Maternity Nursing: Antepartum NCLEX Practice Questions #6 | 55 Questions| 21/2022 UPDATE

Maternity Nursing: Antepartum NCLEX Practice Questions #6 | 55 Questions 1. 1. Question A nursing instructor is conducting a lecture and is reviewing the functions of the female reproductive system. She asks the student nurse to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). The student nurse accurately responds by stating that: o A. FSH and LH are released from the anterior pituitary gland. o B. FSH and LH are secreted by the corpus luteum of the ovary o C. FSH and LH are secreted by the adrenal glands o D. FSH and LH stimulate the formation of milk during pregnancy. Incorrect Correct Answer: A. FSH and LH are released from the anterior pituitary gland. FSH and LH, when stimulated by the gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, the growth of the Graafian follicle, and production of progesterone. • Option B: The primary hormone produced from the corpus luteum is progesterone, but it also produces inhibin A and estradiol. In the absence of fertilization, the corpus luteum will regress over time. • Option C: Development of the ovarian follicle is largely under FSH control, and the secretion of estrogen from this follicle is dependent on FSH and LH. The granulosa cells of the ovary secrete inhibin, which plays a role in cellular differentiation. • Option D: In women, LH stimulates estrogen and progesterone production from the ovary. A surge of LH in the mid menstrual cycle is responsible for ovulation, and continued LH secretion subsequently stimulates the corpus luteum to produce progesterone. 2. 2. Question A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse accurately tells the client that fetal circulation consists of: • A. Two umbilical veins and one umbilical artery. • B. Two umbilical arteries and one umbilical vein. • C. Arteries carrying oxygenated blood to the fetus. • D. Veins carrying deoxygenated blood to the fetus. Incorrect Correct Answer: B. Two umbilical arteries and one umbilical vein. Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus. • Option A: The fetal circulation system is distinctly different from adult circulation. This intricate system allows the fetus to receive oxygenated blood and nutrients from the placenta. It comprises the blood vessels in the placenta and the umbilical cord, which contains two umbilical arteries and one umbilical vein. • Option C: Oxygenated blood from the mother in the placenta flows through the umbilical vein and into the inferior vena cava (IVC), bypassing the liver via the ductus venosus. From the IVC, oxygenated blood travels to the right atrium of the heart. There is greater pressure in the right atrium compared to the left atrium in fetal circulation; therefore most of the blood is shunted from the right atrium to the left atrium through an opening called the foramen ovale. Once in the left atrium, blood travels through the left ventricle into the aorta and the systemic circulation. • Option D: The deoxygenated blood travels back to the placenta via the umbilical arteries to be oxygenated by the mother. Additionally, some oxygenated blood in the right atrium can also enter the right ventricle and then the pulmonary artery. Because there is high resistance to blood flow in the lungs, the blood is shunted from the pulmonary artery into the aorta via the ductus arteriosus, hence bypassing the lungs. Blood then enters the systemic circulation, and the deoxygenated blood is recycled back to the mother via the umbilical arteries. 3. 3. Question During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines that the fetal heart rate is normal if which of the following is noted? • A. 80 BPM • B. 100 BPM • C. 150 BPM • D. 180 BPM Incorrect Correct Answer: C. 150 BPM. The fetal heart rate depends on gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress. • Option A: Data from a recently published study in a different context (Serra et al., 2009) is compatible with the findings of our exploratory analysis with a lower limit of 115 or 120 bpm for the gestational ages. Data for the 97th and 99th percentiles are not shown in this study. But shifting the lower limit to 120 will increase the number of false alarms whereas a lower limit of 115 will inevitably increase the risk to misinterpret maternal heart rates as fetal heart rate. • Option B: A lower limit of 120 bpm leads only near term to more false alarms since normal FHR decreases further, and is more appropriate, to avoid misinterpretation of maternal heartbeat as FHR. • Option D: The upper limit of 160 bpm raised concerns in the FIGO meeting in 1985, as Saling described abnormal findings in 24% of scalp blood analyses if the baseline was higher than 160 bpm. It could be shown that the current FIGO guidelines based on computerized analyses of the CTG show a high sensitivity to detect fetal acidosis in case of a suspect or pathological classification of the baseline level. 4. 4. Question A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele’s rule, the nurse determines the estimated date of confinement as: • A. July 26, 2013 • B. June 12, 2014 • C. June 26, 2014 • D. July 12, 2014 Incorrect Correct Answer: C. June 26, 2014. Accurate use of Naegele’s rule requires that the woman has a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract three months, and then add one year to that date. • Option A: An average pregnancy lasts 280 days from the first day of the last menstrual period (LMP) or 266 days after conception. Historically, an accurate LMP is the best estimator to determine the due date. • Option B: Naegele’s rule, derived from a German obstetrician, subtracts 3 months and adds 7 days to calculate the estimated due date (EDD). It is prudent for the obstetrician to get a detailed menstrual history, including duration, flow, previous menstrual periods, and hormonal contraceptives. These factors are used to determine the length of her cycles and ovulation period. • Option D: There are several fallacies with Naegele’s rule. First, a woman may not accurately recall the first day of her menstrual cycle. Second, this method assumes a woman’s cycle is exactly 28 days, with ovulation occurring at day 14, however, it does not consider menstrual cycles with shorter or longer durations. Third, there are small variations in the duration between fertilization and blastocyst implantation. Last, this method cannot differentiate between menstrual bleeding and early pregnancy bleeding. 5. 