Chapter 4: Physiological Aspects of Antepartum Care
Multiple Choice
1. Folic acid supplementation during pregnancy is to:a. Improve the bone density of pregnant
women b. Decrease the incidence of neural tube defects in the fetus c. Decrease the incidence of
Down syndrome in the fetusd. Improve calcium uptake in pregnant women
ANS: b
Feedback
a.
Folic acid is not related to bone density.
b.
Correct. The use of folic acid has decreased the
incidence of neural tube defects by 50%.
c.
The use of folic acid is not associated with a
reduction in Down syndrome.
d.
Folic acid is not related to calcium uptake in
women.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content
Area: Maternity | Client Need: Pharmacological/Parenteral Therapies | Difficulty Level:
Moderate
2. The positive signs of pregnancy are:a. All physiological and anatomical changes of
pregnancyb. All subjective signs of pregnancyc. All those physiological changes perceived by
the woman herselfd. The objective signs of pregnancy that can only be attributed to the fetus
ANS: d
a.
b.
c.
d.
Feedback
Physiological and anatomical changes of
pregnancy are presumptive signs of pregnancy.
All subjective signs of pregnancy are the
probable signs of pregnancy.
All those physiological changes perceived by
the woman herself are presumptive signs of
pregnancy.
Correct. Positive signs of pregnancy are the
objective signs of pregnancy that can only be
attributed to the fetus, such as fetal heart tones.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content
Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy
3. During a routine prenatal visit in the third trimester, a woman reports she is dizzy and
lightheaded when she is lying on her back. The most appropriate nursing action would be to:a.
Order an EKG.
b. Report this abnormal finding immediately to her care provider.
c. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension.
d. Order a nonstress test to assess fetal well-being.
ANS: c
a.
b.
c.
d.
Feedback
This is a normal occurrence in pregnancy and
does not indicate pathology. The probable
cause of the problem is supine hypotension.
This is a normal finding that does not warrant
immediate notification to her care provider.
Correct. Teaching the woman to avoid lying on
her back because of occlusion of the vena cava
with the gravid uterus causes supine
hypotension syndrome.
Antenatal testing is not indicated with supine
hypotension.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area:
Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
4. Blood volume expansion during pregnancy leads to: a. Iron-deficiency anemiab. Maternal iron
stores being insufficient to meet the demands for iron in fetal developmentc. Plasma fibrin
increase of 40% and fibrinogen increase of 50%d. Physiological anemia of pregnancy
ANS: d
a.
b.
c.
d.
Feedback
Iron-deficiency anemia is treated with iron
supplementation. Iron-deficiency anemia is
defined as hemoglobin of less than 11 g/dL and
hematocrit less than 33%.
Maternal iron stores that are insufficient to
meet the demands for iron in fetal development
result in iron-deficiency anemia.
Hypercoagulation that occurs during pregnancy
is to decrease the risk of postpartum
hemorrhage. These changes taking place are
not related to blood volume expansion.
Correct. Physiological anemia of pregnancy,
also referred to as pseudo-anemia of
pregnancy, is due to hemodilution. The
increase in plasma volume is relatively larger
than the increase in RBCs that results in
decreased hemoglobin and hematocrit values.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area:
Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
5. Intimate partner violence (IPV) against women consists of actual or threatened physical or
sexual violence and psychological and emotional abuse. Screening for IPV during pregnancy is
recommended for:a. Pregnant women with a history of domestic violenceb. All pregnant
womenc. All low-income pregnant womend. Pregnant adolescents
ANS: b
Feedback
a.
Intimate partner violence is underreported by
women, necessitating universal screening.
b.
Correct. AWHONN advocates for universal
screening for domestic violence for all
pregnant women. Homicide is the most likely
cause of death for pregnant or recently
pregnant women, and a significant portion of
those homicides are committed by their
intimate partners. One in six pregnant women
reported physical or sexual abuse during
pregnancy, seriously impacting maternal and
fetal health and infant birth weight.
c.
IPV crosses all ethnic, racial, religious, and
socioeconomic levels.
d.
IPV crosses all ethnic, racial, religious, and
socioeconomic levels.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content
Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Moderate
6. A woman presents to the prenatal clinic at 30 weeks’ gestation reporting dysuria, frequency,
and urgency with urination. Appropriate nursing actions include:a. Obtain clean-catch urine to
assess for a possible urinary tract infection.b. Reassure the woman that the signs are normal
urinary changes in the third trimester.c. Teach the woman to decrease fluid intake to manage
these symptoms.d. Perform a Leopold’s maneuver to assess fetal position and station.
ANS: a
a.
Feedback
Correct. Dysuria, frequency, and urgency with
urination are signs and symptoms of a urinary
tract infection, necessitating further assessment
and testing.
b.
These are abnormal urinary symptoms in the
third trimester.
c.
Pregnant women need to increase their fluid
intake during pregnancy, and dysuria and
urgency are abnormal.
d.
Assessment of fetal position and station is not
an appropriate response to reported signs and
symptoms of a urinary tract infection.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content
Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
7. At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse and tells
you shyly that she wants to maintain a sexual relationship with her partner. The best response is
to: a. Reassure woman/couple of normalcy of responseb. Suggest alternative positions for sexual
intercourse and alternative sexual activity to sexual intercoursec. Recommend cessation of
intercourse until after delivery due to advanced gestationd. Suggest woman discuss this with her
care provider at her next appointment
ANS: b
Feedback
a.
Although this is a normal response, providing
reassurance is not enough. Further intervention
is indicated.
b.
Although shy to discuss this, she wants to
maintain a sexual relationship with her partner.
Suggesting alternative positions for sexual
intercourse and alternative sexual activity to
sexual intercourse provides the woman with
information to maintain sexual relations.
c.
She wants to maintain a sexual relationship
with her partner, and there are no
contraindications to intercourse during a
healthy pregnancy.
d.
The patient is seeking out information and to
defer her to her care provider at her next
appointment is inappropriate. Additionally, she
may not be comfortable discussing this with
anyone else.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Complication | Content
Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
8. The clinic nurse talks to a 30-year-old woman at 34 weeks’ gestation who complains of having
difficulty sleeping. Jayne has noticed that getting back to sleep after she has been up at night is
difficult. The nurse’s best response is:
a. “This is abnormal; it is important that you describe this problem to the doctor.”
b. “This is normal, and many women have this same problem during pregnancy; try napping for
several hours each morning and afternoon.”
c. “This is abnormal; tell the doctor about this problem because diagnostic testing may be
necessary.”
d. “This is normal in pregnancy, particularly during the third trimester when you also feel fetal
movement at night; try napping once a day.”
ANS: d
a.
b.
c.
d.
Feedback
This sleep pattern is a normal finding.
Sleeping for several hours in the morning and
afternoon would contribute to further sleep
disturbances at night.
This sleep pattern is a normal finding.
