Maternity Nursing (OB Maternal & Newborn) NCLEX Practice Quiz #4 | 75 Questions|2022 update with rationales

Maternity Nursing (OB Maternal & Newborn) NCLEX Practice Quiz #4 | 75 Questions 1. 1. Question Discharge teaching for a child with celiac disease would include instructions about avoiding which of the following? o A. Rice o B. Milk o C. Wheat o D. Chicken Incorrect Correct Answer: C. Wheat Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content, wheat and wheat-containing products must be avoided. • Option A: Rice is one of the most popular gluten-free grains for people with celiac disease. Many gluten-free packaged goods are made with rice instead of wheat. • Option B: It’s also important to note that while milk is gluten-free, for those newly diagnosed with celiac disease, secondary lactose intolerance is common due to the loss of lactase, an enzyme that digests milk sugar along the lining of the small intestine. • Option D: There are many naturally gluten-free foods to enjoy on the celiac disease diet, including: Animal proteins: Beef, chicken, dairy products, eggs, game meat, lamb, pork, seafood, and turkey. 2. 2. Question Which of the following would the nurse expect to assess in a child with celiac disease having a celiac crisis secondary to an upper respiratory infection? • A. Respiratory distress • B. Lethargy • C. Watery diarrhea • D. Weight gain Incorrect Correct Answer: C. Watery diarrhea Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergic drugs. Celiac crisis is typically characterized by severe watery diarrhea. Celiac crisis is a rare initial presentation of CD characterized by severe diarrhea, dehydration, weight loss, hypoproteinemia, and metabolic and electrolyte disturbances. Although rare, it should be considered in patients with apparently unexplained chronic diarrhea. • Option A: Respiratory distress is unlikely in a routine upper respiratory infection. Mainly present in children, celiac crisis causes profuse intractable diarrhea with severe metabolic disturbances (such as acidosis and hypokalemia), hypotension, neuromuscular weakness, cardiac arrhythmias, and respiratory failure. • Option B: Irritability, rather than lethargy, is more likely. Due to the wide variety of symptoms that may present themselves, it can sometimes be difficult to diagnose celiac disease. One person might have diarrhea and abdominal pain, while another person has irritability or depression. • Option D: Because of the fluid loss associated with severe watery diarrhea, the child’s weight is more likely to be decreased. 3. 3. Question Which of the following should the nurse do first after noting that a child with Hirschsprung disease has a fever and watery explosive diarrhea? • A. Notify the physician immediately. • B. Administer antidiarrheal medications. • C. Monitor child every 30 minutes. • D. Nothing, this is characteristic of Hirschsprung disease. Incorrect Correct Answer: A. Notify the physician immediately. For the child with Hirschsprung disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified immediately. • Option B: Generally, because of the intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung disease. • Option C: The child is acutely ill and requires intervention, with monitoring more frequently than every 30 minutes. • Option D: Hirschsprung disease typically presents with chronic constipation. Hirschsprung’s disease (congenital megacolon) is caused by the failed migration of colonic ganglion cells during gestation. Varying lengths of the distal colon are unable to relax, causing functional colonic obstruction. 4. 4. Question A newborn’s failure to pass meconium within the first 24 hours after birth may indicate which of the following? • A. Hirschsprung disease • B. Celiac disease • C. Intussusception • D. Abdominal wall defect Incorrect Correct Answer: A. Hirschsprung disease Failure to pass meconium within the first 24 hours after birth may be an indication of Hirschsprung disease, a congenital anomaly resulting in mechanical obstruction due to inadequate motility in an intestinal segment. • Option B: Celiac disease is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications. • Option C: Intussusception is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality rate from intussusception in children is less than 1%. If left untreated, however, this condition is uniformly fatal in 2-5 days. • Option D: Types of abdominal wall defects may include gastroschisis. Contents of the abdomen protrude out of the body through an opening in the abdominal muscles near the umbilical cord. Without a protective covering, the organs are exposed to amniotic fluid and may swell or become damaged. 5. 5. Question When assessing a child for possible intussusception, which of the following would be least likely to provide valuable information? • A. Stool inspection • B. Pain pattern • C. Family history • D. Abdominal palpation Incorrect Correct Answer: C. Family history Because intussusception is not believed to have a familial tendency, obtaining a family history would provide the least amount of information. • Option A: Later signs include rectal bleeding, often with “red currant jelly” stool, and lethargy. Physical examination may reveal a “sausage-shaped” mass. • Option B: Early symptoms include periodic abdominal pain, nausea, vomiting (green from bile), pulling legs to the chest, and cramping abdominal pain. Pain is intermittent because the bowel segment transiently stops contracting. • Option D: A sausage-shaped mass may be palpated in the right upper quadrant. Almost all intussusceptions occur with the intussusceptum having been located proximally to the intussuscipiens. This is because a peristaltic action of the intestine pulls the proximal segment into the distal segment. 6. 6. Question Nurse Barry is performing Leopold’s maneuver and found the following: breech presentation, fetal back at the right side of the mother. Based on these findings, the nurse can hear the fetal heartbeat (PMI) best in which location? • A. Left lower quadrant • B. Right lower quadrant • C. Left upper quadrant • D. Right upper quadrant Incorrect Correct Answer: B. Right lower quadrant Right lower quadrant. The landmark to look for when looking for PMI is the location of the fetal back in relation to the right or left side of the mother and the presentation, whether cephalic or breech. The best site is the fetal back nearest the head. • Option A: The fetal limbs may be palpated at the left lower quadrant. • Option C: The fetal head may be facing the direction of the left upper quadrant. • Option D: The right upper quadrant has the fetal back, but it is nearer to the lower extremities of the fetus. 7. 7. Question In Leopold’s maneuver step #1, the nurse palpated a soft, broad mass that moves with the rest of the mass. The correct interpretation of this finding is: • A. The mass palpated at the fundal part is the head part. • B. The presentation is breech. • C. The mass palpated is the back. • D. The mass palpated is the buttocks. Incorrect Correct Answer: D. The mass palpated is the buttocks. The palpated mass is the fetal buttocks since it is broad and soft and moves with the rest of the mass. The first maneuver also called the fundal grip, assesses the uterine fundus to determine its height and which fetal pole—that is, cephalic or podalic—occupies the fundus. • Option A: The head feels hard and round with a smooth surface of uniform consistency, is very mobile and ballotable. • Option B: The breech gives the sensation of a large, nodular mass, and its surface is uneven, non-ballotable, and not very mobile. The first maneuver aims to determine the gestational age and the fetal lie. • Option C: The uterine fundus is pressed with force using one hand, which accentuates the curvature of the fetal back, allowing for easier palpation with the other hand. The fetal heart can be auscultated at this time, which can also provide information on fetal orientation. The heart is well perceived when the stethoscope or the doppler transducer is placed on the back of the fetus. 