Unit E-Pregnancy and Antepartum

Question 1

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

Answer 1

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

Question 2

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs
and symptoms of pregnancy likely will have:
a. amenorrhea.
b. positive pregnancy test.
c. Chadwick’s sign.
d. Hegar’s sign.

Answer 2

ANS: A
Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are felt by
the woman. A positive pregnancy test, the presence of Chadwick’s sign, and the presence of
Hegar’s sign are all probable signs of pregnancy

Question 3

The 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 3

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

Question 4

A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which
level?
a. Not palpable above the symphysis at this time
b. Slightly above the symphysis pubis
c. At the level of the umbilicus
d. Slightly above the umbilicus

Answer 4

ANS: B
In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the
symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus
grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th
weeks of pregnancy. The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks
of gestation.

Question 5

During a patient’s physical examination the nurse notes that the lower uterine segment is soft
on palpation. The nurse would document this finding as:
a. Hegar’s sign.
b. McDonald’s sign.
c. Chadwick’s sign.
d. Goodell’s sign.

Answer 5

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

Question 6

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 6

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

Question 7

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

Answer 7

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

Question 8

The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can
expect to experience what change?
a. Her center of gravity will shift backward.
b. She will have increased lordosis.
c. She will have increased abdominal muscle tone.
d. She will notice decreased mobility of her pelvic joints

Answer 8

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

Question 9

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

Answer 9

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

Question 10

A woman is in her seventh month of pregnancy. She has been reporting nasal congestion and
occasional epistaxis. The nurse suspects that:
a. this is a normal respiratory change in pregnancy caused by elevated levels of
estrogen.
b. this is an abnormal cardiovascular change, and the nosebleeds are an ominous sign.
c. the woman is a victim of domestic violence and is being hit in the face by her
partner.
d. the woman has been using cocaine intranasally.

Answer 10

ANS: A
Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract. This
may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause
nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in
lower extremities. Determining that the woman is a victim of domestic violence and was hit in
the face cannot be made on the basis of the sparse facts provided. If the woman had been hit
in the face, she most likely would have additional physical findings. Determination of the use
of cocaine by the woman cannot be made on the basis of the sparse facts provided

Question 11

The nurse caring for the pregnant patient must understand that the hormone essential for
maintaining pregnancy is:
a. estrogen.
b. human chorionic gonadotropin (hCG).
c. oxytocin.
d. progesterone.

Answer 11

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

Question 12

A patient at 24 weeks of gestation contacts the nurse at her obstetric provider’s office to
complain that she has cravings for dirt and gravel. The nurse is aware that this condition is
known as ________ and may indicate anemia.
a. ptyalism
b. pyrosis
c. pica
d. decreased peristalsis

Answer 12

ANS: C
Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be
evaluated. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are
normal findings of gastrointestinal change during pregnancy. Food cravings during pregnancy
are normal.

Question 13

Appendicitis may be difficult to diagnose in pregnancy because the appendix is:

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

Answer 13

ANS: A

The appendix is displaced high and to the right, beyond McBurney point.

Question 14

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 14

ANS:A
A primipara is a woman who has completed one pregnancy with a viable fetus. To remember
terms, keep in mind: 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 15

Which time-based description of a stage of development in pregnancy is accurate?
a. Viability—22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal
weight >500 g).
b. Full Term—Pregnancy from the beginning of week 39 of gestation to the end of
week 40.
c. Preterm—Pregnancy from 20 to 28 weeks.
d. Postdate—Pregnancy that extends beyond 38 weeks

Answer 15

ANS: B
Full Term is 39 to 40 weeks of gestation. Viability is the ability of the fetus to live outside the
uterus before coming to term, or 22 to 24 weeks since LMP. Preterm is 20 to 37 weeks of
gestation. Postdate or postterm is a pregnancy that extends beyond 42 weeks or what is
considered the limit of full term.

Question 16

Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and
the basis for many tests. A maternity nurse should be aware that:
a. hCG can be detected 2.5 weeks after conception.
b. the hCG level increases gradually and uniformly throughout pregnancy.
c. much lower than normal increases in the level of hCG may indicate a postdate
pregnancy.
d. a higher than normal level of hCG may indicate an ectopic pregnancy or Down
syndrome

Answer 16

ANS: D
Higher levels also could be a sign of multiple gestation. hCG can be detected 7 to 8 days after
conception. The hCG level fluctuates during pregnancy: peaking, declining, stabilizing, and
increasing again. Abnormally slow increases may indicate impending miscarriage.

Question 17

To reassure and educate pregnant patients about changes in the uterus, nurses should be aware
that:
a. lightening occurs near the end of the second trimester as the uterus rises into a
different position.
b. the woman’s increased urinary frequency in the first trimester is the result of
exaggerated uterine anteflexion caused by softening.
c. Braxton Hicks contractions become more painful in the third trimester, particularly
if the woman tries to exercise.
d. the uterine souffle is the movement of the fetus.

Answer 17

ANS: B
The softening of the lower uterine segment is called Hegar’s sign. Lightening occurs in the
last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more
defined in the final trimester but are not painful. Walking or exercise usually causes them to
stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard
with a fetal stethoscope.

