Maternal and Pediatric Nursing –
Midterm Exam Graded A+
The woman's weight gain is appropriate for this stage of pregnancy is an accurate
statement. This woman's BMI is in 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 is not a definitive diagnosis. 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 pre-pregnancy weight for the
woman's height. A commonly used method of evaluating the appropriateness of weight
for height is the BMI. This woman has gained the appropriate amount of weight for her
size at this point in her pregnancy. Although weight gain does indicate risk for IUGR it
does not apply to this patient.
A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her
husband brings a large container of brown seaweed soup to the hospital. When the
nurse enters the room the husband asks for help with warming the soup so that his wife
can eat it. What is the basis of the nurse's most appropriate response?
a. Asking the patient if she did not like the lunch that was served to her.
b. Checking with the patient that she has obtained permission from her health care
provider to consume seaweed soup.
c. Asking the husband what the soup contains.
d. Offering to warm the soup up in the microwave for the woman. - ANSWER-ANS: D
By offering to warm the soup in the microwave for the woman the nurse is
demonstrating cultural appropriateness to the dietary preferences of the woman and is
the basis of the most appropriate response. Cultural dietary preferences must be
respected. Women may request that family members bring favourite or culturally
appropriate foods to the hospital. Asking the husband what the soup contains does not
show cultural sensitivity. Dietary choices in the postpartum period do not need approval
from a health care provider. Asking her if she did not like her lunch is not appropriate.
A 26-year-old pregnant woman 2-1-0-0-1 is 28 weeks pregnant when she experiences
bright red painless vaginal bleeding. On her arrival at the hospital what would be an
expected diagnostic procedure?
a. Amniocentesis for fetal lung maturity
b. Ultrasound for placental location
c. Contraction stress test (CST)
d. Internal fetal monitoring - ANSWER-ANS: B
The presence of painless bleeding should always alert the health care team to the
possibility of placenta previa. This can be confirmed through ultrasonography.
Amniocentesis would not be performed on a woman who is experiencing bleeding. In
the event of an imminent delivery the fetus would be presumed to have immature lungs
at this gestational age and the mother would be given corticosteroids to aid in fetal lung
maturity. A CST would not be performed at a preterm gestational age. Furthermore
,bleeding would be a contraindication to this test. Internal fetal monitoring would be
contraindicated in the presence of bleeding.
A 27-year-old pregnant woman had a preconception body mass index (BMI) of 18.0.
Which would be within normal range for her total recommended weight gain during
pregnancy?
a. 21 kg
b. 19 kg
c. 14 kg
d. 12 kg - ANSWER-ANS: C
This woman has an underweight BMI and should gain 12.5 to 18 kg during pregnancy.
A weight gain of 21 kg would be unhealthy for most women. A weight gain of 19 kg is
slightly above the range of weight this woman should gain in her pregnancy. A weight
gain of 12 kg is below the range of weight this woman should gain in her pregnancy.
A 3-year-old girl's mother is 6 months pregnant. What concern is this child likely to
express?
a. How the baby will "get out"
b. What the baby will eat
c. Whether her mother will die
d. What colour eyes the baby has - ANSWER-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
the 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 colour does not tend to be the focus of
children's questions about the impending birth of a sibling.
A 31-year-old woman believes that she may be pregnant. She took an over-the counter
(OTC) pregnancy test 1 week ago after missing her period the test was positive. During
her assessment interview the nurse inquires 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 which
reveals that 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 tumour.
d. She has been under considerable stress and has a hormone imbalance. - ANSWER-
ANS: B
Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests
use enzyme-linked immunosorbent assay technology which can yield positive results as
,soon as 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 tumours do not produce hormones and have no bearing
on human chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt
normal hormone cycles (menstrual cycles) it does not affect hCG levels or produce
positive pregnancy test results.