8. 8. Question In Leopold’s maneuver step #3, the nurse palpated a hard round movable mass at the suprapubic area. The correct interpretation is that the mass palpated is: • A. The buttocks because the presentation is breech. • B. The mass palpated is the head. • C. The mass is the fetal back. • D. The mass palpated is the small fetal part. Incorrect Correct Answer: B. The mass palpated is the head. When the mass palpated is hard round and movable, it is the fetal head. The head feels hard and round with a smooth surface of uniform consistency, is very mobile and ballotable. The third maneuver aids in confirmation of fetal presentation. The first Pawlík grip, sometimes called the first pelvic grip, helps to define which presenting part of the fetus is situated in the hypogastrium. • Option A: The palpated mass is the fetal buttocks since it is broad and soft and moves with the rest of the mass. • Option C: The uterine fundus is pressed with force using one hand, which accentuates the curvature of the fetal back, allowing for easier palpation with the other hand. The fetal heart can be auscultated at this time, which can also provide information on fetal orientation. The heart is well perceived when the stethoscope or the doppler transducer is placed on the back of the fetus. • Option D: The second maneuver, sometimes called the umbilical grip, involves palpation of the lateral uterine surfaces. Still facing the maternal xiphoid cartilage, both hands slide down from the uterine fundus towards the lateral uterine walls. The clinician’s hands are placed flat and parallel to each other along the abdominal wall at the level of the umbilicus. It allows establishing if the fetus is in a longitudinal, transverse, or oblique situation, and to determine the position of the back and small parts. 9. 9. Question The hormone responsible for a positive pregnancy test is: • A. Estrogen • B. Progesterone • C. Human Chorionic Gonadotropin • D. Follicle Stimulating Hormone Incorrect Correct Answer: C. Human Chorionic Gonadotropin Human chorionic gonadotropin (HCG) is the hormone secreted by the chorionic villi which is the precursor of the placenta. In the early stage of pregnancy, while the placenta is not yet fully developed, the major hormone that sustains the pregnancy is HCG. • Option A: Estrogen helps control the menstrual cycle and is important for childbearing. Estrogen also has other functions: it keeps cholesterol in control and protects bone health for both women and men. • Option B: Progesterone prepares the endometrium for the potential of pregnancy after ovulation. It triggers the lining to thicken to accept a fertilized egg. It also prohibits the muscle contractions in the uterus that would cause the body to reject an egg. • Option D: In women, FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation. In men, FSH helps control the production of sperm. 10. 10. Question The hormone responsible for the maturation of the Graafian follicle is: • A. Follicle-stimulating hormone • B. Progesterone • C. Estrogen • D. Luteinizing hormone Incorrect Correct Answer: A. Follicle-stimulating hormone The hormone that stimulates the maturation of the Graafian follicle is the Follicle Stimulating Hormone which is released by the anterior pituitary gland. • Option B: Progesterone prepares the endometrium for the potential of pregnancy after ovulation. It triggers the lining to thicken to accept a fertilized egg. It also prohibits the muscle contractions in the uterus that would cause the body to reject an egg. • Option C: Estrogen helps control the menstrual cycle and is important for childbearing. Estrogen also has other functions: it keeps cholesterol in control and protects bone health for both women and men. • Option D: Luteinizing hormone is crucial in regulating the function of the testes in men and ovaries in women. In men, luteinizing hormone stimulates Leydig cells in the testes to produce testosterone, which acts locally to support sperm production. 11. 11. Question The most common normal position of the fetus in utero is: • A. Transverse position • B. Vertical position • C. Oblique position • D. None of the above Incorrect Correct Answer: B. Vertical position Vertical position means the fetal spine is parallel to the maternal spine thus making it easy for the fetus to go out of the birth canal. Most babies are lying vertically by the seventh month, with the baby’s head towards the cervix of the uterus. This is the safest position for normal delivery. • Option A: The transverse lie position is where the fetus’s head is on one side of the mother’s body and the feet on the other, rather than having the head close to the cervix or close to the heart. The fetus can also be slightly at an angle, but still more sideways, than up or down. • Option C: If a fetus is lying diagonally across the uterus, the position is called oblique. It’s very unusual for a fetus to stay in this position right up until labor. Only one percent of babies will be transverse or oblique. 12. 12. Question In the later part of the 3rd trimester, the mother may experience shortness of breath. This complaint may be explained as: • A. A normal occurrence in pregnancy because the fetus is using more oxygen. • B. The fundus of the uterus is high pushing the diaphragm upwards. • C. The woman is having an allergic reaction to the pregnancy and its hormones. • D. The woman may be experiencing complications of pregnancy. Incorrect Correct Answer: B. The fundus of the uterus is high pushing the diaphragm upwards From the 32nd week of the pregnancy, the fundus of the enlarged uterus is pushing the respiratory diaphragm upwards. Thus, the lungs have reduced space for expansion consequently reducing the oxygen supply. • Option A: At the same time that the lung capacity decreases due to the physical constraint of a growing uterus, the respiratory center in the brain is stimulated by the hormone progesterone to get the pregnant woman to take slower breaths. Progesterone is released during pregnancy. Although each breath may bring in less air, the air stays in the lungs longer so that the woman can extract the oxygen she and her baby needs. • Option C: Swelling or narrowing of the throat or the airways to the lungs can cause wheezing. It can also result in shortness of breath because the lungs can’t hold as much air when they are affected by swelling or mucus buildup. • Option D: If asthma cannot be controlled, the woman may be at risk for a serious health problem called preeclampsia. Preeclampsia is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Some of these signs include having protein in the urine, changes in vision, and severe headache. 13. 