Test Bank for Davis Advantage for Maternal-Child Nursing Care 3rd Edition by Scannell Ruggiero

Test Bank for Davis Advantage for Maternal-Child Nursing Care 3rd Edition by Scannell Ruggiero MULTIPLE CHOICE A patient chooses to have the certified nurse midwife (CNM) provide care during her pregnancy. What does the CNMs scope of practice include? • Practice independent from medical supervision • Comprehensive prenatal care • Attendance at all deliveries • Cesarean sections ANS:B The CNM provides comprehensive prenatal and postnatal care, attends uncomplicated deliveries, and ensures that a backup physician is available in case of unforeseen problems. REF: Page 6 Which medical pioneer discovered the relationship between the incidence of puerperal fever and unwashed hands? • Karl Cred • Ignaz Semmelweis • Louis Pasteur • Joseph List ANS: B Ignaz Semmelweis deduced that puerperal fever was septic, contagious, and transmitted by the unwashed hands of physicians and medical students. REF: Page 2 A pregnant woman who has recently immigrated to the United States comments to the nurse, I Am afraid of childbirth. It is so dangerous. I am afraid I will die. What is the best nursing response reflecting cultural sensitivity? • Maternal mortality in the United States is extremely low. • Anesthesia is available to relieve pain during labor and childbirth. • Tell me why you are afraid of childbirth. • Your condition will be monitored during labor and delivery. ANS: C Asking the patient about her concerns helps promote understanding and individualizes patient care. REF: Page 7-8 : : Psychological • An urban area has been reported to have a high perinatal mortality rate. What information does this provide? • Maternal and infant deaths per 100,000 live births per year • Deaths of fetuses weighing more than 500 g per 10,000 births per year • Deaths of infants up to 1 year of age per 1000 live births per year • Fetal and neonatal deaths per 1000 live births per year ANS: D The perinatal mortality rate includes fetal and neonatal deaths per 1000 live births per year. : REF: Page 12, Box 1-6 9 : The Present-Child Care : • What is the focus of current maternity practice? • Hospital births for the majority of women • The traditional family unit • Separation of labor rooms from delivery rooms • A quality family experience for each patient ANS: D Current maternity practice focuses on a high-quality family experience for all families, traditional or otherwise. : REF: Page 6 7 : The Present-Maternity Care N/A : Health Promotion and Maintenance • Who advocated the establishment of the Childrens Bureau? • Lillian Wald • Florence Nightingale • Florence Kelly • C l a r a B a r t o n A N S : A Lillian Wald is credited with suggesting the establishment of a federal Childrens Bureau. REF: Page 4 1 | 2 : The Past : Health Promotion and Maintenance: Growth and Development • What was the result of research done in the 1930s by the Childrens Bureau? • Children with heart problems are now cared for by pediatric cardiologists. • The Child Abuse and Prevention Act was passed. • Hot lunch programs were established in many schools. • Childrens asylums were founded. ANS: C School hot lunch programs were developed as a result of research by the Childrens Bureau on the effects of economic depression on children. REF: Page 4 2 | 3 : The Past N/A : Health Promotion and Maintenance: Coordinated Care • What government program was implemented to increase the educational exposure of preschool children? • WIC • Title XIX of Medicaid • The Childrens Charter • H e a d S t a r t A N S : D Head Start programs were established to increase educational exposure of preschool children. REF: Page 3 5 : Government Influences in Maternity and Pediatric Care N/A : Health Promotion and Maintenance: Growth and Development • What guidelines define multidisciplinary patient care in terms of expected outcome and timeframe from different areas of care provision? • Clinical pathways • Nursing outcome criteria • Standards of care • Nursi ng care plan ANS: A Clinical pathways, also known as critical pathways or care maps, are collaborative guidelines that define patient care across disciplines. Expected progress within a specified timeline is identified. REF: Page 12 14 : Health Care Delivery Systems Safe, Effective Care Environment: Coordinated Care • A nursing student has reviewed a hospitalized pediatric patient chart, interviewed her mother, and collected admission data. What is the next step the student will take to develop a nursing care plan for this child? • Identify measurable outcomes with a timeline. • Choose specific nursing interventions for the child. • Determine appropriate nursing diagnoses. • State nursing actions related to the childs medical diagnosis. ANS: C The nurse uses assessment data to select appropriate nursing diagnoses from the NANDA-I list. Outcomes and interventions are then developed to address the relevant nursing diagnoses. REF: Page 11 13 : Nursing Diagnosis : Safe, Effective Care Environment: Coordinated Care • A nursing student on an obstetric rotation questions the floor nurse about the definition of the LVN/LPN scope of practice. What resource can the nurse suggest to the student? • American Nurses Association • States board of nursing • Joint Commission • Association of Womens Health, Obstetric and Neonatal Nurses ANS: B The scope of practice of the LVN/LPN is published by the states board of nursing. : REF: Page 3, Legal and Ethical Considerations 18 : Critical Thinking : • What was recommended by Karl Cred in 1884? • All women should be delivered in a hospital setting. • Chemical means should be used to combat infection. • Podalic version should be done on all fetuses. • Silver nitrate should be placed in the eyes of newborns. ANS: D In 1884 Karl Cred recommended the use of 2% silver nitrate in the eyes of newborns to reduce the incidence of blindness. REF: Page 2 1 : Use of Silver Nitrate Nursing Process N/A : • What is the purpose of the White House Conference on Children and Youth? • Set criteria for normal growth patterns. • Examine the number of live births in minority populations. • Raise money to support well-child clinics in rural areas. • Promote comprehensive child welfare. ANS: D White House Conferences on Children and Youth are held every 10 years to promote comprehensive child welfare. REF: Page 4 3 : White House Conferences N/A : • How many hours of hospital stay does legislation currently allow for a postpartum patient who has delivered vaginally without complications? • 24 • 48 • 36 • 7 2 A N S : B Postpartum patients who deliver vaginally stay in the hospital for an average of 48 hours; patients who have had a cesarean delivery usually stay 4 days. REF: Page 6 7 : Hospital Terms for Postpartum Patients Planning : • How does the clinical pathway or critical pathway improve quality of care? • Lists diagnosis-specific implementations • Outlines expected progress with stated timelines • Prioritizes effective nursing diagnoses • Describes common complications ANS: B Critical pathways outline expected progress with stated timelines. Any deviation from those timelines is called a variance. : REF: Page 12 14 : Critical Pathway : Safe, Effective Care Environment: Coordinated Care • A patient asks the nurse to explain what is meant by gene therapy. What is the nurses best response? • Gene therapy can replace missing genes. • Gene therapy evaluates the parents genes. • Gene therapy can