Chapter 01: 21st Century Maternity Nursing
1. When providing care for a pregnant woman, the nurse should be aware that one of the most frequently reported maternal medical risk factors is:
a. Diabetes mellitus. c. Chronic hypertension.
b. Mitral valve prolapse (MVP). d. Anemia.
2. To ensure optimal outcomes for the patient, the contemporary maternity nurse must incorporate both teamwork and communication with clinicians into her care delivery, The SBAR technique of communication is an easy-to-remember mechanism for communication. Which of the following correctly defines this acronym?
a. Situation, baseline assessment, response
b. Situation, background, assessment, recommendation
c. Subjective background, assessment, recommendation
d. Situation, background, anticipated recommendation
3. The role of the professional nurse caring for childbearing families has evolved to emphasize:
a. Providing care to patients directly at the bedside.
b. Primarily hospital care of maternity patients.
c. Practice using an evidence-based approach.
d. Planning patient care to cover longer hospital stays.
4. A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement?
a. Perform a nutrition assessment.
b. Refer the woman to a social worker.
c. Advise the woman to see an obstetrician, not a midwife.
d. Explain to the woman the importance of keeping her prenatal care appointments.
5. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic patient with limited English proficiency. It is important for the nurse to:
a. Use maternity jargon in order for the patient to become familiar with these terms.
b. Speak quickly and efficiently to expedite the visit.
c. Provide the patient with handouts.
d. Assess whether the patient understands the discussion.
6. When managing health care for pregnant women at a prenatal clinic, the nurse should recognize that the most significant barrier to access to care is the pregnant woman’s:
a. Age. c. Educational level.
b. Minority status. d. Inability to pay.
7. What is the primary role of practicing nurses in the research process?
a. Designing research studies
b. Collecting data for other researchers
c. Identifying researchable problems
d. Seeking funding to support research studies
8. When the nurse is unsure about how to perform a patient care procedure, the best action would be to:
a. Ask another nurse.
b. Discuss the procedure with the patient’s physician.
c. Look up the procedure in a nursing textbook.
d. Consult the agency procedure manual and follow the guidelines for the procedure.
9. From the nurse’s perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further?
a. Implementing programs to ensure women’s early participation in ongoing prenatal care
b. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days
c. Expanding the number of neonatal intensive care units (NICUs)
d. Mandating that all pregnant women receive care from an obstetrician
10. Alternative and complementary therapies:
a. Replace conventional Western modalities of treatment.
b. Are used by only a small number of American adults.
c. Recognize the value of clients’ input into their health care.
d. Focus primarily on the disease an individual is experiencing.
Chapter 02: Community Care: The Family and Culture
1. A married couple lives in a single-family house with their newborn son and the husband’s daughter from a previous marriage. On the basis of the information given, what family form best describes this family?
a. Married-blended family c. Nuclear family
b. Extended family d. Same-sex family
2. In what form do families tend to be most socially vulnerable?
a. Married-blended family c. Nuclear family
b. Extended family d. Single-parent family
3. Health care functions carried out by families to meet their members’ needs include:
a. Developing family budgets.
b. Socializing children.
c. Meeting nutritional requirements.
d. Teaching family members about birth control.
4. The nurse should be aware that the criteria used to make decisions and solve problems within families are based primarily on family:
a. Rituals and customs. c. Boundaries and channels.
b. Values and beliefs. d. Socialization processes.
5. Using the family stress theory as an intervention approach for working with families experiencing parenting, the nurse can help the family change internal context factors. These include:
a. Biologic and genetic makeup.
b. Maturation of family members.
c. The family’s perception of the event.
d. The prevailing cultural beliefs of society.
6. While working in the prenatal clinic, you care for a very diverse group of patients. When planning interventions for these families, you realize that acceptance of the interventions will be most influenced by:
a. Educational achievement. c. Subcultural group.
b. Income level. d. Individual beliefs.
