OB - Exam 1 - Questions

Question 0

A primigravida client is experiencing Braxton-Hicks contractions. Which statement is true concerning these contractions?

1. They are intensified by talking about.
2. They are not confined to the low back.
3. They do not increase in intensity or frequency.
4. They result in cervical effacement and dilation.

Answer 0

3. They do not increase in intensity or frequency.

False labor contractions decrease when the client is walking, are not concentrated in one part of the uterus, and do not increase in intensity and frequency. True labor is characterized by cervical effacement or dilation. (p. 293).

Question 1

The protein hormone human chorionic gonadotropin (hCG) can be detected in the maternal serum by ____ days after conception.

Answer 1

7 - 10 days

Question 2

A client reports that her last menstrual period was November 10. She asks the nurse, “When will my baby be due?” What is the best answer?

1. “July 3”
2. “August 30”
3. “Around the middle of September”
4. “Around the third week of August”

Answer 2

4. “Around the third week of August”

According to Nagele’s rule, count back 3 months from the date of the last menstrual period and add 7 days to determine the estimated date of conception. About 35% of all women will deliver within 5 days of (either before or after) this date. (p. 330)

Question 3

The nurse is encouraging the pregnant woman to eat a diet rich in folic acid. Which of the following food sources would provide the most folic acid?

1. Meat and dark green, leafy vegetables
2. Dairy products
3. Carrots and raisins
4. Shellfish

Answer 3

1. Meat and dark green, leafy vegetables

Rich dietary sources of folate are dark, green leafy vegetables, whole wheat bread, lightly cooked beans and peas, nuts and seeds, sprouts, oranges and grapefruits, liver and other organ meats, poultry, fortified breakfast cereals, and enriched grain products. Shellfish is rich in iodine. Dairy products are rich in calcium. (p. 311).

Question 4

The nursing student is preparing to teach a prenatal class about fetal circulation. Which statement should be included in the teaching plan?

1. “One artery carries oxygenated blood from the placenta to the fetus.”
2. “Two arteries carry oxygenated blood from the placenta to the fetus.”
3. “Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta.”
4. “Two veins carry blood that is high in carbon dioxide and other waste products away from the fetus to the placenta.”

Answer 4

3. “Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta.”

Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. When oxygenated, the blood is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and the umbilical vein carries oxygenated blood and provides oxygen and nutrients to the fetus. (p. 382-383).

Question 5

A nursing student is assigned to care for a client in labor. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement is correct regarding the ductus venosus?

1. Connects the pulmonary artery to the aorta
2. Is an opening between the right and left atria
3. Connects the umbilical vein to the inferior vena cava
4. Connects the umbilical artery to the inferior vena cava

Answer 5

3. Connects the umbilical vein to the inferior vena cava

The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and pulmonary artery. (p. 279-280).

Question 6

A pregnant client tells the clinic nurse that she wants to know the gender of her baby as soon as it can be determined. The nurse understands that the client should be able to find out the gender at the end of 12 weeks’ gestation because of which factor?

1. The appearance of the fetal external genitalia
2. The beginning of differentiation in the fetal groin
3. The fetal testes are descended into the scrotal sac
4. The internal differences in males and females become apparent

Answer 6

1. The appearance of the fetal external genitalia

By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the gender of the fetus can be determined visually. Differentiation of the external genitalia occurs at the end of the ninth week. Testes descend into the scrotal sac at the end of the thirty-eighth week. Internal differences in the male and female occur at the end of the seventh week.

Question 7

The nurse is performing an assessment on the client who is at 38 weeks’ gestation and notes that the fetal heart rate is 174 beats/minute. On the basis of this finding, what is the priority nursing action?

1. Document the finding.
2. Check the mother’s heart rate.
3. Notify the health care provider (HCP).
4. Tell the client that the fetal heart rate is normal.