13. Question Which of the following findings in a woman would be consistent with a pregnancy of two months duration? • A. Weight gain of 6-10 lbs. And the presence of striae gravidarum. • B. Fullness of the breast and urinary frequency. • C. Braxton Hicks contractions and quickening. • D. Increased respiratory rate and ballottement. Incorrect Correct Answer: B. Fullness of the breast and urinary frequency. The fullness of the breast is due to the increased amount of progesterone in pregnancy. The urinary frequency is caused by the compression of the urinary bladder by the gravid uterus which is still within the pelvic cavity during the first trimester. • Option A: In the first trimester, most women don’t need to gain much weight — which is good news if she is struggling with morning sickness. If the woman starts out at a healthy or normal weight, she needs to gain only about 1 to 4 pounds (0.5 to 1.8 kilograms) in the first few months of pregnancy. • 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: Minute ventilation (V?E) starts to increase significantly (by up to 48%) during the first trimester of gestation, due to higher tidal volume (VT) with unchanged respiratory rate. This ventilatory pattern is then maintained throughout the course of pregnancy. Ballottement is a sharp upward push against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus also. 14. 14. Question Which of the following is a positive sign of pregnancy? • A. Fetal movement felt by mother • B. Enlargement of the uterus • C. (+) pregnancy test • D. (+) ultrasound Incorrect Correct Answer: D. (+) ultrasound A positive ultrasound will confirm that a woman is pregnant since the fetus in utero is directly visualized. • Option A: 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. 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. • Option B: From conception to delivery, a woman’s uterus can grow from the size of a pear to the size of a watermelon. But pregnancy isn’t the only potential reason for an enlarged uterus. An enlarged uterus is common and can be a symptom of a variety of medical conditions, some of which require treatment. • Option C: An elevated ?-hCG in the absence of viable pregnancy can occur for multiple reasons and has a broad differential diagnosis including miscarriage, ectopic pregnancy, pituitary hCG production, trophoblastic disease, and phantom hCG. 15. 15. Question What event occurring in the second trimester helps the expectant mother to accept the pregnancy? • A. Lightening • B. Ballotment • C. Pseudocyesis • D. Quickening Incorrect Correct Answer: D. Quickening Quickening is the first fetal movement felt by the mother that makes the woman realize that she is truly pregnant. In early pregnancy, the fetus is moving but too weak to be felt by the mother. In the 18th-20th week of gestation, the fetal movements become stronger thus the mother already feels the movements. • Option A: Lightening is one of the major signs that labor is approaching. It happens when the baby’s head literally “drops” lower into the pelvis, becoming engaged within the pubic bones. This starts the baby’s descent down and out into the world. Lightening can start as early as a few weeks before labor actually begins. • Option B: Ballottement is a sharp upward push against the uterine wall with a finger inserted into the vagina for diagnosing pregnancy by feeling the return impact of the displaced fetus also. • Option C: Pseudocyesis is defined by the DSM-5 as a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy, which may include abdominal enlargement, reduced menstrual flow, amenorrhea, subjective sensation of fetal movement, nausea, breast engorgement and secretions, and labor pains at the expected date of delivery. 16. 16. Question Shoes with low, broad heels, plus a good posture will prevent which prenatal discomfort? • A. Backache • B. Vertigo • C. Leg cramps • D. Nausea Incorrect Correct Answer: A. Backache Backache usually occurs in the lumbar area and becomes more problematic as the uterus enlarges. The pregnant woman in her third trimester usually assumes a lordotic posture to maintain balance causing an exaggeration of the lumbar curvature. Low broad heels provide the pregnant woman with good support. • Option B: Neurotologists and gynecologists should be aware of pregnant women with vertigo. To improve the quality of life during gestation, clinicians should consider this pathology in their differential diagnosis, which will help avoid vertigo-related undesirable conditions that may compromise both maternal and fetal status. • Option C: It may have to do with changes in blood circulation and stress on the leg muscles from carrying extra weight. A growing baby also puts pressure on the nerves and blood vessels that go to the legs. And some doctors say low calcium, or a change in the way the body processes calcium, may cause cramps. • Option D: The pathophysiology of nausea and vomiting during early pregnancy is unknown, although metabolic, endocrine, GI, and psychologic factors probably all play a role. Estrogen may contribute because estrogen levels are elevated in patients with hyperemesis gravidarum. 17. 17. Question When a pregnant woman experiences leg cramps, the correct nursing intervention to relieve the muscle cramps is: • A. Allow the woman to exercise. • B. Let the woman walk for a while. • C. Let the woman lie down and dorsiflex the foot towards the knees. • D. Ask the woman to raise her legs. Incorrect Correct Answer: C. Let the woman lie down and dorsiflex the foot towards the knees Leg cramps are caused by the contraction of the gastrocnemius (leg muscle). Thus, the intervention is to stretch the muscle by dorsiflexing the foot of the affected leg towards the knee. • Option A: During pregnancy, exercise can reduce backaches, constipation, bloating, and swelling; boost the mood and energy levels; help the woman sleep better; prevent excess weight gain; and promote muscle tone, strength, and endurance. • Option B: For most pregnant women, at least 30 minutes of moderate-intensity exercise is recommended on most, if not all, days of the week. Walking is a great exercise for beginners. It provides moderate aerobic conditioning with minimal stress on the joints. • Option D: Elevating the legs is a great way to relieve leg pain during pregnancy. Lie back on the couch or bed and place both legs on a pillow. Raising both legs just 6-12 inches above the heart allows gravity to help pull the blood back toward the heart. 18. 18. Question From the 33rd week of gestation till full term, a healthy mother should have a prenatal check-up every: • A. Week • B. 2 weeks • C. 3 weeks • D. 4 weeks Incorrect Correct Answer: A. Week In the 9th month of pregnancy, the mother needs to have a weekly visit to the prenatal clinic to monitor fetal condition and to ensure that she is adequately prepared for the impending labor and delivery. • Option B: Starting from week 28 to week 36 of pregnancy, the woman should have a prenatal visit every 2 weeks. The healthcare provider will probably measure the height of the woman’s uterus, which can very much help to determine how big the baby is growing. The healthcare provider will also listen to her heart rate with a fetal doppler. In addition, if the pregnant woman did not undergo any screening at her last appointment, the healthcare provider may recommend that she takes a test like the quad screen, which can identify possible cases of chromosomal, or other developmental abnormalities. • Option C: In the third trimester, the pregnant woman will have a prenatal visit every 2 weeks until week 36. After that, she will see her provider every week. • Option D: The next prenatal visits — often scheduled about every four weeks during the first trimester — might be shorter than the first. Near the end of the first trimester — by about 12 to 14 weeks of pregnancy — the woman might be able to hear her baby’s heartbeat with a small device that bounces sound waves off the baby’s heart (Doppler). 