Pregnancy sleep patterns are characterized by
reduced sleep efficiency, fewer hours of night
sleep, frequent awakenings, and difficulty
going to sleep. Nurses can advise patients that
afternoon napping may help alleviate the
fatigue associated with the sleep alterations.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
9. A 26-year-old woman at 29 weeks’ gestation experienced epigastric pain following the
consumption of a large meal of fried fish and onion rings. The pain resolved a few hours later.
The most likely diagnosis for this symptom is:
a. Cholelithiasis
b. Influenza
c. Urinary tract infection
d. Indigestion
ANS: a
a.
Feedback
The progesterone-induced prolonged emptying
time of bile from the gallbladder, combined
with elevated blood cholesterol levels, may
predispose the pregnant woman to gallstone
formation (cholelithiasis). Pain in the
b.
c.
d.
epigastric region following ingestion of a highfat meal constitutes the major symptom of
these conditions. The pain is self-limiting and
usually resolves within 2 hours.
The symptoms described are not associated
with influenza.
The symptoms described are not associated
with urinary tract infection.
Prolonged emptying time of bile from the
gallbladder, combined with elevated blood
cholesterol levels, make cholelithiasis a more
probable diagnosis than indigestion.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance |
Difficulty Level: Moderate
10. The clinic nurse reviews the complete blood count results for a 30-year-old woman who is
now 33 weeks’ gestation. Tamara’s hemoglobin value is 11.2 g/dL, and her hematocrit is 38%.
The clinic nurse interprets these findings as:
a. Normal adult values
b. Normal pregnancy values for the third trimester
c. Increased adult values
d. Increased values for 33 weeks’ gestation
ANS: b
a.
b.
c.
d.
Feedback
The values are low normal for adults but
represent normal findings for pregnant women.
During pregnancy the woman’s hematocrit
values may appear low due to the increase in
total plasma volume (on average, 50%).
Because the plasma volume is greater than the
increase in erythrocytes (30%), the hematocrit
decreases by about 7%. This alteration is
termed “physiologic anemia of pregnancy,” or
“pseudo-anemia.” The hemodilution effect is
most apparent at 32 to 34 weeks. The mean
acceptable hemoglobin level in pregnancy is 11
to 12 g/dL of blood.
The values are not increased; they are low
normal for adults but represent normal findings
for pregnant women.
The values are not increased; they are low
normal for adults but represent normal findings
for pregnant women.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Analysis
| Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty
Level: Difficult
11. The clinic nurse is aware that the pregnant woman’s blood volume increases by:
a. 20% to 25%
b. 30% to 35%
c. 40% to 45%
d. 50% to 55%
ANS: c
a.
b.
c.
d.
Feedback
An increase in maternal blood volume begins
during the first trimester and peaks at term.
The increase approaches 40% to 45%, not 20%
to 25%.
An increase in maternal blood volume begins
during the first trimester and peaks at term.
The increase approaches 40% to 45, not 30%
to 35%.
An increase in maternal blood volume begins
during the first trimester and peaks at term.
The increase approaches 40% to 45% and is
primarily due to an increase in plasma and
erythrocyte volume. Additional erythrocytes,
needed because of the extra oxygen
requirements of the maternal and placental
tissue, ensure an adequate supply of oxygen to
the fetus. The elevation in erythrocyte volume
remains constant during pregnancy.
An increase in maternal blood volume begins
during the first trimester and peaks at term.
The increase approaches 40% to 45%, not as
high as 50% to 55%.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Knowledge | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Easy
12. The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and
position. The nurse’s hands are placed on the maternal abdomen to gently palpate the fundal
region of the uterus. This action is best described as the:
a. First maneuver
b. Second maneuver
c. Third maneuver
d. Fourth maneuver
ANS: a
a.
b.
c.
d.
Feedback
Leopold maneuvers are a four-part clinical
assessment method used to determine the lie,
presentation, and position of the fetus. The first
maneuver determines which fetal body part
(e.g., head or buttocks) occupies the uterine
fundus. The examiner faces the patient’s head
and places the hands on the abdomen, using the
palmar surface of the hands to gently palpate
the fundal region of the uterus. The buttocks
feel soft, broad, and poorly defined and move
with the trunk. The fetal head feels firm and
round and moves independently of the trunk.
Leopold maneuvers are a four-part clinical
assessment method used to determine the lie,
presentation, and position of the fetus. The first
maneuver is described in this scenario.
Leopold maneuvers are a four-part clinical
assessment method used to determine the lie,
presentation, and position of the fetus. The first
maneuver is described in this scenario.
Leopold maneuvers are a four-part clinical
assessment method used to determine the lie,
presentation, and position of the fetus. The first
maneuver is described in this scenario.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
13. The clinic nurse talks with Kathy about her possible pregnancy. Kathy has experienced
amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast
tenderness. These symptoms are best described as:
a. Positive signs of pregnancy
b. Presumptive signs of pregnancy
c. Probable signs of pregnancy
d. Possible signs of pregnancy
ANS: b
a.
b.
c.
d.
Feedback
Positive signs include fetal heartbeat,
visualization of the fetus, and fetal movements
palpated by the examiner.
Presumptive signs of pregnancy include
amenorrhea, nausea and vomiting, frequent
urination, breast tenderness, perception of fetal
movement, skin changes, and fatigue. Probable
signs of pregnancy include abdominal
enlargement, Piskacek sign, Hegar sign,
Goodell sign, Braxton Hicks sign, positive
pregnancy test, and ballottement. Positive signs
include fetal heartbeat, visualization of the
fetus, and fetal movements palpated by the
examiner.
Probable signs of pregnancy include abdominal
enlargement, Piskacek sign, Hegar sign,
Goodell sign, Braxton Hicks sign, positive
pregnancy test, and ballottement.
Possible signs of pregnancy may vary widely.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
14. Lina is an 18-year-old woman at 20 weeks’ gestation. This is her first pregnancy. Lina is
complaining of fatigue and listlessness. Her vital signs are within a normal range: BP = 118/60,
pulse = 70, and respiratory rate 16 breaths per minute. Lina’s fundal height is at the umbilicus,
and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over
the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The perinatal nurse’s best
approach to care at this visit is to:
a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week.
b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry.
c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20
pounds by 20 weeks’ gestation).
d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including
the risk of gestational diabetes.
ANS: a
Feedback
a.
b.
c.
d.
Nutrition and weight management play an
essential role in the development of a healthy
pregnancy. Not only does the patient need to
have an understanding of the essential
nutritional elements, she must also be able to
assess and modify her diet for the developing
fetus and her own nutritional maintenance. To
facilitate this process, it is the nurse’s
responsibility to provide education and
counseling concerning dietary intake, weight
management, and potentially harmful
nutritional practices. To facilitate this process,
it is the nurse’s responsibility to gather more
information on the woman’s dietary practices
through a food diary.
Nutrition and weight management play an
essential role in the development of a healthy
pregnancy. To facilitate this process, it is the
nurse’s responsibility to provide education and
counseling concerning dietary intake, weight
management, and potentially harmful
nutritional practices.