Question 18

To reassure and educate pregnant patients about changes in the cervix, vagina, and position of
the fetus, nurses should be aware that:
a. because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests
are much easier to evaluate.
b. Quickening is a technique of palpating the fetus to engage it in passive movement.
c. the deepening color of the vaginal mucosa and cervix (Chadwick’s sign) usually
appears in the second trimester or later as the vagina prepares to stretch during
labor.
d. increased vascularity of the vagina increases sensitivity and may lead to a high
degree of arousal, especially in the second trimester.

Answer 18

ANS: D
Increased sensitivity and an increased interest in sex sometimes go together. This frequently
occurs during the second trimester. Cervical changes make evaluation of abnormal Pap tests
more difficult. Quickening is the first recognition of fetal movements by the mother.
Ballottement is a technique used to palpate the fetus. Chadwick’s sign appears from the sixth
to eighth weeks

Question 19

The mucous plug that forms in the endocervical canal is called the:

a. operculum.
b. leukorrhea.
c. funic souffle.
d. ballottement

Answer 19

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

Question 20

To reassure and educate pregnant patients about changes in their breasts, nurses should be
aware that:
a. the visibility of blood vessels that form an intertwining blue network indicates full
function of Montgomery’s tubercles and possibly infection of the tubercles.
b. the mammary glands do not develop until 2 weeks before labor.
c. lactation is inhibited until the estrogen level declines after birth.
d. colostrum is the yellowish oily substance used to lubricate the nipples for
breastfeeding

Answer 20

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

Question 21

To reassure and educate pregnant patients about changes in their cardiovascular system,
maternity nurses should be aware that:
a. a pregnant woman experiencing disturbed cardiac rhythm, such as sinus
arrhythmia requires close medical and obstetric observation, no matter how healthy
she otherwise may appear.
b. changes in heart size and position and increases in blood volume create auditory
changes from 20 weeks to term.
c. palpitations are twice as likely to occur in twin gestations.
d. all of the above changes will likely occur.

Answer 21

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

Question 22

To reassure and educate their pregnant patients 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 patient’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 22

ANS:D
Compression of the iliac veins and inferior vena cava also leads to varicose veins in the legs
and vulva. 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 decreases and then gradually increases.

Question 23

Some pregnant patients may complain of changes in their voice and impaired hearing. The
nurse can tell these patients that these are common reactions to:
a. a decreased estrogen level.
b. displacement of the diaphragm, resulting in thoracic breathing.
c. congestion and swelling, which occur because the upper respiratory tract has
become more vascular.
d. increased blood volume

Answer 23

ANS: C
Estrogen levels increase, causing the upper respiratory tract to become more vascular
producing swelling and congestion in the nose and ears leading to voice changes and impaired
hearing. The diaphragm is displaced, and the volume of blood is increased. However, the
main concern is increased estrogen levels.

Question 24

To reassure and educate pregnant patients about the functioning of their kidneys in
eliminating waste products, maternity nurses should be aware that:
a. increased urinary output makes pregnant women less susceptible to urinary
infection.
b. increased bladder sensitivity and then compression of the bladder by the enlarging
uterus results in the urge to urinate even if the bladder is almost empty.
c. renal (kidney) function is more efficient when the woman assumes a supine
position.
d. using diuretics during pregnancy can help keep kidney function regular.

Answer 24

ANS: B
First bladder sensitivity and then compression of the bladder by the uterus result in the urge to
urinate more often. Numerous anatomic changes make a pregnant woman more susceptible to
urinary tract infection. Renal function is more efficient when the woman lies in the lateral
recumbent position and less efficient when she is supine. Diuretic use during pregnancy can
overstress the system and cause problems.

Question 25

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

Answer 25

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

Question 26

A first-time mother at 18 weeks of gestation comes for her regularly scheduled prenatal visit.
The patient tells the nurse that she is afraid that she is going into premature labor because she
is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks
sign and teaches the patient that this type of contraction:
a. is painless.
b. increases with walking.
c. causes cervical dilation.
d. impedes oxygen flow to the fetus.

Answer 26

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

Question 27

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

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

Answer 27

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

Question 28

The maternity nurse understands that vascular volume increases 40% to 45% during
pregnancy to:
a. compensate for decreased renal plasma flow.
b. provide adequate perfusion of the placenta.
c. eliminate metabolic wastes of the mother.
d. prevent maternal and fetal dehydration.

Answer 28

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

Question 29

Physiologic anemia often occurs during pregnancy as a result of:

a. inadequate intake of iron.
b. dilution of hemoglobin concentration.
c. the fetus establishing iron stores.
d. decreased production of erythrocytes.

Answer 29

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

Question 30

A patient in her first trimester complains of nausea and vomiting. She asks, “Why does this
happen?” The nurse’s best response is:
a. “It is due to an increase in gastric motility.”
b. “It may be due to changes in hormones.”
c. “It is related to an increase in glucose levels.”
d. “It is caused by a decrease in gastric secretions.”

Answer 30

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

Question 31

The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that

apply. )
a. Identification of fetal heartbeat
b. Palpation of fetal outline
c. Visualization of the fetus
d. Verification of fetal movement
e. Positive hCG test

Answer 31

ANS: A, C, D
Identification of fetal heartbeat, visualization of the fetus, and verification of fetal movement
are all positive, objective signs of pregnancy. Palpation of fetal outline and a positive hCG test
are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may
lead to false-positive results on pregnancy tests.

