Chapter 4 - Test Questions

Leifer: Introduction to Maternity & Pediatric Nursing, 6th Edition Chapter 04: Prenatal Care and Adaptations to Pregnancy Test Bank MULTIPLE CHOICE 1. A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a 2-year-old son and had one previous spontaneous abortion. Using the TPAL system, the patient’s obstetric history would be recorded as: a. gravida 2 para 20120. b. gravida 3 para 10011. c. gravida 3 para 10110. d. gravida 2 para 11110. ANS: C Refer to Box 4-1 in the textbook for the TPAL system of identifying gravida and para. DIF: Cognitive Level: Application REF: p. 46, Box 4-1 OBJ: 1 TOP: Definition of Terms KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 2. A woman asks the nurse about the frequency of prenatal visits. In an uncomplicated pregnancy, the nurse would tell her that appointments are scheduled: a. every 3 weeks until the 6th month, then every 2 weeks until delivery. b. every 4 weeks until the 7th month, after which appointments will become more frequent. c. monthly until the 8th month. d. every 2 to 3 weeks for the entire pregnancy. ANS: B Monthly visits are scheduled up to 28 weeks, and then visits increase to every 2 to 3 weeks through 36 weeks. From 36 weeks until delivery, visits are weekly. DIF: Cognitive Level: Application REF: p. 45 OBJ: 2 and 3 TOP: Prenatal Visits KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 3. During the physical examination for the first prenatal visit, it is noted that Chadwick’s sign is present. This refers to the: a. bluish or purplish discoloration of the vulva, vagina, and cervix. b. presence of early fetal movements. c. darkening of the areola and breast tenderness. d. palpation of the fetal outline. Copyright © 2011 by Saunders, an imprint of Elsevier Inc.

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ANS: A Chadwick’s sign is the purplish or bluish discoloration of the cervix and vagina. DIF: TOP: KEY: MSC:

Cognitive Level: Knowledge REF: p. 49 OBJ: 7 Normal Physiological Changes in Pregnancy Nursing Process Step: Assessment NCLEX: Physiological Integrity: Physiological Adaptation

4. After the examination is completed, the patient asks the nurse why Chadwick’s sign occurs during pregnancy. The nurse would explain that it is caused by the: a. enlargement of the uterus. b. progesterone action on the breasts. c. increasing activity of the fetus. d. vascular congestion in the pelvic area. ANS: D Chadwick’s sign is caused by increased vascular congestion in the cervical and vaginal area. DIF: TOP: KEY: MSC:

Cognitive Level: Application REF: p. 49 OBJ: 7 Normal Physiological Changes in Pregnancy Nursing Process Step: Implementation NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse has explained physiological changes that occur during pregnancy. Which statement indicates that the woman understands the information? a. “Blood pressure goes up toward the end of pregnancy.” b. “My breathing will get deeper and a little faster.” c. “I’ll notice a decreased pigmentation in my skin.” d. “There will be a curvature in the upper spine area.” ANS: B The pregnant woman breathes more deeply, and her respiratory rate may increase slightly. DIF: Cognitive Level: Analysis REF: p. 52 OBJ: 7 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. A woman reports that her last normal menstrual period began on August 5, 2010. Using Nägele’s rule, her expected date of delivery would be _____, 2011. a. April 30 b. May 5 c. May 12 d. May 26

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ANS: C To determine the expected date of delivery, count backward 3 months from the first day of the last menstrual period, then add 7 days. DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 48, Box 4-2 5 TOP: Determining Estimated Date of Delivery Nursing Process Step: Assessment NCLEX: Health Promotion and Maintenance: Growth and Development