5. Question A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child that was delivered at 37 weeks and tells the nurse that she doesn’t have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as: • A. G = 3, T = 2, P = 0, A = 0, L =1 • B. G = 2, T = 0, P = 1, A = 0, L =1 • C. G = 1, T = 1. P = 1, A = 0, L = 1 • D. G = 2, T = 0, P = 0, A = 0, L = 1 Incorrect Correct Answer: B. G = 2, T = 0, P = 1, A = 0, L =1. Pregnancy outcomes can be described with the acronym GTPAL. • “G” is Gravidity, the number of pregnancies. • “T” is term births, the number of born at term (38 to 41 weeks). • “P” is preterm births, the number born before 38 weeks gestation. • “A” is abortions or miscarriages, included in “G” if before 20 weeks gestation, included in parity if past 20 weeks AOE. • “L” is live births, the number of births of living children. Therefore, a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 37 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1. • Option A: Gravida should be 2, term births should be 0, and parity is 1. • Option C: Gravida should be 2 and term births should be 0. • Option D: Parity should be 1. 6. 6. Question A nurse is performing an assessment of a primipara who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing? • A. Consistent increase in fundal height • B. Fetal heart rate of 180 BPM • C. Braxton Hicks contractions • D. Quickening Incorrect Correct Answer: B. Fetal heart rate of 180 BPM. The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected. • Option A: A fundal height measurement is typically done to determine if a baby is small for its gestational age. The measurement is generally defined as the distance in centimeters from the pubic bone to the top of the uterus. The expectation is that after week 24 of pregnancy the fundal height for a normally growing baby will match the number of weeks of pregnancy — plus or minus 2 centimeters. • Option C: Braxton Hicks contractions are sporadic contractions and relaxation of the uterine muscle. Sometimes, they are referred to as prodromal or “false labor” pains. It is believed they start around 6 weeks gestation but usually are not felt until the second or third trimester of the pregnancy. • Option D: Quickening often occurs between the 16th to the 22nd week of pregnancy. This is called a presumptive sign of pregnancy as the other movements of the woman’s body can mimic early fetal movements such as flatus, peristalsis, and abdominal muscle contractions. A multiparous woman will usually first notice these fluttering movements of the fetus at an earlier gestation than a primiparous woman. 7. 7. Question A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell’s sign. The nurse determines this sign indicates: • A. A softening of the cervix. • B. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus. • C. The presence of hCG in the urine. • D. The presence of fetal movement. Incorrect Correct Answer: A. A softening of the cervix. In the early weeks of pregnancy, the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell’s sign. • Option B: Uterine souffle or placental souffle is a soft, blowing sound heard using a stethoscope, usually in the second trimester of pregnancy (13–28 weeks). This sound is heard most clearly in the lower part of the uterus and is synchronous with the pulse of the mother. • Option C: hCG levels can usually be detected in the urine about 10 days after conception. If the woman takes a urine pregnancy test fewer than 10 days after conception, the at-home tests might give a “false negative” response. This means it will show that she is not pregnant when she actually is. • Option D: Adequate oxygenation of the fetal tissues is central to fetal wellbeing. The importance of fetal movements as a marker of health has been demonstrated in sheep models, with fetal behavior being reflective of fetal brain function. 8. 8. Question A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term? • A. “It is the irregular, painless contractions that occur throughout pregnancy.” • B. “It is the soft blowing sound that can be heard when the uterus is auscultated.” • C. “It is the fetal movement that is felt by the mother.” • D. “It is the thinning of the lower uterine segment.” Incorrect Correct Answer: C. “It is the fetal movement that is felt by the mother.” Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar’s sign. • Option A: Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy. • Option B: Uterine souffle or placental souffle is a soft, blowing sound heard using a stethoscope, usually in the second trimester of pregnancy (13–28 weeks). This sound is heard most clearly in the lower part of the uterus and is synchronous with the pulse of the mother. • Option D: The lower uterine segment, therefore, is defined as the portion of the uterine musculature which must undergo circumferential dilatation during labor, its extent being dependent upon the size of the presenting part and its level in the uterine cavity. The available evidence suggests that brachystasis, with retraction, occurs in this segment just as it does in the upper, and that thinning in the first stage of labor is due not to passive elongation, but rather to active shortening of the cup-shaped lower pole with dilatation as it is pulled up about the presenting part. 9. 9. Question A nurse-midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement? • A. Auscultating for fetal heart sounds. • B. Palpating the abdomen for fetal movement. • C. Assessing the cervix for thinning. • D. Initiating a gentle upward tap on the cervix. Incorrect Correct Answer: D. Initiating a gentle upward tap on the cervix. Ballottement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger. • Option A: There are two methods of fetal heart rate monitoring in labor. Auscultation is a method of periodically listening to the fetal heartbeat. Electronic fetal monitoring is a procedure in which instruments are used to continuously record the heartbeat of the fetus and the contractions of the woman’s uterus during labor. • Option B: The Leopold maneuvers, named after the German obstetrician and gynecologist Christian Gerhard Leopold (1846–1911), are part of the physical examination of pregnant women. Four classical maneuvers are used to palpate the gravid uterus systematically. This method of abdominal palpation is of low cost, easy to perform, and non-invasive. It is used to determine the position, presentation, and engagement of the fetus in utero. • Option C: Effacement means that the cervix stretches and gets thinner. Dilatation means that the cervix opens. As labor nears, the cervix may start to thin or stretch (efface) and open (dilate). This prepares the cervix for the baby to pass through the birth canal (vagina). 10. 