19. 19. Question The expected weight gain in a normal pregnancy during the 3rd trimester is: • A. 1 pound a week • B. 2 pounds a week • C. 10 lbs a month • D. 10 lbs total weight gain in the 3rd trimester Incorrect Correct Answer: A. 1 pound a week During the 3rd trimester, the fetus is gaining more subcutaneous fat and is growing fast in preparation for extrauterine life. Thus, one pound a week is expected. • Option B: In the first trimester, most women don’t need to gain much weight — which is good news if she is struggling with morning sickness. If a pregnant woman starts out at a healthy or normal weight, she needs to gain only about 1 to 4 pounds (0.5 to 1.8 kilograms) in the first few months of pregnancy. • Option C: Gaining too much weight during pregnancy can increase the baby’s risk of health problems, such as being born significantly larger than average (fetal macrosomia). The woman might also be at increased risk of pregnancy-related hypertension, gestational diabetes, prolonged labor, and the need for a C-section or delivery before her due date. Excessive weight gain during pregnancy can also increase the risk of postpartum weight retention and increases the risk of blood clots in the postpartum period. • Option D: Steady weight gain is more important in the second and third trimesters — especially if a pregnant woman starts out at a healthy weight or she is underweight. According to the guidelines, the pregnant woman will gain about 1 pound (0.5 kilogram) a week until delivery. An extra 300 calories a day — half a sandwich and a glass of skim milk — might be enough to help her meet this goal. 20. 20. Question In Bartholomew’s Rule of 4, when the level of the fundus is midway between the umbilicus and xiphoid process the estimated age of gestation (AOG) is: • A. 5th month • B. 6th month • C. 7th month • D. 8th month Incorrect Correct Answer: C. 7th month In Bartholomew’s Rule of 4, the landmarks used are the symphysis pubis, umbilicus, and xiphoid process. At the level of the umbilicus, the AOG is approximately 5 months and at the level of the xiphoid process 9 months. Thus, midway between these two landmarks would be considered as 7 months AOG. • Option A: The uterus has been described as a soft and globular pelvic organ. In pregnancy, the uterus increases in size to accommodate the developing fetus. At approximately 12 weeks gestation the uterus becomes large enough to be palpable just above the pubic symphysis. • Option B: At 16 weeks gestation, the fundus of the uterus can be palpated at the midpoint between the umbilicus and the pubic symphysis. • Option D: At 20 weeks gestation, the fundus can be palpable at the level of the umbilicus. After 20 weeks of gestation, the pubic symphysis to fundal height in centimeters should correlate with the week of gestation. 21. 21. Question The following are ways of determining the expected date of delivery (EDD) when the LMP is unknown EXCEPT: • A. Naegele’s rule • B. Quickening • C. McDonald’s rule • D. Batholomew’s rule of 4 Incorrect Correct Answer: A. Naegele’s rule Naegele’s Rule is determined based on the last menstrual period of the woman. Establish the date of the last menstrual period by obtaining a history from the patient. From this date, add 1 year and 7 days, then subtract 3 months. This will approximate the estimated delivery date. The date of the last known menstrual period will give the approximate start date for the age of the fetus. • Option B: 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. 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. • Option C: Fundal height, or McDonald’s rule, is a measure of the size of the uterus used to assess fetal growth and development during pregnancy. It is measured from the top of the mother’s uterus to the top of the mother’s pubic symphysis. • Option D: In Bartholomew’s Rule of 4, the landmarks used are the symphysis pubis, umbilicus, and xiphoid process. 22. 22. Question If the LMP is Jan. 30, the expected date of delivery (EDD) is: • A. Oct. 7 • B. Oct. 24 • C. Nov. 7 • D. Nov. 8 Incorrect Correct Answer: C. Nov. 7 Based on the last menstrual period, the expected date of delivery is Nov. 7. The formula for Naegele’s Rule is to subtract 3 from the month and add 7 to the day. • Option A: This is an incorrect EDD. 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: Oct 24 is incorrect. 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: Nov 8 is not the correct, exact EDD. Having accurate birth dating might decrease maternal/fetal morbidity and or mortality through timely consulting with experts in the field of maternal-fetal medicine, obstetrics/gynecology, oncology, or genetics. For example, fetal genetic abnormalities can be detected in a timely fashion providing the mother with sufficient time to make a lifetime decision. 23. 23. Question Kegel’s exercise is done in pregnancy in order to: • A. Strengthen perineal muscles. • B. Relieve backache. • C. Strengthen abdominal muscles. • D. Prevent leg varicosities and edema. Incorrect Correct Answer: A. Strengthen perineal muscles Kegel’s exercise is done by contracting and relaxing the muscles surrounding the vagina and anus in order to strengthen the perineal muscles. • Option B: The expanding uterus shifts the center of gravity and stretches out and weakens the abdominal muscles. This changes the pregnant woman’s posture and puts a strain on her back. Wear supportive clothing and shoes. Pay attention to position when sitting, sleeping, and lifting things. If the woman needs to stand for a long time, rest one foot on a stool or a box to take the strain off the back. She also can use heat or cold to soothe sore muscles. • Option C: The abdominal muscles support the spine and play an important role in the health of the back. During pregnancy, these muscles stretch and weaken. These changes also can increase the risk of hurting the back during exercise. Look for an abdominal support garment. It looks like a girdle and helps take the weight of the belly of the back muscles. Also, some maternity pants come with a wide elastic band that fits under the curve of the belly to help support its weight. • Option D: Varicose veins occur when veins of the legs swell. Many changes in pregnancy can increase the risk of varicose veins, such as increased blood volume, which enlarges the vein; the heavyweight of the growing baby, which presses on the large blood vessels in the pelvis; and altering blood flow. Most varicose veins that develop during pregnancy get better within the first year after birth. But for now, the pregnant woman should limit standing or sitting for a long time without a break, and try not to cross the legs. She should also try to raise her legs and feet whenever she is sitting or lying down. 24. 