change the sex of the fetus. • Gene therapy supports the regeneration of defective genes. ANS: A Gene therapy can replace missing or defective genes. REF: Page 8 7 : Gene Therapy : • The nurse is clarifying information to a patient regarding diagnosis-related groups (DRGs). What is the nurses best response when the patient asks how DRGs reduce medical care costs? • By determining payment based on diagnosis • By requiring two medical opinions to confirm a diagnosis • By organizing HMOs • By defining a person who will require hospitalization ANS: A DRGs determine the amount of payment and length of hospital stay based on the diagnosis. : REF: Page 8 11 : DRGs : • What is the best example of a Nursing Interventions Classification (NIC) intervention? • Patient will ambulate in the hall independently for 10 minutes three times a day. • Nurse will report temperature elevations to the charge nurse. • Nurse will offer extra liquids at all meals. • Patient will express pain relief after massage. ANS: C NIC is a guide to nursing actions. : REF: Page 12 | Page 14 15 : NICs N/A : • How does electronic charting ensure comprehensive charting more effectively than handwritten charting? • Provides a uniform style of chart • Requires certain responses before allowing the user to progress • All documentation is reflective of the nursing care plan • Requires a daily audit by the charge nurse ANS: B Comprehensive electronic documentation is ensured by requiring specific input in designated categories before the user can progress through the system. : REF: Page 15-16 22 : Computer Charting : Safe, Effective Care Environment: Coordinated Care • The nurse reminds family members that the philosophy of family-centered care is to provide control to the family over health care decisions. What is the appropriate term for this type of control? • Empowerment • Insight • Regulation • O r g a n i z a t i o n A N S : A The term empowerment refers to the control a family has over its own health care decisions. REF: Page 2 7 : Empowerment : • A patient in the prenatal clinic is concerned about losing her job because of her pregnancy. The nurse instructs her that the Family Medical Leave Act (FMLA) allows an employee to be absent from work without pay. How many weeks does the FMLA allow a woman to recover from childbirth or care for a sick family member without loss of benefits or pay status? • 4 • 6 • 10 • 1 2 A N S : D The FMLA allows for employees to leave work for up to 12 weeks to recover from childbirth or to care for an ill family member without losing benefits or pay status. REF: Page 3 5 : FMLA : : • What term appropriately describes the nurse who is able to adapt health care practices to meet the needs of various cultures? • Culturally aware • Culturally sensitive • Culturally competent • Cultur ally adaptiv e ANS: C The nurse who is able to adapt health care to meet the needs of various cultures is said to be culturally competent. REF: Page 7 8 : Cultural Competency N/A • What is one major advantage to the application of critical thinking? • Problem-free care • Limitation of approaches to care • Decreased need for assessment • Proble m prevent ion ANS: D Critical thinking results in problem prevention in designing nursing care. : REF: Page 14 19 : Critical Thinking Nursing Process N/A • Student practical nurses are discussing the North American Nursing Diagnosis Association International (NANDA-I) taxonomy in post conference on the acute care clinical setting. The students are aware that the role of the LPN with nursing diagnosis formulation is what? • To initiate and identify nursing diagnosis specific to patient • To update changes in nursing diagnosis as needed • To have an understanding of nursing diagnosis terminology • To accurately document nursing diagnosis on patient plan of care ANS: C The registered nurse is responsible to initiate, identify, update, and document nursing diagnoses. The licensed practical nurse is responsible to have an understanding of nursing diagnosis terminology. : REF: Page 14 17 : NANDA-I taxonomy Nursing Diagnosis : Health Promotion and Maintenance: Techniques MULTIPLE RESPONSE • What services are birthing centers able to provide? (Select all that apply.) • Prenatal care • Labor and delivery services • Classes for new mothers • Adoption referrals • Fam ily plan ning AN S: A, B, C, E Birthing centers are capable of providing full-service obstetric care, classes for new mothers, and family planning. Birthing centers do not offer adoption services. : REF: Page 6 7 : Birthing Centers : Health Promotion and Maintenance: Coordinated Care • What developments in the early 20th century encouraged women to seek hospitalization for childbirth? (Select all that apply.) • Use of specialized obstetric instruments • Use of anesthesia • Physicians closer relationships with hospitals • Focus on family-centered care • Insura nce covera ge ANS: A, B, C In the early 1900s, the development of specialized obstetric instruments, better modes of anesthesia, and the physicians reliance on hospital services were instrumental in encouraging women to seek hospitalization for childbirth. : REF: Page 3 7 : Hospitalization for Childbirth : Safe, Effective Care Environment: Safety and Infection Control • What nonfamily-centered policies were prevalent in the 1960s? (Select all that apply.) • Waiting room for fathers • Sedation of mother during labor • Delay of reunion of mother and infant • Lenient visiting hours • Restrictions of visitations by minor children ANS: A, B, C, E Hospital policies in the 1960s provided a separate waiting room for fathers while the mother went through labor in a sedated state. The reunion of mother and infant was delayed for several hours because of the sedation. Visiting hours were rigid and disallowed the visitation of minor children. : REF: Page 3 7 : Nonfamily-centered Practices : Safe, Effective Care Environment: Safety and Infection Control • The nurse is aware that there is a legal responsibility to report certain diseases and conditions to county or state health authorities. Which would be included? (Select all that apply.) • Tuberculosis • Child abuse • Industrial accidents • Sexually transmitted diseases • Foodborne infections ANS: A, B, D, E The nurse has a legal responsibility to report communicable diseases (such as tuberculosis and sexually transmitted diseases), food-borne infections, child abuse, and threats of suicide. : REF: Page 6, Legal and Ethical Considerations box 6 : Reportable Diseases Planning : Safe, Effective Care Environment: • An inservice program at a long-term care facility is reviewing the Nursing Outcomes Classification (NOC) with nursing staff. After the presentation the nurses review resident care plans. Which of the following are found to be appropriately written outcomes? (Select all that apply.) • Suction patient orally every 4 hours and as needed. • Auscultate lung sounds every 2 hours. • Provide Tylenol as ordered by health care provider. • Patient states Pain has decreased after medication administration. • Patient blood pressure recorded as 120/72 after dressing change. ANS: D, E NOC was developed to identify outcomes of nursing care that are directly influenced by nursing actions. Outcomes are defined as the behaviors and feelings of the patient in response to the nursing care given. Suctioning patient, auscultating lung sounds, and providing Tylenol are nursing actions. REF: Page 12-14 16 : Nursing Outcomes