Nutrition and weight management play an
essential role in the development of a healthy
pregnancy. Not only does the patient need to
have an understanding of the essential
nutritional elements, she must also be able to
assess and modify her diet for the developing
fetus and her own nutritional maintenance. To
facilitate this process, it is the nurse’s
responsibility to provide education and
counseling concerning dietary intake, weight
management, and potentially harmful
nutritional practices, not just inform the patient
of expected normal weight gain.
Nutrition and weight management play an
essential role in the development of a healthy
pregnancy. Not only does the patient need to
have an understanding of the essential
nutritional elements, she must also be able to
assess and modify her diet for the developing
fetus and her own nutritional maintenance. To
facilitate this process, it is the nurse’s
responsibility to provide education and
counseling concerning dietary intake, weight
management, and potentially harmful
nutritional practices.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
15. A woman presents to a prenatal clinic appointment at 10 weeks’ gestation, in the first
trimester of pregnancy. Which of the following symptoms would be considered a normal finding
at this point in pregnancy?
a. Occipital headache
b. Urinary frequency
c. Diarrhea
d. Leg cramps
ANS: b
a.
b.
c.
d.
Feedback
Headaches may be benign or, especially if
noted after 20 weeks’ gestation, may be a
symptom of pregnancy-induced hypertension
(PIH).
Urinary frequency is a common complaint of
women during their first trimester.
Diarrhea is rarely seen in pregnancy.
Constipation is a common complaint.
Leg cramps are commonly seen during the
second and third trimesters.
KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Comprehension |
Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty
Level: Easy
16. The nurse is providing prenatal teaching to a group of diverse pregnant women. One woman,
who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy.
The nurse explains that the most significant risk to the fetus is:
a. Respiratory distress at birth
b. Severe neonatal anemia
c. Low neonatal birth weight
d. Neonatal hyperbilirubinemia
ANS: C
Feedback
a.
b.
c.
d.
Respiratory distress is not the most significant
risk to the fetus unless the fetus is also
premature.
Severe neonatal anemia is not associated with
pregnancies complicated by cigarette smoking.
Low neonatal birth weight is the most common
complication seen in pregnancies complicated
by cigarette smoking.
Neonatal hyperbilirubinemia is not associated
with pregnancies complicated by cigarette
smoking.
KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive
Level: Application | Content Area: Antepartum Care; Growth and Development | Client Need:
Health Promotion and Maintenance | Difficulty Level: Moderate
17. While performing Leopold’s maneuvers on a woman in early labor, the nurse palpates a flat
area in the fundal region, a hard round mass on the left side, a soft round mass on the right side,
and small parts just above the symphysis. The nurse concludes which of the following?
a. The fetal position is right occiput posterior.
b. The fetal attitude is flexed.
c. The fetal presentation is scapular.
d. The fetal lie is vertical.
ANS: c
a.
b.
c.
d.
Feedback
This is a shoulder presentation.
It is not possible to determine whether the
attitude is flexed or not when doing Leopold’s
maneuvers.
This is a shoulder presentation.
The lie is transverse or horizontal.
KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Assessment | Cognitive
Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and
Maintenance | Difficulty Level: Easy
18. A nurse is reviewing diet with a pregnant woman in her second trimester. Which of the
following foods should the nurse advise the patient to avoid consuming during her pregnancy?
a. Brie cheese
b. Bartlett pears
c. Sweet potatoes
d. Grilled lamb
ANS: a
a.
b.
c.
d.
Feedback
Soft cheese may harbor Listeria. The patient
should avoid consuming uncooked soft cheese.
A pear is an excellent food for a pregnant
woman to consume.
Sweet potatoes are an excellent food for a
pregnant woman to consume.
Grilled lamb is an excellent food for a pregnant
woman to consume, although it should be well
cooked.
KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive
Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Potential for
Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological
Integrity: Reduction of Risk Potential | Difficulty Level: Moderate
19. The nurse is working in a prenatal clinic caring for a patient at 14 weeks’ gestation, G2
P1001. Which of the following findings should the nurse highlight for the nurse midwife?
a. Body mass index of 23
b. Blood pressure of 100/60
c. Hematocrit of 29%
d. Pulse rate of 76 bpm
ANS: c
a.
b.
c.
d.
Feedback
A body mass index of 23 is normal.
A blood pressure of 100/60 is normal.
A hematocrit of 29% indicates that the patient
is anemic. The nurse should highlight the
finding for the nurse-midwife.
A pulse rate of 76 bpm is a normal rate.
KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application |
Content Area: Antepartum Care; Potential for Alterations in Body Systems; Reduction of Risk
Potential: Laboratory Values | Client Need: Health Promotion and Maintenance: Antepartum
Care; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Easy
20. A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm above
the symphysis. She denies experiencing quickening. Which of the following nursing conclusions
made by the nurse is correct?
a. The woman is experiencing a normal pregnancy.
b. The woman may be having difficulty accepting this pregnancy.
c. The woman must see a nutritionist as soon as possible.
d. The woman will likely miscarry the conceptus.
ANS: a
a.
b.
c.
d.
Feedback
The patient is experiencing a normal
pregnancy.
Quickening is not felt until 16 to 20 weeks’
gestation.
There is no apparent need for a nutritionist to
see this patient.
There is no indication in the scenario that this
patient is at high risk for a miscarriage.
KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content
Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level:
Moderate
21. A patient at 37 weeks’ gestation is being seen in the prenatal clinic. Where would the nurse
expect the fundal height to be palpated?
a. At the xiphoid process
b. At a point between the umbilicus and the xiphoid
c. At the umbilicus
d. At a level directly above the symphysis pubis
ANS: a
a.
b.
c.
d.
Feedback
At 36 weeks’ gestation, the fundus should be
felt at the xiphoid process.
At 36 weeks’ gestation, the fundus should be
felt at the xiphoid process.
At 20 weeks’ gestation, the fundus should be
felt at the umbilicus.
At 12 weeks’ gestation, the fundus should be
felt directly above the symphysis pubis.
KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Comprehension |
Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty
Level: Easy
22. A nurse is performing an assessment on a pregnant woman during a prenatal visit. Which of
the following findings would lead the nurse to report to the obstetrician that the patient may be
experiencing intrauterine growth restriction (IUGR)?
a. Leopold’s maneuvers: Hard round object in the fundus, flat object on left of uterus, small parts
on right of uterus, soft round object above the symphysis
b. Weight gain: 6-pound increase over 4-week period
c. Fundal height measurement: 22 cm at 26 weeks’ gestation
d. Alpha-fetoprotein assessment: level is one-half normal, accompanied by complaints of severe
nausea and vomiting
ANS: c
a.
b.
c.
d.
Feedback
This baby is in the breech position. This is not
a sign of IUGR.
This weight gain is slightly above normal. This
is not a sign of IUGR.
The fundal height at 26 weeks should be
approximately 26 cm. The fundal height,
therefore, is below expected. This patient may
be experiencing intrauterine growth restriction.