7. The nurse’s care of a Hispanic family includes teaching about infant care. When developing a plan of care, the nurse bases interventions on the knowledge that in traditional Hispanic families:
a. Breastfeeding is encouraged immediately after birth.
b. Male infants typically are circumcised.
c. The maternal grandmother participates in the care of the mother and her infant.
d. Special herbs mixed in water are used to stimulate the passage of meconium.
8. The woman’s family members are present when the home care maternal-child nurse arrives for a postpartum and newborn visit. What should the nurse do?
a. Observe the family members’ interactions with the newborn and one another.
b. Ask the woman to meet with her and the baby alone.
c. Do a brief assessment on all family members present.
d. Reschedule the visit for another time so that the mother and infant can be assessed privately.
9. The nurse should be aware that during the childbearing experience an African-American woman is most likely to:
a. Seek prenatal care early in her pregnancy.
b. Avoid self-treatment of pregnancy-related discomfort.
c. Request liver in the postpartum period to prevent anemia.
d. Arrive at the hospital in advanced labor.
10. To provide competent care to an Asian-American family, the nurse should include which of the following questions during the assessment interview?
a. “Do you prefer hot or cold beverages?”
b. “Do you want milk to drink?”
c. “Do you want music playing while you are in labor?”
d. “Do you have a name selected for the baby?”
Chapter 03: Assessment and Health Promotion
1. The two primary functions of the ovary are:
a. Normal female development and sex hormone release.
b. Ovulation and internal pelvic support.
c. Sexual response and ovulation.
d. Ovulation and hormone production.
2. The uterus is a muscular, pear-shaped organ that is responsible for:
a. Cyclic menstruation. c. Fertilization.
b. Sex hormone production. d. Sexual arousal.
3. Unique muscle fibers make the uterine myometrium ideally suited for:
a. Menstruation. c. Ovulation.
b. The birth process. d. Fertilization.
4. The hormone responsible for maturation of mammary gland tissue is:
a. Estrogen. c. Prolactin.
b. Testosterone. d. Progesterone.
5. Because of the effect of cyclic ovarian changes on the breast, the best time for breast self-examination (BSE) is:
a. 5 to 7 days after menses ceases. c. Midmenstrual cycle.
b. Day 1 of the endometrial cycle. d. Any time during a shower or bath.
6. Menstruation is periodic uterine bleeding:
a. That occurs every 28 days.
b. In which the entire uterine lining is shed.
c. That is regulated by ovarian hormones.
d. That leads to fertilization.
7. Individual irregularities in the ovarian (menstrual) cycle are most often caused by:
a. Variations in the follicular (preovulatory) phase.
b. An intact hypothalamic-pituitary feedback mechanism.
c. A functioning corpus luteum.
d. A prolonged ischemic phase.
8. Prostaglandins are produced in most organs of the body, including the uterus. Other source(s) of prostaglandins is/are:
a. Ovaries. c. Menstrual blood.
b. Breast milk. d. The vagina.
9. Physiologically, sexual response can be characterized by:
a. Coitus, masturbation, and fantasy. c. Erection and orgasm.
b. Myotonia and vasocongestion. d. Excitement, plateau, and orgasm.
10. The long-term treatment plan for an adolescent with an eating disorder focuses on:
a. Managing the effects of malnutrition.
b. Establishing sufficient caloric intake.
c. Improving family dynamics.
d. Restructuring perception of body image.
Chapter 04: Reproductive System Concerns
1. When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by:
a. Anatomic abnormalities. c. Lack of exercise.
b. Type 1 diabetes mellitus. d. Hysterectomy.
2. When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended?
a. Increasing the intake of red meat and simple carbohydrates
b. Reducing the intake of diuretic foods such as peaches and asparagus
c. Temporarily substituting physical activity for a sedentary lifestyle
d. Using a heating pad on the abdomen to relieve cramping
3. Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)?
a. “I feel irritable and moody a week before my period is supposed to start.”
b. “I have lower abdominal pain beginning the third day of my menstrual period.”
c. “I have nausea and headaches after my period starts, and they last 2 to 3 days.”
d. “I have abdominal bloating and breast pain after a couple days of my period.”
