OB-Study Guide by Chapters, Exams of Nursing

Download OB-Study Guide by Chapters and more Exams Nursing in PDF only on Docsity! OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A Chapter 1: Trends and Issues 1) Since 1995 there has been a significant decrease in the rate of infant death related to which of the following: a. Disorders associated with short gestation and low birth weight b. Accidents c. Sudden infant death d. Newborns affected by complications of placenta, cord, and membranes ANS: c 2) Tobacco use during pregnancy is associated with adverse effects on the unborn infant such as intrauterine growth restriction, preterm births, and respiratory problems. By race, which has the highest percentages of smokers? a. American Indian and Alaskan Natives b. Asian or Pacific Islanders c. Non-Hispanic blacks d. Non-Hispanic whites ANS: a Feedback a. The rates of prematurity and low birth weight are increasing. b. The rates of accidents have increased. c. Correct. The rate of infant death related to SIDS has decreased from 87.1 to 47.2. The decrease in rate is partially attributed to placing infants on their backs when sleeping. d. The rates of newborns affected by complications of placenta, cord, and membranes have increased. Feedback a. 36% of American Indian and Native American women are cigarette smokers. b. 4.3% of Asian or Pacific Islander women are cigarette smokers. c. 17.1% of non-Hispanic black women are cigarette smokers. d. 19.6% of non-Hispanic white women are cigarette smokers. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 3) Which of the following women is at the highest risk for health disparity? a. A white, middle-class, 16-year-old woman OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A a. Sudden Infant Death Syndrome b. Respiratory distress of newborns c. Disorders related to short gestation and low birth weight d. Congenital malformations and chromosomal abnormalities ANS: d Multiple Response 7) Which of the following statements are true related to teen pregnancies? (Select all that apply.) a. Teen mothers are at higher risk for HIV. b. Teen mothers are at higher risk for hypertensive problems. c. The birth rate for teenaged women has increased in the past 15 years. d. Infants born to teen mothers are at higher risk for health problems. ANS: a, b, d Health statistics report higher risk for HIV, for hypertensive problems, and for health problems to infants born to teen mothers. Birth rates for teen mothers in all age categories have decreased since 1991. Chapter 2: Ethics and Standards of Practice Issues Multiple Choice 1. An ethical dilemma unique to perinatal nursing is the:a. Innate conflict between maternal and fetal rights b. Intensive use of technologyc. Shortage of health-care resourcesd. Risk of violation of the principle of veracity ANS: a Feedback a. A unique aspect of maternity nursing is that the OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A nurse advocates for two individuals: the woman and the fetus. b. The use of technology is not unique to perinatal nursing. c. Currently, in the United States, decisions in perinatal nursing are not based on resources available. d. In perinatal nursing, the obligation to tell the truth is generally adhered to. 2. The American Nurses Association Code of Ethics for Nurses directs nurses to provide patient care that is:a. Curativeb. Utilitarianc. Negotiabled. Respectful OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: d Feedback a. Adaptation rather than cure is the goal of nursing. b. Nursing does not define the value of a person by his or her utility. c. The Code of Ethics outlines the nursing profession’s nonnegotiable ethical standard. d. Respect for the inherent dignity, worth, and uniqueness of every individual is part of the Code of Ethics. 3. Evidence-based practice is the integration of the best: a. Randomized clinical trials, clinical expertise, and patients’ requestsb. Research evidence, clinical expertise, and patients’ valuesc. Quantitative research, clinical expertise, and patients’ preferencesd. Research findings, clinical experience, and patients’ preferences ANS: b Feedback a. Evidence-based practice is the use of evidence that may include research beyond randomized clinical trials. b. These elements are the accepted definition of evidence-based practice. c. Qualitative research, as well as quantitative research, contributes to evidence-based practice. d. Clinical expertise, as well as clinical experience, defines evidence-based practice. Multiple Response OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested. Wearing a mask will not decrease the risk through ingestion of the parasite. c. Exposure to toxoplasmosis can cause fetal death, mental retardation, and blindness. d. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested. 3. The fetal circulatory structure that connects the pulmonary artery with the descending aorta is known as which of the following? a. Ductus venosus b. Foramen ovale c. Ductus arteriosus d. Internal iliac artery OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: c Feedback a. The ductus venosus connects the umbilical vein to the inferior vena cava. b. The foramen ovale is the opening between the right and left atria. c. Correct. d. The internal iliac artery connects the external iliac artery to the umbilical artery. 4. A woman at 40 weeks’ gestation has a diagnosis of oligohydramnios. Which of the following statements related to oligohydramnios is correct? a. It indicates that there is a 25% increase in amniotic fluid. b. It indicates that there is a 25% reduction of amniotic fluid. c. It indicates that there is a 50% increase in amniotic fluid. d. It indicates that there is a 50% reduction of amniotic fluid. ANS: d Feedback a. Oligohydramnios is a decrease, not an increase in amniotic fluid. b. Oligohydramnios is a 50% reduction in amniotic fluid. c. Oligohydramnios is a decrease, not an increase in amniotic fluid. d. Correct. Oligohydramnios refers to a decreased amount of amniotic fluid of less than 500 mL at term or 50% reduction of normal amounts. 5. A diagnostic test commonly used to assess problems of the fallopian tubes is: a. Endometrial biopsy b. Ovarian reserve testing c. Hysterosalpingogram d. Screening for sexually transmitted infections OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: c Feedback a. Endometrial biopsy provides information on the response of the uterus to hormonal signals. b. Ovarian reserve testing is used to assess ovulatory functioning. c. Correct. Hysterosalpingogram provides information on the endocervical canal, uterine cavity, and fallopian tubes. d. STIs can cause adhesions within the fallopian tubes, but screening cannot confirm that adhesions are present. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A d. Glomerular nephritis ANS: c 9. A nurse is teaching a woman about her menstrual cycle. The nurse states that is the most important change that happens during the secretory phase of the menstrual cycle. a. Maturation of the graafian follicle b. Multiplication of the fimbriae c. Secretion of human chorionic gonadotropin d. Proliferation of the endometrium ANS: d 10. An ultrasound of a fetus’ heart shows that “normal fetal circulation is occurring.” Which of the following statements is consistent with the finding? a. A right to left shunt is seen between the atria. Feedback a. Amblyopia rarely results from a genetic predisposition. b. A subdural hematoma does not result from a genetic defect. c. Sickle cell anemia is an autosomal recessive illness. This client needs to be seen by a genetic counselor. d. Glomerular nephritis does not result from a genetic defect. Feedback a. The maturation of the graafian follicle occurs during the follicular phase. b. There is no such thing as the multiplication of the fimbriae. c. Human chorionic gonadotropin is secreted by the fertilized ovum during the early weeks of a pregnancy. d. The proliferation of the endometrium occurs during the secretory phase of the menstrual cycle. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A b. Blood is returning to the placenta via the umbilical vein. c. Blood is returning to the right atrium from the pulmonary system. d. A right to left shunt is seen between the umbilical arteries. ANS: a Feedback a. This is correct. The foramen ovale is a duct between the atria. In fetal circulation, there is a right to left shunt through the duct. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A b. Blood returns to the placenta via the umbilical arteries. c. Most of the blood bypasses the pulmonary system. The blood that does enter the pulmonary system returns to the left atrium. d. There is no duct between the umbilical arteries. 11. The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the: a. Menstrual phase b. Proliferative phase c. Secretory phase d. Ischemic phase ANS: c 12. A clinic nurse explains to the pregnant woman that the amount of amniotic fluid present at 24 weeks’ gestation is approximately: a. 500 mL b. 750 mL c. 800 mL d. 1000 mL Feedback a. The menstrual phase is the time of vaginal bleeding, approximately days 1 to 6. b. The proliferative phase ends the menses through ovulation, approximately days 7 to 14. c. The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26. d. The ischemic phase occurs from the end of the secretory phase to the onset of menstruation, approximately days 27 to 28. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 16. Karen, a 26-year-old woman, has come for preconception counseling and asks about caring for her cat as she has heard that she “should not touch the cat during pregnancy.” The clinic nurse’s best response is: a. It is best if someone other than you change the cat’s litter pan during pregnancy so that you OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A have no risk of toxoplasmosis during pregnancy. b. It is important to have someone else change the litter pan during pregnancy and also avoid consuming raw vegetables. c. Have you had any “flu-like” symptoms since you got your cat? If so, you may have already had toxoplasmosis and there is nothing to worry about. d. Toxoplasmosis is a concern during pregnancy, so it is important to have someone else change the cat’s litter pan and also to avoid consuming uncooked meat. ANS: d Feedback a. The nurse should also explain that the patient should not eat uncooked meat as it is a potential source for toxoplasmosis. b. Raw vegetables are not a source for toxoplasmosis. c. This is not an accurate way to diagnose if the woman has had toxoplasmosis. d. Women need to be aware that Toxoplasma gondii, a single-celled parasite, is responsible for the infection toxoplasmosis. The majority of individuals who become infected with toxoplasmosis are asymptomatic, although when present, symptoms are described as “flu like” and include glandular pain and enlargement and myalgia. Severe toxoplasmosis infection may cause damage to the fetal brain, eyes, or other organs. Toxoplasmosis is usually acquired by consuming raw or poorly cooked meat that has been contaminated with T. gondii. Toxoplasmosis may also be acquired OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A through close contact with feces from an infected animal (usually cats) or soil that has been contaminated with T. gondii. 17. A couple who has sought infertility counseling has been told that the man’s sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur? a. The testes are overheated. b. The vas deferens is ligated. c. The prostate gland is enlarged. d. The flagella are segmented. ANS: a Feedback a. Spermatogenesis occurs in the testes. High OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A delivered to the fetal heart, head, neck, and upper limbs, and the blood with the lowest oxygen content is shunted toward the placenta. Fill-in-the-Blank 20. After birth, the perinatal nurse explains to the new mother that is the hormone responsible for stimulating milk production. ANS: prolactin Following birth and delivery of the placenta, there is an abrupt decrease in estrogen. This event triggers an increased secretion of prolactin (the hormone that stimulates milk production) by the anterior pituitary gland. The posterior pituitary and hypothalamus play a role in the production and secretion of oxytocin, a hormone that causes release of milk from the alveoli. 21. During prenatal class, the childbirth educator describes the two membranes that envelop the fetus. The contains the amniotic fluid, and the is the thick, outer membrane. ANS: amnion; chorion The embryonic membranes (chorion and amnion) are early protective structures that begin to form at the time of implantation. The thick chorion, or outer membrane, forms first. It develops from the trophoblast and encloses the amnion, embryo, and yolk sac. The amnion arises from the ectoderm during early embryonic development. The amnion is a thin, protective structure that contains the amniotic fluid. With embryonic growth, the amnion expands and comes into contact with the chorion. The two fetal membranes are slightly adherent and form the amniotic sac. 22. The perinatal nurse is teaching nursing students about fetal circulation and explains that fetal blood flows through the superior vena cava into the right via the . ANS: atrium; foramen ovale Blood flows through the vein from the placenta to the fetus. Most of the blood bypasses the liver OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A and then enters the inferior vena cava by way of the ductus venosus, a vascular channel that connects the umbilical vein to the inferior vena cava. The blood then empties into the right atrium, passes through the foramen ovale (an opening in the septum between the right and left atrium) into the left atrium, and then moves into the right ventricle and on into the aorta. From the aorta, blood travels to the head, upper extremities, and lower extremities. 23. The perinatal nurse explains to the student nurse that the growing embryo is called a beginning at 8 weeks of gestational age. ANS: fetus Major organs are being formed (organogenesis) during the first weeks following fertilization. During this time, the developing organism is called an embryo. By the end of 8 weeks, the embryo has sufficiently developed to be called a fetus. 