Question 32

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

Answer 32

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

Question 33

The nurse caring for a newly pregnant woman would advise her that ideally prenatal care
should begin:
a. before the first missed menstrual period.
b. after the first missed menstrual period.
c. after the second missed menstrual period.
d. after the third missed menstrual period

Answer 33

ANS: B
Prenatal care ideally should begin soon after the first missed menstrual period. Regular
prenatal visits offer opportunities to ensure the health of the expectant mother and her infant.

Question 34

Prenatal testing for human immunodeficiency virus (HIV) is recommended for:

a. all women, regardless of risk factors.
b. a woman who has had more than one sexual partner.
c. a woman who has had a sexually transmitted infection.
d. a woman who is monogamous with her partner

Answer 34

ANS: A
Testing for the antibody to HIV is strongly recommended for all pregnant women. A HIV test
is recommended for all women, regardless of risk factors. Women who test positive for HIV
can be treated, reducing the risk of transmission to the fetus.

Question 35

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

Answer 35

ANS: D
Signs and symptoms that must be reported include severe vomiting, fever and chills, burning
on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be
signs of potential complications of the pregnancy. Nausea with occasional vomiting, fatigue,
and urinary frequency are normal first-trimester complaints. Although they may be worrisome
or annoying to the mother, they usually are not indications of pregnancy problems

Question 36

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is
concerned about the effect of exercise on the fetus. The nurse should inform her:
a. “You don’t need to modify your exercising any time during your pregnancy.”
b. “Stop exercising because it will harm the fetus.”
c. “You may find that you need to modify your exercise to walking later in your
pregnancy, around the seventh month.”
d. “Jogging is too hard on your joints; switch to walking now

Answer 36

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

Question 37

The multiple marker test is used to assess the fetus for which condition?

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

Answer 37

ANS: A
The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural
tube defects, and other chromosome anomalies. The multiple marker test would not detect
diaphragmatic hernia, congenital cardiac abnormality, or anencephaly. Additional testing,
such as ultrasonography and amniocentesis, would be required to diagnose these conditions.

Question 38

A woman who is 32 weeks’ pregnant is informed by the nurse that a danger sign of pregnancy
could be:
a. constipation.
b. alteration in the pattern of fetal movement.
c. heart palpitations.
d. edema in the ankles and feet at the end of the day.

Answer 38

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

Question 39

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

Answer 39

ANS: D
The statement “Because no one knows how much or how little alcohol it takes to cause fetal
problems, the best course is to abstain throughout your pregnancy” is accurate. A safe level of
alcohol consumption during pregnancy has not yet been established. Although the
consumption of occasional alcoholic beverages may not be harmful to the mother or her
developing fetus, complete abstinence is strongly advised.

Question 40

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been
experiencing occasional backaches of mild-to-moderate intensity. The nurse would
recommend that she:
a. do Kegel exercises.
b. do pelvic rock exercises.
c. use a softer mattress.
d. stay in bed for 24 hours.

Answer 40

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

Question 41

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

Answer 41

ANS:D
The statement “Hormonal changes during pregnancy commonly result in mood swings” is
accurate and the most appropriate response by the nurse. The statement “Don’t worry about it;
you’ll feel better in a month or so” dismisses the patient’s concerns and is not the most
appropriate response. Although women should be encouraged to share their feelings, “Have
you talked to your husband about how you feel” is not the most appropriate response and does
not provide the patient with a rationale for the psychosocial dynamics of her pregnancy.
“Perhaps you really don’t want to be pregnant” is completely inappropriate and deleterious to
the psychologic well-being of the woman. Hormonal and metabolic adaptations often cause
mood swings in pregnancy. The woman’s responses are normal. She should be reassured
about her feelings.

Question 42

The nurse should be aware that the partner’s main role in pregnancy is to:

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

Answer 42

ANS: C
The partner’s main role in pregnancy is to nurture the pregnant woman and to respond her
feelings of vulnerability. In older societies, the man enacted the ritual couvade. Changing
cultural and professional attitudes have encouraged fathers’ participation in the birth
experience over the past 30 years

Question 43

During the first trimester, a woman can expect which of the following changes in her sexual
desire?
a. An increase, because of enlarging breasts
b. A decrease, because of nausea and fatigue
c. No change
d. An increase, because of increased levels of female hormones

Answer 43

ANS: B
Maternal physiologic changes such as breast enlargement, nausea, fatigue, abdominal
changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses
may affect sexuality and sexual expression. Libido may be depressed in the first trimester but
often increases during the second and third trimesters. During pregnancy, the breasts may
become enlarged and tender; this tends to interfere with coitus, decreasing the desire to
engage in sexual activity.

Question 44

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

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

Answer 44

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

Question 45

A 3-year-old girl’s mother is 6 months pregnant. What concern is this child likely to
verbalize?
a. How the baby will “get out”?
b. What the baby will eat?
c. Whether her mother will die?
d. What color eyes the baby has

Answer 45

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

Question 46

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

Answer 46

ANS: D
The purpose of all cultural practices is to protect the mother and fetus during pregnancy.
Although many cultures consider pregnancy normal, certain practices are expected of women
of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and
cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal
illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable
fetus.