A low AFP level is seen in patients whose
babies have spina bifida and other central
nervous system defects.
KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application Content
Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level:
Moderate
23. A pregnant woman informs the nurse that her last normal menstrual period was on July 6,
2007. Using Naegele’s rule, which of the following would the nurse determine to be the patient’s
estimated date of delivery (EDC)?
a. January 9, 2008
b. April 13, 2008
c. April 20, 2008
d. September 6, 2008
ANS: b
a.
b.
Feedback
The EDC is calculated as April 13, 2008.
The EDC is calculated as April 13, 2008.
Naegele’s rule: subtract 3 months and add 7
days to the first day of the last normal
menstrual period.
c.
d.
The EDC is calculated as April 13, 2008.
The EDC is calculated as April 13, 2008.
KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content
Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level:
Easy
24. Which of the following findings, seen in pregnant women in the third trimester, would the
nurse consider to be within normal limits?
a. Diplopia
b. Epistaxis
c. Bradycardia
d. Oliguria
ANS: b
a.
b.
c.
d.
Feedback
Diplopia is sometimes seen in patients with
pregnancy-induced hypertension (PIH).
Epistaxis is commonly seen in pregnant
patients. The bleeding is related to the
increased vascularity of the mucous
membranes. Unless the blood loss is
significant, it is a normal finding.
Bradycardia is often seen immediately after
delivery but not during the third trimester.
Oliguria is seen in patients with PIH.
KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content
Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level:
Easy
25. A primigravida patient is 39 weeks pregnant. Which of the following symptoms would the
nurse expect the patient to exhibit?
a. Nausea
b. Dysuria
c. Urinary frequency
d. Intermittent diarrhea
ANS: c
a.
b.
c.
d.
Feedback
Nausea is usually not seen in the third
trimester.
Dysuria is not a normal finding at any time
during a pregnancy. The possibility of a
urinary traction infection (UTI) should be
considered.
Urinary frequency recurs at the end of the third
trimester. As the uterus enlarges, it again
compresses the bladder causing urinary
frequency.
Diarrhea is not a normal finding at any time
during a pregnancy.
KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content
Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level:
Easy
26. The nurse has taken a health history on four multigravida patients at their first prenatal visits.
It is high priority that the patient whose first child was diagnosed with which of the following
diseases receives nutrition counseling?
a. Development dysplasia of the hip
b. Achondroplastic dwarfism
c. Spina bifida
d. Muscular dystrophy
ANS: c
a.
b.
c.
d.
Feedback
The etiology of developmental dysplasia of the
hip is unrelated to the mother’s nutritional
status.
Achondroplasia is an inherited defect. Its
etiology is unrelated to the mother’s nutritional
status.
The incidence of spina bifida is much higher in
women with poor folic acid intakes. It is a
priority that this patient receives nutrition
counseling.
Most forms of muscular dystrophy are
inherited. Their etiologies are unrelated to the
mother’s nutritional status.
KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application |
Content Area: Antepartum Care; Collaboration with Interdisciplinary Team; Management of
Care: Referrals | Client Need: Health Promotion and Maintenance; Safe and Effective Care
Environment: Management of Care | Difficulty Level: Moderate
27. A nurse working in a prenatal clinic is caring for a woman who asks advice on foods that are
high in vitamin C because “I hate oranges.” The nurse states that 1 cup of which of the following
raw foods will meet the patient’s daily vitamin C needs?
a. Strawberries
b. Asparagus
c. Iceberg lettuce
d. Cucumber
ANS: a
a.
b.
c.
d.
Feedback
Strawberries are an excellent source of vitamin
C.
Although asparagus has some vitamin C, it is
not an excellent source.
Iceberg lettuce is a poor source of vitamin C.
Cucumber is a poor source of vitamin C.
KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive
Level: Knowledge | Content Area: Health and Wellness | Client Need: Health Promotion and
Maintenance | Difficulty Level: Easy
28. The nurse notes each of the following findings in a woman at 10 weeks’ gestation. Which of
the findings would enable the nurse to tell the woman that she is probably pregnant?
a. Fetal heart rate via Doppler
b. Positive pregnancy test
c. Positive ultrasound assessment
d. Absence of menstrual period
ANS: b
a.
b.
Feedback
A fetal heart rate is a positive sign of
pregnancy.
A positive pregnancy test is a probable sign of
pregnancy. It is not a positive sign because the
hormone tested for—human chorionic
gonadatropin (hCG)—may be being produced
by, for example, a hydatidiform mole.
c.
d.
A positive ultrasound is a positive sign of
pregnancy.
Amenorrhea is a presumptive sign of
pregnancy.
KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Comprehension | Content
Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level:
Easy
29. A nurse who is discussing serving sizes of foods with a new prenatal patient would state that
which of the following is equal to 1 (one) serving from the dairy food group?
a.. 1 cup low-fat milk
b. ½ cup vanilla yogurt
c. ½ cup cottage cheese
d.. 1 ounce cream cheese
ANS: a
a.
b.
c.
d.
Feedback
1 cup of any milk (e.g., whole milk, skim milk,
buttermilk, chocolate milk) is equal to 1
serving size from the dairy group.
1 cup of yogurt is equal to 1 serving size from
the dairy group.
1 ½ cup of cottage cheese is equal to 1 serving
size from the dairy group.
Cream cheese is not included in the dairy
group. It is a fat product.
KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive
Level: Comprehension | Content Area: Antepartum Care; Basic Care and Comfort: Nutrition |
Client Need: Health Promotion and Maintenance; Physiological Integrity: Basic Care and
Comfort | Difficulty Level: Easy
30. The nurse who is assessing a G2 P1 palpates the fundal height at the location noted on the
picture below.
The nurse concludes that the fetus is equal to which of the following gestational ages?
a. 12 weeks
b. 20 weeks
c. 28 weeks
d. 36 weeks
ANS: b
a.
b.
c.
d.
Feedback
At 12 weeks’ gestation, the fundus should be
felt at the level of the symphysis pubis.
The fundus at the level of the umbilicus
indicates 20 weeks’ gestation. In this question,
the fact that this patient is a multigravida is not
relevant. Uterine growth should be consistent
for both primigravidas and multigravidas.
At 28 weeks’ gestation, the fundus should be
felt 8 cm above the level of the umbilicus.
At 36 weeks’ gestation, the fundus should be
felt at the xiphoid process.
KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Assessment | Cognitive
Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and
Maintenance | Difficulty Level: Easy
31. A patient at 28 weeks’ gestation was last seen in the prenatal clinic at 24 weeks’ gestation.
Which of the following changes should the nurse bring to the attention of the Certified Nurse
Midwife?
a. Weight change from 128 pounds to 132 pounds
b. Pulse change from 88 bpm to 92 bpm
c. Blood pressure change from 110/70 to 140/90
d. Respiratory change from 16 rpm to 20 rpm
ANS: c
a.
b.
c.
d.