4. A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:
a. Endometriosis. c. Primary dysmenorrhea.
b. PMS. d. Secondary dysmenorrhea.
5. Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug:
a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity.
b. Should be sprayed into one nostril every other day.
c. Should be injected into subcutaneous tissue BID.
d. Can cause her to experience some hot flashes and vaginal dryness.
6. While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the client’s recent menstrual cycles. The nurse should collect additional information with which statement?
a. The woman says her menstrual flow lasts 5 to 6 days.
b. She describes her flow as very heavy.
c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months.
d. She says the length of her menstrual cycle varies from 26 to 29 days.
7. When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of:
a. Stress. c. Pregnancy.
b. Excessive exercise. d. Eating disorders.
8. A 36-year-old woman has been given a diagnosis of uterine fibroids. When planning care for this patient, the nurse should know that:
a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy.
b. Fibroids increase in size during the perimenopausal period.
c. Menorrhagia is a common finding.
d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus.
9. During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as:
a. Amenorrhea. c. Dyspareunia.
b. Dysmenorrhea. d. Premenstrual syndrome (PMS).
10. With regard to dysmenorrhea, nurses should be aware that:
a. It is more common in older women.
b. It is more common in leaner women who exercise strenuously.
c. Symptoms can begin at any point in the ovulatory cycle.
d. Pain usually occurs in the suprapubic area or lower abdomen.
Chapter 05: Infertility, Contraception, and Abortion
1. Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?
b. Endometrial biopsy
d. Follicle-stimulating hormone (FSH) level
2. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurse’s most appropriate response is:
a. “Your sperm count seems to be okay in the first semen analysis.”
b. “Only marijuana cigarettes affect sperm count.”
c. “Smoking can give you lung cancer, even though it has no effect on sperm.”
d. “Smoking can reduce the quality of your sperm.”
3. A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed?
a. Testicular biopsy
b. Antisperm antibodies
c. Follicle-stimulating hormone (FSH) level
d. Examination for testicular infection
4. A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurse’s most appropriate response is:
a. “Tell your friends and family so they can help you.”
b. “Talk only to other friends who are infertile because only they can help.”
c. “Get involved with a support group. I’ll give you some names.”
d. “Start adoption proceedings immediately because it is very difficult to obtain an infant.”
5. A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the client in which herbal preparations to avoid while trying to conceive?
a. “You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant.”
b. “You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive.”
c. “You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile.”
d. “Herbs have no bearing on fertility.”
6. In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurse’s most appropriate response is:
a. “IVF-ET is a type of assisted reproductive therapy that involves collecting eggs from your wife’s ovaries, fertilizing them in the laboratory with your sperm, and transferring the embryo to her uterus.”
b. “A donor embryo will be transferred into your wife’s uterus.”
c. “Donor sperm will be used to inseminate your wife.”
d. “Don’t worry about the technical stuff; that’s what we are here for.”
7. Nurses should be aware that infertility:
a. Is perceived differently by women and men.
b. Has a relatively stable prevalence among the overall population and throughout a woman’s potential reproductive years.
c. Is more likely the result of a physical flaw in the woman than in her male partner.
d. Is the same thing as sterility.
8. With regard to the assessment of female, male, and couple infertility, nurses should be aware that:
a. The couple’s religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis.
b. The investigation takes 3 to 4 months and a significant financial investment.
c. The woman is assessed first; if she is not the problem, the male partner is analyzed.
d. Semen analysis is for men; the postcoital test is for women.
9. In their role of implementing a plan of care for infertile couples, nurses should:
a. Be comfortable with their sexuality and nonjudgmental about others to counsel their clients effectively.
b. Know about such nonmedical remedies as diet, exercise, and stress management.
c. Be able to direct clients to sources of information about what herbs to take that might help and which ones to avoid.
d. Do all of the above plus be knowledgeable about potential drug and surgical remedies.
10. Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple before treatment?
a. Risks of multiple gestation
b. Whether or how to disclose the facts of conception to offspring
c. Freezing embryos for later use
d. Financial ability to cover the cost of treatment
Chapter 06: Genetics, Conception, and Fetal Development
1. A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won’t be affected. What response by the nurse is most accurate?
a. “Good planning; you need to take advantage of the odds in your favor.”
b. “I think you’d better check with your doctor first.”
c. “You are both carriers, so each baby has a 25% chance of being affected.”
d. “The ultrasound indicates a boy, and boys are not affected by PKU.”
2. The nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should:
a. Tell the couple they need to have an abortion within 2 to 3 weeks.
b. Explain that the fetus has a 50% chance of having the disorder.
c. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected.
d. Refer the couple to a psychologist for emotional support.
3. The nurse is assessing the knowledge of new parents with a child born with maple syrup urine disease (MSUD). This is an autosomal recessive inherited disorder, which means that:
a. Both genes of a pair must be abnormal for the disorder to be expressed.
b. Only one copy of the abnormal gene is required for the disorder to be expressed.
c. The disorder occurs in males and heterozygous females.
d. The disorder is carried on the X chromosome.
4. In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as:
a. Anxiety and altered family relationships.
b. Denial of insurance benefits.
c. High false-positive results associated with genetic testing.
d. Ethnic and socioeconomic disparity associated with genetic testing.
5. A man’s wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as:
a. Occurrence risk. c. Predictive testing.
b. Recurrence risk. d. Predisposition testing.
6. A key finding from the Human Genome Project is:
a. Approximately 20,000 genes make up the genome.
b. All human beings are 80.99% identical at the DNA level.
c. Human genes produce only one protein per gene; other mammals produce three proteins per gene.
d. Single gene testing will become a standardized test for all pregnant clients in the future.
7. You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant?
a. Disturbed body image c. Anxiety
b. Interrupted family processes d. Risk for injury
8. A couple has been counseled for genetic anomalies. They ask you, “What is karyotyping?” Your best response is:
a. “Karyotyping will reveal if the baby’s lungs are mature.”
b. “Karyotyping will reveal if your baby will develop normally.”
c. “Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes.”
d. “Karyotyping will detect any physical deformities the baby has.”
9. In practical terms regarding genetic health care, nurses should be aware that:
a. Genetic disorders affect people of all socioeconomic backgrounds, races, and ethnic groups equally.
b. Genetic health care is more concerned with populations than individuals.
c. The most important of all nursing functions is providing emotional support to the family during counseling.
d. Taking genetic histories is the province of large universities and medical centers.
10. With regard to prenatal genetic testing, nurses should be aware that:
a. Maternal serum screening can determine whether a pregnant woman is at risk of carrying a fetus with Down syndrome.
b. Carrier screening tests look for gene mutations of people already showing symptoms of a disease.
c. Predisposition testing predicts with near certainty that symptoms will appear.
d. Presymptomatic testing is used to predict the likelihood of breast cancer.
Chapter 07: Anatomy and Physiology of Pregnancy
1. A woman’s obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?
a. 3-1-1-1-3 c. 3-0-3-0-3
b. 4-1-2-0-4 d. 4-2-1-0-3
2. A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have:
a. Amenorrhea. c. Chadwick’s sign.
b. Positive pregnancy test. d. Hegar’s sign.
3. The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse’s instructions if she states that a positive sign of pregnancy is:
a. A positive pregnancy test.
b. Fetal movement palpated by the nurse-midwife.
c. Braxton Hicks contractions.