7. During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an electronic Doppler device. When this instrument is used, fetal heart tones can be detected as early as _____ weeks. a. 4 b. 8 c. 10 d. 14 ANS: C The fetal heartbeat can be detected as early as 10 weeks of pregnancy using a Doppler device. DIF: Cognitive Level: Comprehension REF: p. 50 OBJ: 7 TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 8. In a routine prenatal visit, the nurse examining a patient who is 37 weeks pregnant notices that the fetal heart rate (FHR) has dropped to 120 beats/min from a rate of 160 beats/min earlier in the pregnancy. The nurse should: a. ask if the patient has taken a sedative. b. notify the physician. c. turn the patient to her right side. d. record rate as a normal finding. ANS: D The FHR at term ranges from a low of 110 to 120 beats/min to a high of 150 to 160 beats/min. This should be recorded as normal. The FHR drops in the late stages of pregnancy. DIF: Cognitive Level: Analysis REF: p. 50 OBJ: 3 TOP: Assessing Fetal Heart Tone KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. A woman’s prepregnant weight is average for her height. The nurse would advise the woman that her recommended weight gain during pregnancy would be _____ pounds. a. 10 to 20

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b. 15 to 25 c. 25 to 35 d. 28 to 40 ANS: C The recommended weight gain for a woman of normal weight before pregnancy is 25 to 35 pounds. DIF: Cognitive Level: Application REF: p. 59 OBJ: 8 TOP: Nutrition in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 10. When the nurse tells a pregnant woman that she needs 1,200 mg of calcium daily during pregnancy, the woman responds, “I don’t like milk.” What dietary adjustments could the nurse recommend? a. Increase intake of organ meats. b. Eat more green leafy vegetables. c. Choose more fresh fruits, particularly citrus fruits. d. Include molasses and whole-grain breads in the diet. ANS: B For women who do not like milk, other sources of calcium include enriched cereals, legumes, nuts, dried fruits, green leafy vegetables, and canned salmon and sardines that contain bones. DIF: Cognitive Level: Application REF: p. 60 OBJ: 8 TOP: Nutrition for Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 11. A pregnant woman is experiencing nausea in the early morning. What recommendations would the nurse offer to alleviate this symptom? a. Eat three well-balanced meals per day and limit snacks. b. Drink a full glass of fluid at the beginning of each meal. c. Have crackers handy at the bedside, and eat a few before getting out of bed. d. Eat a bland diet and avoid concentrated sweets. ANS: C The nurse can recommend eating dry toast or crackers before getting out of bed in the morning to alleviate nausea during pregnancy. DIF: TOP: KEY: MSC:

Cognitive Level: Application REF: p. 65 OBJ: 10 Common Discomforts in Pregnancy Nursing Process Step: Implementation NCLEX: Physiological Integrity: Physiological Adaptation

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12. The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. The nurse should initially: a. assess food intake. b. weigh the patient again. c. take the blood pressure. d. notify the physician. ANS: C The marked weight gain may be an indication of gestational hypertension. The blood pressure should be assessed before notifying the physician. DIF: Cognitive Level: Analysis REF: p. 47 OBJ: 4 TOP: Gestational Hypertension KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The patient remarks that she has heard some foods will enhance brain development of the fetus. The nurse replies that foods high in docosahexaenoic acid (DHA) are thought to enhance brain development. Such foods include: a. fried fish. b. olive oil. c. red meat. d. leafy green vegetables. ANS: C Foods rich in DHA are red meat, flounder, halibut, and soybean and canola oil. Frying fish negatively alters the DHA. DIF: Cognitive Level: Application REF: p. 55 OBJ: 8 TOP: Nutrition in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. The nurse encourages adequate intake of folic acid because it is thought to decrease the incidence of: a. structural heart defects. b. craniofacial deformities. c. limb deformities. d. neural tube defects. ANS: D Folic acid can reduce the incidence of neural tube defects such as spina bifida and anencephaly. DIF: Cognitive Level: Application REF: p. 60 OBJ: 8 TOP: Nutrition for Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk

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15. A woman tells the nurse that she is quite sure she is pregnant. The nurse recognizes which as a positive sign of pregnancy? a. Amenorrhea b. Uterine enlargement c. HCG detected in the urine d. Fetal heartbeat ANS: D Positive indications are caused only by the developing fetus and include fetal heart activity, visualization by ultrasound, or fetal movements felt by the examiner. DIF: TOP: KEY: MSC:

Cognitive Level: Knowledge REF: p. 50 OBJ: 7 Physiological Changes During Pregnancy Nursing Process Step: Assessment NCLEX: Physiological Integrity: Physiological Adaptation