10. Question A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Which of the following signs indicates a probable sign of pregnancy? Select all that apply. • A. Uterine enlargement • B. Fetal heart rate detected by nonelectric device • C. Outline of the fetus via radiography or ultrasound • D. Chadwick’s sign • E. Braxton Hicks contractions • F. Ballottement Incorrect Correct Answer: A, D, E, and F. The probable signs of pregnancy include: • Uterine Enlargement • Hegar’s sign or softening and thinning of the uterine segment that occurs at week 6. • Goodell’s sign or softening of the cervix that occurs at the beginning of the 2nd month • Chadwick’s sign or bluish coloration of the mucous membranes of the cervix, vagina, and vulva. Occurs at week 6. • Ballottement or rebounding of the fetus against the examiner’s fingers of palpation • Braxton-Hicks contractions • Positive pregnancy test measuring for hCG. Positive signs of pregnancy include: • Fetal Heart Rate detected by electronic device (Doppler) at 10-12 weeks • Fetal Heart rate detected by nonelectronic device (fetoscope) at 20 weeks AOG • Active fetal movement palpable by the examiners • Outline of the fetus via radiography or ultrasound 11. 11. Question A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps and is awakened by the cramps at night. To provide relief from the leg cramps, the nurse tells the client to: • A. Dorsiflex the foot while extending the knee when the cramps occur. • B. Dorsiflex the foot while flexing the knee when the cramps occur. • C. Plantar flex the foot while flexing the knee when the cramps occur. • D. Plantar flex the foot while extending the knee when the cramps occur. Incorrect Correct Answer: A. Dorsiflex the foot while extending the knee when the cramps occur. Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping. • Option B: If the cramps are in the calf, flex the foot to attempt to stretch the muscle, or walk around on the heels if the pain isn’t unbearable. • Option C: Because they often happen at night when the legs are slightly bent and the feet are pointed downward, some have suggested that this tightening triggers a spasm. • Option D: Although the exact cause of muscle cramps is unknown (idiopathic), some researchers believe inadequate stretching and muscle fatigue leads to abnormalities in the mechanisms that control muscle contraction. Other factors may also be involved, including poor conditioning, exercising or working in intense heat, dehydration, and depletion of salt and minerals (electrolytes). 12. 12. Question A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to: • A. Avoid wearing a bra. • B. Wash the nipples and areola area daily with soap and massage the breasts with lotion. • C. Wear tight-fitting blouses or dresses to provide support. • D. Wash the breasts with warm water and keep them dry. Incorrect Correct Answer: D. Wash the breasts with warm water and keep them dry. The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. Breasts can become sore in early pregnancy for several reasons, but one of the primary causes is changing hormone levels (such as estrogen, progesterone, and prolactin). • Option A: Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Back closures rather than front closures will give you the ability to adjust as necessary. • Option B: The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. • Option C: Tight-fitting blouses or dresses will cause discomfort. The woman might instinctually do everything she can to avoid allowing anything to touch her breasts. For example, if the seatbelt is uncomfortable, adjust the strap that zigzags across the torso so that it runs between the breasts and not across the top of one of them. 13. 13. Question A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for: • A. Any bleeding, such as in the gums, petechiae, and purpura. • B. Enlargement of the breasts. • C. Periods of fetal movement followed by quiet periods. • D. Complaints of feeling hot when the room is cool. Incorrect Correct Answer: A. Any bleeding, such as in the gums, petechiae, and purpura. Severe preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D. • Option B: Estrogen stimulates growth of the breast duct cells and generates the secretion of prolactin, another hormone. Prolactin stimulates breast enlargement and milk production. Progesterone supports the formation and growth of milk-producing cells within the glands of the breasts. • Option C: The first fetal movements which are felt by the mother are called quickening. One function of these movements is to alert the pregnant woman that she has a fetus growing in her uterus. Most providers recommend that pregnant women monitor fetal movements, especially by the third trimester. This can be accomplished by simply instructing the woman to have a general awareness of the fetus and determine if the fetus is moving less than normal on any given day or about the same as other days. • Option D: At the beginning of your pregnancy, new hormones are like little workers that help keep everything humming along smoothly. These hormonal changes also raise your body temperature a small amount. 14. 14. Question A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education? • A. “I will maintain strict bedrest throughout the remainder of the pregnancy.” • B. “I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding.” • C. “I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad.” • D. “I will watch for the evidence of the passage of tissue.” Incorrect Correct Answer: A. “I will maintain strict bedrest throughout the remainder of the pregnancy.” Strict bed rest throughout the remainder of pregnancy is not required. Bedrest and other activity restrictions have not been found to be efficacious in the prevention of a threatened abortion progressing to spontaneous abortion and have been shown to increase the risk of other complications including deep vein thrombosis and/or pulmonary embolism and therefore should not be recommended • Option B: The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. • Option C: The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. Patients with a threatened abortion should be managed expectantly without any medical or surgical interventions. However, patients should be given strict return precautions concerning excessive vaginal bleeding, abdominal pain, or fever and patients should be educated on the importance of follow-up. • Option D: The woman also should watch for the evidence of the passage of tissue. A threatened abortion is defined as vaginal bleeding before 20 weeks gestational age in the setting of positive urine and/or blood pregnancy test with a closed cervical os, without passage of products of conception, and without evidence of fetal or embryonic demise. 15. 