Answer 7

3. Notify the health care provider (HCP).

The fetal heart rate (FHR) depends on gestational age and ranges from 160 to 170 beats/minute in the first trimester, but slows with fetal growth to 110 to 160 beats/minute near or at term. At or near term, if the FHR is less than 110 beats/minute or more than 160 beats/minute with the uterus at rest, the fetus may be in distress. Because the FHR is increased from the reference range, the nurse should notify the HCP. Options 2 and 4 are inappropriate actions based on the information in the question. Although the nurse documents the findings, based on the information in the question, the HCP needs to be notified.

Question 8

The nurse is conducting a prenatal class on the prenatal reproductive system. When a client in class asks why the fertilized ovum stays in the Fallopian tube for 3 days, what is the nurse’s best response?

1. “It promotes the fertilized ovum’s chances of survival.”
2. “It promotes the fertilized ovum’s exposure to estrogen and progesterone.”
3. “It promotes the fertilized ovum’s normal implantation in the top portion of the uterus.”
4. “It promotes the fertilized ovum’s exposure to luteinizing hormone and follicle-stimulating hormone.”

Answer 8

3. “It promotes the fertilized ovum’s normal implantation in the top portion of the uterus.”

The tubal isthmus remains contracted until 3 days after conception to allow the fertilized ovum to develop within the tube. This initial growth of the fertilized ovum promotes its normal implantation in the fundal portion of the uterine corpus. Estrogen is a hormone produced by the ovarian follicles, corpus luteum, adrenal cortex, and placenta during pregnancy. Progesterone is a hormone secreted by the corpus luteum of the ovary, adrenal glands, and placenta during pregnancy. Luteinizing hormone and follicle-stimulating hormone are excreted by the anterior pituitary gland. The survival of the fertilized ovum does not depend on it staying in the Fallopian tube for 3 days.
(p. 273).

Question 9

The nursing instructor asks a nursing student to list the characteristics of the amniotic fluid. The student responds correctly by listing which as characteristics of amniotic fluid? Select all that apply.

1. Allows for fetal movement
2. Surrounds, cushions, and protects the fetus
3. Maintains the body temperature of the fetus
4. Can be used to measure fetal kidney function
5. Prevents large particles such as bacteria from passing to the fetus
6. Provides an exchange of nutrients and waste products between the mother and the fetus

Answer 9

1. Allows for fetal movement
2. Surrounds, cushions, and protects the fetus
3. Maintains the body temperature of the fetus
4. Can be used to measure fetal kidney function

The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the mother and the fetus.
(p. 275-276).

Question 10

Which explanation should the nurse provide to the prenatal client about the purpose of the placenta?

1. It cushions and protects the baby.
2. It maintains the temperature of the baby.
3. It is the way the baby gets food and oxygen.
4. It prevents all antibodies and viruses from passing to the baby.

Answer 10

3. It is the way the baby gets food and oxygen.

The placenta provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. Nutrients, drugs, antibodies, and viruses can pass through the placenta.
(p. 277-279).

Question 11

The nurse is performing an assessment on a client who suspects that she is pregnant and is checking on the client for probable signs of pregnancy. Which are probable signs of pregnancy? Select all that apply.

1. Ballottement
2. Chadwick’s sign
3. Uterine enlargement
4. Braxton Hicks contractions
5. Fetal heart rate detected by a nonelectric device
6. Outline of fetus via radiography or ultrasonography

Answer 11

1. Ballottement
2. Chadwick’s sign
3. Uterine enlargement
4. Braxton Hicks contractions
   The probable signs of pregnancy include uterine enlargement, Hegar’s sign (compressibility and softening of the lower uterine segment that occurs at about week 6). Goodell’s sign (softening of the cervix that occurs at the beginning of the second month), Chadwick’s sign (violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 4), ballottement (rebounding of the fetus against the examiner’s fingers on palpation), Braxton Hicks contractions, and a positive pregnancy test for the presence of human chorionic gonadotropin. Positive signs of pregnancy include fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by nonelectric device (fetoscope) at 20 weeks of gestation, active fetal movements palpable by the examiner, and an outline of the fetus by radiography or ultrasonography.
   (pp. 292, 330).