Question 47

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

Answer 47

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

Question 48

With regard to a woman’s reordering of personal relationships during pregnancy, the
maternity nurse should understand that:
a. because of the special motherhood bond, a woman’s relationship with her mother
is even more important than with the father of the child.
b. nurses need not get involved in any sexual issues the couple has during pregnancy,
particularly if they have trouble communicating them to each other.
c. women usually express two major relationship needs during pregnancy: feeling
loved and valued and having the child accepted by the father.
d. the woman’s sexual desire is likely to be highest in the first trimester because of
the excitement and because intercourse is physically easier.

Answer 48

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

Question 49

What represents a typical progression through the phases of a woman’s establishing a
relationship with the fetus?
a. Accepts the fetus as distinct from herself—accepts the biologic fact of
pregnancy—has a feeling of caring and responsibility.
b. Fantasizes about the child’s gender and personality—views the child as part of
herself—becomes introspective.
c. Views the child as part of herself—has feelings of well-being—accepts the
biologic fact of pregnancy.
d. “I am pregnant.”—“I am going to have a baby.”—“I am going to be a mother.

Answer 49

ANS:D
The woman first centers on herself as pregnant, then on the baby as an entity separate from
herself, and then on her responsibilities as a mother. The expressions, “I am pregnant,” “I am
going to have a baby,” and “I am going to be a mother” sum up the progression through the
three phases.

Question 50

As relates to the father’s acceptance of the pregnancy and preparation for childbirth, the
maternity nurse should know that:
a. the father goes through three phases of acceptance of his own.
b. the father’s attachment to the fetus cannot be as strong as that of the mother
because it does not start until after birth.
c. in the last 2 months of pregnancy, most expectant fathers suddenly get very
protective of their established lifestyle and resist making changes to the home.
d. typically men remain ambivalent about fatherhood right up to the birth of their
child.

Answer 50

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

Question 51

With regard to the initial visit with a patient who is beginning prenatal care, nurses should be
aware that:
a. the first interview is a relaxed, get-acquainted affair in which nurses gather some
general impressions.
b. if nurses observe handicapping conditions, they should be sensitive and not
enquire about them because the patient will do that in her own time.
c. nurses should be alert to the appearance of potential parenting problems, such as
depression or lack of family support.
d. because of legal complications, nurses should not ask about illegal drug use; that is
left to physicians.

Answer 51

ANS: C
Besides these potential problems, nurses need to be alert to the woman’s attitude toward
health care. The initial interview needs to be planned, purposeful, and focused on specific
content. A lot of ground must be covered. Nurses must be sensitive to special problems, but
they do need to inquire because discovering individual needs is important. People with
chronic or handicapping conditions forget to mention them because they have adapted to
them. Getting information on drug use is important and can be done confidentially. Actual
testing for drug use requires the patient’s consent.

Question 52

With regard to follow-up visits for women receiving prenatal care, nurses should be aware
that:
a. the interview portions become more intensive as the visits become more frequent
over the course of the pregnancy.
b. monthly visits are scheduled for the first trimester, every 2 weeks for the second
trimester, and weekly for the third trimester.
c. during the abdominal examination, the nurse should be alert for supine
hypotension.
d. for pregnant women, a systolic blood pressure (BP) of 130 and a diastolic BP of 80
is sufficient to be considered hypertensive.

Answer 52

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

Question 53

While teaching the expectant mother about personal hygiene during pregnancy, maternity
nurses should be aware that:
a. tub bathing is permitted even in late pregnancy unless membranes have ruptured.
b. the perineum should be wiped from back to front.
c. bubble bath and bath oils are permissible because they add an extra soothing and
cleansing action to the bath.
d. expectant mothers should use specially treated soap to cleanse the nipples.

Answer 53

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

Question 54

To provide the patient with accurate information about dental care during pregnancy,
maternity nurses should be aware that:
a. dental care can be dropped from the priority list because the woman has enough to
worry about and is getting a lot of calcium anyway.
b. dental surgery, in particular, is contraindicated because of the psychologic stress it
engenders.
c. if dental treatment is necessary, the woman will be most comfortable with it in the
second trimester.
d. dental care interferes with the expectant mother’s need to practice conscious relaxation

Answer 54

ANS: C
The second trimester is best for dental treatment because that is when the woman will be able
to sit most comfortably in the dental chair. Dental care such as brushing with fluoride
toothpaste is especially important during pregnancy because nausea during pregnancy may
lead to poor oral hygiene. Emergency dental surgery is permissible, but the mother must
clearly understand the risks and benefits. Conscious relaxation is useful, and it may even help
the woman get through any dental appointments; it is not a reason to avoid them.

Question 55

When discussing work and travel during pregnancy with a pregnant patient, nurses should
instruct them that:
a. women should sit for as long as possible and cross their legs at the knees from time
to time for exercise.
b. women should avoid seat belts and shoulder restraints in the car because they press
on the fetus.
c. metal detectors at airport security checkpoints can harm the fetus if the woman
passes through them a number of times.
d. while working or traveling in a car or on a plane, women should arrange to walk
around at least every 2 hours or so.