24. Question Pelvic rocking is an appropriate exercise in pregnancy to relieve which discomfort? • A. Leg cramps • B. Urinary frequency • C. Orthostatic hypotension • D. Backache Incorrect Correct Answer: D. Backache Backache is caused by the stretching of the muscles of the lower back because of the pregnancy. Pelvic rocking is good to relieve backache. • Option A: Straightening the leg and flexing the foot helps when a pregnant woman gets a cramp. A gentle massage of the calf may help relax the muscle. Make sure there is enough fluid intake during the day. If cleared by the doctor, get regular exercise, which can help reduce cramps. • Option B: HCG increases the blood flow to the pelvic area, which in turn increases the pregnant woman’s need to pee. The growing uterus also puts pressure on the bladder, giving it less room to store urine. To prevent frequent urination, the pregnant woman should already empty her bladder every time she urinates. She should also skip diuretics like caffeine, and try to limit fluids right before bedtime. • Option C: It’s not uncommon to have a drop in blood pressure during pregnancy. Many women don’t realize that pregnancy can have an effect on blood pressure. It occurs because the circulation expands during pregnancy and hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure. The woman should take time to wake up slowly in the morning to prevent dizziness or fainting. If she does feel faint, she should sit or lie down gently to avoid falling and take steady breaths. Lying on the left side may also help increase blood flow to the heart, which may help stabilize the body. 25. 25. Question The main reason for an expected increased need for iron in pregnancy is: • A. The mother may have physiologic anemia due to the increased need for red blood cell mass as well as the fetal requires about 350-400 mg of iron to grow. • B. The mother may suffer anemia because of poor appetite. • C. The fetus has an increased need for RBC which the mother must supply. • D. The mother may have a problem with digestion because of pica. Incorrect Correct Answer: A. The mother may have physiologic anemia due to the increased need for red blood cell mass, as well as the fetal, requires about 350-400 mg of iron to grow. About 400 mg of iron is needed by the mother in order to produce more RBC mass to be able to provide the needed increase in blood supply for the fetus. Also, about 350-400 mg of iron is needed for the normal growth of the fetus. Thus, about 750-800 mg iron supplementation is needed by the mother to meet this additional requirement. • Option B: If the woman loses her appetite, she may experience a general disinterest in all foods or a lack of desire to eat. Keep in mind that appetite loss differs from an aversion to a few specific foods, which is also fairly common during pregnancy. Pregnant women with chronically poor appetites run a risk of anemia, fetal growth abnormalities, and preterm birth. • Option C: Anemia during pregnancy is especially a concern because it is associated with low birth weight, premature birth, and maternal mortality. Women who are pregnant are at a higher risk for developing anemia due to the excess amount of blood the body produces to help provide nutrients for the baby. • Option D: Pica is the practice of craving substances with little or no nutritional value. Most pregnancy and pica-related cravings involve non-food substances such as dirt or chalk. Eating non-food substances is potentially harmful to both the mother and the baby. Eating non-food substances may interfere with the nutrient absorption of healthy food substances and actually cause a deficiency. 26. 26. Question The diet that is appropriate in normal pregnancy should be high in: • A. Protein, minerals, and vitamins • B. Carbohydrates and vitamins • C. Proteins, carbohydrates, and fats • D. Fats and minerals Incorrect Correct Answer: A. Protein, minerals, and vitamins In a normal pregnancy, there is a higher demand for protein (bodybuilding foods), vitamins (esp. vitamin A, B, C, folic acid), and minerals (esp. iron, calcium, phosphorous, zinc, iodine, magnesium) because of the need of the growing fetus. • Option B: Maternal glucose is substantially influenced by the type of carbohydrates in the diet through its direct effect on glycemia. The rate at which each carbohydrate raises blood glucose levels after ingestion can be measured via the dietary glycemic index (GI). Carbohydrate type and the GI of the diet enhance or inhibit abnormal hyperglycemia during pregnancy caused by either pathological conditions or the inability of the mother to cope with the physiological IR of pregnancy. • Option C: During pregnancy, the body needs more fat. Roughly 25 percent to 35 percent of the daily calories should come from fat, depending on the woman’s carbohydrate goals. Eating monounsaturated fat is preferred over saturated varieties. • Option D: Unsaturated fats provide vital nutrients to help build and develop cells in both the woman’s body and her baby’s. Polyunsaturated fats are rich in omega-3s — EPA (or eicosapentaenoic acid, found in plant sources) and DHA (or docosahexaenoic acid, found in fish) — to help develop and sustain the health of the baby’s heart, immune system, brain, eyes, and more. Some monounsaturated fats may also be a good source of folate, otherwise known as folic acid, which helps protect the baby against birth defects 27. 27. Question Which of the following signs will require a mother to seek immediate medical attention? • A. When the first fetal movement is felt. • B. No fetal movement is felt on the 6th month. • C. Mild uterine contraction. • D. Slight dyspnea on the last month of gestation. Incorrect Correct Answer: B. No fetal movement is felt on the 6th month. Fetal movement is usually felt by the mother during 4.5 – 5 months. If the pregnancy is already in its 6th month and no fetal movement is felt, the pregnancy is not normal either the fetus is already dead intra-uterine or it is an H-mole. • Option A: 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. 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. • Option C: Sometime during the second or third trimester, the woman might start to feel mild, sporadic contractions, especially when she is tired or dehydrated, or after sex. These normal contractions, called Braxton Hicks contractions or false labor, are the body’s way of rehearsing for birth. • Option D: In the first few weeks of pregnancy, a normal increase in the hormone progesterone causes the woman to breathe more often. This can look and feel like shortness of breath. This hormone expands the lung capacity, allowing blood to carry large quantities of oxygen to the baby. 28. 28. Question You want to perform a pelvic examination on one of your pregnant clients. You prepare your client for the procedure by: • A. Asking her to void. • B. Taking her vital signs and recording the readings. • C. Giving the client perineal care. • D. Doing a vaginal prep. Incorrect Correct Answer: A. Asking her to void. A pelvic examination includes abdominal palpation. If the pregnant woman has a full bladder, the manipulation may cause discomfort and accidental urination because of the pressure applied during the abdominal palpation. Also, a full bladder can impede the accuracy of the examination because the bladder (which is located in front of the uterus) can block the uterus. • Option B: A pelvic exam is a procedure followed by the physician to examine the vaginal area and the adjoining regions of the pelvis. General anesthesia is usually given prior to the pelvic exam. Also, the vaginal fluids may be collected during a pelvic exam to check for any infections. The vulva, uterus, cervix, ovaries, bladder, or even rectum is checked when a pregnant woman undergoes a pelvic exam. • Option C: Because the pelvic organs, including the uterus and ovaries, can’t be seen from outside the body, the doctor needs to feel (palpate) the abdomen and pelvis for this part of the exam. The doctor will insert two lubricated, gloved fingers into the vagina with one hand, while the other hand presses gently on the outside of the lower abdomen. • Option D: During this part of the exam, the doctor will check the size and shape of the uterus and ovaries, noting any tender areas or unusual growths. After the vaginal exam, the doctor will insert a gloved finger into the rectum to check for tenderness, growth, or other irregularities. 