15. Question A prenatal nurse is providing instructions to a group of pregnant clients regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions? • A. “I need to cook meat thoroughly.” • B. “I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat.” • C. “I need to drink unpasteurized milk only.” • D. “I need to avoid contact with materials that are possibly contaminated with cat feces.” Incorrect Correct Answer: C. “I need to drink unpasteurized milk only.” All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Everyone, including immunocompetent patients, should be educated about toxoplasmosis risk factors and ways to minimize the risks. Preventing toxoplasmosis is particularly important in seronegative immunocompromised patients and in pregnant women. • Option A: Avoid eating raw meat, unpasteurized milk, and uncooked eggs, oysters, clams, and mussels. Rarely, infection by tachyzoites occurs from ingestion of unpasteurized milk or by direct entry into the bloodstream through a blood transfusion or laboratory accident. Transmission can also occur via ingestion of tissue cysts (bradyzoites) in undercooked or uncooked meat or through transplantation of an organ that contains tissue cysts. (Slaughterhouse workers and butchers may be at increased risk of infection.) In Europe and the United States, pork is the major source of T gondii infection in humans. • Option B: Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption. • Option D: Avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sandboxes, and garden soil. T gondii oocysts are ingested in material contaminated by feces from infected cats. Oocysts may also be transported to food by flies and cockroaches. When T gondii is ingested, bradyzoites are released from cysts or sporozoites are released from oocysts, and the organisms enter gastrointestinal cells. Host cell receptors consisting of laminin, lectin, and SAG1 are involved in T gondii tachyzoite attachment and penetration. Tachyzoites multiply, rupture cells, and infect contiguous cells. They are transported via the lymphatics and are disseminated hematogenously throughout the tissues. 16. 16. Question A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the preeclampsia and the need to notify the physician? • A. Blood pressure reading is at the prenatal baseline. • B. Urinary output has increased. • C. The client complains of a headache and blurred vision. • D. Dependent edema has resolved. Incorrect Correct Answer: C. The client complains of a headache and blurred vision. If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening preeclampsia. • Option A: In normal pregnancy, women’s mean arterial pressure drops 10-15 mm Hg over the first half of pregnancy. Most women with mild chronic hypertension (ie, SBP 140-160 mm Hg, DBP 90-100 mm Hg) have a similar decrease in blood pressures and may not require any medication during this period. • Option B: In addition to rising hormones, the body’s fluid levels start to increase during pregnancy. This means the kidneys have to work extra hard to flush the extra fluid. The amount of urine released will increase as well. In the third trimester, the baby’s growing size means they’re pressing even more on the bladder. • Option D: During normal pregnancy total body water increases by 6 to 8 liters, 4 to 6 liters of which are extracellular, of which at least 2 to 3 liters are interstitial. At some stage in pregnancy 8 out of 10 women have demonstrable clinical edema. 17. 17. Question A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education? • A. “I need to stay on the diabetic diet.” • B. “I will perform glucose monitoring at home.” • C. “I need to avoid exercise because of the negative effects of insulin production.” • D. “I need to be aware of any infections and report signs of infection immediately to my health care provider.” Incorrect Correct Answer: C. “I need to avoid exercise because of the negative effects of insulin production.” Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood glucose level. • Option A: The goal of dietary therapy is to avoid single large meals and foods with a large percentage of simple carbohydrates. The diet should include foods with complex carbohydrates and cellulose, such as whole-grain breads and legumes. • Option B: The best method for screening for gestational diabetes continues to be controversial. The 2-step system is currently recommended in the United States. A 50-g, 1-hour glucose challenge test (GCT) is followed by a 100-g, 3-hour OGTT for those with an abnormal screening result. Alternatively, for high-risk women, or in areas in which the prevalence of insulin resistance is 5% or higher (eg, the southwestern and southeastern United States), a 1-step approach can be used by proceeding directly to the 100-g, 3-hour OGTT. • Option D: Pregnant women with gestational diabetes mellitus (GDM) are reported to be at increased risk for infections of the genital tract. Bacterial vaginosis (BV) is known to be a crucial factor for preterm delivery (PTD), causing up to 40 percent of premature births. 18. 18. Question A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse? • A. Urinary output of 20 ml since the previous assessment • B. Deep tendon reflexes of 2+ • C. Respiratory rate of 10 BPM • D. Fetal heart rate of 120 BPM Incorrect Correct Answer: C. Respiratory rate of 10 BPM. Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. • Option A: A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. The kidneys face remarkable demands during pregnancy, and it is critical that the practicing nephrologist understands the normal kidney adaptations to pregnancy. GFR rises early to a peak of 40% to 50% that of prepregnancy levels, resulting in lower levels of serum creatinine, urea, and uric acid. There is a net gain of sodium and potassium, but a greater retention of water, with gains of up to 1.6 L. • Option B: Deep tendon reflexes of 2+ are normal. With preeclampsia, a woman’s reflexes become unusually active. Increasing blood pressure will lead to increasing hyperreflexia until uncontrollable seizures eventually result. Testing for this change is difficult in the field setting; in a clinic setting an overactive patellar response is a good indicator. • Option D: The fetal heart rate is WNL for a resting fetus. Current international guidelines recommend for the normal fetal heart rate (FHR) baseline different ranges of 110 to 150 beats per minute (bpm) or 110 to 160 bpm. 19. 