Answer 55

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

Question 56

With regard to medications, herbs, shots, and other substances normally encountered by
pregnant women, the maternity nurse should be aware that:
a. both prescription and over-the-counter (OTC) drugs that otherwise are harmless
can be made hazardous by metabolic deficiencies of the fetus.
b. the greatest danger of drug-caused developmental deficits in the fetus is seen in the
final trimester.
c. killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but
live-virus vaccines (e.g., measles) are permissible.
d. no convincing evidence exists that secondhand smoke is potentially dangerous to
the fetus

Answer 56

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

Question 57

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

Answer 57

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

Question 58

The phenomenon of someone other than the mother-to-be experiencing pregnancy-like
symptoms such as nausea and weight gain applies to the:
a. mother of the pregnant woman.
b. couple’s teenage daughter.
c. sister of the pregnant woman.
d. expectant father.

Answer 58

ANS: D

An expectant father’s experiencing pregnancy-like symptoms is called the couvade syndrome

Question 59

In response to requests by the U.S. Public Health Service for new models of prenatal care, an
innovative new approach to prenatal care known as centering pregnancy was developed.
Which statement would accurately apply to the centering model of care?
a. Group sessions begin with the first prenatal visit.
b. At each visit, blood pressure, weight, and urine dipsticks are obtained by the nurse.
c. Eight to twelve women are placed in gestational-age cohort groups.
d. Outcomes are similar to those of traditional prenatal care.

Answer 59

ANS:C
Gestational-age cohorts comprise the groups with approximately 8 to 12 women in each
group. This group remains intact throughout the pregnancy. Individual follow-up visits are
scheduled as needed. Group sessions begin at 12 to 16 weeks of gestation and end with an
early after birth visit. Before group sessions the patient has an individual assessment, physical
examination, and history. At the beginning of each group meeting, patients measure their own
blood pressure, weight, and urine dips and enter these in their record. Fetal heart rate
assessment and fundal height are obtained by the nurse. Results evaluating this approach have
been very promising. In a study of adolescent patients, there was a decrease in
low-birth-weight infants and an increase in breastfeeding rates.

Question 60

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

Answer 60

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

Question 61

Signs and symptoms that a woman should report immediately to her health care provider

include: (Select all that apply.)
a. vaginal bleeding.
b. rupture of membranes.
c. heartburn accompanied by severe headache.
d. decreased libido.
e. Urinary frequency

Answer 61

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

Question 62

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

Answer 62

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

Question 63

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 lbs) 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 63

ANS: D
The statement “The woman’s weight gain is appropriate for this stage of pregnancy” is
accurate. This woman’s BMI is within the normal range. During the first trimester, the
average total weight gain is only 1 to 2 kg. Although weight gain does indicate possible
gestational hypertension, it does not apply to this patient. 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.
Although weight gain does indicate risk for IUGR, this does not apply to this patient. Weight
gain should occur at a steady rate throughout the pregnancy. The optimal rate of weight gain
also depends on the stage of the pregnancy

Question 64

Which meal would provide the most absorbable iron?

a. Toasted cheese sandwich, celery sticks, tomato slices, and a grape drink
b. Oatmeal, whole wheat toast, jelly, and low-fat milk
c. Black bean soup, wheat crackers, orange sections, and prunes
d. Red beans and rice, cornbread, mixed greens, and decaffeinated tea

Answer 64

ANS: C
Food sources that are rich in iron include liver, meats, whole grain or enriched breads and
cereals, deep green leafy vegetables, legumes, and dried fruits. In addition, the vitamin C in
orange sections aids absorption. Dairy products and tea are not sources of iron.

Question 65

A pregnant woman’s diet consists almost entirely of whole grain breads and cereals, fruits,
and vegetables. The nurse would be most concerned about this woman’s intake of:
a. calcium.
b. protein.
c. vitamin B12.
d. folic acid

Answer 65

ANS: C
This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only
plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in
vitamin B12.

Question 66

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 66

ANS: B
Eating small, frequent meals is the correct suggestion for a woman experiencing nausea and
vomiting. A pregnant woman experiencing nausea and vomiting should avoid consuming
fluids early in the day or when nauseated, but should compensate by drinking fluids at other
times. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried
and other fatty foods.

Question 67

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse
would be most concerned that during and after tennis matches this woman consumes:
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 67

ANS: A
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.
The woman’s calorie intake should be sufficient to meet the increased needs of pregnancy and
the demands of exercise.

Question 68

Which statement made by a lactating woman would lead the nurse to believe that the woman
might have lactose intolerance?
a. “I always have heartburn after I drink milk.”
b. “If I drink more than a cup of milk, I usually have abdominal cramps and
bloating.”
c. “Drinking milk usually makes me break out in hives.”
d. “Sometimes I notice that I have bad breath after I drink a cup of milk.”

Answer 68

ANS:B
Abdominal cramps and bloating are consistent with lactose intolerance. One problem that can
interfere with milk consumption is lactose intolerance, which is the inability to digest milk
sugar because of a lack of the enzyme lactase in the small intestine. Milk consumption may
cause abdominal cramping, bloating, and diarrhea in people who are lactose intolerant,
although many affected individuals can tolerate small amounts of milk without symptoms.