Question 12

A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. The nurse determines that she is experiencing Braxton Hicks contractions. On the basis of this finding, which nursing action is most appropriate?

1. Contact the health care provider.
2. Instruct the client to maintain bed rest for the remainder of the pregnancy.
3. Inform the client that these contractions are common and may occur throughout the pregnancy.
4. Call the maternity unit and inform them that the client will be admitted in a prelabor condition.

Answer 12

3. Inform the client that these contractions are common and may occur throughout the pregnancy.

Braxton Hicks contractions are irregular, painless contractions that may occur intermittently throughout pregnancy. Because Braxton Hicks contractions may occur and are normal in some pregnant women during pregnancy, options 1, 2, and 4 are unnecessary and inappropriate actions.

Question 13

The nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The health care provider has documented the presence of Goodell’s sign. This finding is most closely associated with which characteristic?

1. A softening of the cervix
2. The presence of fetal movement
3. The presence of human chorionic gonadotropin in the urine
4. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus

Answer 13

1. A softening of the cervix

At the beginning of the second month of gestation, the cervix becomes softer as a result of increased vascularity and hyperplasia, which cause Goodell’s sign. Cervical softening is noted by the examiner during pelvic examination. Goodell’s sign does not indicate the presence of fetal movement. Human chorionic gonadotropin noted in maternal urine is a probable sign of pregnancy. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus and is caused by blood circulating through the placenta.
(p. 293-294).

Question 14

The health care provider (HCP) is assessing the client for the presence of ballottement. To make this determination, the HCP should take which action?

1. Auscultate for fetal heart sounds
2. Assess the cervix for compressibility
3. Palpate the abdomen for fetal movement
4. Initiate a gentle upward tap on the cervix

Answer 14

4. Initiate a gentle upward tap on the cervix

Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger. Options 1, 2, and 3 are not assessment techniques to check for ballottement. Option 2 is related to Hegar’s sign. Options 1 and 3 are a part of fetal assessment.
(p. 294-295, 330).

Question 15

The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client’s chart?

1. G=3, T=2, P=0, A=0, L=1
2. G=2, T=1, P=0, A=0, L=1
3. G=1, T=1, P=1, A=0, L=1
4. G=2, T=0, P=0, A=0, L=1

Answer 15

2. G=2, T=1, P=0, A=0, L=1

Pregnancy outcomes can be described with the acronym GTPAL. G is gravidity, the number of pregnancies; T is term births, the number born at term (longer than 37 weeks); P is preterm births, the number born before 37 weeks’ gestation; A is abortion or miscarriages, the number of abortions or miscarriages (included in gravida if before 20 weeks’ gestation; included in parity [number of births] if past 20 weeks’ gestation); and L is the number of current living children.

A woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of term births is 1, and the number of preterm births is 0. The number of abortions is 0, and the number of living children is 1.
(p. 289-290)

Question 16

A pregnant client asks the nurse in the clinic when she will be able to begin to feel the fetus move. The nurse responds by telling the mother that fetal movements will be noted between which weeks of gestation?

1. 6 and 8
2. 8 and 10
3. 10 and 12
4. 14 and 18

Answer 16

4. 14 and 18

Quickening is fetal movement that is felt by the mother. In the multiparous woman this may occur as early as the fourteenth to sixteenth weeks. The nulliparous woman may not notice these sensations until the eighteenth week or later. Options 1, 2, and 3 are incorrect time frames because quickening does occur this early during pregnancy.
(p. 294)

Question 18

A woman’s cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate?

a. “We don’t really know when such defects occur.”
b. “It depends on what caused the defect.”
c. “They occur between the third and fifth weeks of development.”
d. “They usually occur in the first 2 weeks of development.”

Answer 18

c. “They occur between the third and fifth weeks of development.”

Rationale: Choice A is an inaccurate statement. Regardless of the cause of a defect, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. Choice D is an inaccurate statement.

Question 19

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate?

a. “Many women imagine what their baby is like.”
b. “A baby in utero does respond to the mother’s voice.”
c. “You’ll need to ask the doctor if the baby can hear yet.”
d. “Thinking that your baby hears will help you bond with the baby.”