29. 29. Question When preparing the mother who is in her 4th month of pregnancy for an abdominal ultrasound, the nurse should instruct her to: • A. Observe NPO from midnight to avoid vomiting. • B. Do perineal flushing properly before the procedure. • C. Drink at least 2 liters of fluid 2 hours before the procedure and not void until the procedure is done. • D. Void immediately before the procedure for better visualization. Incorrect Correct Answer: C. Drink at least 2 liters of fluid 2 hours before the procedure and not void until the procedure is done. Drinking at least 2 liters of water 2 hours before the procedure will result in a distended bladder. A full bladder is needed when doing an abdominal ultrasound to serve as a “window” for the ultrasonic sound waves to pass through and allow visualization of the uterus (located behind the urinary bladder). • Option A: Eat a low-fat dinner on the evening before the examination- (no fried, fatty or greasy foods and no dairy products) and nothing to eat or drink for 12 hours prior to the appointment. • Option B: There is no need for perineal flushing. The sonographer gently presses the transducer against the stomach area, moving it back and forth. The device sends signals to a computer, which creates images that show how blood flows through the structures in the abdomen. • Option D: Food and liquids in the stomach (and urine in the bladder) can make it difficult for the technician to get a clear picture of the structures in the abdomen. 30. 30. Question The nursing intervention to relieve “morning sickness” in a pregnant woman is by giving: • A. Dry carbohydrate food like crackers • B. Low sodium diet • C. Intravenous infusion • D. Antacid Incorrect Correct Answer: A. Dry carbohydrate food like crackers Morning sickness may be caused by hypoglycemia early in the morning thus giving carbohydrate food will help. Foods high in starch — such as saltines, bread, and toast — help absorb gastric acid and settle a queasy stomach. The bland nature of a cracker helps to satisfy hunger (excessive hunger can exacerbate nausea) without the strong smells or tastes that may increase nausea, according to Erin Palinski-Wade, RD, CDE. • Option B: A beverage containing sodium, such as a broth, may also help to promote hydration — which is important when the woman may be dehydrated from vomiting. • Option C: In treating ailments like cramping, electrolyte loss, dehydration, and nausea, mobile IV drip therapy can effectively and quickly relieve even the most persistent cases of stomach upset. Nausea, especially when persistent, can significantly affect daily life. Intravenous fluid administration (20-30 mL/kg of isotonic sodium chloride 0.9% solution over 1-2 h) may also be used until oral rehydration is tolerated. • Option D: Antacids containing aluminum, calcium, and magnesium were not found to be teratogenic in animal studies and are recommended as first-line treatment of heartburn and acid reflux during pregnancy. 31. 31. Question The common normal site of nidation/implantation in the uterus is: • A. Upper uterine portion • B. Mid-uterine area • C. Lower uterine segment • D. Lower cervical segment Incorrect Correct Answer: A. Upper uterine portion The embryo’s normal nidation site is the upper portion of the uterus. If the implantation is in the lower segment, this is an abnormal condition called placenta previa. • Option B: Implantation begins with apposition of the blastocyst at the uterine epithelium, generally about 2-4 days after the morula enters the uterine cavity. The implantation site in the human uterus is usually in the upper and posterior wall in the midsagittal plane. • Option C: When the implantation takes place in the lower part of the uterus, the placenta will later develop in the cervix uteri. This type of implantation is called placenta previa. A birth through the birth canal would detach the placenta before the fetus is born. This can lead to serious hemorrhages. • Option D: Aberrant implantation in the lower segment of the human uterus can occur in the cervix, cervico-isthmus (close to internal os of the uterine cervix), and previous cesarean scars. Cervical pregnancy (CP) is a rare form of ectopic pregnancy and its incidence is about 1 in 1000 to 1 in 18,000 live births 32. 32. Question Mrs. Santos is on her 5th pregnancy and has a history of abortion in the 4th pregnancy, and the first pregnancy was a twin. She is considered to be: • A. G 4 P 3 • B. G 5 P 3 • C. G 5 P 4 • D. G 4 P 4 Incorrect Correct Answer: B. G 5 P 3 Gravida refers to the total number of pregnancies including the current one. Para refers to the number of pregnancies that have reached viability. Thus, if the woman has had one abortion, she would be considered Para 3. Twin pregnancy is counted only as 1. • Option A: Gravida should be 5 since the woman is on her 5th pregnancy. • Option C: Para should be 3 because twin pregnancies are counted as one and the woman has one abortion. • Option D: Gravida should be 5 since the woman is on her 5th pregnancy. 33. 33. Question The following are skin changes in pregnancy EXCEPT: • A. Chloasma • B. Striae gravidarum • C. Linea negra • D. Chadwick’s sign Incorrect Correct Answer: D. Chadwick’s sign Chadwick’s sign is bluish discoloration of the vaginal mucosa as a result of the increased vascularization in the area. • Option A: It is also sometimes known as ‘melasma’ or the ‘mask of pregnancy’. Chloasma is thought to be due to stimulation of pigment-producing cells by female sex hormones so that they produce more melanin pigments (dark colored pigments) when the skin is exposed to the sun. • Option B: Striae gravidarum (SG) are atrophic linear scars that represent one of the most common connective tissue changes during pregnancy. Histologically, the appearance of SG is similar to striae distensae (SD) and contingent on lesion age. Early on, active lesions are comprised predominantly of fine elastic fibers but aging lesions demonstrate a thinning of the dermis and decrease of collagen content in the upper dermis • Option C: Linea Nigra is the dark line that develops across the belly during pregnancy. The specific cause of the linea nigra is unknown, but it is believed to be related to the changing hormones or the imbalance of hormones as a result of the developing baby. One theory is that the melanocyte-stimulating hormone created by the placenta is the main contributing factor. 34. 