16. At her initial prenatal visit a woman asks, “When can I hear the baby’s heartbeat?” The nurse would respond that the fetal heartbeat can be auscultated with a specially adapted stethoscope or fetoscope at _____ weeks. a. 4 b. 12 c. 18 d. 24 ANS: C The fetal heartbeat can be heard with a fetoscope between the 18th and 20th week of pregnancy. DIF: TOP: KEY: MSC:

Cognitive Level: Knowledge REF: p. 50 OBJ: 7 Physiological Changes During Pregnancy Nursing Process Step: Assessment NCLEX: Health Promotion and Maintenance: Growth and Development

17. A woman pregnant for the first time asks the nurse, “When will I begin to feel the baby move?” The nurse would answer: a. “You may notice the baby moving around the 4th to 5th month.” b. “Quickening varies with every woman.” c. “You’ll feel something by the end of the first trimester.” d. “The baby will be big enough for you to feel in your 8th month.” ANS: A Quickening, fetal movement felt by the mother, is first perceived at 16 to 20 weeks of gestation. DIF:

Cognitive Level: Application

REF: p. 49

OBJ: 7

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TOP: Physiological Changes During Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 18. The patient who is 40 weeks pregnant complains of a sense of weakness and dizziness when she lies on her back. The nurse assesses this as an indication of: a. supine hypotension. b. orthostatic hypotension. c. gestational hypertension. d. pseudoanemia. ANS: A When in the supine position, the weight of the uterus compresses the vena cava and aorta, causing hypotension. Placing a pillow under the right hip will reduce the symptoms. DIF: OBJ: KEY: MSC:

Cognitive Level: Analysis REF: p. 53, Figure 4-5 10 TOP: Supine Hypotension Nursing Process Step: Assessment NCLEX: Physiological Integrity: Physiological Adaptation

19. A pregnant woman inquires about exercising during pregnancy. In planning the teaching for this woman, the nurse should include what information? a. Exercise elevates the mother’s temperature and improves fetal circulation. b. Exercise increases catecholamines, which can prevent preterm labor. c. A regular schedule of moderate exercise during pregnancy is beneficial. d. Pregnant women should limit water intake during exercise. ANS: C In general, moderate exercise several times a week, from the 8th week through delivery, is advised during pregnancy. DIF: Cognitive Level: Comprehension REF: p. 62 OBJ: 9 TOP: Exercise During Pregnancy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. An ultrasound confirms that a 16-year-old girl is pregnant. The nurse recognizes the need for prenatal care and counseling for adolescents because: a. a pregnant adolescent is experiencing two major life transitions at the same time. b. adolescents who get pregnant are more likely to have other chronic health problems. c. adolescents are at greater risk for multifetal pregnancies. d. at this age, a pregnant adolescent will accept the nurse’s advice. ANS: A The pregnant adolescent must cope with two of life’s most stress-laden transitions simultaneously: adolescence and parenthood.

Copyright © 2011 by Saunders, an imprint of Elsevier Inc.

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Cognitive Level: Analysis REF: p. 69 Psychological Adaptations to Pregnancy Nursing Process Step: Planning NCLEX: Psychosocial Integrity: Coping and Adaptation

OBJ: 11

21. The nurse explains that the number of years between menarche and the date of conception is known as _____ age. a. gynecological b. fertile c. conception d. gravid ANS: A Gynecological age is a term that refers to the number of years between the starting of the menses and the date of conception. DIF: Cognitive Level: Comprehension REF: p. 61 OBJ: 1 TOP: Gynecological Age KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 22. The woman who becomes pregnant for the first time after the age of ____ years is described as an “elderly primip.” a. 25 b. 28 c. 30 d. 35 ANS: D A woman over the age of 35 who becomes pregnant for the first time is described as an “elderly primip.” DIF: Cognitive Level: Comprehension REF: p. 69 TOP: Elderly Primip KEY: N/A MSC: NCLEX: Physiological Integrity: Physical Adaptation

OBJ: 1 Nursing Process Step:

23. The nurse explains that the softening of the cervix and vagina is a probable sign of pregnancy called _____ sign. a. Chadwick’s b. Hegar’s c. McDonald’s d. Goodell’s ANS: D

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Goodell’s sign is one of the probable signs of pregnancy that describes a softened cervix and vagina. DIF: Cognitive Level: Knowledge REF: p. 49 OBJ: 1 TOP: Goodell’s Sign KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physical Adaptation MULTIPLE RESPONSE 24. A woman who is 36 weeks pregnant tells the nurse she plans to fly to Hawaii, which is a 12-hour flight. What would the nurse recommend that the patient do during the flight? Select all that apply. a. Wear tight fitting clothing to promote venous return. b. Eat a large meal before boarding the flight. c. Request a seat with greater leg room. d. Drink at least 4 ounces of water every hour. e. Get up and walk around the plane frequently ANS: C, D, E Because of the increase in clotting potential, the pregnant patient is prone to a thromboembolism. Adequate hydration, frequent position changes and movement decrease the risk. DIF: Cognitive Level: Application REF: pp. 64-65 OBJ: 10 TOP: Flight Precautions KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 25. The nurse cautions the patient that, because of hormonal changes in late pregnancy, the pelvic joints relax. What does this result in? Select all that apply. a. Waddling gait b. Joint instability c. Urinary frequency d. Back pain e. Aching in cervical spine ANS: A, B A waddling gait and joint instability are the only signs that relate to joint changes. The other discomforts are related to the enlarging uterus with its attendant weight. DIF: Cognitive Level: Analysis REF: p. 55 OBJ: 7 TOP: Joint Changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. The nurse assesses the progress from the announcement stage of fatherhood to the acceptance stage when the patient reports which action(s) by the father? Select all that apply.

Copyright © 2011 by Saunders, an imprint of Elsevier Inc.

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Goes fishing every afternoon Has revised his financial plan Spends leisure time with his friends Traded his sports car for a sedan Helped select a crib

ANS: B, D, E Active planning for an infant is an indication of the acceptance stage. Concentration on a hobby and spending time away from home are indicators of nonacceptance. DIF: Cognitive Level: Application REF: p. 68 OBJ: 11 TOP: Stages of Fatherhood KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 27. What should the nurse do for the prenatal patient in terms of prenatal care? Select all that apply. a. Offer nutritional counseling. b. Reinforce responsibility of parenthood. c. Reduce risk factors. d. Improve health practices. e. Make financial arrangements for delivery. ANS: A, B, C, D Nutritional counseling, reinforcing and discussing the responsibility of parenthood, reducing risk factors for the pregnant woman and the fetus, and improving health practices are all goals of prenatal care. DIF: Cognitive Level: Application REF: pp. 44-45 OBJ: 11 TOP: Goals of Prenatal Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 28. The nurse recognizes which behavior characteristic(s) of women in their first trimester of pregnancy? Select all that apply. a. Showing off her sonogram photos b. Ambivalence about pregnancy c. Emotional and labile mood d. Focusing on her infant e. Fatigue ANS: A, B, C, E Showing off photos, feeling ambivalence about the pregnancy, fragile emotions, and fatigue and sleepiness are all characteristic of behaviors seen in the first trimester. Women are not focused on their infant; they are focused on themselves and the physical changes they are experiencing.

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DIF: Cognitive Level: Application REF: p. 67 OBJ: 11 TOP: Behaviors of First Trimester KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation COMPLETION 29. The nurse reminds the prenatal patient that she should add ________ kcal to her daily intake to nourish the fetus. ANS: 300 The recommended dietary intake increase is 300 kcal a day. DIF: Cognitive Level: Comprehension REF: p. 59 OBJ: 8 TOP: Nutrition During Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development 30. The patient confesses to eating crushed ice 10 or 12 times daily. The nurse assesses this behavior as __________. ANS: pica Pica is the craving and ingestion of nonfood substances such as clay, crushed ice, and ashes. DIF: Cognitive Level: Comprehension REF: p. 61 OBJ: 8 TOP: Pica KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. The nurse is aware that ______________ maneuver can assess the position and presentation of the fetus. ANS: Leopold’s Leopold’s maneuver assesses the position and the presentation of the fetus by palpation. DIF: Cognitive Level: Comprehension REF: p. 47 OBJ: 3 TOP: Leopold’s Maneuver KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk

Copyright © 2011 by Saunders, an imprint of Elsevier Inc.