Feedback
A weight change of approximately 4 pounds in
4 weeks is normal in the second and third
trimesters of pregnancy.
This pulse rate change is within normal limits.
A blood pressure elevation to 140/90 is a sign
of mild preeclampsia.
This respiratory rate change is within normal
limits.
KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation |
Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential—
Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance;
Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Easy
32. The clinic nurse includes screening for domestic violence in the first prenatal visit for all
patients. An appropriate question would be:
a. This is something that we ask everyone. Do you feel safe in your current living environment
and relationships?
b. This is something we ask everyone. Do you have any abuse in your life right now?
c. Is your partner threatening or harming you in any way right now?
d. I need to ask you, do you feel safe from abuse right now?
ANS: a
a.
b.
Feedback
Intimate partner violence is a difficult subject
to discuss, and the nurse may fear insulting or
psychologically hurting the patient more. A
nonthreatening approach is to ask patients
directly whether they feel safe going home and
whether they have been hurt physically,
emotionally, or sexually by a past or present
partner.
Intimate partner violence is a difficult subject
to discuss, and the nurse may fear insulting or
psychologically hurting the patient more. A
nonthreatening approach is to ask patients
directly whether they feel safe going home
c.
d.
rather than asking if they have any abuse, as
women may define abuse differently than care
providers.
Intimate partner violence is a difficult subject
to discuss, and the nurse may fear insulting or
psychologically hurting the patient more. A
nonthreatening approach is to ask patients
directly whether they feel safe going home and
whether they have been hurt physically,
emotionally, or sexually by a past or present
partner.
Intimate partner violence is a difficult subject
to discuss, and the nurse may fear insulting or
psychologically hurting the patient more. A
nonthreatening approach is to ask patients
directly whether they feel safe going home
rather than asking if they have any abuse, as
women may define abuse differently than care
providers.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
Multiple Response
33. An 18-year-old woman at 23 weeks’ gestation tells the nurse that she has fainted two times.
The nurse teaches about the warning signs that often precede syncope so that she can sit or lie
down to prevent personal injury. Warning signs include (select all that apply):
a. Sweating
b. Nausea
c. Chills
d. Yawning
ANS: a, b, d
Sweating is a warning sign that often precedes syncope. Syncope (a trandient loss of
consciousness and postural tone with spontaneous recovery) during pregnancy is frequently
attributed to orthostatic hypotension or inferior vena cava compression by the gravid uterus.
Nausea and yawning are warning signs that often precede syncope. Lightheadedness, sweating,
nausea, yawning, and feelings of warmth are warning signs that often precede syncope. Chills
are not a warning sign that often precede syncope.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
34. The perinatal nurse teaches the student nurse about the physiological changes in pregnancy
that most often contribute to the increased incidence of urinary tract infections. These changes
include (select all that apply):
a. Relaxation of the smooth muscle of the urinary sphincter
b. Relaxation of the smooth muscle of the bladder
c. Inadequate emptying of the bladder
d. Increased incidence of bacteriuria
ANS: a, b, c, d
Ascension of bacteria into the bladder can cause asymptomatic bacteriuria (ASB), or urinary
tract infections (UTIs). These infections occur more frequently in pregnancy due to relaxation of
the smooth muscle of the bladder and urinary sphincter and inadequate emptying of the bladder,
changes that allow bacterial ascent into the bladder.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
35. The clinic nurse discusses normal bladder function in pregnancy with a 22-year-old pregnant
woman who is now in her 29th gestational week. The nurse explains that at this time in
pregnancy, it is normal to experience (select all that apply):
a. Urinary frequency
b. Urinary urgency
c. Nocturia
d. Incontinence
ANS: a, b, c
During pregnancy, the bladder, a pelvic organ, is compressed by the weight of the growing
uterus. The added pressure, along with progesterone-induced relaxation of the urethra and
sphincter musculature, leads to urinary urgency, frequency, and nocturia. Incontinence of urine is
not a normal change during pregnancy.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
36. A 32-year-old woman now at 32 weeks’ gestation is complaining of right-sided sharp
abdominal pain. The patient is examined by the clinic nurse and given information about
abdominal discomfort in pregnancy. She is also instructed to seek immediate attention if she
(select all that apply):
a. Has heartburn
b. Has chills or a fever
c. Feels decreased fetal movements
d. Has increased abdominal pain
ANS: b, c, d
Heartburn is a common discomfort throughout pregnancy. Because the appendix is pushed
upward and posterior by the gravid uterus, the typical location of pain is not a reliable indicator
for a ruptured appendix during pregnancy. The pain should gradually subside, but if it persists or
is accompanied by fever, a change in bowel habits, or decreased fetal movement, the patient
should promptly contact her medical provider.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
37. The clinic nurse talks with Suzy, a pregnant woman at 9 weeks’ gestation who has just
learned of her pregnancy. Suzy’s nausea and vomiting are most likely caused by (select all that
apply):
a. Increased levels of estrogen
b. Increased levels of progesterone
c. An altered carbohydrate metabolism
d. Increased levels of human chorionic gonadotropin
ANS: c, d
Nausea and vomiting during the first trimester most likely are related to rising levels of human
chorionic gonadotropin (hCG) and altered carbohydrate metabolism. Changes in taste and smell,
due to alterations in the oral and nasal mucosa, can further aggravate the gastrointestinal
discomfort.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
38. The clinic nurse encourages all pregnant women to increase their water intake to at least 8 to
10 glasses per day in order to (select all that apply):
a. Decrease the risk of constipation
b. Decrease the risk of bile stasis
c. Decrease their feelings of fatigue
d. Decrease the risk of urinary tract infections
ANS: a, b, c, d
Patients should be encouraged to drink at least 8 to 10 glasses of water each day and empty their
bladders at least every 2 to 3 hours and immediately after intercourse. These measures will help
prevent stasis of urine and the bacterial contamination that leads to infection, as well as
constipation. Some women experience symptoms of fatigue that can be alleviated by remaining
adequately hydrated.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
39. The perinatal nurse examines the thyroid gland as part of the physical examination of
Savannah, a pregnant woman who is now at 16 weeks’ gestation. The perinatal nurse informs
Savannah that during pregnancy (select all that apply):
a. Increased size of the thyroid gland is normal
b. Increased function of the thyroid gland is normal
c. Decreased function of the thyroid gland is normal
d. The thyroid gland will return to its normal size and function during the postpartal period
ANS: a, b, d
The thyroid gland changes in size and activity during pregnancy. Enlargement is caused by
increased circulation from the progesterone-induced effects on the vessel walls, and by estrogeninduced hyperplasia of the glandular tissue. The thyroid gland increases not decreases in size and
activity during pregnancy. The thyroid gland returns to normal size and activity postpartum.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
40. The clinic nurse describes the respiratory system changes common to pregnancy to the new
nurse. These changes include (select all that apply):
a. An increased tidal volume
b. A decreased airway resistance
c. An increased chest circumference
d. An increased airway resistance
ANS: a, b, c
During pregnancy, a number of changes occur to meet the woman’s increased oxygen
requirements. The tidal volume (amount of air breathed in each minute) increases 30% to 40%.