19. Question A nurse is caring for a pregnant client with preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from preeclampsia to eclampsia, the nurse’s first action is to: • A. Administer magnesium sulfate intravenously • B. Assess the blood pressure and fetal heart rate. • C. Clean and maintain an open airway. • D. Administer oxygen by face mask. Incorrect Correct Answer: C. Clean and maintain an open airway. The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased. • Option A: In this case, the doctor may prescribe magnesium sulfate as well as medications to help reduce blood pressure. Magnesium sulfate therapy is used to prevent seizures in women with preeclampsia. It can also help prolong a pregnancy for up to two days. • Option B: Preeclampsia is when the blood pressure, or the force of blood against the walls of the arteries, becomes high enough to damage the arteries and other blood vessels. Damage to the arteries may restrict blood flow. It can produce swelling in the blood vessels in the brain and to the growing baby. If this abnormal blood flow through vessels interferes with the brain’s ability to function, seizures may occur. • Option D: The initial treatment for eclampsia includes maintaining oxygen delivery to both mother and fetus, minimizing the risk of aspiration, treating the seizure, and controlling hypertension. 20. 20. Question A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for preeclampsia. The nurse checks the client for which specific signs of preeclampsia? Select all that apply. • A. Elevated blood pressure • B. Negative urinary protein • C. Facial edema • D. Increased respirations • E. Polydipsia Incorrect Correct Answer: A & C. Elevated blood pressure and facial edema. The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia. • Option A: Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher. • Option B: In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia. • Option C: Edema exists in many pregnant women, but a sudden increase in edema or facial edema is suggestive of preeclampsia. The edema of preeclampsia occurs by a distinct mechanism that is similar to that of angioneurotic edema. • Option D: Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. If these symptoms are new to you, they could indicate an elevated blood pressure, or more rarely, fluid collecting in your lungs (pulmonary edema). • Option E: Primary polydipsia (PP) is a condition where there is excess consumption of fluids leading to polyuria with diluted urine and, ultimately, hyponatremia. 21. 21. Question Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following? • A. Being affected by Rh incompatibility. • B. Having Rh-positive blood. • C. Developing a rubella infection. • D. Developing physiological jaundice. Incorrect Correct Answer: A. Being affected by Rh incompatibility. Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh-positive. Administration of Rho(D) immune globulin prevents the woman from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen. • Option B: During pregnancy and at delivery, some of the baby’s Rh-positive blood can enter the maternal circulation, causing the woman’s immune system to form antibodies against Rh-positive blood. • Option C: Rubella can be prevented with MMR vaccine. This protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults also should also be up to date on their MMR vaccination. • Option D: The best preventive of infant jaundice is adequate feeding. Breast-fed infants should have eight to 12 feedings a day for the first several days of life. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 milliliters) of formula every two to three hours for the first week. 22. 22. Question A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment? • A. Presence of deep tendon reflexes. • B. Serum magnesium level of 6 mEq/L. • C. Proteinuria of +3. • D. Respirations of 10 per minute. Incorrect Correct Answer: D. Respirations of 10 per minute. Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. • Option A: Although deep tendon reflexes are more useful in assessing magnesium toxicity, the presence of clonus may indicate an increased risk of convulsions. • Option B: Therapeutic levels of magnesium are 4-7 mEq/L. Magnesium sulfate is the first-line treatment for the prevention of primary and recurrent eclamptic seizures. For eclamptic seizures that are refractory to magnesium sulfate, lorazepam and phenytoin may be used as second-line agents. • Option C: Proteinuria of +3 would be noted in a client with preeclampsia. Proteinuria is defined as the presence of at least 300 mg of protein in a 24-hour urine collection, a protein (mg/dL)/creatinine (mg/dL) ratio greater than or equal to 0.3, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable). Serial confirmations 6 hours apart increase the predictive value. Although more convenient, a urine dipstick value of 1+ or more (30 mg/dL) is not reliable in the diagnosis of proteinuria. 23. 23. Question A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if: • A. Ankle clonus is noted. • B. The blood pressure decreases. • C. Seizures do not occur. • D. Scotomas are present. Incorrect Correct Answer: C. Seizures do not occur. For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Seizures were a half or a third less likely to recur after treatment with magnesium. Maternal mortality was also lower in women allocated magnesium rather than phenytoin or diazepam, although this did not achieve statistical significance. Recent Cochrane reviews, however, indicated a significant reduction in maternal mortality with magnesium. • Option A: Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Although brisk or hyperactive reflexes are common during pregnancy, clonus is a sign of neuromuscular irritability that usually reflects severe preeclampsia. • Option B: Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. • Option D: Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure. 24. 24. Question A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client. • A. Monitor maternal vital signs every 2 hours. • B. Notify the physician if respirations are less than 18 per minute. • C. Monitor renal function and cardiac function closely. • D. Keep calcium gluconate on hand in case of a magnesium sulfate overdose. • E. Monitor deep tendon reflexes hourly. • F. Monitor I and O’s hourly. • G. Notify the physician if urinary output is less than 30 ml per hour. Incorrect Correct Answer: C, D, E, F, and G. • Option A: BP should be assessed with the goal of maintaining the diastolic BP at less than 110 mm Hg with administration of antihypertensive medications as needed (eg, hydralazine, labetalol, nifedipine). • Option B: When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. • Option C: Cardiac and renal function are monitored closely. Eclampsia-associated renal abnormalities can include decreases in glomerular filtration rate, renal plasma flow, and uric acid clearance as well as proteinuria. Eclampsia is associated with cardiovascular derangements such as generalized vasospasm, increased peripheral vascular resistance, and increased left ventricular stroke work index. Pulmonary capillary wedge pressure (PCWP) may vary from low to elevated. Importantly, central venous pressure (CVP) may not correlate with PCWP in patients with severe preeclampsia or eclampsia. • Option D: Calcium gluconate is kept on hand in case of magnesium sulfate overdose because calcium gluconate is the antidote for magnesium sulfate toxicity. • Option E: Deep tendon reflexes are assessed hourly. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Although brisk or hyperactive reflexes are common during pregnancy, clonus is a sign of neuromuscular irritability that usually reflects severe preeclampsia. • Option F: Monitor fluid intake and urine output, maternal respiratory rate, and oxygenation, as indicated, and continuously monitor fetal status. Pulmonary arterial pressure monitoring is rarely indicated but may be helpful in patients who have evidence of pulmonary edema or oliguria/anuria. • Option G: The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys. Source: 25. 25. Question In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh-negative, the nurse must: • A. Administer RhoGAM within 72 hours. • B. Make certain she receives RhoGAM on her first clinic visit. • C. Not give RhoGAM, since it is not used with the birth of a stillborn. • D. Make certain the client does not receive RhoGAM since the gestation only lasted 12 weeks. Incorrect Correct Answer: A. Administer RhoGAM within 72 hours. RhoGAM is given within 72 hours postpartum if the client has not been sensitized already. When the blood of an Rh-positive fetus gets into the bloodstream of an Rh-negative woman, her body will recognize that the Rh-positive blood is not hers. Her body will try to destroy it by making anti-Rh antibodies. These antibodies can cross the placenta and attack the fetus’s blood cells. This can lead to serious health problems, even death, for a fetus or a newborn. • Option B: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. RhoGAM is administered by intramuscular (IM) injection. RhoGAM is purified from human plasma containing anti-Rh (anti-D). • Option C: The doctor will administer at least one dose of RhoGAM between 26 and 28 weeks of pregnancy. If the baby is found to be Rh-positive at birth, the mother will receive an additional dose within 72 hours after delivery. • Option D: 1 Rh-negative pregnant woman in 5 will become sensitive to the Rh-positive factor if she doesn’t receive RhoGAM. That means that her baby can be born with one or more of the following things: anemia, a lack of healthy red blood cells. heart failure. 26. 26. Question In a lecture on sexual functioning, the nurse plans to include the fact that ovulation occurs when the: • A. Oxytocin is too high. • B. Blood level of LH is too high. • C. Progesterone level is high. • D. Endometrial wall is sloughed off. Incorrect Correct Answer: B. Blood level of LH is too high. It is the surge of LH secretion in mid-cycle that is responsible for ovulation. LH is responsible for inducing ovulation, preparation for fertilized oocyte uterine implantation, and the ovarian production of progesterone through stimulation of theca cells and luteinized granulosa cells. • Option A: Ovulation is the third phase within the larger Uterine Cycle (i.e. Menstrual Cycle). The follicular release follows the Follicular phase (i.e. dominant follicle development) and precedes the Luteal phase (i.e. maintenance of corpus luteum) that progresses to either endometrial shedding or implantation. Follicular release occurs around 14 days prior to menstruation in a cyclic pattern if the hypothalamic-pituitary-ovarian axis function is well regulated. • Option C: Ovulation occurs around day 14 of a typical 28-day cycle. Estrogen levels rise as a result of increased estrogen production by hormonally active granulosa cells within the follicle. One of the estrogen levels reach a critical point and remain at the level for 2 days, estrogen transitions from a negative feedback modulator of GnRH to a positive feedback modulator on the hypothalamus. • Option D: FSH and LH stimulate what remains of the mature follicle after ovulation to become the corpus luteum. The corpus luteum grows and secretes progesterone and some estrogen, which makes the endometrium more receptive to implantation. If fertilization does not occur, progesterone/estrogen levels fall, and the corpus luteum dies forming the corpus Albicans. These falling hormone levels stimulate FSH to begin recruiting follicles for the next cycle. 27. 27. Question The chief function of progesterone is the: • A. Development of the female reproductive system. • B. Stimulation of the follicles for ovulation to occur. • C. Preparation of the uterus to receive a fertilized egg. • D. Establishment of secondary male sex characteristics. Incorrect Correct Answer: C. Preparation of the uterus to receive a fertilized egg. Progesterone stimulates differentiation of the endometrium into a secretory type of tissue. Progesterone is an endogenous steroid hormone that is commonly produced by the adrenal cortex as well as the gonads, which consist of the ovaries and the testes. • Option A: The increase of progesterone, specifically in the menstrual cycle, occurs due to the initiation of a mid-cycle luteinizing hormone (LH) surge near the end of the follicular phase. This mid-cycle rise of progesterone also allows for an increase in follicle-stimulating hormone (FSH). • Option B: At the end of the LH and FSH surge, the menstrual cycle begins the luteal phase, during which progesterone prepares the endometrium in a woman’s uterus to receive and nourish the fertilized egg, also known as implantation during the luteal phase. • Option D: Testosterone is the primary male hormone responsible for regulating sex differentiation, producing male sex characteristics, spermatogenesis and fertility. 28. 28. Question The developing cells are called a fetus from the: • A. Time the fetal heart is heard • B. Eighth week to the time of birth. • C. Implantation of the fertilized ovum. • D. End of the send week to the onset of labor. Incorrect Correct Answer: B. Eighth week to the time of birth. In the first 7-14 days, the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth. • Option A: The ectoderm forms the epidermis, nails, hair, peripheral nervous system, brain, and spinal cord. The mesoderm forms the muscle, bone, connective tissue, notochord, kidney, gonads, and circulatory system. The endoderm forms the epithelial lining of the digestive tract, stomach, colon, liver, bladder, and pancreas. • Option C: Once fertilization takes place, there are quick changes at the cellular level of the zygote. The zygote is a single cell, and it undergoes mitosis to create many cells. Once the zygote has reached the thirty-two cell stage, it becomes morula. Day four begins blastulation and cavities begin to form by first forming a hollow ball. Some studies suggest that the timing of this process may affect implantation. • Option D: At sixteen weeks the primitive streak forms. The primitive streak establishes the midline of the body. The next stage in development is neurulation. At this time the notochord induces the ectoderm to form the neural plate which eventually forms the neural tube. The neural tube will become the brain and spinal cord. 29. 