1. Myrna, who’s 4 months pregnant asks the
Examine the vagina to determine whether her
nurse how much and what type of exercise she
should get during pregnancy. How should nurse
Maricel counsel her?
a. “Try high-intensity aerobics, but limit sessions
to 15 minutes daily.”
b. “Perform gentle back-lying exercises for 30
minutes daily.”
c. “Walk briskly for 10 to 15 minutes daily, and
gradually increase this time.”
d. “Exercise to raise the heart rate above 140
beats/minute for 20 minutes daily.”
2. Linda, who’s 37 weeks pregnant comes to the regarding breast-feeding success?
clinic for a prenatal checkup. To assess the client’s a. “It’s contraindicated for you to breast-feed
preparation for parenting, nurse Kim might ask
which question?
a. “Are you planning to have epidural
anesthesia?”
b. “Have you begun prenatal classes?”
c. “What changes have you made at home to get determine whether breast-feeding would be
ready for the baby?”
d. “Can you tell me about the meals you
typically eat each day?”
3. Nurse Tanya is aware that the best place to
detect fetal heart sounds for a client in the first
trimester of pregnancy?
a. Above the symphysis pubis
b. Below the symphysis pubis
c. Above the umbilicus
d. At the umbilicus
4. Lovelyn, asks the nurse whether she can take
castor oil for her constipation. How should the
nurse respond?
a. “Yes, it produces no adverse effects.”
b. “No, it can initiate premature uterine
contractions.”
c. “No, it can promote sodium retention.”
d. “No, it can lead to increased absorption of fat-
soluble vitamins.”
5. A client at 35 weeks’ gestation complains of
severe abdominal pain and passing clots. The
client’s vital signs are blood pressure 150/100 mm
Hg, heart rate 95 beats/minute, respiratory rate 25
breaths/minute, and fetal heart tones 160
beats/minute. Nurse Nikki must determine the
cause of the bleeding and respond appropriately to
this emergency. Which of the following should the
nurse do first?
a.
client is in labor
b. Assess the location and consistency of the
uterus
c. Perform an ultrasound to determine placental
placement
d. Prepare for immediate delivery
6. When assessing a client during her first
prenatal visit, nurse Lucy discovers that the client
had a reduction mammoplasty. The mother
indicates she wants to breast-feed. What
information should the nurse give to this mother
following this type of surgery.”
b. “I support your commitment; however, you
may have to supplement each feeding with
formula.”
c. “You should check with your surgeon to
possible.”
d. “You should be able to breast-feed without
difficulty.”
7. When questioned, Alma admits she sometimes
has several glasses of wine with dinner. Her
alcohol consumption puts her fetus at risk for
which condition?
a. Alcohol addiction
b. Anencephaly
c. Down syndrome
d. Learning disability
8. Nurse Helen has a client at 30 weeks’
gestation who has tested positive for the human
immunodeficiency virus (HIV). What should the
nurse tell the client when she says that she wants
to breast-feed her baby?
a. Encourage breast-feeding so that she can get
her rest and get healthier
b. Encourage breast-feeding because it’s
healthier for the baby
c. Encourage breast-feeding to facilitate bonding
d. Discourage breast-feeding because HIV can
be transmitted through breast milk
9. During each prenatal checkup, nurse Paul
obtains the client’s weight and blood pressure and
measures fundal height. What is another essential
part of each prenatal checkup?
a. Evaluating the client for edema
b. Measuring the client’s hemoglobin (Hb) level
c. Obtaining pelvic measurements
d. Determining the client’s Rh factor
10. Which of the following instructions should
nurse Dan give to a client who’s 26 weeks
pregnant and complains of constipation?
a. Encourage her to increase her intake of
roughage and to drink at least six glasses of water prenatal visit. Nurse Alex should include which of
per day.
b. Tell her to ask her caregiver for a mild
laxative.
c. Suggest the use of an over-the-counter stool
softener.
d. Tell her to go to the evaluation unit because
constipation may cause contractions.
11. During the 6th month of pregnancy, Gail
reports intermittent earaches and a constant feeling
of fullness in the ears. What is the most likely
cause of these symptoms?
a. A serious neurologic disorder
b. Eustachian tube vascularization
c. Increasing progesterone levels
d. An ear infection
12. Malou, 2 months pregnant, has hyperemesis
gravidarum. Which expected outcome is most
appropriate for her?
a. “Client will accept the pregnancy and stop
vomiting.”
b. “Client will gain weight according to the
expected pattern for pregnancy.”
c. “Client will remain hospitalized for the
duration of pregnancy to relieve stress.”
d. “Client will exhibit uterine growth within the pregnant client. The client is taking an iron
expected norms for gestational age.”
