Chapter 04: Prenatal Care and Adaptations to Pregnancy
Leifer: Introduction to Maternity and Pediatric Nursing, 8th Edition
MULTIPLE CHOICE
1. A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a
2-year-old son and had one previous spontaneous abortion. How would the nurse document
the patient’s obstetric history using the TPALM system?
a. Gravida 2, para 20120
b. Gravida 3, para 10011
c. Gravida 3, para 10110
d. Gravida 2, para 11110
ANS: C
Refer to Box 4-1 in the textbook for the TPALM system of identifying gravida and para.
DIF: Cognitive Level: Application REF: p. 51|Box 4-1
OBJ: 1 TOP: Definition of Terms
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
2. A woman calls her health care provider to schedule prenatal visits in an uncomplicated
pregnancy. How frequently will the nurse assist the patient to schedule these appointments?
a. Every 3 weeks until the 6th month, then every 2 weeks until delivery
b. Every 4 weeks until the 7th month, after which appointments will become more
frequent
c. Monthly until the 8th month
d. Every 2 to 3 weeks for the entire pregnancy
ANS: B
Monthly visits are scheduled up to 28 weeks, and then visits increase to every 2 to 3 weeks
through 36 weeks. From 36 weeks until delivery, visits are weekly.
DIF: Cognitive Level: Application REF: p. 49 OBJ: 2 | 3
TOP: Prenatal Visits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
3. During the physical examination for the first prenatal visit, it is noted that Chadwick’s sign is
present. What is Chadwick’s sign?
a. Bluish or purplish discoloration of the vulva, vagina, and cervix
b. Presence of early fetal movements
c. Darkening of the areola and breast tenderness
d. Palpation of the fetal outline
ANS: A
Chadwick’s sign is the purplish or bluish discoloration of the cervix, vulva and vagina.
DIF: Cognitive Level: Knowledge REF: p. 53 OBJ: 7
, TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. After the examination is completed, the patient asks the nurse why Chadwick’s sign occurs
during pregnancy. What would the nurse explain as the cause of Chadwick’s sign?
a. Enlargement of the uterus
b. Progesterone action on the breasts
c. Increasing activity of the fetus
d. Vascular congestion in the pelvic area
ANS: D
Chadwick’s sign is caused by increased vascular congestion in the cervical and vaginal area.
DIF: Cognitive Level: Comprehension REF: p. 53 OBJ: 6 | 7
TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
5. The nurse has explained physiological changes that occur during pregnancy. Which statement
indicates that the woman understands the information?
a. “Blood pressure goes up toward the end of pregnancy.”
b. “My breathing will get deeper and a little faster.”
c. “I’ll notice a decreased pigmentation in my skin.”
d. “There will be a curvature in the upper spine area.”
ANS: B
The pregnant woman breathes more deeply, and her respiratory rate may increase slightly.
DIF: Cognitive Level: Comprehension REF: p. 56 OBJ: 7 | 13
TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
6. A woman reports that her last normal menstrual period began on August 5, 2013. What is this
woman’s expected delivery date using Nägele’s rule?
a. April 30, 2014
b. May 5, 2014
c. May 12, 2014
d. May 26, 2014
ANS: C
To determine the expected date of delivery, count backward 3 months from the first day of the
last menstrual period, then add 7 days and change the year if necessary.
DIF: Cognitive Level: Analysis REF: p. 52|Box 4-2
OBJ: 5 TOP: Determining Estimated Date of Delivery
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
Leifer: Introduction to Maternity and Pediatric Nursing, 8th Edition
MULTIPLE CHOICE
1. A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a
2-year-old son and had one previous spontaneous abortion. How would the nurse document
the patient’s obstetric history using the TPALM system?
a. Gravida 2, para 20120
b. Gravida 3, para 10011
c. Gravida 3, para 10110
d. Gravida 2, para 11110
ANS: C
Refer to Box 4-1 in the textbook for the TPALM system of identifying gravida and para.
DIF: Cognitive Level: Application REF: p. 51|Box 4-1
OBJ: 1 TOP: Definition of Terms
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
2. A woman calls her health care provider to schedule prenatal visits in an uncomplicated
pregnancy. How frequently will the nurse assist the patient to schedule these appointments?
a. Every 3 weeks until the 6th month, then every 2 weeks until delivery
b. Every 4 weeks until the 7th month, after which appointments will become more
frequent
c. Monthly until the 8th month
d. Every 2 to 3 weeks for the entire pregnancy
ANS: B
Monthly visits are scheduled up to 28 weeks, and then visits increase to every 2 to 3 weeks
through 36 weeks. From 36 weeks until delivery, visits are weekly.
DIF: Cognitive Level: Application REF: p. 49 OBJ: 2 | 3
TOP: Prenatal Visits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
3. During the physical examination for the first prenatal visit, it is noted that Chadwick’s sign is
present. What is Chadwick’s sign?
a. Bluish or purplish discoloration of the vulva, vagina, and cervix
b. Presence of early fetal movements
c. Darkening of the areola and breast tenderness
d. Palpation of the fetal outline
ANS: A
Chadwick’s sign is the purplish or bluish discoloration of the cervix, vulva and vagina.
DIF: Cognitive Level: Knowledge REF: p. 53 OBJ: 7
, TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. After the examination is completed, the patient asks the nurse why Chadwick’s sign occurs
during pregnancy. What would the nurse explain as the cause of Chadwick’s sign?
a. Enlargement of the uterus
b. Progesterone action on the breasts
c. Increasing activity of the fetus
d. Vascular congestion in the pelvic area
ANS: D
Chadwick’s sign is caused by increased vascular congestion in the cervical and vaginal area.
DIF: Cognitive Level: Comprehension REF: p. 53 OBJ: 6 | 7
TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
5. The nurse has explained physiological changes that occur during pregnancy. Which statement
indicates that the woman understands the information?
a. “Blood pressure goes up toward the end of pregnancy.”
b. “My breathing will get deeper and a little faster.”
c. “I’ll notice a decreased pigmentation in my skin.”
d. “There will be a curvature in the upper spine area.”
ANS: B
The pregnant woman breathes more deeply, and her respiratory rate may increase slightly.
DIF: Cognitive Level: Comprehension REF: p. 56 OBJ: 7 | 13
TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
6. A woman reports that her last normal menstrual period began on August 5, 2013. What is this
woman’s expected delivery date using Nägele’s rule?
a. April 30, 2014
b. May 5, 2014
c. May 12, 2014
d. May 26, 2014
ANS: C
To determine the expected date of delivery, count backward 3 months from the first day of the
last menstrual period, then add 7 days and change the year if necessary.
DIF: Cognitive Level: Analysis REF: p. 52|Box 4-2
OBJ: 5 TOP: Determining Estimated Date of Delivery
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