Answer 19

b. “A baby in utero does respond to the mother’s voice.”

Although choice A is an accurate statement, it is not the most appropriate response. Fetuses respond to the sound of a mother’s voice by 24 weeks. The fetus can be soothed by a mother’s voice.

Choice C is not an appropriate statement. The mother should be instructed that her fetus can hear at 24 weeks and can respond to the sound of her voice.

Choice D is not an appropriate statement. It gives the impression that her baby cannot hear her. It also belittles the mother’s interpretation of her fetus’s

Question 20

A maternity nurse should be aware of which fact about the amniotic fluid?

a. It serves as a source of oral fluid and as a repository for waste from the fetus.
b. The volume remains about the same throughout the term of a healthy pregnancy.
c. A volume of less than 300 ml is associated with gastrointestinal malformations.
d. A volume of more than 2 L is associated with fetal renal abnormalities.

Answer 20

a. It serves as a source of oral fluid and as a repository for waste from the fetus.

Choice A is an accurate statement. Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

Question 21

Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that:

a. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing
b. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins
c. Identical twins are more common in Caucasian families
d. Fraternal twins are same gender, usually male

Answer 21

a. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing

Choice A is an accurate statement. If the parents-to-be are older and have taken fertility drugs, they would be very interested in this information. Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference; fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender. Identical twins are the same gender.

Question 22

The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping:

a. In a side-lying position
b. On her back with a pillow under her knees
c. With the head of the bed elevated
d. On her abdomen

Answer 22

a. In a side-lying position

Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, thereby enhancing blood flow to the fetus.

However, it is now known that either side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium will be diminished. Although elevating the head of the bed is recommended and ideal for later in pregnancy, the woman must still maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women will find sleeping on the abdomen uncomfortable as pregnancy advances.

Side-lying is the ideal position to promote blood flow to the fetus.

Question 23

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates:

a. The fetus is at risk for Down syndrome
b. The woman is at high risk for developing preterm labor
c. Lung maturity
d. Meconium is present in the amniotic fluid

Answer 23

c. Lung maturity

Rationale: The presence of surface-active phospholipids is not an indication of Down syndrome. The result of the amniocentesis in no way indicates risk for preterm labor. The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. Meconium should not be present in the amniotic fluid.

Question 24

Which time span delineates the appropriate length for a normal pregnancy?

a. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days
b. 10 lunar months, 9 calendar months, 40 weeks, 280 days
c. 9 calendar months, 10 lunar months, 42 weeks, 294 days
d. 9 calendar months, 38 weeks, 266 days

Answer 24

b. 10 lunar months, 9 calendar months, 40 weeks, 280 days

Rationale: The time span in choice A is just short of a term pregnancy. Choice B is correct. Pregnancy lasts approximately 10 lunar months, 9 calendar months, 40 weeks, 280 days. Length of pregnancy is computed from the first day of the last menstrual period (LMP) until the day of birth. The time span in choice C is longer than the average length of a pregnancy and would be considered postterm.

Choice D is incorrect. Because conception occurs approximately 2 weeks after the first day of the LMP, this represents the post-conception age of 266 days or 38 weeks. Postconception age is used in the discussion of fetal development.

Question 25

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?

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

Answer 25

c. 3-1-0-1-0

Rationale: Using the GTPAL (gravidity, term, preterm, abortions, living children) system outlined in question 1, this woman’s gravidity and parity information is calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time)
T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term)
P: Number of pregnancies that resulted in a preterm birth (none)
A: Abortions or miscarriages before the period of viability (she has had one)
L: Number of children born who are currently living (she has no living children)

Question 26

Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)?

a. Radioimmunoassay
b. Radioreceptor assay
c. Latex agglutination test
d. Enzyme-linked immunosorbent assay (ELISA)

Answer 26

d. Enzyme-linked immunosorbent assay (ELISA)

Rationale: The radioimmunoassay tests for the summit of hCG in serum or urine samples. This test must be performed in the laboratory. The radioreceptor assay is a serum test that measures the ability of a blood sample to inhibit the binding of hCG to receptors. The Latex agglutination test in no way determines pregnancy. Rather it is done to detect specific antigens and antibodies. OTC pregnancy tests use ELISA for its one-step, accurate results.