4. A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level?
a. Not palpable above the symphysis at this time
b. Slightly above the symphysis pubis
c. At the level of the umbilicus
d. Slightly above the umbilicus
5. During a client’s physical examination the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as:
a. Hegar’s sign c. Chadwick’s sign
b. McDonald’s sign d. Goodell’s sign
6. Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
a. Less audible heart sounds (S1, S2)
b. Increased pulse rate
c. Increased blood pressure
d. Decreased red blood cell (RBC) production
7. Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth?
a. Epulis c. Telangiectasia
b. Chloasma d. Striae gravidarum
8. The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?
a. Her center of gravity will shift backward.
b. She will have increased lordosis.
c. She will have increased abdominal muscle tone.
d. She will notice decreased mobility of her pelvic joints.
9. A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman’s last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which reveals that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?
a. She took the pregnancy test too early.
b. She takes anticonvulsants.
c. She has a fibroid tumor.
d. She has been under considerable stress and has a hormone imbalance.
10. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:
a. This is a normal respiratory change in pregnancy caused by elevated levels of estrogen.
b. This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign.
c. The woman is a victim of domestic violence and is being hit in the face by her partner.
d. The woman has been using cocaine intranasally.
Chapter 08: Nursing Care of the Family During Pregnancy
1. The nurse caring for a newly pregnant woman would advise her that ideally prenatal care should begin:
a. Before the first missed menstrual period.
b. After the first missed menstrual period.
c. After the second missed menstrual period.
d. After the third missed menstrual period.
2. Prenatal testing for human immunodeficiency virus (HIV) is recommended for:
a. All women, regardless of risk factors.
b. A woman who has had more than one sexual partner.
c. A woman who has had a sexually transmitted infection.
d. A woman who is monogamous with her partner.
3. Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider?
a. Nausea with occasional vomiting c. Urinary frequency
b. Fatigue d. Vaginal bleeding
4. A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her:
a. “You don’t need to modify your exercising any time during your pregnancy.”
b. “Stop exercising because it will harm the fetus.”
c. “You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
d. “Jogging is too hard on your joints; switch to walking now.”
5. The multiple marker test is used to assess the fetus for which condition?
a. Down syndrome c. Congenital cardiac abnormality
b. Diaphragmatic hernia d. Anencephaly
6. A woman who is 32 weeks’ pregnant is informed by the nurse that a danger sign of pregnancy could be:
b. Alteration in the pattern of fetal movement.
c. Heart palpitations.
d. Edema in the ankles and feet at the end of the day.
7. A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her:
a. “Since you’re in your second trimester, there’s no problem with having one drink with dinner.”
b. “One drink every night is too much. One drink three times a week should be fine.”
c. “Since you’re in your second trimester, you can drink as much as you like.”
d. “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”
8. A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she:
a. Do Kegel exercises. c. Use a softer mattress.
b. Do pelvic rock exercises. d. Stay in bed for 24 hours.
9. For what reason would breastfeeding be contraindicated?
a. Hepatitis B
b. Everted nipples
c. History of breast cancer 3 years ago
d. Human immunodeficiency virus (HIV) positive
10. A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she doesn’t know what is happening; one minute she’s happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate?
a. “Don’t worry about it; you’ll feel better in a month or so.”
b. “Have you talked to your husband about how you feel?”
c. “Perhaps you really don’t want to be pregnant.”
d. “Hormonal changes during pregnancy commonly result in mood swings.”
Chapter 09: Maternal and Fetal Nutrition
1. A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lb) since conception. How would the nurse interpret this?
a. This weight gain indicates possible gestational hypertension.
b. This weight gain indicates that the woman’s infant is at risk for intrauterine growth restriction (IUGR).
c. This weight gain cannot be evaluated until the woman has been observed for several more weeks.
d. The woman’s weight gain is appropriate for this stage of pregnancy.
2. Which meal would provide the most absorbable iron?
a. Toasted cheese sandwich, celery sticks, tomato slices, and a grape drink
b. Oatmeal, whole wheat toast, jelly, and low-fat milk
c. Black bean soup, wheat crackers, orange sections, and prunes
d. Red beans and rice, cornbread, mixed greens, and decaffeinated tea
3. Which nutrient’s recommended dietary allowance (RDA) is higher during lactation than during pregnancy?
a. Energy (kcal) c. Vitamin A
b. Iron d. Folic acid
4. A pregnant woman’s diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this woman’s intake of:
a. Calcium. c. Vitamin B12.
b. Protein. d. Folic acid.