34. Question Which of the following statements is TRUE of conception? • A. Within 2-4 hours after intercourse, conception is possible in a fertile woman. • B. Generally, fertilization is possible 4 days after ovulation. • C. Conception is possible during menstruation in a long menstrual cycle. • D. To avoid conception, intercourse must be avoided 5 days before and 3 days after menstruation. Incorrect Correct Answer: A. Within 2-4 hours after intercourse conception is possible in a fertile woman. The sperms when deposited near the cervical os will be able to reach the fallopian tubes within 4 hours. If the woman has just ovulated (within 24hours after the rupture of the Graafian follicle), fertilization is possible. • Option B: Following ovulation, the egg is capable of fertilization for only 12 to 24 hours. Contact between the egg and sperm is random. Once the egg arrives at a specific portion of the tube, called the ampullary-isthmic junction, it rests for another 30 hours. • Option C: Conception during menstrual period is unlikely because the ovulation time is several days away, decreasing any chances of getting pregnant during this time. However, there are exceptions. This applies to women who have a typical 28 to 30 day or longer cycle. If the woman has a shorter cycle, that means that she may ovulate earlier in the cycle. • Option D: The likelihood of getting pregnant right before menstruation is extremely low. For women with a typical 28- to 30-day cycle or longer and their cycles are regular, it is fairly safe to say that ovulation occurred between Day 11 and Day 21. The egg is only available for 12 to 24 hours for conception. 35. 35. Question Which of the following are the functions of amniotic fluid? Select all that apply. • A. Cushions the fetus from abdominal trauma • B. Serves as the fluid for the fetus • C. Maintains the internal temperature • D. Facilitates fetal movement Incorrect Correct Answer: A, B, C, & D All the four functions enumerated are true of amniotic fluid. Amniotic fluid surrounds the embryo and fetus during development and has a myriad of functions. • Option A: Physically, it protects the fetus in the event the maternal abdomen is the object of trauma. It protects the umbilical cord by providing a cushion between the fetus and the umbilical cord thus reducing risk of compression between the fetus and the uterine wall. • Option B: It serves as a reservoir of fluid and nutrients for the fetus containing: proteins, electrolytes, immunoglobulins, and vitamins from the mother. Option C: The fluid insulates the fetus, keeping it warm and maintaining a regular temperature. • Option D: It provides the necessary fluid, space, and growth factors to allow normal development and growth of fetal organs such as the musculoskeletal system, gastrointestinal system, and pulmonary system. 36. 36. Question You are performing an abdominal exam on a 9th-month pregnant woman. While lying supine, she felt breathless, had pallor, tachycardia, and cold clammy skin. The correct assessment of the woman’s condition is that she is: • A. Experiencing the beginning of labor. • B. Having supine hypotension. • C. Having sudden elevation of BP. • D. Going into shock. Incorrect Correct Answer: B. Having supine hypotension. Supine hypotension is characterized by breathlessness, pallor, tachycardia, and cold, clammy skin. This is due to the compression of the abdominal aorta by the gravid uterus when the woman is in a supine position. • Option A: The woman may be at the beginning of labor if the fetus drops or moves lower into the pelvis, increase in vaginal discharge that is clear, pink, or slightly bloody, and cervical effacement and dilatation occurs. • Option C: Preeclampsia occurs when hypertension develops after 20 weeks of pregnancy and is associated with signs of damage to other organ systems, including the kidneys, liver, blood, or brain. Untreated preeclampsia can lead to serious — even fatal — complications for mother and baby, including development of seizures (eclampsia). • Option D: Shock is a state of compromised tissue perfusion that causes cellular hypoxia and is defined as a syndrome initiated by acute hypoperfusion, leading to tissue hypoxia and vital organ dysfunction. The treatment of shock in a pregnant woman differs in two important respects from the treatment of shock in other adults. [1] First, normal physiologic changes occur in most organ systems during pregnancy. Second, the mother and the fetus are both vulnerable during pregnancy. Therefore, obstetric critical care involves simultaneous assessment and management of the mother and fetus, who have differing physiological profiles. 37. 37. Question Smoking is contraindicated in pregnancy because: • A. Nicotine causes vasodilation of the mother’s blood vessels. • B. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus. • C. The smoke will make the fetus, and the mother feels dizzy. • D. Nicotine will cause vasoconstriction of the fetal blood vessels. Incorrect Correct Answer: B. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus. Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus. • Option A: There is blood flow restriction to the placenta due to the vasoconstrictive effects of catecholamines released from the adrenals and nerve cells after nicotine activation. • Option C: Nicotine is rapidly absorbed when the tobacco smoke reaches the small airways and alveoli of the lung. This causes a quick rise in blood nicotine concentrations, but due to the eventual burnout of the cigarette, these levels also peak early and thereafter drop to lower levels. • Option D: Direct effects on nicotinic acetylcholine receptors (nAChRs), which are present and functional very early in the fetal brain [5] are also likely to contribute. 38. 38. Question Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy? • A. Large for gestational age (LGA) fetus • B. Hemorrhage • C. Small for gestational age (SGA) baby • D. Erythroblastosis fetalis Incorrect Correct Answer: C. Small for gestational age (SGA) baby Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus. • Option A: Women who gain a lot of weight during pregnancy often give birth to babies who are large for gestational age. Diabetes in the mother is the most common cause of babies who are large for gestational age. When a pregnant woman has high blood sugar, she can pass that along to her baby. • Option B: Subchorionic bleeding affects the chorionic membranes. These lift apart and form another sac between the placenta and the uterus. The movement and resulting clots are what cause this type of bleeding. These hematomas can range in size, with the smallest being most common. • Option D: Erythroblastosis fetalis is hemolytic anemia in the fetus (or neonate, as erythroblastosis neonatorum) caused by transplacental transmission of maternal antibodies to fetal red blood cells. The disorder usually results from an incompatibility between maternal and fetal blood groups, often Rho(D) antigens. 39. 39. Question Which of the following signs and symptoms will most likely make the nurse suspect that the patient has hydatidiform mole? • A. Slight bleeding • B. Passage of clear vesicular mass per vagina • C. Absence of fetal heartbeat • D. Enlargement of the uterus Incorrect Correct Answer: B. Passage of clear vesicular mass per vagina Hydatidiform mole (H-mole) is characterized by the degeneration of the chorionic villi wherein the villi becomes vesicle-like. These vesicle-like substances when expelled per vagina and is a definite sign that the woman has H-mole. • Option A: Implantation bleeding is a common cause of spotting early on in pregnancy. Implantation bleeding happens when the fertilized egg attaches to the uterine lining. This can trigger a few days of light bleeding or spotting. • Option C: If the crown-rump length (CRL) is > 7 mm and there is no embryonic cardiac activity, this is defined as a missed miscarriage, or. If the mean gestational sac diameter is > 25 mm and there is no yolk sac or embryonic pole, this is defined as an empty sac miscarriage. • Option D: Two of the most common causes of an enlarged uterus are uterine fibroids and adenomyosis. Uterine fibroids are commonly noncancerous tumors of the muscular wall of the uterus, affecting as many as eight in 10 women by the age of 50. Fibroids more commonly affect women over age 30. 