The enlarging uterus creates an upward pressure that elevates the diaphragm and increases the
subcostal angle. The chest circumference may increase by as much as 6 centimeters, and airway
resistance decreases. Although the “up and down” capacity of diaphragmatic movement is
reduced, lateral movement of the chest and intercostal muscles accommodates for this loss of
movement and keeps pulmonary functions stable. There is no increase in airway resistance
during pregnancy.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy
41. The clinic nurse teaches the new nurse about pregnancy-induced blood clotting changes. The
nurse explains that a pregnant woman is at risk for venous thrombosis due to (select all that
apply):
a. Increased fibrinogen volume
b. Increased blood factor V
c. Increased blood factor X
d. Venous stasis
ANS: a, c, d
Although the platelet cell count does not change significantly during pregnancy, fibrinogen
volume has been shown to increase by as much as 50%. This alteration leads to an increase in the
sedimentation rate. Blood factors VII, VIII, IX, and X are also increased, and this change causes
hypercoagulability. The hypercoagulability state, coupled with venous stasis (poor blood return
from the lower extremities) places the pregnant woman at an increased risk for venous
thrombosis, embolism, and, when complications are present, disseminated intravascular
coagulation (DIC). Blood factor V does not increase.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
42. The clinic nurse describes possible interventions for the pregnant woman who is
experiencing pain and numbness in her wrists. The nurse suggests (select all that apply):
a. Elevating the arms and wrists at night
b. Reassessment during the postpartum period
c. The use of “cock splints” to prevent wrist flexion
d. Massaging the hands and wrists with alcohol
ANS: a, b, c
Edema from vascular permeability can lead to a collection of fluid in the wrist that puts pressure
on the median nerve lying beneath the carpal ligament, leading to carpal tunnel syndrome.
Elevation of the hands at night may help to reduce the edema. Occasionally, a woman may need
to wear a “cock splint” to prevent the wrist from flexing. Reassessment in the postpartum period
is indicated because although carpal tunnel syndrome usually subsides after the pregnancy has
ended, some women may require surgical treatment if symptoms persist. Massaging the hands
and wrists with alcohol does not improve pain and numbness.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
43. The clinic nurse advocates for smoking cessation during pregnancy. Potential harmful effects
of prenatal tobacco use include (select all that apply):
a. Preterm birth
b. Gestational hypertension
c. Gestational diabetes
d. Low birth weight
ANS: a, d
Nurses can help to improve the fetal environment by educating women about the dangers of
direct and passive smoking during pregnancy. Effects of tobacco use during pregnancy are well
documented and predispose to premature rupture of the membranes, preterm labor, placental
abruption, placenta previa, and infants who are low birth weight or small for gestational age
(SGA). Gestational hypertension and diabetes are not associated with smoking during pregnancy.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance |
Difficulty Level: Easy
44. Asking the pregnant woman about her use of recreational drugs is an essential component of
the prenatal history. Harmful fetal effects that may occur from recreational drugs include (select
all that apply):
a. Miscarriage/spontaneous abortion
b. Low birth weight
c. Macrosomia
d. Post-term labor/birth
ANS: a, b
Illegal or recreational drug use can have a number of detrimental effects on maternal and fetal
health, including spontaneous abortion, low birth weight, placental abruption, and preterm labor.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
45. The clinic nurse schedules Tracy for her first prenatal appointment with the certified nursemidwife (CNM) in the clinic. Tracy has appropriate questions for her potential health-care
provider that include (select all that apply):
a. Complementary and alternative methods used during labor and birth
b. An opportunity to meet other providers in the practice
c. Beliefs and practices concerning an episiotomy and an epidural anesthetic
d. Whether the nurse-midwife will be continually available for support during labor
ANS: a, b, c
A woman’s journey through the pregnancy experience can have long-term effects on her selfperception and self-concept. Therefore, it is especially important that the patient choose a care
provider and group with whom she can openly relate and who shares the same philosophical
views on the management of pregnancy. At the first prenatal visit, it is not common to explore
whether the nurse-midwife will be continually available for support during labor.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
46. The clinic nurse explains to Margaret, a newly diagnosed pregnant woman at 10 weeks’
gestation, that her rubella titer indicates that she is not immune. Margaret should be advised to
(select all that apply):
a. Avoid contact with all children
b. Be retested in 3 months
c. Receive the rubella vaccine postpartum
d. Report signs or symptoms of fever, runny nose, and generalized red rash to the health-care
provider
ANS: c, d
Testing for rubella (German measles) is not necessary as titers are reliable indicators of
immunity. Rubella (German measles) is one of the most commonly recognized viral infections
known to cause congenital problems. If a woman contracts rubella during the first 12 weeks of
pregnancy, the fetus has a 90% chance of being adversely affected. A maternity patient who is
not immune to rubella should be offered the rubella immunization following childbirth, ideally
prior to hospital discharge. The patient should report signs or symptoms of rubella during
pregnancy to her health-care provider. It is not realistic for a woman to avoid contact with all
children.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
47. An overweight or obese pre-pregnancy weight increases the risk for which poor maternal
outcomes? (Select all that apply.)
a. Preeclampsia
b. Hemorrhage
c. Difficult delivery
d. Vaginal infections
ANS: a, b, c
Being overweight or obese can substantially increase perinatal risk; however, no data support an
increase in vaginal infections for the obese pregnant population.
KEY: Integrated Process: Knowledge | Cognitive Level: Complication | Content Area: Maternity
| Client Need: Health Promotion and Maintenance: Antepartum Care | Difficulty Level:
Moderate
48. Presumptive signs of pregnancy include (select all that apply):
a. Nausea
b. Fatigue
c. Ballottement
d. Amenorrhea
ANS: a, b, d
Nausea and vomiting, fatigue, and amenorrhea are all common during pregnancy and are the
presumptive signs of pregnancy. Ballottement is a probably sign, noted during a vaginal exam.
KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Knowledge | Content
Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
49. Physiologic changes that occur in the renal system during pregnancy predispose the pregnant
woman to urinary tract infections (UTIs). Symptoms of a UTI include (select all that apply):
a. Dysuria
b. Hematuria
c. Urgency
d. Delayed urination
ANS: a, b, c
Urinary tract infection (UTI) symptoms include dysuria, hematuria, and urgency.