29. Question After the first four months of pregnancy, the chief source of estrogen and progesterone is the: • A. Placenta • B. Adrenal cortex • C. Corpus luteum • D. Anterior hypophysis Incorrect Correct Answer: A. Placenta. When the placental formation is complete, around the 16th week of pregnancy; it produces estrogen and progesterone. • Option B: The adrenal cortex—the outer part of the gland—produces hormones that are vital to life, such as cortisol (which helps regulate metabolism and helps the body respond to stress) and aldosterone (which helps control blood pressure). • Option C: The primary purpose of the corpus luteum is to pulse out hormones, including progesterone. Progesterone is required for a viable pregnancy to occur and to continue. Progesterone helps the uterine lining, known as the endometrium, to thicken and become spongy. • Option D: Anterior pituitary undergoes two- to three-fold enlargement during pregnancy, because of hyperplasia and hypertrophy of lactotroph cells. In contrast to lactotrophs, the size of other anterior pituitary cells remains unchanged or decreases. 30. 30. Question The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is: • A. A decrease in WBC’s • B. Increase in hematocrit. • C. An increase in blood volume. • D. A decrease in sedimentation rate. Incorrect Correct Answer: C. An increase in blood volume. The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume. • Option A: WBC count increases to 6 to 16 million/mL and can be as high as 20 million/mL during and shortly after labor. • Option B: In pregnancy, the RBC volume increases by 20% to 30%, while the plasma volume increases 45 to 55%. This disproportionate volume increase leads to dilutional anemia with decreased hematocrit. • Option D: Fibrinogen and factors VII – X levels increase, but the clotting and bleeding times remain unchanged. However, increased venous stasis and damaged vessel endothelium result in higher rates of thromboembolic events during pregnancy. 31. 31. Question The nurse is aware that an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as: • A. Ladin’s sign • B. Hegar’s sign • C. Goodell’s sign • D. Chadwick’s sign Incorrect Correct Answer: D. Chadwick’s sign. A purplish color results from the increased vascularity and blood vessel engorgement of the vagina. It can be observed as early as 6 to 8 weeks after conception, and its presence is an early sign of pregnancy. • Option A: Ladin’s sign is a clinical sign of pregnancy in which there is softening in the midline of the uterus anteriorly at the junction of the uterus and cervix. It occurs and is detectable with manual examination at about 6 weeks’ gestation. • Option B: Hegar’s sign is a non-sensitive indication of pregnancy in women — its absence does not exclude pregnancy. It pertains to the features of the cervix and the uterine isthmus. It is demonstrated as a softening in the consistency of the uterus, and the uterus and cervix seem to be two separate regions. • Option C: Goodell sign is an indication of pregnancy. It is a significant softening of the vaginal portion of the cervix from increased vascularization. This vascularization is a result of hypertrophy and engorgement of the vessels below the growing uterus. This sign occurs at approximately four weeks’ gestation. 32. 32. Question A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is: • A. G4 T3 P2 A1 L4 • B. G5 T2 P2 A1 L4 • C. G5 T2 P1 A1 L4 • D. G4 T3 P1 A1 L4 Incorrect Correct Answer: C. G5 T2 P1 A1 L4. 5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children. A good starting point is to ask about the number of children the patient has given birth to. Next, sensitively ask about miscarriages, stillbirths, ectopics and terminations. • Option A: Gravida should be 5, term births should be 3, and parity should be 1. Gravidity is the total number of pregnancies, regardless of outcome. • Option B: Parity should be 1. Parity is the total number of pregnancies carried over the threshold of visibility. • Option D: Gravida should be 5, and term births should be 2. 33. 33. Question An expected cardiopulmonary adaptation experienced by most pregnant women is: • A. Tachycardia • B. Dyspnea at rest • C. Progression of dependent edema • D. Shortness of breath on exertion Incorrect Correct Answer: D. Shortness of breath on exertion. This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm. • Option A: In pregnancy, the cardiac output increases 30 to 60%, with the majority of the increase occurring during the first trimester. The maximum output is reached between 20 and 24 weeks and is maintained until delivery. Initially, the increase in cardiac output is due to an increase in stroke volume. As the stroke volume decreases towards the end of the third trimester, an increase in heart rate acts to maintain the increased cardiac output. • Option B: During pregnancy, the diaphragm elevates, resulting in a 5% decrease in total lung capacity (TLC). However, the tidal volume (TV) increases by 30 to 40%, thereby decreasing the expiratory reserve volume by 20%. Minute ventilation is similarly increased by 30 to 40%, owing to the fact that TV becomes increased while a constant respiratory rate is maintained. • Option C: During pregnancy, the extra fluid in the body and the pressure from the growing uterus can cause swelling (edema) in the ankles and feet. The swelling tends to get worse as a woman’s due date nears, particularly near the end of the day and during hotter weather. 34. 34. Question Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include: • A. A decrease of 200 calories a day. • B. An increase of 300 calories a day. • C. An increase of 500 calories a day. • D. A maintenance of her present caloric intake per day. Incorrect Correct Answer: B. An increase of 300 calories a day. This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy. These calories should come from a balanced diet of protein, fruits, vegetables and whole grains. Sweets and fats should be kept to a minimum. A healthy, well-balanced diet can also help to reduce some pregnancy symptoms, such as nausea and constipation. • Option A: Whenever possible, eat complex carbohydrates and limit simple carbohydrates. • Option C: Protein needs increase considerably during pregnancy and peak during the third trimester. Add a protein-rich food to every meal and snack to ensure enough protein throughout the pregnancy. • Option D: Whole grains and legumes, such as dried peas and beans, and other healthy carbs like fruit and starchy vegetables should make regular appearances on the plate. They provide B vitamins and trace minerals, such as zinc selenium, and magnesium. Grains and legumes are full of nutrients, including iron and the various B vitamins: thiamin (vitamin B-1), riboflavin (vitamin B-2), folate, and niacin. 