40. 40. Question Upon assessment, the nurse found the following: fundus at 2 fingerbreadths above the umbilicus, last menstrual period (LMP) 5 months ago, fetal heartbeat (FHB) not appreciated. Which of the following is the most possible diagnosis of this condition? • A. Hydatidiform mole • B. Missed abortion • C. Pelvic inflammatory disease • D. Ectopic pregnancy Incorrect Correct Answer: A. Hydatidiform mole Hydatidiform mole begins as a pregnancy but early in the development of the embryo degeneration occurs. The proliferation of the vesicle-like substances is rapid causing the uterus to enlarge bigger than the expected size based on ages of gestation (AOG). In the situation given, the pregnancy is only 5 months but the size of the uterus is already above the umbilicus which is compatible with 7 months AOG. Also, no fetal heartbeat is appreciated because the pregnancy degenerated thus there is no appreciable fetal heartbeat. • Option B: A missed abortion is a nonviable intrauterine pregnancy that has been retained within the uterus without spontaneous abortion. Typically, no symptoms exist besides amenorrhea, and the patient finds out that the pregnancy stopped developing earlier when a fetal heartbeat is not observed or heard at the appropriate time. An ultrasound usually confirms the diagnosis. • Option C: Pelvic inflammatory disease (PID) is an infection of one or more of the upper reproductive organs, including the uterus, fallopian tubes, and ovaries. Untreated PID can cause scar tissue and pockets of infected fluid (abscesses) to develop in the reproductive tract, which can cause permanent damage. • Option D: An ectopic pregnancy is when a fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes. The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won’t develop into a baby and the mother’s health may be at risk if the pregnancy continues. 41. 41. Question When a pregnant woman goes into a convulsive seizure, the MOST immediate action of the nurse to ensure the safety of the patient is: • A. Apply restraint so that the patient will not fall out of bed. • B. Put a mouth gag so that the patient will not bite her tongue and the tongue will not fall back. • C. Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration. • D. Check if the woman is also having precipitate labor. Incorrect Correct Answer: C. Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration. Positioning the mother on her side will allow the secretions that may accumulate in her mouth to drain by gravity thus preventing aspiration pneumonia. • Option A: Placing a patient who is in seizure in restraints would further injure him or her. Place the patient on a flat, firm surface during seizure. • Option B: Putting a mouth gag is not safe since during the convulsive seizure the jaw will immediately lock. • Option D: The mother may go into labor also during the seizure, but the immediate concern of the nurse is the safety of the baby. After the seizure, check the perineum for signs of precipitate labor. 42. 42. Question A gravidocardiac mother is advised to observe bed rest primarily to: • A. Allow the fetus to achieve normal intrauterine growth. • B. Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother. • C. Prevent perinatal infection. • D. Reduce incidence of premature labor. Incorrect Correct Answer: B. Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother. The activity of the mother will require more oxygen consumption. Since the heart of a gravido-cardiac is compromised, there is a need to put a mother on bedrest to reduce the need for oxygen. • Option A: In cases of maternal decompensation, fetal monitoring should also be done to ensure fetal well-being. Women with moderate-risk or high-risk lesions, especially cyanotic lesions, have an increased risk of fetal growth restriction and should be followed with monthly ultrasound examinations for fetal growth. • Option C: The 2011 update to the American Heart Association guideline for the prevention of cardiovascular disease (CVD) in women recommends that risk assessment at any stage of life include a detailed history of pregnancy complications. Gestational diabetes, preeclampsia, preterm birth, and birth of an infant small for gestational age are ranked as major risk factors for CVD. • Option D: During the third trimester, cardiac output is further influenced by body position, where the supine position causes caval compression by the gravid uterus. This leads to a decrease in venous return, which can cause supine hypotension of pregnancy. Stroke volume normally increases in the first and second trimester and decreases in the third trimester. This decrease is due to partial vena cava obstruction. 43. 43. Question A pregnant mother is admitted to the hospital with the chief complaint of profuse vaginal bleeding, AOG 36 wks, not in labor. The nurse must always consider which of the following precautions: • A. The internal exam is done only at the delivery under strict asepsis with a double set-up. • B. The preferred manner of delivering the baby is vaginal. • C. An emergency delivery set for vaginal delivery must be made ready before examining the patient. • D. Internal exams must be done following routine procedures. Incorrect Correct Answer: A. The internal exam is done only at the delivery under strict asepsis with a double set-up. Painless vaginal bleeding during the third trimester may be a sign of placenta praevia. • Option B: If the bleeding is due to soft tissue injury in the birth canal, immediate vaginal delivery may still be possible so the set up for vaginal delivery will be used. • Option C: A double set-up means there is a set-up for cesarean section and a set-up for vaginal delivery to accommodate immediately the necessary type of delivery needed. In both cases, strict asepsis must be observed. • Option D: If an internal examination is done in this kind of condition, this can lead to even more bleeding and may require immediate delivery of the baby by cesarean section. 44. 44. Question Which of the following signs will distinguish threatened abortion from imminent abortion? • A. Severity of bleeding. • B. Dilation of the cervix. • C. Nature and location of pain. • D. Presence of uterine contraction. Incorrect Correct Answer: B. Dilation of the cervix In imminent abortion, the pregnancy will definitely be terminated because the cervix is already open unlike in threatened abortion where the cervix is still closed. • Option A: Nearly 25% of pregnant women have some degree of vaginal bleeding during the first two trimesters and about 50% of these progress to loss of the pregnancy. The bleeding during a threatened abortion is typically mild to moderate. • Option C: A threatened abortion occurs when a pregnant patient at less than 20 weeks gestation presents with vaginal bleeding. The cervical os is closed on a physical exam. The patient may also experience abdominal cramping, pelvic pain, pelvic pressure, and/or back pain. • Option D: A pelvic exam is mandatory to determine the type of abortion. Determining factors include the amount and site of bleeding, whether the cervix is dilated, and whether fetal tissue has passed. In a threatened abortion, the vaginal exam may reveal a closed cervical os with no tissue. There is usually no cervical motion tenderness. 45. 45. Question The nursing measure to relieve fetal distress due to maternal supine hypoten