24. The perinatal nurse defines a as any substance that adversely affects the growth OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A and development of the embryo/fetus. ANS: teratogen Teratogens (drugs, radiation, and infectious agents that can cause development of abnormal structures in an embryo) and a variety of internal and external developmental events may cause structural and functional defects. 25. is when sperm and oocytes are mixed outside the woman’s body and then placed into the fallopian tube via laparoscopy. ANS: Gamete intrafallopian transfer Gamete intrafallopian transfer, also referred to as GIFT, is used when there is a history of failed infertility treatment for anovulation, or unexplained infertility, or low sperm count. Multiple Response 26. A woman seeks care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problem she may have? (Select all that apply.) a. Chorionic villus sampling b. Endometrial biopsy c. Hysterosalpingogram d. Serum FSH analysis ANS. b, c, d Feedback a. Chorionic villus sampling is done to assess for genetic disorders of the fetus. b. Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium’s response to progesterone. c. Hysterosalpingogram is used to determine if fallopian tubes are patent. d. Serum FSH levels are used to assess ovarian function. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 30. A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply.) a. The man rides a bike to and from work each day. b. The man takes a calcium channel blocker for the treatment of hypertension. c. The man drinks 6 cups of coffee a day. d. The man was treated for prostatitis 12 months ago and has been symptom free since treatment. ANS: a, b The daily riding of a bike can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel blockers, can have an effect on sperm production. Coffee has not been associated with low sperm counts. Prostatitis or other infections within the last 3 months may have an effect on the sperm analysis. This man’s episode of prostatitis was 12 months prior. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate 31. The clinic nurse recognizes that pregnant women who are in particular need of support are those who (select all that apply): a. Are experiencing a second pregnancy b. Are awaiting genetic testing results c. Are experiencing a first pregnancy d. Are trying to conceal this pregnancy as long as possible ANS: b, d A second pregnancy is not an indication of a woman in need of additional support. A support system may be lacking for women who are trying to conceal a pregnancy or for women who are trying to keep the news of their pregnancy from relatives or friends until results from genetic tests are known. These individuals may need additional support from their nurses and other health-care providers, as they are placed in a powerless situation while awaiting results and face a pregnancy that may be in jeopardy. Chapter 4: Physiological Aspects of Antepartum Care Multiple Choice 1. Folic acid supplementation during pregnancy is to:a. Improve the bone density of pregnant women b. Decrease the incidence of neural tube defects in the fetus c. Decrease the incidence of Down syndrome in the fetusd. Improve calcium uptake in pregnant women ANS: b Feedback a. Folic acid is not related to bone density. b. Correct. The use of folic acid has decreased the OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A incidence of neural tube defects by 50%. c. The use of folic acid is not associated with a reduction in Down syndrome. d. Folic acid is not related to calcium uptake in women. 2. The positive signs of pregnancy are: a. All physiological and anatomical changes of pregnancy b. All subjective signs of pregnancy c. All those physiological changes perceived by the woman herself d. The objective signs of pregnancy that can only be attributed to the fetus ANS: d Feedback a. Physiological and anatomical changes of OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A hemorrhage. These changes taking place are not related to blood volume expansion. d. Correct. Physiological anemia of pregnancy, also referred to as pseudo-anemia of pregnancy, is due to hemodilution. The increase in plasma volume is relatively larger than the increase in RBCs that results in decreased hemoglobin and hematocrit values. 5. Intimate partner violence (IPV) against women consists of actual or threatened physical or sexual violence and psychological and emotional abuse. Screening for IPV during pregnancy is recommended for: a. Pregnant women with a history of domestic violence b. All pregnant women c. All low-income pregnant women d. Pregnant adolescents ANS: b Feedback a. Intimate partner violence is underreported by women, necessitating universal screening. b. Correct. AWHONN advocates for universal screening for domestic violence for all pregnant women. Homicide is the most likely cause of death for pregnant or recently pregnant women, and a significant portion of those homicides are committed by their intimate partners. One in six pregnant women reported physical or sexual abuse during pregnancy, seriously impacting maternal and fetal health and infant birth weight. c. IPV crosses all ethnic, racial, religious, and socioeconomic levels. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A d. IPV crosses all ethnic, racial, religious, and socioeconomic levels. 6. A woman presents to the prenatal clinic at 30 weeks’ gestation reporting dysuria, frequency, and urgency with urination. Appropriate nursing actions include: a. Obtain clean-catch urine to assess for a possible urinary tract infection. b. Reassure the woman that the signs are normal urinary changes in the third trimester. c. Teach the woman to decrease fluid intake to manage these symptoms. d. Perform a Leopold’s maneuver to assess fetal position and station. ANS: a Feedback a. Correct. Dysuria, frequency, and urgency with urination are signs and symptoms of a urinary tract infection, necessitating further assessment and testing. b. These are abnormal urinary symptoms in the OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A third trimester. c. Pregnant women need to increase their fluid intake during pregnancy, and dysuria and urgency are abnormal. d. Assessment of fetal position and station is not an appropriate response to reported signs and symptoms of a urinary tract infection. 7. At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse and tells you shyly that she wants to maintain a sexual relationship with her partner. The best response is to: a. Reassure woman/couple of normalcy of response b. Suggest alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse c. Recommend cessation of intercourse until after delivery due to advanced gestation d. Suggest woman discuss this with her care provider at her next appointment ANS: b Feedback a. Although this is a normal response, providing reassurance is not enough. Further intervention is indicated. b. Although shy to discuss this, she wants to maintain a sexual relationship with her partner. Suggesting alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse provides the woman with information to maintain sexual relations. c. She wants to maintain a sexual relationship with her partner, and there are no contraindications to intercourse during a healthy pregnancy. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 10. The clinic nurse reviews the complete blood count results for a 30-year-old woman who is now 33 weeks’ gestation. Tamara’s hemoglobin value is 11.2 g/dL, and her hematocrit is 38%. The clinic nurse interprets these findings as: a. Normal adult values b. Normal pregnancy values for the third trimester c. Increased adult values d. Increased values for 33 weeks’ gestation ANS: b 11. The clinic nurse is aware that the pregnant woman’s blood volume increases by: a. 20% to 25% b. 30% to 35% c. 40% to 45% d. 50% to 55% Feedback a. The values are low normal for adults but represent normal findings for pregnant women. b. During pregnancy the woman’s hematocrit values may appear low due to the increase in total plasma volume (on average, 50%). Because the plasma volume is greater than the increase in erythrocytes (30%), the hematocrit decreases by about 7%. This alteration is termed “physiologic anemia of pregnancy,” or “pseudo-anemia.” The hemodilution effect is most apparent at 32 to 34 weeks. The mean acceptable hemoglobin level in pregnancy is 11 to 12 g/dL of blood. c. The values are not increased; they are low normal for adults but represent normal findings for pregnant women. d. The values are not increased; they are low normal for adults but represent normal findings for pregnant women. Feedback a. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not 20% to 25%. b An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45, not 30% to 35%. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: c OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A c. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45% and is primarily due to an increase in plasma and erythrocyte volume. Additional erythrocytes, needed because of the extra oxygen requirements of the maternal and placental tissue, ensure an adequate supply of oxygen to the fetus. The elevation in erythrocyte volume remains constant during pregnancy. d. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not as high as 50% to 55%. 12. The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and position. The nurse’s hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the: a. First maneuver b. Second maneuver c. Third maneuver d. Fourth maneuver ANS: a Feedback Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver determines which fetal body part (e.g., head or buttocks) occupies the uterine fundus. The examiner faces the patient’s head and places the hands on the abdomen, using the palmar surface of the hands to gently palpate the fundal region of the uterus. The buttocks feel soft, broad, and poorly defined and move with the trunk. The fetal head feels firm and round and moves independently of the trunk. b. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. c. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. d. Leopold maneuvers are a four-part clinical OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: a Feedback a. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse’s responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. To facilitate this process, it is the nurse’s responsibility to gather more information on the woman’s dietary practices through a food diary. b. Nutrition and weight management play an essential role in the development of a healthy pregnancy. To facilitate this process, it is the nurse’s responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. c. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse’s responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices, not just inform the patient of expected normal weight gain. d. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A facilitate this process, it is the nurse’s responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. 15. A woman presents to a prenatal clinic appointment at 10 weeks’ gestation, in the first trimester of pregnancy. Which of the following symptoms would be considered a normal finding at this point in pregnancy? a. Occipital headache b. Urinary frequency c. Diarrhea d. Leg cramps ANS: b 16. The nurse is providing prenatal teaching to a group of diverse pregnant women. One woman, who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy. The nurse explains that the most significant risk to the fetus is: a. Respiratory distress at birth b. Severe neonatal anemia c. Low neonatal birth weight d. Neonatal hyperbilirubinemia Feedback a. Headaches may be benign or, especially if noted after 20 weeks’ gestation, may be a symptom of pregnancy-induced hypertension (PIH). b. Urinary frequency is a common complaint of women during their first trimester. c. Diarrhea is rarely seen in pregnancy. Constipation is a common complaint. d. Leg cramps are commonly seen during the second and third trimesters. Feedback a. Respiratory distress is not the most significant risk to the fetus unless the fetus is also premature. Severe neonatal anemia is not associated with pregnancies complicated by cigarette smoking. c. Low neonatal birth weight is the most common complication seen in pregnancies complicated by cigarette smoking. d. Neonatal hyperbilirubinemia is not associated OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 19. The nurse is working in a prenatal clinic caring for a patient at 14 weeks’ gestation, G2 P1001. Which of the following findings should the nurse highlight for the nurse midwife? a. Body mass index of 23 b. Blood pressure of 100/60 c. Hematocrit of 29% d. Pulse rate of 76 bpm OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: c Feedback a. A body mass index of 23 is normal. b. A blood pressure of 100/60 is normal. c. A hematocrit of 29% indicates that the patient is anemic. The nurse should highlight the finding for the nurse-midwife. d. A pulse rate of 76 bpm is a normal rate. 20. A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm above the symphysis. She denies experiencing quickening. Which of the following nursing conclusions made by the nurse is correct? a. The woman is experiencing a normal pregnancy. b. The woman may be having difficulty accepting this pregnancy. c. The woman must see a nutritionist as soon as possible. d. The woman will likely miscarry the conceptus. ANS: a Feedback a. The patient is experiencing a normal pregnancy. b. Quickening is not felt until 16 to 20 weeks’ gestation. c. There is no apparent need for a nutritionist to see this patient. d. There is no indication in the scenario that this patient is at high risk for a miscarriage. 21. A patient at 37 weeks’ gestation is being seen in the prenatal clinic. Where would the nurse expect the fundal height to be palpated? a. At the xiphoid process OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A b. At a point between the umbilicus and the xiphoid c. At the umbilicus d. At a level directly above the symphysis pubis ANS: a Feedback a. At 36 weeks’ gestation, the fundus should be felt at the xiphoid process. b. At 36 weeks’ gestation, the fundus should be felt at the xiphoid process. c. At 20 weeks’ gestation, the fundus should be felt at the umbilicus. d. At 12 weeks’ gestation, the fundus should be felt directly above the symphysis pubis. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A b. Epistaxis c. Bradycardia d. Oliguria ANS: b 25. A primigravida patient is 39 weeks pregnant. Which of the following symptoms would the nurse expect the patient to exhibit? a. Nausea b. Dysuria c. Urinary frequency d. Intermittent diarrhea ANS: c Feedback a. Diplopia is sometimes seen in patients with pregnancy-induced hypertension (PIH). b. Epistaxis is commonly seen in pregnant patients. The bleeding is related to the increased vascularity of the mucous membranes. Unless the blood loss is significant, it is a normal finding. c. Bradycardia is often seen immediately after delivery but not during the third trimester. d. Oliguria is seen in patients with PIH. Feedback a. Nausea is usually not seen in the third trimester. b. Dysuria is not a normal finding at any time during a pregnancy. The possibility of a urinary traction infection (UTI) should be considered. c. Urinary frequency recurs at the end of the third trimester. As the uterus enlarges, it again compresses the bladder causing urinary frequency. d. Diarrhea is not a normal finding at any time during a pregnancy. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 26. The nurse has taken a health history on four multigravida patients at their first prenatal visits. It is high priority that the patient whose first child was diagnosed with which of the following diseases receives nutrition counseling? a. Development dysplasia of the hip b. Achondroplastic dwarfism c. Spina bifida d. Muscular dystrophy OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: c Feedback a. The etiology of developmental dysplasia of the hip is unrelated to the mother’s nutritional status. b. Achondroplasia is an inherited defect. Its etiology is unrelated to the mother’s nutritional status. c. The incidence of spina bifida is much higher in women with poor folic acid intakes. It is a priority that this patient receives nutrition counseling. d. Most forms of muscular dystrophy are inherited. Their etiologies are unrelated to the mother’s nutritional status. 27. A nurse working in a prenatal clinic is caring for a woman who asks advice on foods that are high in vitamin C because “I hate oranges.” The nurse states that 1 cup of which of the following raw foods will meet the patient’s daily vitamin C needs? a. Strawberries b. Asparagus c. Iceberg lettuce d. Cucumber ANS: a 28. The nurse notes each of the following findings in a woman at 10 weeks’ gestation. Which of Feedback a. Strawberries are an excellent source of vitamin C. b. Although asparagus has some vitamin C, it is not an excellent source. c. Iceberg lettuce is a poor source of vitamin C. d. Cucumber is a poor source of vitamin C. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 30. The nurse who is assessing a G2 P1 palpates the fundal height at the location noted on the picture below. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A The nurse concludes that the fetus is equal to which of the following gestational ages? a. 12 weeks b. 20 weeks c. 28 weeks d. 36 weeks ANS: b 31. A patient at 28 weeks’ gestation was last seen in the prenatal clinic at 24 weeks’ gestation. Which of the following changes should the nurse bring to the attention of the Certified Nurse Midwife? a. Weight change from 128 pounds to 132 pounds b. Pulse change from 88 bpm to 92 bpm c. Blood pressure change from 110/70 to 140/90 d. Respiratory change from 16 rpm to 20 rpm ANS: c Feedback a. At 12 weeks’ gestation, the fundus should be felt at the level of the symphysis pubis. b. The fundus at the level of the umbilicus indicates 20 weeks’ gestation. In this question, the fact that this patient is a multigravida is not relevant. Uterine growth should be consistent for both primigravidas and multigravidas. c. At 28 weeks’ gestation, the fundus should be felt 8 cm above the level of the umbilicus. d. At 36 weeks’ gestation, the fundus should be felt at the xiphoid process. Feedback a. A weight change of approximately 4 pounds in 4 weeks is normal in the second and third trimesters of pregnancy. b. This pulse rate change is within normal limits. c. A blood pressure elevation to 140/90 is a sign of mild preeclampsia. d. This respiratory rate change is within normal limits. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 32. The clinic nurse includes screening for domestic violence in the first prenatal visit for all patients. An appropriate question would be: a. This is something that we ask everyone. Do you feel safe in your current living environment and relationships? b. This is something we ask everyone. Do you have any abuse in your life right now? c. Is your partner threatening or harming you in any way right now? d. I need to ask you, do you feel safe from abuse right now? OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: a, b, d Sweating is a warning sign that often precedes syncope. Syncope (a trandient loss of consciousness and postural tone with spontaneous recovery) during pregnancy is frequently attributed to orthostatic hypotension or inferior vena cava compression by the gravid uterus. Nausea and yawning are warning signs that often precede syncope. Lightheadedness, sweating, nausea, yawning, and feelings of warmth are warning signs that often precede syncope. Chills are not a warning sign that often precede syncope. 34. The perinatal nurse teaches the student nurse about the physiological changes in pregnancy that most often contribute to the increased incidence of urinary tract infections. These changes include (select all that apply): a. Relaxation of the smooth muscle of the urinary sphincter b. Relaxation of the smooth muscle of the bladder c. Inadequate emptying of the bladder d. Increased incidence of bacteriuria ANS: a, b, c, d Ascension of bacteria into the bladder can cause asymptomatic bacteriuria (ASB), or urinary tract infections (UTIs). These infections occur more frequently in pregnancy due to relaxation of the smooth muscle of the bladder and urinary sphincter and inadequate emptying of the bladder, changes that allow bacterial ascent into the bladder. 35. The clinic nurse discusses normal bladder function in pregnancy with a 22-year-old pregnant woman who is now in her 29th gestational week. The nurse explains that at this time in pregnancy, it is normal to experience (select all that apply): a. Urinary frequency b. Urinary urgency c. Nocturia d. Incontinence OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: a, b, c During pregnancy, the bladder, a pelvic organ, is compressed by the weight of the growing uterus. The added pressure, along with progesterone-induced relaxation of the urethra and sphincter musculature, leads to urinary urgency, frequency, and nocturia. Incontinence of urine is not a normal change during pregnancy. 