35. 35. Question During a prenatal examination, the nurse draws blood from a young Rh-negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for: • A. Acute hemolytic disease • B. Respiratory distress syndrome • C. Protein metabolic deficiency • D. Physiologic hyperbilirubinemia Incorrect Correct Answer: A. Acute hemolytic disease. When an Rh-negative mother carries an Rh-positive fetus there is a risk for maternal antibodies against Rh-positive blood; antibodies cross the placenta and destroy the fetal RBCs. • Option B: Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants. In premature infants, respiratory distress syndrome develops because of impaired surfactant synthesis and secretion leading to atelectasis, ventilation-perfusion (V/Q) inequality, and hypoventilation with resultant hypoxemia and hypercarbia. • Option C: Infants with protein metabolism disorders are unable to metabolize certain amino acids and require specialized formulas without the offending amino acid, allowing the baby to receive essential nutrients for growth. • Option D: Physiologic jaundice is also referred to as non-pathologic jaundice, and it is mild and transient. This occurs because of differences in the metabolism of bilirubin in the neonatal period leading to an increased bilirubin load. 36. 36. Question When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased: • A. Metabolic rates. • B. Production of estrogen. • C. Functioning of the Bartholin glands. • D. Supply of sodium chloride to the cells of the vagina. Incorrect Correct Answer: B. Production of estrogen. The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells. • Option A: The placenta produces human placental lactogen (hPL), which acts to supply nutrition to the fetus. It induces lipolysis to increase free fatty acids, which are preferentially used by the pregnant mother for fuel. It also acts as an insulin antagonist to induce a diabetogenic state. This activity prompts hyperplasia of pancreatic beta-cells to create increased insulin levels and protein synthesis. In early pregnancy, maternal insulin sensitivity increases, followed by resistance in the second and third trimesters. • Option C: The incidence of Bartholin gland abscesses during pregnancy was 0.13%. Eight (20%) abscesses occurred in the first, 18 (45%) in the second, 11 (47.5%) in the third trimester, and 3 (7.5%) in the post-partum course. No severe perineal and neonatal infections occurred during pregnancy. • Option D: Vagina, during pregnancy there is an increase in the blood supply to the vagina, its color change from pink to purple, and becomes more elastic in the second trimester. 37. 37. Question A 26-year old multigravida is 14 weeks pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, “What does the alpha-fetoprotein test indicate?” The nurse bases a response on the knowledge that this test can detect: • A. Kidney defects • B. Cardiac defects • C. Neural tube defects • D. Urinary tract defects Incorrect Correct Answer: C. Neural tube defects. The alpha-fetoprotein test detects neural tube defects and Down syndrome. Alpha-fetoprotein (AFP) is a plasma protein produced by the embryonic yolk sac and the fetal liver. AFP levels in serum, amniotic fluid, and urine functions as a screening test for congenital disabilities, chromosomal abnormalities, as well as some other adult occurring tumors and pathologies. • Option A: In some cases, one or both kidneys may fail to develop. In other instances, an abnormality may be present that blocks the outflow of urine. This blockage may cause urine to back up into the kidney, a condition called hydronephrosis, which causes the kidney to appear enlarged on the ultrasound test. Another common abnormality is called reflux. This occurs when a valve-like mechanism at the point where the ureter joins the bladder does not work, allowing urine to wash back up into the kidney. • Option B: The baby’s heart begins to form immediately after conception and is complete by eight week’s gestation. The heart begins as a tube-shaped structure that twists and divides to form the heart and heart valves. A congenital heart defect usually occurs because the heart does not twist or divide normally. Some mothers wonder if drugs, alcohol, or medications contributed to their child’s heart defect. In most cases, we don’t know why these defects occur. Although, some heart defects can run in families or be related to a disease the mother has, diabetes mellitus, for example. • Option D: Common birth defects of the urinary system include hypospadias, obstructive defects of the renal pelvis, and renal agenesis. Hypospadias is characterized by the location of the urethral opening on the underside of the penis. Obstructive defects of the renal pelvis prevent urine from entering the bladder. 38. 38. Question At a prenatal visit at 36 weeks’ gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to: • A. Lie down until they stop. • B. Walk around until they subside. • C. Time contraction for 30 minutes. • D. Take 10 grains of aspirin for the discomfort. Incorrect Correct Answer: B. Walk around until they subside. Ambulation relieves Braxton Hicks. Braxton Hicks contractions are thought to play a role in toning the uterine muscle in preparation for the birth process. Sometimes Braxton Hicks contractions are referred to as “practice for labor.” Braxton Hicks contractions do not result in dilation of the cervix but may have a role in cervical softening. • Option A: Braxton Hicks contractions may stop with a change in activity level or as the woman changes position. If she can sleep through the contraction, it is a Braxton Hicks contraction. True labor contractions continue and may even become stronger with movement or position change. • Option C: Braxton Hicks contractions are unpredictable. They may last less than 30 seconds or up to 2 minutes. True labor contractions last between 30 to less than 90 seconds and become longer over time. • Option D: There is no medical treatment for Braxton Hicks contractions. However, taking action to change the situation that triggered the Braxton Hicks contractions is warranted. 39. 39. Question The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine position can: • A. Unduly prolonged labor. • B. Cause decreased placental perfusion. • C. Lead to transient episodes of hypotension. • D. Interfere with free movement of the coccyx. Incorrect Correct Answer: B. Cause decreased placental perfusion. This is because of the impedance of venous return by the gravid uterus, which causes hypotension and decreased systemi