A 39-year-old primigravida thinks that she is about 8 weeks pregnant although she has
had irregular menstrual periods all her life. She has a history of smoking approximately
one pack of cigarettes a day but she tells you that she is trying to cut down. Her
laboratory data are within normal limits. What diagnostic technique could be used with
this pregnant woman at this time?
a. Ultrasound examination
b. Maternal serum alpha-fetoprotein screening (MSAFP)
c. Amniocentesis
d. Nonstress test (NST) - ANSWER-ANS: A
An ultrasound examination could be done to confirm the pregnancy and determine the
gestational age of the fetus. It is too early in the pregnancy to perform the MSAFP an
amniocentesis or an NST. The MSAFP is performed at 16 to 18 weeks of gestation
followed by amniocentesis if the MSAFP levels are abnormal or if fetal or maternal
anomalies are detected. An NST is performed to assess fetal well-being in the third
trimester.
A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate
to suggest to her at this time?
a. Biophysical profile
b. Amniocentesis
c. Maternal serum alpha-fetoprotein (MSAFP)
d. Transvaginal ultrasound - ANSWER-ANS: D
An ultrasound is the method of biophysical assessment of the infant that would be
performed at this gestational age. A biophysical profile would be a method of
biophysical assessment of fetal well-being in the third trimester. An amniocentesis is
performed after the fourteenth week of pregnancy. An MSAFP test is performed from
week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).
A 41-week pregnant multigravida presents in the labour and delivery unit after a
nonstress test indicated that her fetus could be experiencing some difficulties in utero.
Which diagnostic tool would yield more detailed information about the fetus?
a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein screening (MSAFP)
d. Percutaneous umbilical blood sampling (PUBS) - ANSWER-ANS: B
Real-time ultrasound permits detailed assessment of the physical and physiological
characteristics of the developing fetus and cataloguing of normal and abnormal
biophysical responses to stimuli. The BPP is a noninvasive dynamic assessment of a
fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal
, anomalies would most likely have occurred earlier in the pregnancy. It is too late in the
pregnancy to perform an MSAFP. Furthermore it does not provide information related to
fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood
disorders karyotyping of malformed fetuses detection of fetal infection determination of
the acid-base status of the fetus with IUGR and assessment and treatment of
isoimmunization and thrombocytopenia in the fetus.
A 62-year-old woman has not been to the clinic for an annual examination for 5 years.
The recent death of her husband reminded her that she should come for a visit. Her
family doctor has retired and she is going to see the women's health nurse practitioner
for her visit. What should the nurse do to facilitate a positive health care experience?
a. Remind the woman that she is long overdue for her examination and that she should
come in annually.
b. Listen carefully and allow extra time for this woman's health history interview.
c. Reassure the woman that a nurse practitioner is just as good as her old doctor.
d. Encourage the woman to talk about the death of her husband and her fears about her
own death. - ANSWER-ANS: B
The nurse has an opportunity to use reflection and empathy while listening and to
ensure open and caring communication. Scheduling a longer appointment time may be
necessary because older women may have longer histories or may need to talk. A
respectful and reassuring approach to caring for women can help ensure that they
continue to seek health care. Reminding the woman about her overdue examination
reassuring the woman that she has a good practitioner and encouraging conversation
about the death of her husband and her own death are not the best approaches at the
initial visit.
A couple comes in for an infertility appointment having attempted to get pregnant for 2
years. The woman 37 has always had irregular menstrual cycles but is otherwise
healthy. The man has fathered two children from a previous marriage and underwent a
vasectomy reversal 2 years ago. The man has had two normal semen analyses but the
sperm seem to be clumped together. What additional test is needed?
a. Testicular biopsy
b. Antisperm antibodies
c. Follicle-stimulating hormone (FSH) level
d. Examination for testicular infection - ANSWER-ANS: C
The woman has irregular menstrual cycles. The scenario does not indicate that she has
had any testing related to this irregularity. Hormone analysis is performed to assess
endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are
absent or irregular. Determination of blood levels of prolactin FSH luteinizing hormone
(LH) estradiol progesterone and thyroid hormones may be necessary to diagnose the
cause of irregular menstrual cycles. A testicular biopsy would be indicated only in cases
of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells).
Antisperm antibodies are produced by a man against his own sperm. This is unlikely to
be the case here because the husband has already produced children. Examination for
testicular infection would be done before semen analysis. Furthermore infection would
affect spermatogenesis.
