP)

Rationale: Intrahepatic cholestasis of Pregnancy (ICP) occurs when there is impaired bile flow due to hormonal changes, causing pruritus, particularly on the palms and soles, and in some cases, jaundice.

217
Q

Increased hair and nail growth during pregnancy is primarily attributed to:

A. Increased progesterone and estrogen levels
B. Increased blood flow to the skin
C. Hormonal changes affecting the skin’s connective tissue
D. Relaxation of ligaments

A

A. Increased progesterone and estrogen levels

Rationale: Elevated levels of progesterone and estrogen during pregnancy stimulate hair and nail growth, often resulting in thicker hair and stronger nails.

218
Q

Which of the following skin conditions involves the appearance of dilated, twisting veins, particularly in the lower legs, due to poor circulation during pregnancy?

A. Palmar erythema
B. Varicosities
C. Pruritus
D. Vascular spiders

A

B. Varicosities

Rationale: Varicosities are enlarged, twisted veins that can develop in the lower legs due to poor circulation, pressure from the uterus, and hormonal changes during pregnancy.

219
Q

What is the primary cause of hyperpigmentation during pregnancy?

A. Decreased estrogen and progesterone levels
B. Increased activity of the maternal adrenal and pituitary glands
C. Elevated blood pressure
D. Increased blood volume

A

B. Increased activity of the maternal adrenal and pituitary glands

Rationale: Increased cortisone levels and enhanced production of progesterone and estrogenic hormones during pregnancy are responsible for most skin changes, including hyperpigmentation.

220
Q

Which of the following skin changes is typically observed in up to 70% of pregnant women and is exacerbated by sun exposure?

A. Striae gravidarum
B. Varicosities
C. Palmar erythema
D. Facial melasma

A

D. Facial melasma

Rationale: Facial melasma, also known as the “mask of pregnancy,” is a common skin condition characterized by brownish pigmentation on the forehead and cheeks, and it is aggravated by sun exposure.

221
Q

Which of the following is true about striae gravidarum (stretch marks)?

A. They are most prominent in the first trimester
B. They are more common in women with lower body mass indexes
C. They are more likely to occur in women with a history of breast or thigh striae
D. Cocoa butter is proven to prevent them

A

C. They are more likely to occur in women with a history of breast or thigh striae

Rationale: Striae gravidarum are more common in women with a family history of stretch marks, those with higher body mass indexes, and those carrying larger infants. Cocoa butter and similar products have not been proven to prevent striae.

222
Q

Which intervention can help reduce the risk of developing varicosities during pregnancy?

A. Lying on the back for extended periods
B. Elevating the legs when sitting or lying down
C. Wearing tight clothing to increase circulation
D. Remaining in a standing position for long periods

A

B. Elevating the legs when sitting or lying down

Rationale: Elevating the legs helps improve venous return and reduce pressure from the uterus on the pelvic veins, which can reduce the risk of varicosities.

223
Q

What is a common vascular-related skin change associated with pregnancy, often seen in the neck, thorax, face, and arms?

A. Palmar erythema
B. Varicosities
C. Vascular spiders
D. Striae gravidarum

A

C. Vascular spiders

Rationale: Vascular spiders are small blood vessels that appear on the skin due to high estrogen levels, commonly seen on the neck, thorax, face, and arms.

224
Q

Which of the following changes in the nails during pregnancy typically resolves postpartum?

A. Whitish discoloration
B. Increased growth rate
C. Brittleness and transverse grooves
D. Increased strength and durability

A

C. Brittleness and transverse grooves

Rationale: While nails may grow faster during pregnancy, conditions such as brittleness, transverse grooves, and distal separation of the nail bed typically resolve after delivery.

225
Q

What is a common characteristic of the “mask of pregnancy” (melasma)?

A. Blotchy, brownish pigmentation on the abdomen
B. A well-defined line from the umbilicus to the pubic area
C. Red, spider-like veins on the neck
D. Brownish pigmentation on the forehead and cheeks

A

D. Brownish pigmentation on the forehead and cheeks

Rationale: The “mask of pregnancy” is characterized by brownish pigmentation that typically appears on the forehead and cheeks and is exacerbated by sun exposure.

226
Q

Which factor contributes to the increased risk of varicosities in pregnant women?

A. Decreased blood volume
B. Elevated estrogen levels
C. Increased venous return
D. Prolonged standing or sitting

A

D. Prolonged standing or sitting

Rationale: Prolonged standing or sitting causes pressure on the pelvic veins, reducing venous return and increasing the risk of varicosities, especially in the legs.

227
Q

Which skin change is most likely to occur during the third trimester as a result of hormonal changes and increased blood volume?

A. Facial melasma
B. Linea nigra
C. Striae gravidarum
D. Vascular spiders

A

C. Striae gravidarum

Rationale: Striae gravidarum, or stretch marks, are most prominent by the third trimester due to the increased size of the abdomen and hormonal changes.

228
Q

Which of the following skin changes is most likely to fade after childbirth but may persist in some women?

A. Linea nigra
B. Striae gravidarum
C. Facial melasma
D. Vascular spiders

A

C. Facial melasma

Rationale: Facial melasma often fades after childbirth but may persist in some women, especially with subsequent pregnancies or continued sun exposure.

229
Q

What is a likely reason why younger women tend to have more pronounced striae gravidarum than older women?

A. Increased estrogen levels
B. Less skin elasticity and reduced collagen production
C. Higher body mass index (BMI)
D. Higher levels of relaxin

A

B. Less skin elasticity and reduced collagen production

Rationale: Younger women often have more pronounced striae gravidarum due to the skin’s higher elasticity, which makes it more prone to stretching.

230
Q

How do you calculate the estimated date of birth?

A

add 7 days and 9 months from the LMP

231
Q

G in GTPAL

A

(gravida): the total number of pregnancies, regardless if terminated or multiples(twins/triplets)

232
Q

T in GTPAL

A

(term births): the number of pregnancies ending >37 weeks’ gestation, at term

233
Q

P in GTPAL

A

(preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks

234
Q

A in GTPAL

A

(abortions): the number of pregnancies ending before 20 weeks or viability

235
Q

L in GTPAL

A

L (living children): number of children currently living

236
Q

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.”

A

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.

237
Q

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

A

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.

238
Q

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

A

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.

239
Q

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

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.

240
Q

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.

A

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.

241
Q

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

A

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.

242
Q

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

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.

243
Q

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

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.

244
Q

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

A

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.

245
Q

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.

A

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.

246
Q

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

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.

247
Q

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

A

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.

248
Q

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

A

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.

249
Q

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

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.

250
Q

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

A

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.

251
Q

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

A

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.

252
Q

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

A

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.

253
Q

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

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.

254
Q

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.

A

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.

255
Q

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

A

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.

256
Q

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

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.

257
Q
A