Question 27

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy.

The woman demonstrates understanding of the nurse’s instructions if she states that a positive sign of pregnancy is:

a. A positive pregnancy test
b. Fetal movement palpated by the nurse-midwife
c. Braxton Hicks contractions
d. Quickening

Answer 27

b. Fetal movement palpated by the nurse-midwife

Rationale: A positive pregnancy test is a probable sign of pregnancy. Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. Braxton Hicks contractions are a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.

Question 28

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

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

Answer 28

a. Hegar sign

Rationale: At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign indicates a fast-food restaurant. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy.

Question 29

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?

a. Less audible heart sounds (S1 , S2 )
b. Increased pulse rate
c. Increased blood pressure
d. Decreased red blood cell (RBC) production

Answer 29

b. Increased pulse rate

Rationale: Splitting of S1 and S2 is more audible. Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. In the first trimester blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

Question 30

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

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

Answer 30

a. Primipara

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

Question 31

Which presumptive sign (felt by woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause?

a. Amenorrhea-stress, endocrine problems
b. Quickening-gas, peristalsis
c. Goodell sign-cervical polyps
d. Chadwick sign-pelvic congestion

Answer 31

c. Goodell sign-cervical polyps

Rationale: Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Goodell sign might be the result of pelvic congestion, not polyps. Chadwick sign might be the result of pelvic congestion.

Question 32

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that:

a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high
b. Shifting the client’s position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit
c. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant
d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy

Answer 32

d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy

Rationale: The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases. Choice D is a correct statement; this compression also leads to varicose veins in the legs and vulva.

Question 33

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

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

Answer 33

c. 33% HCT; 11 g/dl HGB

Rationale: The values in choice A are within normal limits in a nonpregnant woman. The values in choice B are within normal limits in a nonpregnant woman. The values in choice C represent the lowest acceptable value during the first and the third trimesters. The values in choice D represent the lowest acceptable value for the second trimester, when the hemodilution effect of blood volume expansion is at its peak.

Question 34

Which suggestion about weight gain is not an accurate recommendation?

a. Underweight women should gain 12.5 to 18 kg.
b. Obese women should gain at least 7 kg.
c. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale.
d. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.

Answer 34

d. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.

Rationale: Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much.

Question 35

A pregnant woman experiencing nausea and vomiting should:

a. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning
b. Eat small, frequent meals (every 2 to 3 hours)
c. Increase her intake of high-fat foods to keep the stomach full and coated
d. Limit fluid intake throughout the day

Answer 35

b. Eat small, frequent meals (every 2 to 3 hours)

A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated. This is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

Question 36

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

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

Answer 36

a. Several glasses of fluid

Rationale: If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman’s calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman’s calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

Question 37

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

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

Answer 37

b. Intrauterine growth restriction

Rationale: Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.

Question 38

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

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

Answer 38

c. Iron and folate

Rationale: Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Zinc sometimes is supplemented. Most women get enough calcium.

Question 39

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

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

Answer 39

b. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful

Rationale: Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

Question 40

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

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

Answer 40

d. Constipation is common with iron supplements

Rationale: Milk, coffee, and tea inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem.

Question 41

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lb) since conception. How would the nurse interpret this?

a. This weight gain indicates possible gestational hypertension.
b. This weight gain indicates that the woman’s infant is at risk for intrauterine growth restriction (IUGR).
c. This weight gain cannot be evaluated until the woman has been observed for several more weeks.
d. The woman’s weight gain is appropriate for this stage of pregnancy.

Answer 41

d. The woman’s weight gain is appropriate for this stage of pregnancy.

Rationale: Although choice A is an accurate statement, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman’s height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Although this is an accurate statement, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman’s height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy. Choice D is an accurate statement. This woman’s BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.