Midterm Exam Graded A+
The woman's weight gain is appropriate for this stage of pregnancy is an accurate
statement. This woman's BMI is in 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 is not a definitive diagnosis. 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 pre-pregnancy weight for the
woman's height. A commonly used method of evaluating the appropriateness of weight
for height is the BMI. This woman has gained the appropriate amount of weight for her
size at this point in her pregnancy. Although weight gain does indicate risk for IUGR it
does not apply to this patient.
A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her
husband brings a large container of brown seaweed soup to the hospital. When the
nurse enters the room the husband asks for help with warming the soup so that his wife
can eat it. What is the basis of the nurse's most appropriate response?
a. Asking the patient if she did not like the lunch that was served to her.
b. Checking with the patient that she has obtained permission from her health care
provider to consume seaweed soup.
c. Asking the husband what the soup contains.
d. Offering to warm the soup up in the microwave for the woman. - ANSWER-ANS: D
By offering to warm the soup in the microwave for the woman the nurse is
demonstrating cultural appropriateness to the dietary preferences of the woman and is
the basis of the most appropriate response. Cultural dietary preferences must be
respected. Women may request that family members bring favourite or culturally
appropriate foods to the hospital. Asking the husband what the soup contains does not
show cultural sensitivity. Dietary choices in the postpartum period do not need approval
from a health care provider. Asking her if she did not like her lunch is not appropriate.
A 26-year-old pregnant woman 2-1-0-0-1 is 28 weeks pregnant when she experiences
bright red painless vaginal bleeding. On her arrival at the hospital what would be an
expected diagnostic procedure?
a. Amniocentesis for fetal lung maturity
b. Ultrasound for placental location
c. Contraction stress test (CST)
d. Internal fetal monitoring - ANSWER-ANS: B
The presence of painless bleeding should always alert the health care team to the
possibility of placenta previa. This can be confirmed through ultrasonography.
Amniocentesis would not be performed on a woman who is experiencing bleeding. In
the event of an imminent delivery the fetus would be presumed to have immature lungs
at this gestational age and the mother would be given corticosteroids to aid in fetal lung
maturity. A CST would not be performed at a preterm gestational age. Furthermore
,bleeding would be a contraindication to this test. Internal fetal monitoring would be
contraindicated in the presence of bleeding.
A 27-year-old pregnant woman had a preconception body mass index (BMI) of 18.0.
Which would be within normal range for her total recommended weight gain during
pregnancy?
a. 21 kg
b. 19 kg
c. 14 kg
d. 12 kg - ANSWER-ANS: C
This woman has an underweight BMI and should gain 12.5 to 18 kg during pregnancy.
A weight gain of 21 kg would be unhealthy for most women. A weight gain of 19 kg is
slightly above the range of weight this woman should gain in her pregnancy. A weight
gain of 12 kg is below the range of weight this woman should gain in her pregnancy.
A 3-year-old girl's mother is 6 months pregnant. What concern is this child likely to
express?
a. How the baby will "get out"
b. What the baby will eat
c. Whether her mother will die
d. What colour eyes the baby has - ANSWER-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
the 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 colour does not tend to be the focus of
children's questions about the impending birth of a sibling.
A 31-year-old woman believes that she may be pregnant. She took an over-the counter
(OTC) pregnancy test 1 week ago after missing her period the test was positive. During
her assessment interview the nurse inquires 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 which
reveals that 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 tumour.
d. She has been under considerable stress and has a hormone imbalance. - ANSWER-
ANS: B
Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests
use enzyme-linked immunosorbent assay technology which can yield positive results as
,soon as 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 tumours do not produce hormones and have no bearing
on human chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt
normal hormone cycles (menstrual cycles) it does not affect hCG levels or produce
positive pregnancy test results.