36. A 32-year-old woman now at 32 weeks’ gestation is complaining of right-sided sharp abdominal pain. The patient is examined by the clinic nurse and given information about abdominal discomfort in pregnancy. She is also instructed to seek immediate attention if she (select all that apply): a. Has heartburn b. Has chills or a fever c. Feels decreased fetal movements d. Has increased abdominal pain OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: b, c, d Heartburn is a common discomfort throughout pregnancy. Because the appendix is pushed upward and posterior by the gravid uterus, the typical location of pain is not a reliable indicator for a ruptured appendix during pregnancy. The pain should gradually subside, but if it persists or is accompanied by fever, a change in bowel habits, or decreased fetal movement, the patient should promptly contact her medical provider. 37. The clinic nurse talks with Suzy, a pregnant woman at 9 weeks’ gestation who has just learned of her pregnancy. Suzy’s nausea and vomiting are most likely caused by (select all that apply): a. Increased levels of estrogen b. Increased levels of progesterone c. An altered carbohydrate metabolism d. Increased levels of human chorionic gonadotropin ANS: c, d Nausea and vomiting during the first trimester most likely are related to rising levels of human chorionic gonadotropin (hCG) and altered carbohydrate metabolism. Changes in taste and smell, due to alterations in the oral and nasal mucosa, can further aggravate the gastrointestinal discomfort. 38. The clinic nurse encourages all pregnant women to increase their water intake to at least 8 to 10 glasses per day in order to (select all that apply): a. Decrease the risk of constipation b. Decrease the risk of bile stasis c. Decrease their feelings of fatigue d. Decrease the risk of urinary tract infections ANS: a, b, c, d Patients should be encouraged to drink at least 8 to 10 glasses of water each day and empty their OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A Although the platelet cell count does not change significantly during pregnancy, fibrinogen volume has been shown to increase by as much as 50%. This alteration leads to an increase in the sedimentation rate. Blood factors VII, VIII, IX, and X are also increased, and this change causes hypercoagulability. The hypercoagulability state, coupled with venous stasis (poor blood return from the lower extremities) places the pregnant woman at an increased risk for venous thrombosis, embolism, and, when complications are present, disseminated intravascular coagulation (DIC). Blood factor V does not increase. 42. The clinic nurse describes possible interventions for the pregnant woman who is experiencing pain and numbness in her wrists. The nurse suggests (select all that apply): a. Elevating the arms and wrists at night b. Reassessment during the postpartum period c. The use of “cock splints” to prevent wrist flexion d. Massaging the hands and wrists with alcohol OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: a, b, c Edema from vascular permeability can lead to a collection of fluid in the wrist that puts pressure on the median nerve lying beneath the carpal ligament, leading to carpal tunnel syndrome. Elevation of the hands at night may help to reduce the edema. Occasionally, a woman may need to wear a “cock splint” to prevent the wrist from flexing. Reassessment in the postpartum period is indicated because although carpal tunnel syndrome usually subsides after the pregnancy has ended, some women may require surgical treatment if symptoms persist. Massaging the hands and wrists with alcohol does not improve pain and numbness. 43. The clinic nurse advocates for smoking cessation during pregnancy. Potential harmful effects of prenatal tobacco use include (select all that apply): a. Preterm birth b. Gestational hypertension c. Gestational diabetes d. Low birth weight ANS: a, d Nurses can help to improve the fetal environment by educating women about the dangers of direct and passive smoking during pregnancy. Effects of tobacco use during pregnancy are well documented and predispose to premature rupture of the membranes, preterm labor, placental abruption, placenta previa, and infants who are low birth weight or small for gestational age (SGA). Gestational hypertension and diabetes are not associated with smoking during pregnancy. 44. Asking the pregnant woman about her use of recreational drugs is an essential component of the prenatal history. Harmful fetal effects that may occur from recreational drugs include (select all that apply): a. Miscarriage/spontaneous abortion b. Low birth weight c. Macrosomia d. Post-term labor/birth OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: a, b Illegal or recreational drug use can have a number of detrimental effects on maternal and fetal health, including spontaneous abortion, low birth weight, placental abruption, and preterm labor. 45. The clinic nurse schedules Tracy for her first prenatal appointment with the certified nurse- midwife (CNM) in the clinic. Tracy has appropriate questions for her potential health- care provider that include (select all that apply): a. Complementary and alternative methods used during labor and birth b. An opportunity to meet other providers in the practice c. Beliefs and practices concerning an episiotomy and an epidural anesthetic d. Whether the nurse-midwife will be continually available for support during labor ANS: a, b, c A woman’s journey through the pregnancy experience can have long-term effects on her self- perception and self-concept. Therefore, it is especially important that the patient choose a care OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A a. Dysuria b. Hematuria c. Urgency d. Delayed urination ANS: a, b, c Urinary tract infection (UTI) symptoms include dysuria, hematuria, and urgency. 50. Urinary tract infection (UTI) prevention measures during pregnancy include counseling the pregnant woman to (select all that apply): a. Delay urination until bladder is full b. Limit hydration c. Wipe from front to back d. Urinate after intercourse ANS: a, c, d Anticipatory guidance for urinary tract infection prevention includes delaying urination, wipe front to back, and maintaining adequate hydration. 51. Interventions for low back pain during pregnancy should include (select all that apply): a. Utilizing proper body mechanics b. Applying ice or heat to affected area c. Avoiding pelvic rock and pelvic tilt d. Using additional pillows for support during sleep ANS: a, b, d Interventions for back pain during pregnancy include utilizing proper body mechanics, applying heat or ice to the area, using additional pillows during sleep, and not avoiding pelvic rock/tilt, but encouraging pelvic rock/tilt. 52. Jorgina is a 24-year-old pregnant woman at 26 weeks’ gestation. This is Jorgina’s third OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A pregnancy, and her obstetrical history includes one full-term birth, one preterm birth, and two living children. Today Jorgina arrives at the clinic with complaints of fatigue, insomnia, and backache. She reports that she is a nurse on an oncology unit and is worried about continuing with working her 12-hour shifts. The perinatal nurse identifies concerns in Jorgina’s history and work environment including (select all that apply): a. Risk of preterm birth b. Presence of chemotherapeutic agents c. Requirement for heavy lifting d. History of diabetes ANS: a, b, c Women who are currently experiencing pregnancy complications and those who have a history of pregnancy complications (such as history of preterm birth) or other preexisting health disorders may be required to reduce their hours or stop working. The potential for maternal exposure to toxic substances such as chemotherapeutic agents, lead, and ionizing radiation OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A (found in laboratories and health-care facilities); heavy lifting; and use of heavy machinery and other hazardous equipment should prompt reassignment to a different work area. If reassignment is not possible, Jorgina may need to stop working until the pregnancy has been completed. In this scenario there is no history of diabetes. 