5. A pregnant woman experiencing nausea and vomiting should:
a. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.
b. Eat small, frequent meals (every 2 to 3 hours).
c. Increase her intake of high-fat foods to keep the stomach full and coated.
d. Limit fluid intake throughout the day.
6. A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned that during and after tennis matches this woman consumes:
a. Several glasses of fluid.
b. Extra protein sources such as peanut butter.
c. Salty foods to replace lost sodium.
d. Easily digested sources of carbohydrate.
7. Which statement made by a lactating woman would lead the nurse to believe that the woman might have lactose intolerance?
a. “I always have heartburn after I drink milk.”
b. “If I drink more than a cup of milk, I usually have abdominal cramps and bloating.”
c. “Drinking milk usually makes me break out in hives.”
d. “Sometimes I notice that I have bad breath after I drink a cup of milk.”
8. A pregnant woman’s diet history indicates that she likes the following list of foods. The nurse would encourage this woman to consume more of which food to increase her calcium intake?
a. Fresh apricots c. Spaghetti with meat sauce
b. Canned clams d. Canned sardines
9. A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this woman’s total recommended weight gain during pregnancy should be at least:
a. 20 kg (44 lb). c. 12.5 kg (27.5 lb).
b. 16 kg (35 lb). d. 10 kg (22 lb).
10. A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman:
a. Substitute other calcium sources for milk in her diet.
b. Lie down after each meal.
c. Reduce the amount of fiber she consumes.
d. Eat five small meals daily.
Chapter 10: Assessment of High Risk Pregnancy
1. A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine “several times” during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category?
a. Blood pressure, age, BMI
b. Drug/alcohol use, age, family history
c. Family history, blood pressure, BMI
d. Family history, BMI, drug/alcohol abuse
2. A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time?
a. Ultrasound examination
b. Maternal serum alpha-fetoprotein (MSAFP) screening
d. Nonstress test (NST)
3. The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what other tool would be useful in confirming the diagnosis?
a. Doppler blood flow analysis c. Amniocentesis
b. Contraction stress test (CST) d. Daily fetal movement counts
4. A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus?
a. Ultrasound for fetal anomalies
b. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein (MSAFP) screening
d. Percutaneous umbilical blood sampling (PUBS)
5. At 35 weeks of pregnancy a woman experiences preterm labor. Tocolytics are administered and she is placed on bed rest, but she continues to experience regular uterine contractions, and her cervix is beginning to dilate and efface. What would be an important test for fetal well-being at this time?
a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal size
c. Amniocentesis for fetal lung maturity
d. Nonstress test (NST)
6. A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time?
a. Biophysical profile (BPP)
c. Maternal serum alpha-fetoprotein (MSAFP) screening
d. Transvaginal ultrasound
7. Maternal serum alpha-fetoprotein (MSAFP) screening indicates an elevated level. MSAFP screening is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus?
a. Percutaneous umbilical blood sampling (PUBS)
b. Ultrasound for fetal anomalies
c. Biophysical profile (BPP) for fetal well-being
d. Amniocentesis for genetic anomalies
8. A client asks her nurse, “My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?” The best response by the nurse is:
a. “Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.”
b. “Your placenta isn’t working properly, and your baby is in danger.”
c. “This means that we will need to perform an amniocentesis to detect if you have any placental damage.”
d. “Don’t worry about it. Everything is fine.”
9. A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be:
a. Negative. c. Satisfactory.
b. Positive. d. Unsatisfactory.
10. When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that:
a. Alcohol or cigarette smoke can irritate the fetus into greater activity.
b. “Kick counts” should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off.
c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.
d. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women.
AND MUCH MORE