Question 42

With regard to protein in the diet of pregnant women, nurses should be aware that:

a. Many protein-rich foods are also good sources of calcium, iron, and B vitamins
b. Many women need to increase their protein intake during pregnancy
c. As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the
d. High-protein supplements can be used without risk by women on macrobiotic diets

Answer 42

a. Many protein-rich foods are also good sources of calcium, iron, and B vitamins

Rationale: Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.

Question 43

The breasts of a bottle-feeding woman are engorged. The nurse should instruct her to:

a. Wear a snug, supportive bra
b. Allow warm water to soothe the breasts during a shower
c. Express milk from breasts occasionally to relieve discomfort
d. Place absorbent pads with plastic liners into her bra to absorb leakage

Answer 43

a. Wear a snug, supportive bra

Rationale: A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Ice packs, fresh cabbage leaves, and mild analgesics may also relieve discomfort. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners keep the nipples and areola moist, leading to excoriation and cracking.

Question 44

A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman’s bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:

a. Urinary tract infection
b. Excessive uterine bleeding
c. A ruptured bladder
d. Bladder wall atony

Answer 44

b. Excessive uterine bleeding

Rationale: A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distension may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.

Question 45

What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?

a. “My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter.”
b. “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
c. “I will not have a menstrual cycle for 6 months after childbirth.”
d. “My first menstrual cycle will be heavier than normal and then will be light for several months after.”

Answer 45

b. “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”

Rationale: She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles. This is an accurate statement and indicates her understanding of her expected menstrual activity. Most women experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth.

Question 46

With regard to afterbirth pains, nurses should be aware that these pains are:

a. Caused by mild, continual contractions for the duration of the postpartum period
b. More common in first-time mothers
c. More noticeable in births in which the uterus was overdistended
d. Alleviated somewhat when the mother breastfeeds

Answer 46

c. More noticeable in births in which the uterus was overdistended

Rationale: The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large baby or multiple babies overdistend the uterus. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

Question 47

Postbirth uterine/vaginal discharge, called lochia:

a. Is similar to a light menstrual period for the first 6 to 12 hours
b. Is usually greater after cesarean births
c. Will usually decrease with ambulation and breastfeeding
d. Should smell like normal menstrual flow unless an infection is present

Answer 47

d. Should smell like normal menstrual flow unless an infection is present

Rationale: Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding. An offensive odor usually indicates an infection.

Question 48

Which description of postpartum restoration or healing times is accurate?

a. The cervix shortens, becomes firm, and returns to form within a month postpartum.
b. Rugae reappear within 3 to 4 weeks.
c. Most episiotomies heal within a week.
d. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

Answer 48

b. Rugae reappear within 3 to 4 weeks.

Rationale: The cervix regains its form within days; the cervical os may take longer. Rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.

Question 49

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:

a. Kidney function returns to normal a few days after birth
b. Diastasis recti abdominis is a common condition that alters the voiding reflex
c. Fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium
d. With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth

Answer 49

c. Fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium

Rationale: Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Option C is correct; excess fluid loss through other means occurs as well. Bladder tone usually is restored 5 to 7 days after childbirth. Puerperium is the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original nonpregnant condition.

Question 50

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding is:

a. Little if any change
b. Leakage of milk at let-down
c. Swollen, warm and tender on palpation
d. A few blisters and a bruise on each areola

Answer 50

a. Little if any change

Rationale: Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used.

Question 51

While evaluating the reflexes of a male newborn, the nurse notes that with a loud noise, the newborn symmetrically abducts and extends his arms, his fingers fan out and form a “C” with the thumb and forefinger, and he has a slight tremor. The nurse documents this finding as a positive:

a. Tonic neck reflex
b. Glabellar (Myerson) reflex
c. Babinski reflex
d. Moro reflex

Answer 51

d. Moro reflex
The characteristics displayed by the infant are associated with a positive Moro reflex.

Tonic neck reflex
The tonic neck reflex occurs when the infant extends the leg on the side to which the infant’s head simultaneously turns.