Classification (NOC) Evaluation : • Practical nursing students are using critical thinking skills to study for an upcoming test. What will these students include when studying? (Select all that apply.) • Memorization of facts first • Prioritizing information • Relating facts to other facts • Making assumptions • Reviewing before the test ANS: B, C, E Using critical thinking when studying involves understanding facts before memorizing, prioritizing information to be memorized, relating facts to other facts, using all five senses, reviewing before tests, and reading critically. Critical thinking does not involve assumption as does general thinking. : REF: Page 15 20 : Critical Thinking Evaluation : Safe, Effective Care Environment • What factors have played a role in meeting the goals of Healthy People 2020 as it relates the goals for outcomes of pregnancy? (Select all that apply.) • Early prenatal care • Increased number of surgical births • NICU care • Use of prenatal glucocorticoids • F et al su rg er y A N S: A, C, D, E Early prenatal care, fetal surgery, use of prenatal glucocorticoids, technology, and NICU care have played a role in increasing the positive outcome of pregnancy, and the goals of Healthy People 2020 may well be met. Increase in surgical births and multiple gestations do not work toward meeting the goals of Healthy People 2020. : REF: Page 16-17 21 : Healthy People 2020 : Health Promotion and Maintenance: Prevention and Early Detection • A community health nurse is providing specialized care to patients in the home setting. What kind of specialized care may this nurse be providing? (Select all that apply.) • Glucose monitoring • Heparin therapy • Family education • Total parenteral nutrition • Provision of referral services ANS: A, B, D Glucose monitoring, heparin therapy, and total parenteral nutrition are categorized as specialized care that may be provided by the community health nurse. Family education and provision of referral are categorized as therapeutic care. REF: Page 16-17 23 : Community Health : Basic Care and Comfort COMPLETION • The nurse who is very conscientious about hand hygiene is following the concepts set out by and . ANS: Lister, Pasteur OR Pasteur, Lister Both Lister and Pasteur set out that handwashing could reduce incidence of infection by crosscontamination. REF: Page 2 1 : Handwashing : Health Promotion and Maintenance: • The first White House Conference on Children and Youth was called by President . ANS: Theodore Roosevelt Theodore Roosevelt called the first White House Conference in 1909. REF: Page 4 1 : White House Conferences N/A : • The nurse reviewing the specific recovery goals set out on a clinical pathway observed that two goals were not met by their designated timeline. The nurse records a negative for these two goals. ANS: variance Using a clinical pathway model with goals and associated timelines, the nurse must record a negative variance when a timeline is not met and consider a new approach or an extended timeline. : REF: Page 12 14 : Variances Evaluation : Safe, Effective Care Environment: Management of Care • . is purposeful, goal-directed thinking based on scientific evidence rather than assumption or memorization. ANS: Critical thinking Critical thinking is purposeful and goal-directed thinking as oppo Chapter 2.Reproduction + Chapter 3.Conception and Development of the Embryo and Fetus What is the total number of chromosomes contained in a mature sperm or ovum? • 22 • 23 • 44 • 4 6 A N S : B Gametes (sex chromosomes) contain 23 chromosomes. : Knowledge REF: Page 31 2 : Gametogenesis N/A : Health Promotion and Maintenance: Growth and Development • A pregnant woman states, My husband hopes I will give him a boy because we have three girls. What will the nurse explain to this woman? • The sex chromosome of the fertilized ovum determines the gender of the child. • When the sperm and ovum are united, there is a 75% chance the child will be a girl. • When the pH of the female reproductive tract is acidic, the child will be a girl. • If a sperm carrying a Y chromosome fertilizes an ovum, then a boy is produced. ANS: D When a Y-bearing sperm fertilizes an ovum, a male child is produced. : REF: Page 33 3 : Sex Determination : Health Promotion and Maintenance: Growth and Development • What is the most common site for fertilization? • Lower segment of the uterus • Outer third of the fallopian tube near the ovary • Upper portion of the uterus • Area of the fallopian tube farthest from the ovary ANS: B Fertilization takes place in the outer third of the fallopian tube, which is closest to the ovary. REF: Page 33 3 : Fertilization : Health Promotion and Maintenance: Growth and Development • The embryo is termed a fetus at which stage of prenatal development? • 2 weeks • 4 weeks • 9 weeks • 1 6 w e e k s A N S : C The fetus (third stage of prenatal development) begins at the ninth week and continues until the 40th week of gestation or until birth. REF: Page 36 4 : Prenatal Developmental Milestones : Health Promotion and Maintenance: Growth and Development • The nurse is reviewing fetal circulation with a pregnant patient and explains that blood circulates through the placenta to the fetus. What vessel(s) carry blood to the fetus? • One umbilical vein • Two umbilical veins • One umbilical artery • Two umbilical arteries ANS: A The umbilical vein transports richly oxygenated blood from the placenta to the fetus. REF: Page 39-40 7 : Fetal Circulation : Health Promotion and Maintenance: Growth and Development • Where is the usual location for implantation of the zygote? • Upper section of the posterior uterine wall • Lower portion of the uterus near the cervical os • Inner third of the fallopian tube near the uterus • Lateral aspect of the uterine wall ANS: A The zygote usually implants in the upper section of the posterior uterine wall. REF: Page 35 3 : Implantation N/A : Health Promotion and Maintenance: Growth and Development • What is the embryonic membrane that contains fingerlike projections on its surface, which attach to the uterine wall? • Amnion • Yolk sac • Chorion • De cid ua bas alis AN S: C The chorion is a thick membrane with fingerlike projections (villi) on its outermost surface. REF: Page 35 4 : Accessory Structures of Pregnancy N/A : Health Promotion and Maintenance: Growth and Development • Which hormone is responsible for converting the endometrium into decidual cells for implantation? • Estrogen • Human chorionic gonadotropin • Human placental lactogen • P r o g e s t e r o n e A N S : D At high levels, progesterone maintains the endometrial lining for implantation of the zygote. REF: Page 39 6 : Placenta N/A : Health Promotion and Maintenance: Growth and Development • A patient asks the nurse when her infants heart will begin to pump blood. What will the nurse reply? • By the end of week 3 • Beginning in week 8 • At the end of week 16 • Beginnin g in week 24 ANS: A The fetal heart begins to pump by week 3 of gestation. REF: Page 36 5 : Prenatal Development Nursing Process N/A : Health Promotion and Maintenance: Growth and Development • What organ does the ductus venosus shunt blood away from in fetal circulation? • Liver • Heart • Lungs • K i d n e y s A N S : A Fetal blood bypasses the liver through the ductus venosus by carrying blood directly to the inferior vena cava. REF: Page 39 7 : Prenatal Development Nursing Process N/A : Health Promotion and Maintenance: Growth and Development • What complication can result from untreated respiratory distress in the newborn? • Esophageal atresia • Gastric dilation • Cold stress • Reopening of the foramen ovale ANS: D Respiratory distress can cause increased pressure in the right ventricle, causing reopening of the foramen ovale. : REF: Page 40 7 : Fetal Circulation : Health Promotion and Maintenance: Growth and Development • During an ultrasound, two amnions and two placentas are observed. What will be the most likely result of this pregnancy? • Dizygotic twins • Monozygotic twins • Conjoined twins • High birthweight twins ANS: A Dizygotic twins always have two amnions and two chorions (placentas). : REF: Page 42 8 : Multifetal Pregnancy Data Health Promotion and Maintenance: Growth and Development • A woman who is 25 weeks pregnant asks the nurse what her fetus looks like. What does the nurse explain is one physical characteristic present in a 25-week-old fetus? • Lanugo covering the body • Constant motion • Skin that is pink and smooth • Eyes that are closed ANS: A By 25 weeks, the body of the fetus is covered with lanugo, the eyes are open, the skin is wrinkled, and the fetus has definite periods of movement and sleeping. : REF: Page 37-38, Table 3-1 5 : Prenatal Development : Health Promotion and Maintenance: Growth and Development • At what point in prenatal development do the lungs begin to produce surfactant? • 17 weeks • 20 weeks • 25 weeks • 3 0 w e e k s A N S : C During week 25, the alveoli begin to produce surfactant, which enables the alveoli to stay open for adequate lung oxygenation to occur. REF: Page 37, Table 3-1 5 : Prenatal Development N/A : Health Promotion and Maintenance: Growth and Development • A woman missed her menstrual period 1 week ago and has come to the doctors office for a pregnancy test. Which placental hormone is measured in pregnancy tests? • Progesterone • Estrogen • Human chorionic gonadotropin • Human placental lactogen ANS: C Human chorionic gonadotropin is the basis for most pregnancy tests. It is detectable in maternal blood as soon as implantation occurs, usually 7 to 9 days after fertilization. REF: Page 39 6 : Accessory Structures of Pregnancy Data Health Promotion and Maintenance: Growth and Development • When preparing to teach a class about prenatal development, the nurse would include information about folic acid supplementation. What is folic acid known to prevent? • Congenital heart defects • Neural tube defects • Mental retardation • Pre ma tur e birt h AN S: B It is now known that folic acid supplements can prevent neural tube defects such as spina bifida. : REF: Page 37 5 : Prenatal Development Planning : Health Promotion and Maintenance: Growth and Development • The nurse is educating a class of expectant parents about fetal development. What is considered fetal age of viability? • 14 weeks • 20 weeks • 25 weeks • 3 0 w e e k s A N S : B By 20 weeks of gestation, the lungs have matured enough for the fetus to survive outside the uterus (age of viability). REF: Page 37 5 : Prenatal Developmental Milestones N/A : Health Promotion and Maintenance: Growth and Development • The nurse is presenting a conference on gene dominance. What does the nurse report as the percentage of children carrying the dominant gene if one parent has a dominant gene and the other parent does not? a. 10% b. 25% c. 50% d. 1 0 0 % A N S: C If one parent has a dominant trait and the other does not, then 50% of the children will inherit the trait. : REF: Page 34 4 : Dominant Traits : Health Promotion and Maintenance: Growth and Development • The nurse explains that the birth weight of monozygotic twins is frequently below average. What is the most likely cause? • Inadequate space in the uterus • Inadequate blood supply • Inadequate maternal health • Inadequate placental nutrition ANS: D The single placenta may not be able to provide adequate nutrition to two fetuses. : REF: Page 42 8 : Low Birth-weight Twins : Health Promotion and Maintenance: Growth and Development • The school nurse is counseling a group of adolescent girls. What does the nurse explain about sperm ejaculated near the cervix? • They are destroyed by the acidic pH of the vagina. • They survive up to 5 days and can cause pregnancy. • They lose their motility in about 12 hours after intercourse. • They are usually pushed out of the vagina by the muscular action of the vaginal wall. ANS: B Sperm ejaculated near the cervix can survive up to 5 days and cause pregnancy even before ovulation. : REF: Page 33 3 : Fertilization : Health Promotion and Maintenance: Growth and Development • What does the nurse explain can affect the survival of the X- and Y-bearing sperm after intercourse? • Age • Estrogen level • Body temperature • Level of feminine hygiene ANS: B Estrogen levels and the pH of the female reproductive tract can affect the survival of the X- and Y-bearing sperm as well as their motility. REF: Page 33 3 : Fertilization : Health Promotion and Maintenance: Growth and Development • Of what is the normal umbilical cord comprised? • 1 artery carrying blood to the fetus and 1 vein carrying blood away from the fetus • 1 artery carrying blood to the fetus and 2 veins carrying blood away from the fetus • 2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus • 2 arteries carrying blood to the fetus and 2 veins carrying blood away from the fetus ANS: C The umbilical cord is comprised of 2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus. REF: Page 39 6 : Fetal Circulation Nursing Process N/A : Health Promotion and Maintenance: Growth and Development • What part of the fetal body derives from the mesoderm? • Nails • Oil glands • Muscles • Lining of the bladder ANS: C The mesoderm is responsible for the development of muscles. Nails and oil glands derive from the ectoderm. The lining of the bladder derives from the endoderm. REF: Page 35, Box 3-1 4 : Embryonic development N/A : Health Promotion and Maintenance: Growth and Development • A couple just learned they are expecting their first child and are curious if they are having a boy or a girl. At what point of development can the couple first expect to see the sex of their child on ultrasound? • 4 weeks gestational age • 6 weeks gestational age • 10 weeks gestational age • 16 weeks gestational age ANS: C The fetal period begins at the ninth week, and by the tenth week the external genitalia are visible to ultrasound examination. REF: Page 37 5 : Fetal Development : Health Promotion and Maintenance: Growth and Development MULTIPLE RESPONSE • A nurse is teaching a lesson on fetal development to a class of high school students and explains the primary germ layers. What are the germ layers? (Select all that apply.) • Ectoderm • Endoderm • Mesoderm • Plastoderm • B l a s t o d e r m A N S : A , B , C The zygote transforms its embryonic disc into three layers: the ectoderm, the mesoderm, and the endoderm. REF: Page 35, Box 3-1 4 : Primary Germ Layers : Health Promotion and Maintenance: Growth and Development • What are the functions of amniotic fluid? (Select all that apply.) • Maintaining an even temperature • Impeding excessive fetal movement • Lubricating fetal skin • Acting as a reservoir for nutrients • Acting as a cushion for the fetus ANS: A, E The amniotic fluid provides maintenance of even temperature; prevents amnion from adhering to fetal skin; allows buoyancy, symmetrical growth, and fetal movement; and acts as a cushion for the fetus. Although the fetus does swallow amniotic fluid, it has no nutritional value. REF: Page 35, Box 3-1 6 : Amniotic Fluid : Health Promotion and Maintenance: Growth and Development • A patient at the obstetric office has just learned she is pregnant with dizygotic twins. What facts will the nurse include when educating this patient? (Select all that apply.) • Dizygotic twins are the same sex. • Dizygotic twins share a placenta. • Dizygotic pregnancies tend to repeat in families. • Dizygotic twins have separate chorions. • Dizygotic twin incidence decreases with maternal age. ANS: C, D Dizygotic twins tend to repeat in families and have separate chorions. They can be the same sex or different sexes and have their own placenta. Incidence increases with maternal age. : REF: Page 42 8 : Dizygotic Twins : Health Promotion and Maintenance: Growth and Development • The nurse explains that prior to fertilization each cell is reduced from 46 chromosomes to 23 chromosomes. This is referred to as the number. ANS: haploid When each cell reduces its chromosomes from 46 to 23, it is called the haploid number. REF: Page 32 2 : Haploid Number : Health Promotion and Maintenance: Growth and Development • The component of development that programs the genetic code into the nucleus of the cell is . ANS: DNA The DNA programs the genetic code to the nucleus of the cell to be replicated. REF: Page 31 | Page 34 4 : DNA N/A : Health Promotion and Maintenance: Growth and Development • The vessels comprising the umbilical cord are cushioned and protected by a substance called . ANS: Whartons jelly Whartons jelly is a substance in the umbilical cord that cushions and protects the vessels. REF: Page 39 1 : Fetal Circulation N/A : Health Promotion and Maintenance: Growth and Development • The normal volume of amniotic fluid is approximately mL at 37 weeks gestation. ANS: 1000 The volume of amniotic fluid steadily increases from about 30 mL at 10 weeks of pregnancy to 350 mL at 20 weeks. The volume of fluid is about 1000 mL at 37 weeks. In the latter part of pregnancy the fetus may swallow up to 400 mL of amniotic fluid per day and normally excretes urine into the fluid. Chapter 4.Physiological and Psychosocial Changes During Pregnancy • A pregnant clients mother is worried that her daughter is not big enough at 20 weeks of gestation. The nurse palpates and measures the fundal height at 20 cm, which is even with the womans umbilicus. Which should the nurse report to the client and her mother? a . Youre right. Well inform the practitioner immediately. b . Lightening has occurred, so the fundal height is lower than expected. c . The body of the uterus is at the belly button level, just where it should be at this time. d . When you come for next months appointment, well check you again to make sure that the baby is growing. ANS: C At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks gestation is located at the level of the umbilicus. Lightening has not yet occurred. At 20 weeks, the uterus should be at the umbilical level. The descent of the fetal head (lightening) occurs in late pregnancy. Waiting until the next appointment avoids the direct question and might increase the anxiety of the mother and grandmother. : 1 : Application REF: 94 : Client Needs: Health Promotion and Maintenance • While the vital signs of a pregnant client in her third trimester are being assessed, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a . Have the client stand up and retake her blood pressure. b . Have the client sit down and hold her arm in a dependent position. c . Have the client turn to her left side and recheck her blood pressure in 5 minutes. d Have the client lie supine for 5 minutes and recheck her blood pressure on both . arms. ANS: C Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This would cause an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension. : 1 REF: 96 : Client Needs: Physiologic Integrity • A pregnant client has come to the emergency department with complaints of nasal congestion and epistaxis. Which is the correct interpretation of these symptoms by the health care provider? a . Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. b . These conditions are abnormal. Refer the client to an ear, nose, and throat specialist. c . Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d . Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds. ANS: D As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy. Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. The client should be reassured that these symptoms are within normal limits. No referral is needed at this time. Relaxation of the smooth muscles in the respiratory tract is affected by progesterone. : 1 REF: 97 Client Needs: Physiologic Integrity • Which suggestion is appropriate for the pregnant client who is experiencing heartburn? a . Drink plenty of fluids at bedtime. b . Eat only three meals a day so the stomach is empty between meals. c . Drink coffee or orange juice immediately on arising in the morning. d . Use Tums or Alkamints to obtain relief, as directed by the health care provider. ANS: D Antacids high in calcium (e.g., Tums, Alkamints) can provide temporary relief. Fluids overstretch the stomach and may precipitate reflux when lying down. Instruct the woman to eat five or six small meals per day rather than three full meals. Coffee and orange juice stimulate acid formation in the stomach. : 1 : Understanding REF: 114 : Client Needs: Physiologic Integrity • While providing education to a primiparous client regarding the normal changes of pregnancy, what is important for the nurse to explain about Braxton Hicks contractions? a . These contractions may indicate preterm labor. b . These are contractions that never cause any discomfort. c . Braxton Hicks contractions only start during the third trimester. d . These occur throughout pregnancy, but you may not feel them until the third trimester. ANS: D Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks contractions. During the first two trimesters, the contractions are infrequent and usually not felt by the woman until the third trimester. Braxton Hicks contractions do not indicate preterm labor. Braxton Hicks contractions can cause some discomfort, especially in the third trimester. Braxton Hicks contractions occur throughout the whole pregnancy. : 1 : Application REF: 94 : Client Needs: Health Promotion and Maintenance • What is the reason for vascular volume increasing by 40% to 60% during pregnancy? a . Prevents maternal and fetal dehydration b . Eliminates metabolic wastes of the mother c . Provides adequate perfusion of the placenta d . Compensates for decreased renal plasma flow ANS: C The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Preventing maternal and fetal dehydration is not the primary reason for the increase in volume. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. Renal plasma flow increases during pregnancy. : 1 : Understanding REF: 94 : Client Needs: Physiologic Integrity • Physiologic anemia often occurs during pregnancy because of: a . inadequate intake of iron. b . the fetus establishing iron stores. c . dilution of hemoglobin concentration. d . decreased production of erythrocytes. ANS: C When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. There is increased production of erythrocytes during pregnancy. : 1 : Understanding REF: 95 : Client Needs: Physiologic Integrity • Which is a positive sign of pregnancy? a . Amenorrhea b . Breast changes c . Fetal movement felt by the woman d . Visualization of fetus by ultrasound ANS: D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Amenorrhea is a presumptive sign of pregnancy. Breast changes are a presumptive sign of pregnancy. Fetal movement is a presumptive sign of pregnancy. • Which is a major concern among members of lower socioeconomic groups? a . Practicing preventive health care b . Meeting health needs as they occur c . Maintaining an optimistic view of life d . Maintaining group health insurance for their families ANS: B Because of their economic uncertainty, lower socioeconomic groups place more emphasis on meeting the needs of the present rather than on future goals. Lower socioeconomic groups may value health care but generally cannot afford preventive health care. They may struggle for basic needs and often do not see a way to improve their situation. It is difficult to maintain optimism. Lower socioeconomic groups usually do not have group health insurance. : 1 : Understanding REF: 134 : Client Needs: Health Promotion and Maintenance • Which comment made by a new mother exhibits understanding of her toddlers response to a new sibling? a . I cant believe he is sucking his thumb again. b . He is being difficult and I dont have time to deal with him. c . When we brought the baby home, we made Michael stop sleeping in the crib. d . My husband is going to stay with the baby so I can take Michael to the park tomorrow. ANS: D It is important for a mother to seek time alone with her toddler to reassure him that he is loved. It is normal for a child to regress when a new sibling is introduced into the home. The toddler may have feelings of jealousy and resentment toward the new baby taking attention away from him. Frequent reassurance of parental love and affection are important. Changes in sleeping arrangements should be made several weeks before the birth so the child does not feel displaced by the new baby. : 1 REF: 132 Evaluation : Client Needs: Health Promotion and Maintenance • While teaching an Asian client about prenatal care, the nurse notes that the client refuses to make eye contact. Which is the most likely cause? a A submissive attitude . b Lack of understanding . c Embarrassment about the subject . d Cultural beliefs about eye contact . ANS: D The nurse must understand that making eye contact means different things in different cultures. The nurse should have a basic understanding of normal responses of various cultures within her community. Asians believe that eye contact shows disrespect, not submission. Many Asian women may nod and smile during client teaching, but this does not show understanding. They are responding that they heard you; validation of information is important. Modesty is important in some cultures, but the main response with this questions is the cultural beliefs. : 1 : Understanding REF: 138 : Client Needs: • The nurse in labor and birth is caring for a Muslim client during the active phase of labor. The nurse notes that the client quickly draws away when touched. Which intervention should the nurse implement? a . Ask the charge nurse to reassign you to another client. b . Assume that she doesnt like you and decrease your time with her. c . Continue to touch her as much as you need to while providing care. d . Limit touching to a minimum because physical contact may not be acceptable in her culture. ANS: D Touching is an important component of communication in various cultures, but if the client appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her. Asking the charge nurse to reassign you could be offensive to the client. A Muslims response to touch does not reflect like or dislike. By continuing to touch her, the nurse is showing disrespect for her cultural beliefs. : 1 REF: 138 : Client Needs: • Which client may require more help and understanding when integrating the newborn into the family? a . A primipara from an upper income family b . A primipara who comes from a large family c . A multipara (gravida 2) who has a supportive husband and mother d . A multipara (gravida 6) who has two children younger than 3 years ANS: D Pregnancy tasks are more complex for the multipara (gravida 6), and she may need special assistance to integrate the infant into the family structure. A primipara from an upper income family has the financial resources to assist her with daily care of the home. This leaves her free to concentrate on the newborns needs. The primipara with a large support system has help available to her. The multipara (gravida 2) who has a supportive husband and mother has a support system to assist with integrating the infant into the family structure. : 1 REF: 133 : Client Needs: Health Promotion and Maintenance • An Asian-American expectant father tells the nurse that he seems to be gaining weight, just like his wife. The nurse recognizes that this behavior is most likely a reflection of which? a . Couvade b . Embarrassment c . Ambivalence regarding the pregnancy d . Limited interest in the well-being of his wife ANS: A Couvade is when expectant fathers sometimes experience physical symptoms similar to those of pregnant women, such as loss of appetite, nausea, headache, fatigue, and weight gain. The father did not express anything that would indicate embarrassment. There is no indication in the fathers statement that he is ambivalent to the pregnancy. There is no data in the question that indicates that the father is not interested in his wife. : 1 : Understanding REF: 131 : Client Needs: Health Promotion and Maintenance • An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. What should the nurse tell the couple? a . Intercourse is safe until the third trimester. b . Safer sex practices should be used once the membranes rupture. c . Intercourse should be avoided if any spotting from the vagina occurs afterward. d . Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present. . b . Safer sex practices should be used once the membranes rupture. c . Intercourse should be avoided if any spotting from the vagina occurs afterward. d . Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present. ANS: D Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman is at risk for or has a history of preterm labor. Intercourse can continue as long as the pregnancy is progressing normally. Rupture of the membranes may require abstaining from intercourse. Safer sex practices are always recommended. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. : 1 REF: 126 : Client Needs: Health Promotion and Maintenance • A pregnant client comes into the medical clinic stating that her family and friends are telling her that she is always talking about the pregnancy and nothing else. She is concerned that something is wrong with her. What psychological behavior is she exhibiting? a . Antepartum obsession b . Ambivalence c . Uncertainty d . Introversion ANS: D The client is exhibiting behaviors associated with introversion and/or narcissism. These are normal findings during pregnancy as long as they do not become obsessive to the exclusion of everything else. The client is talking about the pregnancy but there is no evidence that it is affecting her perception of reality and/or ability to perform ADLs. It is normal for pregnant women to focus on the self as being of prime importance in their life initially during the pregnancy. Some women may feel ambivalent about their pregnancy, which is a normal reaction. However, this clients behavior does not support this finding. Some women react with uncertainty at the news of being pregnant, which is a normal reaction. However, this clients behavior does not support this finding. : 1 REF: 125 : Client Needs: • During the course of the pregnancy, the client states that she feels a deep connection with her unborn child. This behavior illustrates the maternal task acquisition of: a . safe passage. b . gaining acceptance. c . fostering an interconnection. d . developing empathy through physical actions. ANS: C During pregnancy, it is important for the mother to relate to and connect with the unborn child as part of the initial attachment and bonding experience. Safe passage refers to securing safety as a primary concern through the pregnancy and birth process. Gaining acceptance relates to behaviors acknowledging the pregnancy as a part of ones maternal role. Pregnant woman may appear to be more nurturing during pregnancy, but this is not necessarily associated through physical actions. : 1 REF: 128 : Client Needs: • A pregnant client relates a story of how her boyfriend is feeling her aches and pains associated with her pregnancy. She is concerned that her boyfriend is making fun of her concerns. How would you respond to this client statement? a Tell her not to worry because it is natural for her boyfriend to make her feel . better by identifying with her pregnancy. b Refer the client to a psychologist for counseling to deal with this problem . because it is clearly upsetting her. c Explain that her boyfriend may be experiencing couvade syndrome and that this . is a normal finding seen with male partners. d Ask the client specifically to define her concerns related to her relationship with . her boyfriend and suggest methods to stop this type of behavior by her significant other. ANS: C Provide factual information that will help reduce stress and modify acceptance. Telling her not to worry does not address the possibility that her boyfriend may be experiencing couvade syndrome. The client is expressing concern but does not have all the facts related to couvade syndrome and requires education, rather than referral. Couvade syndrome is not an abnormal condition and should be treated with acceptance and understanding. : 1 REF: 131 : Client Needs: • Which of the following would be considered to be a system barrier to the birth of prenatal care? a . Adolescent pregnant client b . Inability to schedule an appointment with the health care provider because of a busy medical practice c . Pregnant client has no health insurance d . Having to sign in for the initial appointment and complete health history records ANS: B A delay in the ability to schedule an appointment with a health care provider is an example of a system barrier to the birth of prenatal care. An adolescent pregnant client would not be considered to be a system barrier but rather a psychosocial factor that would affect the pregnancy state. Having no health insurance is an example of a financial barrier to the birth of prenatal care. Completing a health history record is part of a comprehensive assessment. : 1 REF: 134 : Client Needs: Health Promotion and Maintenance • The nurse reveals to the patient that the over-the-counter test is verified and that she is pregnant. The patient confides to the nurse, We have wanted to be pregnant for some time. These last few days I have been questioning our decision. I am feeling really bad right now. What is the nurses best response? a . You will come around in time and you will grow to love this baby. b . Dont feel bad. It is the hormones of pregnancy talking right now. c . Why do you think you are feeling bad when you wanted to be pregnant? d . Your feelings are understandable. Ambivalence is not uncommon right now. ANS: D Early in pregnancy, ambivalence is not uncommon because pregnancy is a lifechanging event, even if planned and strongly desired. The client needs reassurance and validation of these natural feelings. Although it is true that the patient will grow to love the baby, this statement does not acknowledge her ambivalent feelings. Dont feel bad dismisses the patients natural feelings and is a nontherapeutic response. Why is nontherapeutic and places the patient on the defensive in her response. Chapter 5.Promoting a Healthy Pregnancy • 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 patients obstetric history using the TPALM system? • Gravida 2, para 20120 • Gravida 3, para 10011 • Gravida 3, para 10110 • Gravida 2, para 11110 ANS: C Refer to Box 4-1 in the textbook for the TPALM system of identifying gravida and para. REF: Page 48, Box 4-1 1 : Definition of Terms : • 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? • Every 3 weeks until the 6th month, then every 2 weeks until delivery • Every 4 weeks until the 7th month, after which appointments will become more frequent • Monthly until the 8th month • 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. REF: Page 46 2 | 3 : Prenatal Visits : • During the physical examination for the first prenatal visit, it is noted that Chadwicks sign is present. What is Chadwicks sign? • Bluish or purplish discoloration of the vulva, vagina, and cervix • Presence of early fetal movements • Darkening of the areola and breast tenderness • Palpation of the fetal outline ANS: A Chadwicks sign is the purplish or bluish discoloration of the cervix and vagina. REF: Page 49 7 : Normal Physiological Changes in Pregnancy Data Collection : • After the examination is completed, the patient asks the nurse why Chadwicks sign occurs during pregnancy. What would the nurse explain as the cause of Chadwicks sign? • Enlargement of the uterus • Progesterone action on the breasts • Increasing activity of the fetus • Vascular congestion in the pelvic area ANS: D Chadwicks sign is caused by increased vascular congestion in the cervical and vaginal area. : REF: Page 49 6 | 7 : Normal Physiological Changes in Pregnancy : • The nurse has explained physiological changes that occur during pregnancy. Which statement indicates that the woman understands the information? • Blood pressure goes up toward the end of pregnancy. • My breathing will get deeper and a little faster. • Ill notice a decreased pigmentation in my skin. • 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. : REF: Page 52 7 | 13 : Normal Physiological Changes in Pregnancy Evaluation : • A woman reports that her last normal menstrual period began on August 5, 2013. What is this womans expected delivery date using Ngeles 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. REF: Page 48, Box 4-2 5 : Determining Estimated Date of Delivery : Health Promotion and Maintenance: Growth and Development • During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an electronic Doppler device. How early might fetal heart tones be detected with an electronic Doppler device? • 4 weeks • 8 weeks • 10 weeks • 1 4 w e e k s A N S : C The fetal heartbeat can be detected as early as 10 weeks of pregnancy using a Doppler device. REF: Page 50 3 | 7 : Normal Physiological Changes in Pregnancy : • In a routine prenatal visit, the nurse examining a patient who is 37 weeks pregnant notices that the fetal heart rate (FHR) has dropped to 120 beats/min from a rate of 160 beats/min earlier in the pregnancy. What is the nurses first action? • Ask if the patient has taken a sedative. • Notify the physician. • Turn the patient to her right