Chapter 4: Prenatal Care and Adaptations to Pregnancy My Nursing Test Banks

Chapter 4: Prenatal Care and Adaptations to Pregnancy

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

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 clients obstetrical 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: Text Reference: 48, Box 4-1

OBJ: Objective: 1 TOP: Topic: Definition of Terms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

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: Text Reference: 45

OBJ: Objective: 4, 5 TOP: Topic: Prenatal Visits

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

3. During the physical examination for the first prenatal visit, it is noted that Chadwicks 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

ANS: A

Chadwicks sign is the purplish or bluish discoloration of the cervix and vagina.

DIF: Cognitive Level: Knowledge REF: Text Reference: 49

OBJ: Objective: 7 TOP: Topic: Normal Physiological Changes in Pregnancy

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. After the examination is completed, the patient asks the nurse why Chadwicks 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

Chadwicks sign is caused by increased vascular congestion in the cervical and vaginal area.

DIF: Cognitive Level: Application REF: Text Reference: 49

OBJ: Objective: 7 TOP: Topic: Normal Physiological Changes in Pregnancy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse has explained physiological changes that occur during pregnancy. Which of the following statements indicate 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.

Ill 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: Text Reference: 49

OBJ: Objective: 7 TOP: Topic: 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, 2006. Using Ngeles rule, her expected date of delivery would be:

a.

April 30, 2007

b.

May 5, 2007

c.

May 12, 2007

d.

May 26, 2007

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: Cognitive Level: Application REF: Text Reference: 48, Box 4-2

OBJ: Objective: 2 TOP: Topic: Determining Estimated Date of Delivery

KEY: Nursing Process Step: Assessment

MSC: 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:

a.

4 weeks

b.

8 weeks

c.

10 weeks

d.

14 weeks

ANS: C

The fetal heartbeat can be detected as early as 10 weeks of pregnancy using a Doppler device.

DIF: Cognitive Level: Comprehension REF: Text Reference: 54

OBJ: Objective: 7 TOP: Topic: Normal Physiological Changes in Pregnancy

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

8. In a routine prenatal visit the nurse examines a client who is 37 weeks pregnant and notices that the fetal heart rate has dropped to 120 beats/min from a rate of 160 beats/min earlier in the pregnancy. The nurse should:

a.

Ask if the client has taken a sedative

b.

Notify the physician

c.

Turn the client to her right side

d.

Record rate as a normal finding

ANS: D

The fetal heart rate (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: Text Reference: 50

OBJ: Objective: 6 TOP: Topic: Assessing Fetal Heart Tone

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. A womans prepregnant weight is average for her height. The nurse would advise the woman that her recommended weight gain during pregnancy would be:

a.

10 to 20 pounds

b.

15 to 25 pounds

c.

25 to 35 pounds

d.

28 to 40 pounds

ANS: C

The recommended weight gain for a woman of normal weight before pregnancy is 25 to 35 pounds.

DIF: Cognitive Level: Application REF: Text Reference: 58

OBJ: Objective: 8 TOP: Topic: 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 dont 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: Text Reference: 60

OBJ: Objective: 8 TOP: Topic: 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: Cognitive Level: Application REF: Text Reference: 66

OBJ: Objective: 9 TOP: Topic: Common Discomforts in Pregnancy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. The client 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 client 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: Text Reference: 45

OBJ: Objective: 6 TOP: Topic: Gestational Hypertension

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. The client remarks that she has heard that some foods will enhance the brain development of the fetus. The nurse replies that foods that are high in 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: Text Reference: 55-56

OBJ: Objective: 8 TOP: Topic: 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: Text Reference: 61

OBJ: Objective: 8 TOP: Topic: Nutrition for Pregnancy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

15. A woman tells the nurse that shes quite sure that she is pregnant. The nurse recognizes which of the following to be 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: Cognitive Level: Knowledge REF: Text Reference: 50

OBJ: Objective: 7 TOP: Topic: Physiological Changes During Pregnancy

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. At her initial prenatal visit a woman asks, When can I hear the babys heartbeat? The nurse would respond that the fetal heartbeat can be auscultated with a specially adapted stethoscope or fetoscope at:

a.

4 weeks

b.

12 weeks

c.

18 weeks

d.

24 weeks

ANS: C

The fetal heartbeat can be heard with a fetoscope between the 18th and 20th week of pregnancy.

DIF: Cognitive Level: Knowledge REF: Text Reference: 49

OBJ: Objective: 7 TOP: Topic: Physiological Changes During Pregnancy

KEY: Nursing Process Step: Assessment

MSC: 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.

Mothers may notice the baby moving around the 4th to 5th month.

b.

Quickening varies with every woman.

c.

Youll 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 gestation.

DIF: Cognitive Level: Application REF: Text Reference: 49

OBJ: Objective: 7 TOP: Topic: Physiological Changes During Pregnancy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

18. The client 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: Cognitive Level: Analysis REF: Text Reference: 52

OBJ: Objective: 6 TOP: Topic: Supine Hypotension

KEY: Nursing Process Step: Assessment

MSC: 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 which of the following information?

a.

Exercise elevates the mothers 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: Text Reference: 63

OBJ: Objective: 12 TOP: Topic: 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 nurses advice.

ANS: A

The pregnant adolescent must cope with two of lifes most stress-laden transitions simultaneously: adolescence and parenthood.

DIF: Cognitive Level: Analysis REF: Text Reference: 70

OBJ: Objective: 11

TOP: Topic: Psychological Adaptations to Pregnancy

KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

MULTIPLE RESPONSE

1. A woman who is 36 weeks pregnant tells the nurse she plans to fly to Hawaii, which is a 12-hour flight. The nurse would recommend that during the flight the patient should:

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: Text Reference: 65

OBJ: Objective: 9 TOP: Topic: Flight Precautions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Physiological Integrity: Reduction of Risk

2. The nurse cautions the patient that because of hormonal changes in late pregnancy, the pelvic joints relax, which can 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: Text Reference: 54

OBJ: Objective: 9 TOP: Topic: Joint Changes

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse assesses the progress from the announcement stage of fatherhood to the acceptance stage when the patient reports that the father has:

Select all that apply.

a.

Begun fishing every afternoon

b.

Revised his financial plan

c.

Begun spending leisure time with his friends

d.

Traded his sports car for a sedan

e.

Helped select a crib

ANS: B, D, E

Active planning for a baby is an indication of the acceptance stage. Such activities as concentration on a hobby or spending time away from home are indicators of nonacceptance.

DIF: Cognitive Level: Application REF: Text Reference: 69

OBJ: Objective: 11 TOP: Topic: Stages of Fatherhood

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

COMPLETION

1. The nurse reminds the prenatal patient that she should add ________ kcal to her daily intake to nourish the fetus.

ANS: 300

DIF: Cognitive Level: Comprehension REF: Text Reference: 58

OBJ: Objective: 8 TOP: Topic: Nutrition During Pregnancy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

NOT: Rationale: The recommended dietary intake increase is 300 kcal a day.

2. The patient confesses to eating crushed ice 10 or 12 times daily. The nurse assesses this behavior as ____________________.

ANS: pica

DIF: Cognitive Level: Comprehension REF: Text Reference: 82

OBJ: Objective: 8 TOP: Topic: Pica KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

NOT: Rationale: Pica is the craving and ingestion of nonfood substances such as clay, crushed ice, and ashes.

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