Glabellar (Myerson) reflex
The glabellar reflex is elicited by tapping on the infant’s head while the eyes are open. A characteristic response is blinking for the first few taps.

Babinski reflex
The Babinski reflex occurs when the sole of the foot is stroked upward along the lateral aspect of the sole and then across the ball of the foot. A positive response occurs when all the toes hyperextend, with dorsiflexion of the big toe.

Question 52

In most healthy newborns, blood glucose levels stabilize at _________ mg/dl during the first hours after birth:

a. 80 to 100
b. Less than 40
c. 50 to 60
d. 60 to 70

Answer 52

c. 50 to 60

In most healthy term newborns, blood glucose levels stabilize at 50 to 60 mg/dl during the first several hours after birth.

Other choices:

a. 80 to 100
This is the normal plasma glucose level in the adult.

b. Less than 40
A blood sugar level less than 40 mg/dl in the newborn is considered abnormal and warrants intervention. This infant can display classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures.

d. 60 to 70
By the third day of life the blood glucose levels should be approximately 60 to 70 mg/dl.

Question 53

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is:

a. Vision
b. Hearing
c. Smell
d. Taste

Answer 53

a. Vision

The visual system continues to develop for the first 6 months.
As soon as the amniotic fluid drains from the ear (minutes), the infant’s hearing is similar to that of an adult.
Newborns have a highly developed sense of smell.
The newborn can distinguish and react to various tastes.

Question 54

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver:

a. Tells the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking
b. Alerts the physician that the infant has a dislocated hip
c. Informs the parents and physician that molding has not taken place
d. Suggests that if the condition does not change, surgery to correct vision problems might be needed

Answer 54

b. Alerts the physician that the infant has a dislocated hip

The Ortolani maneuver is a technique for checking hip integrity. Unequal movement suggests that the hip is dislocated. The physician should be notified.

Question 55

With regard to the respiratory development of the newborn, nurses should be aware that:

a. Crying increases the distribution of air in the lungs
b. Newborns must expel the fluid at uterine life from the respiratory system within a few minutes of birth
c. Newborns are instinctive mouth breathers
d. Seesaw respirations are no cause for concern in the first hour after birth

Answer 55

a. Crying increases the distribution of air in the lungs

Respirations in the newborn can be stimulated by mechanical factors such as changes in intrathoracic pressure resulting from the compression of the chest during vaginal birth. With birth, the pressure on the chest is released, which helps draw air into the lungs. The positive pressure created by crying helps to keep the alveoli open and increases distribution of air throughout the lungs.

Question 56

While caring for the newborn, the nurse must be alert for any signs of cold stress. This would include which symptom?

a. Decreased activity level
b. Increased respiratory rate
c. Hyperglycemia
d. Shivering

Answer 56

b. Increased respiratory rate

In an infant that is cold, the respiratory rate increases in response to the increased need for oxygen.

Question 57

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is very dark green, almost black. She asks the nurse if something is wrong. The nurse should respond to this mother’s concern by:

a. Telling the mother not to worry because all breastfed babies have this type of stool
b. Explaining to the mother that this stool is called meconium and is expected for the first few bowel movements of all newborns
c. Asking the mother what she ate for her last meal
d. Suggesting to the mother that she ask her pediatrician to explain normal newborn stooling patterns to her

Answer 57

b. Explaining to the mother that this stool is called meconium and is expected for the first few bowel movements of all newborns

The majority of healthy term infants pass meconium during the first 12 to 24 hours after birth. Meconium is composed of amniotic fluid, intestinal secretions, shed mucosal cells, and possibly blood, resulting in the dark green to black color.

Question 58

A newborn male, estimated to be 39 weeks of gestation, exhibits:

a. Testes descended into the scrotum
b. Extended posture when at rest
c. Abundant lanugo over his entire body
d. Ability to move his elbow past his sternum

Answer 58

a. Testes descended into the scrotum

A full-term male infant has both testes descended into his scrotum and rugae appear on the anterior portion.