KEY: Integrated Process: Knowledge | Cognitive Level: Complication | Content Area: Maternity
| Client Need: Physiologic Adaptation | Difficulty Level: Moderate
50. Urinary tract infection (UTI) prevention measures during pregnancy include counseling the
pregnant woman to (select all that apply):
a. Delay urination until bladder is full
b. Limit hydration
c. Wipe from front to back
d. Urinate after intercourse
ANS: a, c, d
Anticipatory guidance for urinary tract infection prevention includes delaying urination, wipe
front to back, and maintaining adequate hydration.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
51. Interventions for low back pain during pregnancy should include (select all that apply):
a. Utilizing proper body mechanics
b. Applying ice or heat to affected area
c. Avoiding pelvic rock and pelvic tilt
d. Using additional pillows for support during sleep
ANS: a, b, d
Interventions for back pain during pregnancy include utilizing proper body mechanics, applying
heat or ice to the area, using additional pillows during sleep, and not avoiding pelvic rock/tilt, but
encouraging pelvic rock/tilt.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Intrapartum care | Client Need: Health Promotion and Maintenance: Intrapartum Care |
Difficulty Level: Moderate
52. Jorgina is a 24-year-old pregnant woman at 26 weeks’ gestation. This is Jorgina’s third
pregnancy, and her obstetrical history includes one full-term birth, one preterm birth, and two
living children. Today Jorgina arrives at the clinic with complaints of fatigue, insomnia, and
backache. She reports that she is a nurse on an oncology unit and is worried about continuing
with working her 12-hour shifts. The perinatal nurse identifies concerns in Jorgina’s history and
work environment including (select all that apply):
a. Risk of preterm birth
b. Presence of chemotherapeutic agents
c. Requirement for heavy lifting
d. History of diabetes
ANS: a, b, c
Women who are currently experiencing pregnancy complications and those who have a history
of pregnancy complications (such as history of preterm birth) or other preexisting health
disorders may be required to reduce their hours or stop working. The potential for maternal
exposure to toxic substances such as chemotherapeutic agents, lead, and ionizing radiation
(found in laboratories and health-care facilities); heavy lifting; and use of heavy machinery and
other hazardous equipment should prompt reassignment to a different work area. If reassignment
is not possible, Jorgina may need to stop working until the pregnancy has been completed. In this
scenario there is no history of diabetes.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
53. The clinic nurse is assessing the complete blood count results for Kim-Ly, a 23-year-old
pregnant woman. Kim-Ly’s hemoglobin is 9.8 g/dL. This laboratory finding places Kim-Ly’s
pregnancy at risk for (select all that apply):
a. Preterm birth
b. Placental abruption
c. Intrauterine growth restriction
d. Thrombocytopenia
ANS: a, c
True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL.
The blood’s decreased oxygen-carrying capacity causes a reduction in oxygen transport to the
developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth
restriction (IUGR) and preterm birth. There is not a risk factor for abruption or
thrombocytopenia.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Analysis
| Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level:
Difficult
54. Teera is a 22-year-old woman who is experiencing her third pregnancy. Her obstetrical
history includes one first-trimester elective abortion and one first-trimester spontaneous abortion.
Teera is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake.
The perinatal nurse discusses Teera’s diet with her as she may be deficient in (select all that
apply):
a. Iron
b. Magnesium
c. Zinc
d. Vitamin B12
ANS: a, c
Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork and
have adequate intake of magnesium. Pregnant women who adhere to this diet may consume
inadequate amounts of iron and zinc. Because strict vegetarians (vegans) consume only plant
products, their diets are deficient in vitamin B12, found only in foods of animal origin.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
55. During the initial antenatal visit, the clinic nurse asks questions about the woman’s
nutritional intake. Specific questions should include information pertaining to (select all that
apply):
a. Preferred foods
b. The presence of cravings
c. Use of herbal supplements
d. Aversions to certain foods and odors
ANS: a, b, c, d
The nurse should obtain a nutritional history on all pregnant patients and patients of childbearing
age to gain specific information related to the pregnancy, including foods that are preferred while
pregnant (which may provide information about cultural and environmental dietary factors),
special diets (which will assist the nurse in planning for education or interventions for risk
factors associated with dietary practices), cravings or aversions to specific foods, and use of
herbal supplements.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
56. The perinatal nurse talks to the prenatal class attendees about guidelines for exercise in
pregnancy. Recommended guidelines include (select all that apply):
a. Stopping if the woman is tired
b. Bouncing and slowly arching the back
c. Increasing fluid intake throughout the physical activity
d. Maintaining the ability to walk and talk during exercise
ANS: a, c, d
Women should adhere to some basic safety guidelines when formulating their exercise program,
including monitoring the breathing rate and ensuring that the ability to walk and talk comfortably
is maintained during physical activity, stopping exercise when the woman becomes tired, and
maintaining adequate fluid intake. Pregnant women should avoid exercises that can cause any
degree of trauma to the abdomen or those that include rigorous bouncing, arching of the back, or
bending beyond a 45-degree angle.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
Short Answer
57. Lesions at the gum line that bleed easily
ANS: Epulis gravidarum
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
58. Anterior convexity of the lumbar spine
ANS: Lumbar lordosis
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
59. Increased saliva production
ANS: Ptyalism
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
60. Reflux of the stomach contents into the esophagus
ANS: Pyrosis
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
61. Severe itching due to stasis of bile in the liver
ANS: Pruritis gravidarum
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
62. Nosebleeds
ANS: Epistaxis
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
True/False
63. The clinic nurse speaks with the student nurse prior to the physical examination of a pregnant
woman who is 32 weeks’ gestation. The clinic nurse explains that the heart sounds heard in
pregnancy are usually S1 and S3 with a possible murmur related to increased cardiac output.
ANS: True
Exaggerated first and third heart sounds and systolic murmurs are common findings during
pregnancy. The murmurs are usually asymptomatic and require no treatment.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
64. Cecilia, a pregnant woman at 30 weeks’ gestation, has her vital signs assessed during a
routine prenatal visit. Cecilia’s blood pressure has remained at 110/70 for the last few visits, and
her pulse rate has increased from 70 to 80 beats per minute. These findings would be considered
normal at this time in pregnancy.
ANS: True
During the first trimester, blood pressure normally remains the same as prepregnancy levels but
then gradually decreases up to around 20 weeks’ of gestation. After 20 weeks, the vascular
volume expands and the blood pressure increases to reach prepregnant levels by term.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Easy
65. The clinic nurse knows that every time a woman of childbearing age comes in to the office
for a health maintenance visit, she should be counseled about the benefits of daily folic acid
supplementation.
ANS: True
Because of the strong connection between folic acid deficiency and the subsequent development
of neural tube defects, all women of childbearing age should take a folic acid supplement of at
least 400 mcg/day.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
66. The perinatal nurse recommends strengthening exercises during pregnancy, as this can
improve posture and increase energy levels.
ANS: True
Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy,
which include weight gain and postural changes. Muscle strengthening exercises also help to
decrease the risk of ligament and joint injury.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
67. The perinatal nurse explains to the new nurse that ptyalism is a condition more acute than the
normal nausea and vomiting of pregnancy and is often associated with dehydration,
hypokalemia, and weight loss.