A 39-year-old primigravida thinks that she is about 8 weeks pregnant although she has
had irregular menstrual periods all her life. She has a history of smoking approximately
one pack of cigarettes a day but she tells you that she is trying to cut down. Her
laboratory data are within normal limits. What diagnostic technique could be used with
this pregnant woman at this time?
a. Ultrasound examination
b. Maternal serum alpha-fetoprotein screening (MSAFP)
c. Amniocentesis
d. Nonstress test (NST) - ANSWER-ANS: A
An ultrasound examination could be done to confirm the pregnancy and determine the
gestational age of the fetus. It is too early in the pregnancy to perform the MSAFP an
amniocentesis or an NST. The MSAFP is performed at 16 to 18 weeks of gestation
followed by amniocentesis if the MSAFP levels are abnormal or if fetal or maternal
anomalies are detected. An NST is performed to assess fetal well-being in the third
trimester.
A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate
to suggest to her at this time?
a. Biophysical profile
b. Amniocentesis
c. Maternal serum alpha-fetoprotein (MSAFP)
d. Transvaginal ultrasound - ANSWER-ANS: D
An ultrasound is the method of biophysical assessment of the infant that would be
performed at this gestational age. A biophysical profile would be a method of
biophysical assessment of fetal well-being in the third trimester. An amniocentesis is
performed after the fourteenth week of pregnancy. An MSAFP test is performed from
week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).
A 41-week pregnant multigravida presents in the labour and delivery unit after a
nonstress test indicated that her fetus could be experiencing some difficulties in utero.
Which diagnostic tool would yield more detailed information about the fetus?
a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein screening (MSAFP)
d. Percutaneous umbilical blood sampling (PUBS) - ANSWER-ANS: B
Real-time ultrasound permits detailed assessment of the physical and physiological
characteristics of the developing fetus and cataloguing of normal and abnormal
biophysical responses to stimuli. The BPP is a noninvasive dynamic assessment of a
fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal
, anomalies would most likely have occurred earlier in the pregnancy. It is too late in the
pregnancy to perform an MSAFP. Furthermore it does not provide information related to
fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood
disorders karyotyping of malformed fetuses detection of fetal infection determination of
the acid-base status of the fetus with IUGR and assessment and treatment of
isoimmunization and thrombocytopenia in the fetus.
A 62-year-old woman has not been to the clinic for an annual examination for 5 years.
The recent death of her husband reminded her that she should come for a visit. Her
family doctor has retired and she is going to see the women's health nurse practitioner
for her visit. What should the nurse do to facilitate a positive health care experience?
a. Remind the woman that she is long overdue for her examination and that she should
come in annually.
b. Listen carefully and allow extra time for this woman's health history interview.
c. Reassure the woman that a nurse practitioner is just as good as her old doctor.
d. Encourage the woman to talk about the death of her husband and her fears about her
own death. - ANSWER-ANS: B
The nurse has an opportunity to use reflection and empathy while listening and to
ensure open and caring communication. Scheduling a longer appointment time may be
necessary because older women may have longer histories or may need to talk. A
respectful and reassuring approach to caring for women can help ensure that they
continue to seek health care. Reminding the woman about her overdue examination
reassuring the woman that she has a good practitioner and encouraging conversation
about the death of her husband and her own death are not the best approaches at the
initial visit.
A couple comes in for an infertility appointment having attempted to get pregnant for 2
years. The woman 37 has always had irregular menstrual cycles but is otherwise
healthy. The man has fathered two children from a previous marriage and underwent a
vasectomy reversal 2 years ago. The man has had two normal semen analyses but the
sperm seem to be clumped together. What additional test is needed?
a. Testicular biopsy
b. Antisperm antibodies
c. Follicle-stimulating hormone (FSH) level
d. Examination for testicular infection - ANSWER-ANS: C
The woman has irregular menstrual cycles. The scenario does not indicate that she has
had any testing related to this irregularity. Hormone analysis is performed to assess
endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are
absent or irregular. Determination of blood levels of prolactin FSH luteinizing hormone
(LH) estradiol progesterone and thyroid hormones may be necessary to diagnose the
cause of irregular menstrual cycles. A testicular biopsy would be indicated only in cases
of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells).
Antisperm antibodies are produced by a man against his own sperm. This is unlikely to
be the case here because the husband has already produced children. Examination for
testicular infection would be done before semen analysis. Furthermore infection would
affect spermatogenesis.