Question 69

A pregnant woman’s diet history indicates that she likes the following list of foods. The nurse
would encourage this woman to consume more of which food to increase her calcium intake?
a. Fresh apricots
b. Canned clams
c. Spaghetti with meat sauce
d. Canned sardines

Answer 69

ANS: D
Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are
not high in calcium.

Question 70

A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The
nurse knows that this woman’s total recommended weight gain during pregnancy should be at
least:
a. 20 kg (44 lbs).
b. 16 kg (35 lbs).
c. 12.5 kg (27.5 lbs).
d. 10 kg (22 lbs).

Answer 70

ANS: C
This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy. A weight
gain of 20 kg would be unhealthy for most women. A weight gain 35 lbs is the high end of the
range of weight this woman should gain in her pregnancy. A weight gain of 22 lbs would be
appropriate for an obese woman

Question 71

A woman in week 34 of pregnancy reports that she is very uncomfortable because of

heartburn. The nurse would suggest that the woman:
a. substitute other calcium sources for milk in her diet.
b. lie down after each meal.
c. reduce the amount of fiber she consumes.
d. eat five small meals daily

Answer 71

ANS: D
Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting
other calcium sources for milk, lying down after eating, and reducing fiber intake are
inappropriate dietary suggestions for all pregnant women and do not alleviate heartburn.

Question 72

A woman has come to the clinic for preconception counseling because she wants to start
trying to get pregnant in 3 months. She can expect the following advice:
a. “Discontinue all contraception now.”
b. “Lose weight so that you can gain more during pregnancy.”
c. “You may take any medications you have been taking regularly.”
d. “Make sure that you include adequate folic acid in your diet.”

Answer 72

ANS: D
A healthy diet before conception is the best way to ensure that adequate nutrients are available
for the developing fetus. A woman’s folate or folic acid intake is of particular concern in the
periconception period. Neural tube defects are more common in infants of women with a poor
folic acid intake. Depending on the type of contraception used, discontinuing all contraception
may not be appropriate advice. Losing weight is not appropriate advice. Depending on the
type of medication the woman is taking, continuing its use may not be appropriate.

Question 73

To prevent gastrointestinal upset, patients should be instructed to take iron supplements:

a. on a full stomach.
b. at bedtime.
c. after eating a meal.
d. with milk.

Answer 73

ANS: B
Patients should be instructed to take iron supplements at bedtime. Iron supplements are best
absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may
reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is
taken between meals

Question 74

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 74

ANS: B
Both normal-weight and underweight women with inadequate weight gain have an increased
risk of giving birth to an infant with intrauterine growth restriction. Spina bifida, diabetes
mellitus, and Down syndrome are not associated with inadequate maternal weight gain.

Question 75

After you complete your nutritional counseling for a pregnant woman, you ask her to repeat
your instructions so you can assess her understanding of the instructions given. Which
statement indicates that she understands the role of protein in her pregnancy?
a. “Protein will help my baby grow.”
b. “Eating protein will prevent me from becoming anemic.”
c. “Eating protein will make my baby have strong teeth after he/she is born.”
d. “Eating protein will prevent me from being diabetic.”

Answer 75

ANS: A
Protein is the nutritional element basic to growth. An adequate protein intake is essential to
meeting the increasing demands of pregnancy. These demands arise from the rapid growth of
the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the
maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia.
Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in
diabetics; protein is one nutritional factor to consider, but this is not the primary role of
protein intake.

Question 76

Maternal nutritional status is an especially significant factor of the many factors that influence
the outcome of pregnancy because:
a. it is very difficult to adjust because of people’s ingrained eating habits.
b. it is an important preventive measure for a variety of problems.
c. women love obsessing about their weight and diets.
d. a woman’s preconception weight becomes irrelevant.

Answer 76

ANS: B
Nutritional status draws so much attention not only for its effect on a healthy pregnancy and
birth but also because significant changes are within relatively easy reach.

Question 77

Which statement regarding acronyms in nutrition is accurate?
a. Dietary reference intakes (DRIs) consist of recommended dietary allowances
(RDAs), adequate intakes (AIs), and upper limits (ULs).
b. RDAs are the same as ULs except with better data.
c. AIs offer guidelines for avoiding excessive amounts of nutrients.
d. They all refer to green leafy vegetables, whole grains, and fruit.

Answer 77

ANS: A
DRIs consist of RDAs, AIs, and ULs. AIs are similar to RDAs except that they deal with
nutrients about which data are insufficient for certainty (RDA status). ULs are guidelines for
avoiding excesses of nutrients for which excess is toxic. Green leafy vegetables, whole grains,
and fruit are important, but they are not the whole nutritional story

Question 78

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 diet.
d. high-protein supplements can be used without risk by women on macrobiotic diets.

Answer 78

ANS: A
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 79

Which nutritional recommendation about fluids is accurate?
a. A woman’s daily intake should be 8 to 10 glasses (2.3 L) of water, milk, or juice.
b. Coffee should be limited to no more than two cups, but tea and cocoa can be
consumed without worry.
c. Of the artificial sweeteners, only aspartame has been not associated with any
maternity health concerns.
d. Water with fluoride is especially encouraged because it reduces the child’s risk of
tooth decay.