ANS: False
Hyperemesis gravidarum is a pregnancy-related condition characterized by persistent,
continuous, severe nausea and vomiting, often accompanied by dry retching. Hyperemesis
gravidarum results in weight loss and fluid and electrolyte imbalance. Ptyalism is an excessive
production of saliva.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
Fill-in-the-Blank
68. The clinic nurse explains to the new nurse that during pregnancy, the maternal metabolism is
altered to support the pregnancy by the hormones __________ and __________, which are
produced by the anterior __________ gland.
ANS: thyrotropin; adrenotropin; pituitary
Maternal metabolism is altered to support the pregnancy by thyrotropin and adrenotropin. These
hormones, produced by the anterior pituitary gland, exert their effects on the thyroid and adrenal
glands. Thyrotropin causes an increased basal metabolism, and adrenotropin alters adrenal gland
function to increase fluid retention by the kidneys.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
69. During the prenatal class, the perinatal nurse describes factors that may initiate the process of
labor. One of these factors is the production of __________, which are found in the uterine
__________ and are released from the __________ at term as it softens and dilates.
ANS: prostaglandins; decidua or lining; cervix
Prostaglandins are lipid substances found in high concentrations in the female reproductive tract
and in the uterine decidua during pregnancy. Their exact function in pregnancy is unknown,
although they may maintain a reduced placental vascular resistance. A decrease in prostaglandin
levels may contribute to hypertension and preeclampsia. At term, an increased release of
prostaglandins from the cervix as it softens and dilates may contribute to the onset of labor.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
70. The perinatal nurse describes common complaints of pregnancy to the prenatal class
attendees. Nasal __________, medically termed “__________ of pregnancy,” is caused by
increased levels of estrogen and progesterone.
ANS: stuffiness; rhinitis
Nasal stuffiness and congestion (rhinitis of pregnancy) are common complaints during
pregnancy. The nurse should educate the patient about these normal changes and offer
reassurance. Increasing oral fluid intake helps to keep the mucus thin and easier to mobilize.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
71. The clinic nurse promotes a diet rich in vitamin __________ during the third trimester to
prevent the possibility of __________ rupture of the membranes.
ANS: C; premature
Low levels of vitamin C may predispose women to premature rupture of membranes. As the
cellular availability of vitamin C decreases, the rate of degradation of cervical collagen increases.
With decreased collagen, the cervix more easily ripens, prompting effacement and dilatation.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
72. The clinic nurse monitors the blood pressure and assesses a woman’s urine at each prenatal
visit to assess for signs or symptoms of __________. A previous history or the presence of a
__________ are also risk factors.
ANS: preeclampsia; new partner
A previous history of preeclampsia increases the woman’s likelihood of a recurrence during
subsequent pregnancies. If a woman did not experience preeclampsia with previous pregnancies
but has a new partner for her current pregnancy, her risk of developing preeclampsia is similar to
that of a woman who is pregnant for the first time. Although preeclampsia is a systemic disorder
that occurs only during pregnancy, it is generally recognized by two classic symptoms: elevated
blood pressure and proteinuria.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Moderate
73. The clinic nurse is aware of the importance of chlamydia screening during pregnancy.
Chlamydia transmission to the infant at __________ may result in __________.
ANS: birth; ophthalmia neonatorum
Chlamydia trachomatis is a bacteria that causes infection that is prevalent in sexually active
populations, especially those in the under-25 age group. Complications of chlamydia infections
include salpingitis, pelvic inflammatory disease, infertility, ectopic pregnancy, premature rupture
of the membranes, and preterm birth. Transmission to the neonate may occur during birth and
results in ophthalmia neonatorum and chlamydial neonatal pneumonia.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance |
Difficulty Level: Easy
74. The prenatal nurse describes the need for __________ and __________ screening at the first
antenatal visit. If the pregnant woman is not immune, she will be counseled to avoid contact with
young children who have a rash and could be infectious.
ANS: rubella; varicella
Some of the routine maternal laboratory tests screen for childhood diseases that are known to
cause congenital anomalies or other pregnancy complications if contracted during early
pregnancy. When contracted during the first trimester, rubella causes a number of fetal
deformities. Varicella (chickenpox) is another common childhood disease that may cause
problems in the developing embryo and fetus. Therefore, all pregnant women are screened for
rubella and varicella.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
75. The prenatal nurse cautions a pregnant woman about Caesar salad consumption during
pregnancy or any source of __________ or __________ milk.
ANS: raw eggs; unpasteurized
A word of caution should be provided by health-care providers to pregnant women with regard
to microbial food-borne illness. Raw, or unpasteurized, milk as well as partially cooked eggs and
foods containing raw or partially cooked eggs should be avoided.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
76. The clinic nurse describes to the student nurse that __________ is excessive saliva
production in pregnancy. This condition is most likely caused by increased __________ levels.
ANS: ptyalism; hormone
Ptyalism, or excessive salivation, can be quite distressing for the pregnant woman who must
frequently wipe her mouth or spit into a cup. Although the cause of ptyalism is unknown, it is
most likely related to increased hormone levels.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
77. The clinic nurse talks with the newly diagnosed pregnant woman about the nausea that the
woman is experiencing in this pregnancy. The clinic nurse suggests eating __________ meals
more often, remaining __________ after eating, and the using __________ techniques.
ANS: smaller; upright; relaxation
Nausea is often one of the first symptoms of pregnancy experienced. Nurses can suggest
strategies to help offset the nausea, such as the avoidance of “trigger foods” (foods that cause
nausea from sight or smell) and tight clothing that constricts the abdomen. The use of relaxation
techniques (i.e., slow, deep breathing, mental imagery) can also help to decrease nausea. Other
techniques that are often helpful include consuming plain, dry crackers or sucking on peppermint
candy before arising; adhering to small, frequent meals; and remaining in an upright position
after eating.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area:
Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate
78. The clinic nurse understands that the physiological changes of pregnancy include vascular
relaxation from the effects of __________ and impaired venous circulation from pressure exerted
by the enlarged uterus, predisposing the pregnant woman to __________.
ANS: progesterone; varicose veins
Progesterone results in vascular relaxation which combined with impaired venous return
increases the incidence of varicose veins in pregnant women.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Easy
79. The perinatal nurse knows that __________, which is the eating of nonnutritive substances,
is a common __________.
ANS: pica; eating disorder
Pica, the consumption of nonnutritive substances or food, is a common eating disorder that can
affect pregnancy. Substances that are most often ingested include clay, dirt, cornstarch, and ice.
KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level:
Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment |
Difficulty Level: Easy
Matching
The clinic nurse understands the meaning of the following terms related to pregnancy care.
Match these terms with the definitions listed below:
Advocacy
Lordosis
Amenorrhea
Ballottement
Striae gravidarum
Preterm birth
80. Passive movement of the unengaged fetus
ANS: Ballottement
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
81. Verbalizing someone else’s wishes if he or she is unable to do so
ANS: Advocacy
Refer To: Chapter 2
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
82. Absence of menses
ANS: Amenorrhea
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
83. Curvature of the spine
ANS: Lordosis
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy
84. Stretch marks
ANS: Striae gravidarum
Refer To: Glossary
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area:
Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy