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. How would the nurse document the patients obstetric history using the TPALM system?
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 TPALM system of identifying gravida and para.

A woman calls her health care provider to schedule prenatal visits in an uncomplicated pregnancy. How frequently will the nurse assist the patient to schedule these appointments?
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.

During the physical examination for the first prenatal visit, it is noted that Chadwicks sign is present. What is Chadwicks sign?
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.

After the examination is completed, the patient asks the nurse why Chadwicks sign occurs during pregnancy. What would the nurse explain as the cause of Chadwicks sign?
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.

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. 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.

A woman reports that her last normal menstrual period began on August 5, 2013. What is this womans expected delivery date using Ngeles rule?
a. April 30, 2014
b. May 5, 2014
c. May 12, 2014
d. May 26, 2014

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 and change the year if necessary.

During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an electronic Doppler device. How early might fetal heart tones be detected with an electronic Doppler device?
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.

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. What is the nurses first action?
a. Ask if the patient has taken a sedative.
b. Notify the physician.
c. Turn the patient to her right side.
d. Record the 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.

A womans prepregnant weight is determined to be average for her height. What will the nurse advise the woman regarding recommended weight gain during pregnancy?
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.

When the nurse tells a pregnant woman that she needs 1200 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.

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.

The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. What is the nurses initial action?
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.

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. What food can the nurse recommend?
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.

The nurse encourages adequate intake of folic acid for women of childbearing age before and during pregnancy. What is folic acid thought to decrease the incidence of in fetal development?
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.

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, and fetal movements felt by the examiner.

At her initial prenatal visit a woman asks, When can I hear the babys heartbeat? At what gestational age can the fetal heartbeat be auscultated with a specially adapted stethoscope or fetoscope?
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 weeks of pregnancy.

A woman pregnant for the first time asks the nurse, When will I begin to feel the baby move? What is the nurses best response?
a. You may notice the baby moving around the 4th or 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 of gestation.

A pregnant woman inquires about exercising during pregnancy. What information should the nurse include when planning to educate this woman?
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.

An ultrasound confirms that a 16-year-old girl is pregnant. How does the need for prenatal care and counseling for adolescents different from other age populations?
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.

At what age is a woman who becomes pregnant for the first time described as an elderly primip?
a. After 25 years old
b. After 28 years old
c. After 30 years old
d. After 35 years old

ANS: D
A woman over the age of 35 who becomes pregnant for the first time is described as an elderly primip.

The nurse explains that the softening of the cervix and vagina is a probable sign of pregnancy. What is the appropriate term for this sign?
a. Chadwicks
b. Hegars
c. McDonalds
d. Goodells

ANS: D
Goodells sign is one of the probable signs of pregnancy and describes a softened cervix and vagina.

When obtaining a prenatal history on a pregnant patient the nurse notes a family history of sickle cell disease. Given this information, what lab test can the nurse anticipate the physician will order?
a. Endovaginal ultrasound
b. Pap test
c. Complete blood count
d. Hemoglobin electrophoresis

ANS: D
Hemoglobin electrophoresis identifies presence of sickle cell trait or disease (in women of African or Mediterranean descent). It is ordered in the first trimester, if indicated.

A pregnant woman is attending her second postpartum visit. Prenatal lab work indicates she is not immune to the rubella virus. What is the most appropriate nursing intervention?
a. Provide the rubella vaccine as ordered by the physician immediately.
b. Inform the woman she should receive the vaccine in the hospital after delivery.
c. Hold all immunizations until 1 month postpartum.
d. Encourage the patient to decide whether or not to get the rubella vaccine prenatally.

ANS: B
The rubella vaccine is contraindicated during pregnancy. A woman should be instructed to avoid pregnancy for at least 1 month following rubella immunization. It is not necessary to hold all immunizations until 1 month postpartum.

A woman who is 37 weeks pregnant reports feeling dizzy when lying on her back. What does the nurse explain as the most likely cause of this symptom?
a. Supine hypotension syndrome
b. Gestational diabetes
c. Pregnancy-induced hypertension
d. Malnutrition

ANS: A
Supine hypotension syndrome, also called aortocaval compression or vena cava syndrome, may occur if the woman lies on her back. Symptoms of supine hypotension syndrome include faintness, lightheadedness, dizziness, and agitation.

A woman who is 36 weeks pregnant tells the nurse she plans to take a 12-hour flight to Hawaii. 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.

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.

The nurse assesses the progress from the announcement stage of fatherhood to the acceptance stage when the patient reports which actions by the father? (Select all that apply.)
a. Goes fishing every afternoon
b. Has revised his financial plan
c. Spends 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 an infant is an indication of the acceptance stage. Concentration on a hobby and spending time away from home are indicators of nonacceptance.

What nursing interventions are appropriate 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.

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.

The number of years between menarche and the date of conception is known as
___________________ age.

ANS:
gynecological

Gynecological age is a term that refers to the number of years between the starting of the menses and the date of conception.

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.

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.

The nurse is aware that ______________ maneuver can assess the position and presentation of the fetus.

ANS:
Leopolds
Leopolds maneuver assesses the position and the presentation of the fetus by palpation.

Fathers go through phases similar to the expectant mother. Place the following phases in order from first to last. Put a comma and space between each answer choice (a, b, c, d, etc.)
a. Focus phase
b. Announcement phase
c. Adjustment phase

ANS:
B, C, A
For fathers, the announcement phase begins when pregnancy is confirmed. The second phase of the fathers response is the adjustment phase. The third phase of the fathers response is the focus phase, in which active plans for participation in the labor process, birth, and change in lifestyle result in the partner feeling like a father.