Answer 79

ANS: A
Eight to ten glasses is the standard for fluids; however, they should be the right fluids. All
beverages containing caffeine, including tea, cocoa, and some soft drinks should be avoided
or drunk only in limited amounts. Artificial sweeteners, including aspartame, have no ill
effects on the normal mother or fetus; however, mothers with phenylketonuria should avoid
aspartame. No evidence indicates that prenatal fluoride consumption reduces childhood tooth
decay

Question 80

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 80

ANS: C
Iron generally should be supplemented, and folic acid supplements often are needed because
folate is so important. 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.
Zinc sometimes is supplemented. Most women obtain enough calcium through their regular
diet.

Question 81

Which vitamins or minerals can lead to congenital malformations of the fetus if taken in
excess by the mother?
a. Zinc
b. Vitamin D
c. Folic acid
d. Vitamin A

Answer 81

ANS: D
Zinc, vitamin D, and folic acid are vital to good maternal and fetal health and are highly
unlikely to be consumed in excess. Vitamin A taken in excess causes a number of problems.
An analog of vitamin A appears in prescribed acne medications, which must not be taken
during pregnancy.

Question 82

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 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 82

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

Question 83

While taking a diet history, the nurse might be told that the expectant mother has cravings for
ice chips, cornstarch, and baking soda. This represents a nutritional problem known as:
a. preeclampsia.
b. pyrosis.
c. pica.
d. purging.

Answer 83

ANS: C
The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt,
laundry starch) is called pica.

Question 84

When counseling a patient 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 84

ANS: D
Constipation can be a problem. 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.

Question 85

To help a woman reduce the severity of nausea caused by morning sickness, the nurse might
suggest that she:
a. try a tart food or drink such as lemonade or salty foods such as potato chips.
b. drink plenty of fluids early in the day.
c. brush her teeth immediately after eating.
d. never snack before bedtime

Answer 85

ANS: A
Some women can tolerate tart or salty foods when they are nauseous. The woman should
avoid drinking too much when nausea is most likely, but she should make up the fluid levels
later in the day when she feels better. The woman should avoid brushing her teeth
immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help
the stomach in the morning.

Question 86

Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish
adequately supply the recommended amount of protein for a pregnant woman. Many patients
are concerned about the increased levels of mercury in fish and may be afraid to include this
source of nutrients in their diet. Sound advice by the nurse to assist the patient in determining
which fish is safe to consume would include:
a. canned white tuna is a preferred choice.
b. avoid shark, swordfish, and mackerel.
c. fish caught in local waterways are the safest.
d. salmon and shrimp contain high levels of mercury.

Answer 86

ANS: B
As a precaution, the pregnant patient should avoid eating all of these and the less common
tilefish. High levels of mercury can harm the developing nervous system of the fetus. It is
essential for the nurse to assist the patient in understanding the differences between numerous
sources of this product. A pregnant patient can take 12 ounces a week of canned light tuna;
however, canned white, albacore, or tuna steaks contain higher levels of mercury and should
be limited to no more than 6 ounces per week. It is a common misconception that fish caught
in local waterways are the safest. Pregnant women and mothers of young children should
check with local advisories about the safety of fish caught by families and friends in nearby
bodies of water. If no information is available, these fish sources should be avoided, limited to
less than 6 ounces, or the only fish consumed that week. Commercially caught fish that are
low in mercury include salmon, shrimp, pollock, or catfish.

Question 87

Nutrition is one of the most significant factors influencing the outcome of a pregnancy. It is an
alterable and important preventive measure for various potential problems, such as low birth
weight and prematurity. While completing the physical assessment of the pregnant patient, the
nurse can evaluate the patient’s nutritional status by observing a number of physical signs.
Which sign would indicate that the patient has unmet nutritional needs?
a. Normal heart rate, rhythm, and blood pressure
b. Bright, clear, shiny eyes
c. Alert, responsive, and good endurance
d. Edema, tender calves, and tingling

Answer 87

ANS: D
The physiologic changes of pregnancy may complicate the interpretation of physical findings.
Lower-extremity edema often occurs when caloric and protein deficiencies are present;
however, it may also be a common physical finding during the third trimester. It is essential
that the nurse complete a thorough health history and physical assessment and request further
laboratory testing if indicated. A malnourished pregnant patient may display rapid heart rate,
abnormal rhythm, enlarged heart, and elevated blood pressure. A patient receiving adequate
nutrition has bright, shiny eyes with no sores and moist, pink membranes. Pale or red
membranes, dryness, infection, dull appearance of the cornea, or blue sclerae all are signs of
poor nutrition. This patient is well nourished. Cachexia, listlessness, and tiring easily would
be indications of poor nutritional status.

Question 88

Which pregnant woman should restrict her weight gain during pregnancy?

a. Woman pregnant with twins
b. Woman in early adolescence
c. Woman shorter than 62 inches or 157 cm
d. Woman who was 20 lbs overweight before pregnancy

Answer 88

ANS: D
A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and
obese women should be advised to lose weight before conception to achieve the best
pregnancy outcomes. A higher weight gain in twin gestations may help prevent low birth
weights. Adolescents need to gain weight toward the higher acceptable range, which provides
for their own growth as well as for fetal growth. In the past, women of short stature were
advised to restrict their weight gain; however, evidence to support these guidelines has not
been found.

