NURS 306
Expanding Family and Community Nursing (OB)
Questions and Answers|Latest Update| West Coast University
,1. A nurse is teaching a client about fetal development. During which period of
gestation does organogenesis primarily occur, making the embryo most
vulnerable to teratogens?
A. Weeks 1-2
B. Weeks 3-8
C. Weeks 9-12
D. Weeks 20-24
Answer: B
Rationale: Organogenesis, the formation of major organ systems, occurs during
weeks 3-8 (the embryonic period). This is the period of greatest teratogenic
vulnerability because organ structures are actively forming. Before week 3,
exposure typically results in an all-or-none effect (loss of pregnancy or no effect);
after week 8, the fetus is in the fetal period where organs mature and grow rather
than form, so teratogen exposure causes growth restriction or minor
structural/functional effects rather than major malformations.
2. At which gestational age does the neural tube normally close, making folic
acid supplementation critical prior to this point?
A. Day 14
B. Day 21-28
C. Week 10
D. Week 16
Answer: B
Rationale: The neural tube closes between days 21 and 28 after conception, often
before a woman knows she is pregnant. This is why folic acid (400-800 mcg/day) is
recommended for all women of childbearing age, ideally beginning before
conception, to reduce the risk of neural tube defects such as spina bifida and
anencephaly.
3. A client at 12 weeks gestation asks why her healthcare provider ordered a
nuchal translucency ultrasound combined with serum markers (PAPP-A and
hCG). The nurse explains that this first-trimester screening primarily assesses
risk for which condition?
A. Neural tube defects
B. Trisomy 21 (Down syndrome) and trisomy 18
, C. Gestational diabetes
D. Placenta previa
Answer: B
Rationale: The first-trimester combined screen (nuchal translucency ultrasound
plus PAPP-A and free beta-hCG) is used to calculate risk for trisomy 21 and trisomy
18. Increased nuchal fluid and abnormal serum marker levels raise the statistical
risk, prompting consideration of diagnostic testing such as CVS or amniocentesis.
Neural tube defects are better screened by maternal serum AFP at 15-20 weeks.
4. A pregnant client's maternal serum alpha-fetoprotein (MSAFP) is significantly
elevated at 16 weeks. The nurse should recognize this finding is most associated
with which condition?
A. Down syndrome
B. Neural tube defects
C. Gestational hypertension
D. Placental abruption
Answer: B
Rationale: Elevated MSAFP is associated with open neural tube defects (such as
spina bifida or anencephaly), abdominal wall defects, and multiple gestation,
because AFP leaks into amniotic fluid and maternal serum through open fetal
defects. Low MSAFP, in contrast, is associated with chromosomal trisomies such
as Down syndrome. An elevated result warrants follow-up ultrasound and possibly
amniocentesis.
5. During the first prenatal visit, the nurse calculates the client's estimated date
of birth (EDB) using Naegele's rule. The client's LMP was March 10. What is the
estimated date of birth?
A. December 3
B. December 17
C. January 3
D. November 17
Answer: B
Rationale: Naegele's rule: subtract 3 months from the LMP and add 7 days (and
add 1 year if applicable). March 10 minus 3 months = December 10; plus 7 days =
, December 17. This rule assumes a regular 28-day cycle and is an estimate, not an
exact due date.
6. A nurse is reviewing the obstetric history of a client who is G4 P2. Which
statement correctly interprets this notation?
A. 4 pregnancies, 2 living children
B. 4 total pregnancies, 2 births that reached viability
C. 2 pregnancies, 4 living children
D. 4 term births, 2 preterm births
Answer: B
Rationale: G (gravida) refers to the total number of pregnancies, regardless of
outcome, and P (para) refers to the number of pregnancies carried to viability
(traditionally 20 weeks or beyond), regardless of whether the infant was born alive.
G4 P2 means the client has been pregnant 4 times and has had 2 births that
reached viability; this does not directly indicate the number of living children.
7. A client at her initial prenatal visit reports a history of one full-term birth, one
preterm birth, one spontaneous abortion, and three living children. Using GTPAL,
how would the nurse document this history?
A. G3 T1 P1 A1 L3
B. G3 T1 P1 A1 L2
C. G4 T1 P1 A1 L3
D. G4 T1 P1 A2 L3
Answer: A
Rationale: GTPAL = Gravida, Term births, Preterm births, Abortions (including
miscarriages), Living children. Gravida = total pregnancies = 1 term + 1 preterm +
1 abortion = 3. G3 T1 P1 A1 L3 correctly reflects 3 total pregnancies, 1 term birth,
1 preterm birth, 1 abortion, and 3 living children (twins would be counted
separately if applicable, but here it is stated as 3 living children).
8. Which finding during a prenatal visit at 8 weeks gestation is a presumptive
sign of pregnancy rather than a probable or positive sign?
A. Positive serum hCG
B. Fetal heart tones auscultated by Doppler
C. Nausea and breast tenderness
Expanding Family and Community Nursing (OB)
Questions and Answers|Latest Update| West Coast University
,1. A nurse is teaching a client about fetal development. During which period of
gestation does organogenesis primarily occur, making the embryo most
vulnerable to teratogens?
A. Weeks 1-2
B. Weeks 3-8
C. Weeks 9-12
D. Weeks 20-24
Answer: B
Rationale: Organogenesis, the formation of major organ systems, occurs during
weeks 3-8 (the embryonic period). This is the period of greatest teratogenic
vulnerability because organ structures are actively forming. Before week 3,
exposure typically results in an all-or-none effect (loss of pregnancy or no effect);
after week 8, the fetus is in the fetal period where organs mature and grow rather
than form, so teratogen exposure causes growth restriction or minor
structural/functional effects rather than major malformations.
2. At which gestational age does the neural tube normally close, making folic
acid supplementation critical prior to this point?
A. Day 14
B. Day 21-28
C. Week 10
D. Week 16
Answer: B
Rationale: The neural tube closes between days 21 and 28 after conception, often
before a woman knows she is pregnant. This is why folic acid (400-800 mcg/day) is
recommended for all women of childbearing age, ideally beginning before
conception, to reduce the risk of neural tube defects such as spina bifida and
anencephaly.
3. A client at 12 weeks gestation asks why her healthcare provider ordered a
nuchal translucency ultrasound combined with serum markers (PAPP-A and
hCG). The nurse explains that this first-trimester screening primarily assesses
risk for which condition?
A. Neural tube defects
B. Trisomy 21 (Down syndrome) and trisomy 18
, C. Gestational diabetes
D. Placenta previa
Answer: B
Rationale: The first-trimester combined screen (nuchal translucency ultrasound
plus PAPP-A and free beta-hCG) is used to calculate risk for trisomy 21 and trisomy
18. Increased nuchal fluid and abnormal serum marker levels raise the statistical
risk, prompting consideration of diagnostic testing such as CVS or amniocentesis.
Neural tube defects are better screened by maternal serum AFP at 15-20 weeks.
4. A pregnant client's maternal serum alpha-fetoprotein (MSAFP) is significantly
elevated at 16 weeks. The nurse should recognize this finding is most associated
with which condition?
A. Down syndrome
B. Neural tube defects
C. Gestational hypertension
D. Placental abruption
Answer: B
Rationale: Elevated MSAFP is associated with open neural tube defects (such as
spina bifida or anencephaly), abdominal wall defects, and multiple gestation,
because AFP leaks into amniotic fluid and maternal serum through open fetal
defects. Low MSAFP, in contrast, is associated with chromosomal trisomies such
as Down syndrome. An elevated result warrants follow-up ultrasound and possibly
amniocentesis.
5. During the first prenatal visit, the nurse calculates the client's estimated date
of birth (EDB) using Naegele's rule. The client's LMP was March 10. What is the
estimated date of birth?
A. December 3
B. December 17
C. January 3
D. November 17
Answer: B
Rationale: Naegele's rule: subtract 3 months from the LMP and add 7 days (and
add 1 year if applicable). March 10 minus 3 months = December 10; plus 7 days =
, December 17. This rule assumes a regular 28-day cycle and is an estimate, not an
exact due date.
6. A nurse is reviewing the obstetric history of a client who is G4 P2. Which
statement correctly interprets this notation?
A. 4 pregnancies, 2 living children
B. 4 total pregnancies, 2 births that reached viability
C. 2 pregnancies, 4 living children
D. 4 term births, 2 preterm births
Answer: B
Rationale: G (gravida) refers to the total number of pregnancies, regardless of
outcome, and P (para) refers to the number of pregnancies carried to viability
(traditionally 20 weeks or beyond), regardless of whether the infant was born alive.
G4 P2 means the client has been pregnant 4 times and has had 2 births that
reached viability; this does not directly indicate the number of living children.
7. A client at her initial prenatal visit reports a history of one full-term birth, one
preterm birth, one spontaneous abortion, and three living children. Using GTPAL,
how would the nurse document this history?
A. G3 T1 P1 A1 L3
B. G3 T1 P1 A1 L2
C. G4 T1 P1 A1 L3
D. G4 T1 P1 A2 L3
Answer: A
Rationale: GTPAL = Gravida, Term births, Preterm births, Abortions (including
miscarriages), Living children. Gravida = total pregnancies = 1 term + 1 preterm +
1 abortion = 3. G3 T1 P1 A1 L3 correctly reflects 3 total pregnancies, 1 term birth,
1 preterm birth, 1 abortion, and 3 living children (twins would be counted
separately if applicable, but here it is stated as 3 living children).
8. Which finding during a prenatal visit at 8 weeks gestation is a presumptive
sign of pregnancy rather than a probable or positive sign?
A. Positive serum hCG
B. Fetal heart tones auscultated by Doppler
C. Nausea and breast tenderness