53. The clinic nurse is assessing the complete blood count results for Kim-Ly, a 23-year-old pregnant woman. Kim-Ly’s hemoglobin is 9.8 g/dL. This laboratory finding places Kim- Ly’s pregnancy at risk for (select all that apply): a. Preterm birth b. Placental abruption c. Intrauterine growth restriction d. Thrombocytopenia ANS: a, c True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The blood’s decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction (IUGR) and preterm birth. There is not a risk factor for abruption or thrombocytopenia. 54. Teera is a 22-year-old woman who is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. Teera is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. The perinatal nurse discusses Teera’s diet with her as she may be deficient in (select all that apply): a. Iron b. Magnesium c. Zinc d. Vitamin B12 ANS: a, c OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A Refer To: Glossary 60. Reflux of the stomach contents into the esophagus ANS: Pyrosis Refer To: Glossary 61. Severe itching due to stasis of bile in the liver ANS: Pruritis gravidarum Refer To: Glossary OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 62. Nosebleeds ANS: Epistaxis Refer To: Glossary True/False 63. The clinic nurse speaks with the student nurse prior to the physical examination of a pregnant woman who is 32 weeks’ gestation. The clinic nurse explains that the heart sounds heard in pregnancy are usually S1 and S3 with a possible murmur related to increased cardiac output. ANS: True Exaggerated first and third heart sounds and systolic murmurs are common findings during pregnancy. The murmurs are usually asymptomatic and require no treatment. 64. Cecilia, a pregnant woman at 30 weeks’ gestation, has her vital signs assessed during a routine prenatal visit. Cecilia’s blood pressure has remained at 110/70 for the last few visits, and her pulse rate has increased from 70 to 80 beats per minute. These findings would be considered normal at this time in pregnancy. ANS: True During the first trimester, blood pressure normally remains the same as pre-pregnancy levels but then gradually decreases up to around 20 weeks of gestation. After 20 weeks, the vascular volume expands, and the blood pressure increases to reach prepregnant levels by term. 65. The clinic nurse knows that every time a woman of childbearing age comes in to the office for a health maintenance visit, she should be counseled about the benefits of daily folic acid supplementation. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: True Because of the strong connection between folic acid deficiency and the subsequent development of neural tube defects, all women of childbearing age should take a folic acid supplement of at least 400 mcg/day. 66. The perinatal nurse recommends strengthening exercises during pregnancy, as this can improve posture and increase energy levels. ANS: True Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy, which include weight gain and postural changes. Muscle strengthening exercises also help to decrease the risk of ligament and joint injury. 67. The perinatal nurse explains to the new nurse that ptyalize is a condition more acute than the normal nausea and vomiting of pregnancy and is often associated with dehydration, hypokalemia, and weight loss. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 72. The clinic nurse monitors the blood pressure and assesses a woman’s urine at each prenatal visit to assess for signs or symptoms of . A previous history or the presence of a are also risk factors. ANS: preeclampsia; new partner A previous history of preeclampsia increases the woman’s likelihood of a recurrence during subsequent pregnancies. If a woman did not experience preeclampsia with previous pregnancies but has a new partner for her current pregnancy, her risk of developing preeclampsia is similar to that of a woman who is pregnant for the first time. Although preeclampsia is a systemic disorder that occurs only during pregnancy, it is generally recognized by two classic symptoms: elevated blood pressure and proteinuria. 73. The clinic nurse is aware of the importance of chlamydia screening during pregnancy. Chlamydia transmission to the infant at may result in . ANS: birth; ophthalmia neonatorum Chlamydia trachomatis is a bacterium that causes infection that is prevalent in sexually active populations, especially those in the under-25 age group. Complications of chlamydia infections include salpingitis, pelvic inflammatory disease, infertility, ectopic pregnancy, premature rupture of the membranes, and preterm birth. Transmission to the neonate may occur during birth and results in ophthalmia neonatorum and chlamydial neonatal pneumonia. 74. The prenatal nurse describes the need for and screening at the first antenatal visit. If the pregnant woman is not immune, she will be counseled to avoid contact with young children who have a rash and could be infectious. ANS: rubella; varicella Some of the routine maternal laboratory tests screen for childhood diseases that are known to cause congenital anomalies or other pregnancy complications if contracted during early pregnancy. When contracted during the first trimester, rubella causes a number of fetal OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A deformities. Varicella (chickenpox) is another common childhood disease that may cause problems in the developing embryo and fetus. Therefore, all pregnant women are screened for rubella and varicella. 75. The prenatal nurse cautions a pregnant woman about Caesar salad consumption during pregnancy or any source of or milk. ANS: raw eggs; unpasteurized A word of caution should be provided by health-care providers to pregnant women with regard to microbial food-borne illness. Raw, or unpasteurized, milk as well as partially cooked eggs and foods containing raw or partially cooked eggs should be avoided. 76. The clinic nurse describes to the student nurse that is excessive saliva production in pregnancy. This condition is most likely caused by increased levels. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: ptyalism; hormone Ptyalism, or excessive salivation, can be quite distressing for the pregnant woman who must frequently wipe her mouth or spit into a cup. Although the cause of ptyalism is unknown, it is most likely related to increased hormone levels. 77. The clinic nurse talks with the newly diagnosed pregnant woman about the nausea that the woman is experiencing in this pregnancy. The clinic nurse suggests eating meals more often, remaining after eating, and the using techniques. ANS: smaller; upright; relaxation Nausea is often one of the first symptoms of pregnancy experienced. Nurses can suggest strategies to help offset the nausea, such as the avoidance of “trigger foods” (foods that cause nausea from sight or smell) and tight clothing that constricts the abdomen. The use of relaxation techniques (i.e., slow, deep breathing, mental imagery) can also help to decrease nausea. Other techniques that are often helpful include consuming plain, dry crackers or sucking on peppermint candy before arising; adhering to small, frequent meals; and remaining in an upright position after eating. 78. The clinic nurse understands that the physiological changes of pregnancy include vascular relaxation from the effects of and impaired venous circulation from pressure exerted by the enlarged uterus, predisposing the pregnant woman to . ANS: progesterone; varicose veins Progesterone results in vascular relaxation which combined with impaired venous return increases the incidence of varicose veins in pregnant women. 79. The perinatal nurse knows that , which is the eating of nonnutritive substances, is a common . ANS: pica; eating disorder Pica, the consumption of nonnutritive substances or food, is a common eating disorder that can OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A c. Correct, because talking to the fetus is a sign of positive maternal adaptation. All other answers indicate pathology. d. Interacting with the fetus in utero represents normal development of attachment to the fetus. 2. What is the most common expected emotional reaction of a woman to the news that she is pregnant? a. Jealousy b. Acceptance c. Ambivalence d. Depression OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A ANS: c Feedback a. Others in the family may be jealous of the fetus, but that is not a common maternal response. b. Acceptance of the pregnancy typically occurs later in the pregnancy. c. Ambivalence is a normal expected reaction to the news of pregnancy, whether or not the pregnancy is planned or wanted. d. This would represent an abnormal emotional response to pregnancy. 3. Which of the following information regarding sexual activity would the nurse give a pregnant woman who is 35 weeks’ gestation? a. Sexual activity should be avoided from now until 6 weeks postpartum. b. Sexual desire may be affected by nausea and fatigue. c. Sexual desire may be increased due to increased pelvic congestion. d. Sexual activity may require different positions to accommodate the woman’s comfort. ANS: d Feedback a. There are no contraindications to sexual activity during this time for a normally progressing pregnancy. b. Nausea and fatigue affect sexual desire during the first trimester, not the third. c. Increased sexual desire r/t increased pelvic congestion is a characteristic of the second trimester, not the third. d. Correct. An enlarging abdomen creates OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A feelings of awkwardness and bulkiness and may require couples to modify intercourse positions for the pregnant woman’s comfort. 4. Which statement best exemplifies adaptation to pregnancy in relation to the adolescent? a. Adolescents adapt to motherhood in a similar way to other childbearing women. b. Social support has very little effect on adolescent adaptation to pregnancy. c. The pregnant adolescent faces the challenge of multiple developmental tasks. d. Pregnant adolescents of all ages can be capable and active participants in health-care decisions. ANS: c Feedback a. Adolescents must cope with the conflicting developmental tasks of pregnancy and OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A d. This is not appropriate for a 2-year-old but may be appropriate for older age groups. 7. The nurse is interviewing a pregnant client who states she plans to drink chamomile tea to ensure an effective labor. The nurse knows that this is an example of: a. Cultural prescription b. Cultural taboo c. Cultural restriction d. Cultural demonstration ANS: a Feedback a. Correct. Cultural prescription is an expected behavior of the pregnant woman during the childbearing period. b. Taboos are cultural restrictions believed to have serious supernatural consequences. Drinking chamomile tea would not be in this category. c. Restrictions are activities during the childbearing period which are limited for the pregnant woman. Drinking chamomile tea would not be in this category. d. Demonstration is not a term that is used in relation to cultural behaviors. 8. Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country? a. Help her develop a realistic, detailed birth plan. b. Identify her support system. c. Teach her about expected emotional changes of pregnancy. d. Refer her to a doula for labor support. ANS: b Feedback OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A a. A detailed birth plan may not be culturally appropriate and is not first priority. b. Correct, because lack of social support has been correlated with an increased risk of pregnancy complications and difficult adaptation to pregnancy. Pregnant women who are recent immigrants face many challenges in obtaining needed social support, and the nurse should first identify her support system to plan further interventions and referrals. c. There may be cultural variations in emotional changes of pregnancy. d. The nurse should first identify her support system before planning further interventions and referrals. OB-STUDY GUIDE BY CHAPTERS CH1-TO-CH19 QUESTIONS AND ANSWERS 100 % CORRECT RATED A+ DOWNLOAD TO SCORE A 9. A pregnant client at 20 weeks’ gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment? a. “I hate it when the baby moves.” b. “I’ve started calling my mom every day.” c. “My partner and I can’t stop talking about the baby.” d. “I still don’t know much time I’m going to take off work after the baby comes.” ANS: a Feedback a. Experiencing quickening as unpleasant may be a sign of maladaptation to pregnancy and needs further assessment by the nurse. b. This is an expected finding in maternal adaptation and development of the maternal role. c. This is an expected finding in maternal adaptation and development of the maternal role. d. At 20 weeks’ gestation, the client still has plenty of time to process this decision. 10. A pregnant client asks the nurse why she should attend childbirth classes. The nurse’s response would be based on which of the following information? a. Attending childbirth class is a good way to make new friends. b. Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting. c. Attending childbirth classes will help a pregnant woman have a shorter labor. d. Childbirth classes will help a pregnant woman decrease her chance of having a cesarean delivery. ANS: b Feedback