Question 89

The major source of nutrients in the diet of a pregnant woman should be composed of:

a. simple sugars.
b. fats.
c. fiber.
d. complex carbohydrates.

Answer 89

ANS: D
Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. The
most common simple carbohydrate is table sugar, which is a source of energy but does not
provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and
proteins, which provide only 4 kcal in each gram. Fiber is supplied primarily by complex
carbohydrates.

Question 90

A pregnant woman’s diet may not meet her need for folates. A good source of this nutrient is:

a. chicken.
b. cheese.
c. potatoes.
d. green leafy vegetables

Answer 90

ANS: D
Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and
beans. Chicken and cheese are excellent sources of protein but are poor in folates. Potatoes
contain carbohydrates and vitamins and minerals but are poor in folates.

Question 91

When providing care to the prenatal patient, the nurse understands that pica is defined as:

a. intolerance of milk products.
b. iron deficiency anemia.
c. ingestion of nonfood substances.
d. episodes of anorexia and vomiting.

Answer 91

ANS: C
The practice of eating substances not normally thought of as food is called pica. Clay or dirt
and solid laundry starch are the substances most commonly ingested. Intolerance of milk
products is referred to as lactose intolerance. Pica may produce iron deficiency anemia if
proper nutrition is decreased. Pica is not related to anorexia and vomiting.

Question 92

The most important reason for evaluating the pattern of weight gain in pregnancy is to:

a. prevent excessive adipose tissue deposits.
b. identify potential nutritional problems or complications of pregnancy.
c. assess the need to limit caloric intake in obese women.
d. determine cultural influences on the woman’s diet

Answer 92

ANS:B
Maternal and fetal risks in pregnancy are increased when the mother is significantly
overweight. Excessive adipose tissue may occur with excess weight gain; however, this is not
the reason for monitoring the weight gain pattern. It is important to monitor the pattern of
weight gain to identify complications. The pattern of weight gain is not influenced by cultural
influences.

Question 93

A pregnant patient would like to know a good food source of calcium other than dairy

products. Your best answer is:
a. legumes.
b. yellow vegetables.
c. lean meat.
d. whole grains.

Answer 93

ANS: A
Although dairy products contain the greatest amount of calcium, it is also found in legumes,
nuts, dried fruits, and some dark green leafy vegetables. Yellow vegetables are rich in vitamin
A. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and
magnesium

Question 94

To determine the cultural influence on a patient’s diet, the nurse should first:
a. evaluate the patient’s weight gain during pregnancy.
b. assess the socioeconomic status of the patient.
c. discuss the four food groups with the patient.
d. identify the food preferences and methods of food preparation common to that
culture.

Answer 94

ANS: D
Understanding the patient’s food preferences and how she prepares food will assist the nurse
in determining whether the patient’s culture is adversely affecting her nutritional intake.
Evaluation of a patient’s weight gain during pregnancy should be included for all patients, not
just for patients who are culturally different. The socioeconomic status of the patient may alter
the nutritional intake but not the cultural influence. Teaching the food groups to the patient
should come after assessing food preferences.

Question 95

Identify the goal of a patient with the following nursing diagnosis: Imbalanced Nutrition: Less
Than Body Requirements related to diet choices inadequate to meet nutrient requirements of
pregnancy.
a. Gain a total of 30 lbs.
b. Take daily supplements consistently.
c. Decrease intake of snack foods.
d. Increase intake of complex carbohydrates.

Answer 95

ANS:A
A weight gain of 30 lbs is one indication that the patient has gained a sufficient amount for the
nutritional needs of pregnancy. A daily supplement is not the best goal for this patient. It does
not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be
a problem and should be assessed; however, assessing weight gain is the best method of
monitoring nutritional intake for this pregnant patient. Increasing the intake of complex
carbohydrates is important for this patient, but monitoring the weight gain should be the end
goal.

Question 96

Most women with uncomplicated pregnancies can use the nurse as their primary source for
nutritional information. The nurse or midwife should refer a patient to a registered dietitian for
in-depth nutritional counseling in the following situations: (Select all that apply.)
a. preexisting or gestational illness such as diabetes.
b. ethnic or cultural food patterns.
c. obesity.
d. vegetarian diet.
e. allergy to tree nuts.

Answer 96

ANS: A, B, C, D
The nurse should be especially aware that conditions such as diabetes can require in-depth
dietary planning and evaluation. To prevent issues with hypoglycemia and hyperglycemia and
an increased risk for perinatal morbidity and mortality, this patient would benefit from a
referral to a dietitian. Consultation with a dietitian may ensure that cultural food beliefs are
congruent with modern knowledge of fetal development and that adjustments can be made to
ensure that all nutritional needs are met. The obese pregnant patient may be under the
misapprehension that because of her excess weight little or no weight gain is necessary.
According to the Institute of Medicine, a patient with a body mass index in the obese range
should gain at least 7 kg to ensure a healthy outcome. This patient may require in-depth
counseling on optimal food choices. The vegetarian patient needs to have her dietary intake
carefully assessed to ensure that the optimal combination of amino acids and protein intake is
achieved. Very strict vegetarians (vegans) who consume only plant products may also require
vitamin B and mineral supplementation. A patient with a food allergy would not alter that
component of her diet during pregnancy; therefore, no additional consultation is necessary