side. • Record the rate as a normal finding. ANS: D The FHR at term ranges from a low of 110 to 120 beats/min to a high of 150 to 160 beats/min. This should be recorded as normal. The FHR drops in the late stages of pregnancy. REF: Page 50 3 : Assessing Fetal Heart Tone Data Physiological • A womans prepregnant weight is determined to be average for her height. What will the nurse advise the woman regarding recommended weight gain during pregnancy? • 10 to 20 pounds • 15 to 25 pounds • 25 to 35 pounds • 28 to 40 pou nds AN S: C The recommended weight gain for a woman of normal weight before pregnancy is 25 to 35 pounds. REF: Page 57 8 : Nutrition in Pregnancy : • When the nurse tells a pregnant woman that she needs 1200 mg of calcium daily during pregnancy, the woman responds, I dont like milk. What dietary adjustments could the nurse recommend? • Increase intake of organ meats. • Eat more green leafy vegetables. • Choose more fresh fruits, particularly citrus fruits. • Include molasses and whole-grain breads in the diet. ANS: B For women who do not like milk, other sources of calcium include enriched cereals, legumes, nuts, dried fruits, green leafy vegetables, and canned salmon and sardines that contain bones. REF: Page 60 8 | 13 : Nutrition for Pregnancy : Reduction of Risk • A pregnant woman is experiencing nausea in the early morning. What recommendations would the nurse offer to alleviate this symptom? • Eat three well-balanced meals per day and limit snacks. • Drink a full glass of fluid at the beginning of each meal. • Have crackers handy at the bedside, and eat a few before getting out of bed. • Eat a bland diet and avoid concentrated sweets. ANS: C The nurse can recommend eating dry toast or crackers before getting out of bed in the morning to alleviate nausea during pregnancy. REF: Page 65, Table 4-6 10 : Common Discomforts in Pregnancy : • The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. What is the nurses initial action? • Assess food intake. • Weigh the patient again. • Take the blood pressure. • Notify the physicia n. ANS: C The marked weight gain may be an indication of gestational hypertension. The blood pressure should be assessed before notifying the physician. REF: Page 53 4 : Gestational Hypertension : • The patient remarks that she has heard some foods will enhance brain development of the fetus. The nurse replies that foods high in docosahexaenoic acid (DHA) are thought to enhance brain development. What food can the nurse recommend? • Fried fish • Olive oil • Red meat • Leafy green vegetables ANS: C Foods rich in DHA are red meat, flounder, halibut, and soybean and canola oil. Frying fish negatively alters the DHA. REF: Page 55 8 : Nutrition in Pregnancy : • The nurse encourages adequate intake of folic acid for women of childbearing age before and during pregnancy. What is folic acid thought to decrease the incidence of in fetal development? • Structural heart defects • Craniofacial deformities • Limb deformities • Neural tube defects ANS: D Folic acid can reduce the incidence of neural tube defects such as spina bifida and anencephaly. REF: Page 45 | Page 61 8 : Nutrition for Pregnancy : • A woman tells the nurse that she is quite sure she is pregnant. The nurse recognizes which as a positive sign of pregnancy? • Amenorrhea • Uterine enlargement • HCG detected in the urine • Fe tal he art be at A N S: D Positive indications are caused only by the developing fetus and include fetal heart activity, visualization by ultrasound, and fetal movements felt by the examiner. REF: Page 50 6 | 7 : Physiological Changes During Pregnancy : • At her initial prenatal visit a woman asks, When can I hear the babys heartbeat? At what gestational age can the fetal heartbeat be auscultated with a specially adapted stethoscope or fetoscope? • 4 weeks • 12 weeks • 18 weeks • 2 4 w e e k s A N S : C The fetal heartbeat can be heard with a fetoscope between the 18th and 20th weeks of pregnancy. REF: Page 50 7 : Physiological Changes During Pregnancy : Health Promotion and Maintenance: Growth and Development • A woman pregnant for the first time asks the nurse, When will I begin to feel the baby move? What is the nurses best response? • You may notice the baby moving around the 4th or 5th month. • Quickening varies with every woman. • Youll feel something by the end of the first trimester. • The baby will be big enough for you to feel in your 8th month. ANS: A Quickening, fetal movement felt by the mother, is first perceived at 16 to 20 weeks of gestation. REF: Page 49 7 : Physiological Changes During Pregnancy : Health Promotion and Maintenance: Growth and Development • A pregnant woman inquires about exercising during pregnancy. What information should the nurse include when planning to educate this woman? • Exercise elevates the mothers temperature and improves fetal circulation. • Exercise increases catecholamines, which can prevent preterm labor. • A regular schedule of moderate exercise during pregnancy is beneficial. • Pregnant women should limit water intake during exercise. ANS: C In general, moderate exercise several times a week, from the 8th week through delivery, is advised during pregnancy. : REF: Page 62 9 | 13 : Exercise During Pregnancy • An ultrasound confirms that a 16-year-old girl is pregnant. How does the need for prenatal care and counseling for adolescents different from other age populations? • A pregnant adolescent is experiencing two major life transitions at the same time. • Adolescents who get pregnant are more likely to have other chronic health problems. • Adolescents are at greater risk for multifetal pregnancies. • At this age, a pregnant adolescent will accept the nurses advice. ANS: A The pregnant adolescent must cope with two of lifes most stress-laden transitions simultaneously: adolescence and parenthood. : REF: Page 69 12 : Psychological s to Pregnancy Planning : : • At what age is a woman who becomes pregnant for the first time described as an elderly primip? • After 25 years old • After 28 years old • After 30 years old • After 35 years old ANS: D A woman over the age of 35 who becomes pregnant for the first time is described as an elderly primip. REF: Page 69 12 : Elderly Primip Nursing Process Physiological Physical • The nurse explains that the softening of the cervix and vagina is a probable sign of pregnancy. What is the appropriate term for this sign? • Chadwicks • Hegars • McDonalds • G o o d e l l s A N S : D Goodells sign is one of the probable signs of pregnancy and describes a softened cervix and vagina. REF: Page 49 1 | 6 | 7 : Goodells Sign : Physical • When obtaining a prenatal history on a pregnant patient the nurse notes a family history of sickle cell disease. Given this information, what lab test can the nurse anticipate the physician will order? • Endovaginal ultrasound • Pap test • Complete blood count • Hemoglobin electrophoresis ANS: D Hemoglobin electrophoresis identifies presence of sickle cell trait or disease (in women of African or Mediterranean descent). It is ordered in the first trimester, if indicated. : REF: Page 46, Table 4-1 3 : Prenatal laboratory tests : Health Promotion and Maintenance: Prenatal Care • A pregnant woman is attending her second postpartum visit. Prenatal lab work indicates she is not immune to the rubella virus. What is the most appropriate nursing intervention? • Provide the rubella vaccine as ordered by the physician immediately. • Inform the woman she shoul