13. When assessing a pregnant client with
diabetes mellitus, nurse Gio stays alert for signs
and symptoms of a vaginal or urinary tract
infection (UTI). Which condition makes this client
more susceptible to such infections?
a. Electrolyte imbalances
b. Decreased insulin needs
c. Hypoglycemia
d. Glycosuria
14. Josephine, 11 weeks pregnant, is admitted to
the facility with hyperemesis gravidarum. She tells
the nurse she has never known anyone who had
such severe morning sickness. The nurse
understands that hyperemesis gravidarum results
from:
a. a neurologic disorder.
b. inadequate nutrition.
c. an unknown cause.
d. hemolysis of fetal red blood cells (RBCs).
15. A client has come to the clinic for her first
the following statements about using drugs safely
during pregnancy in her teaching?
a. “During the first 3 months, avoid all
medications except ones prescribed by your
caregiver.”
b. “Medications that are available over the
counter are safe for you to use, even early on.”
c. “All medications are safe after you’ve reached
the 5th month of pregnancy.”
d. “Consult with your health care provider
before taking any medications.”
16. A pregnant client asks how she can best
prepare her 3-year-old son for the upcoming birth
of a sibling. Nurse Lou should make which
suggestion?
a. “Tell your son about the childbirth about 1
month before your due date.”
b. “Reassure your son that nothing is going to
change.”
c. “Reprimand your son if he displays immature
behavior.”
d. “Involve your son in planning and preparing
for a sibling.”
17. Nurse Cathy is caring for a 16-year-old
supplement. What should this client drink to
increase the absorption of iron?
a. A glass of milk
b. A cup of hot tea
c. A liquid antacid
d. A glass of orange juice
18. Nurse Rey is using Doppler ultrasound to
assess a pregnant woman. When should the nurse
expect to hear fetal heart tones?
a. 7 weeks
b. 11 weeks
c. 17 weeks
d. 21 weeks
19. Nurse Edith is caring for a client who’s on b. 10%
ritodrine therapy to halt premature labor. What c. 20%
condition indicates an adverse reaction to ritodrine d. 60%
therapy?
25. Sandy, age 39, visits the nurse practitioner
a. Hypoglycemia
for a regular prenatal check-up. She’s 32 weeks
b. Crackles
pregnant. When assessing her, the nurse should
c. Bradycardia
stay especially alert for signs and symptoms of:
d. Hyperkalemia
a. pregnancy-induced hypertension (PIH).
20. Noemi, a newly pregnant woman tells the b. iron deficiency anemia.
nurse that she hasn’t been taking her prenatal c. cephalopelvic disproportion.
vitamins because they make her nauseated. In d. sexually transmitted diseases (STDs).
addition to telling the client how important taking
the vitamins are, the nurse should advise her to:
a. switch brands.
b. take the vitamin on a full stomach.
c. take the vitamin with orange juice for better
absorption.
d. take the vitamin first thing in the morning.
21. A client is scheduled for amniocentesis.
When preparing her for the procedure, nurse Vince
should do which of the following?
a. Ask her to void.
b. Instruct her to drink 1 L of fluid.
c. Prepare her for I.V. anesthesia.
d. Place her on her left side.
22. After determining that a pregnant client is
Rh-negative, Dr. Smith orders an indirect Coombs’
test. What is the purpose of performing this test in
a pregnant client?
a. To determine the fetal blood Rh factor
b. To determine the maternal blood Rh factor
c. To detect maternal antibodies against fetal Rh-
negative factor
d. To detect maternal antibodies against fetal Rh-
positive factor
23. During a routine prenatal visit, a pregnant
client reports heartburn. To minimize her
discomfort, nurse Faith should include which
suggestion in the plan of care?
a. Eat small, frequent meals.
b. Limit fluid intake sharply.
c. Drink more citrus juice.
d. Take sodium bicarbonate.
24. A pregnant client asks nurse Mary about the
percentage of congenital anomalies caused by
drug exposure. How should the nurse respond?
a. 1%
ANSWERS AND RATIONALES:
1. Answer C. Taking brisk walks is one of the
easiest ways to exercise during pregnancy. The
client should begin by walking slowly for 10 to 15 with blood because the placenta has detached early
minutes per day and increase gradually to a
comfortable speed and a duration of 30 to 45
minutes per day. The pregnant client should avoid contraindicated in the presence of bleeding. Most
high-intensity aerobics because these greatly
increase oxygen consumption; pregnancy itself not ultrasound. If the client has a placental abruption,
only increases oxygen consumption but reduces
oxygen reserve. Starting from the 4th month of
pregnancy, the client should avoid back-lying
exercises because in this position the enlarged
uterus may reduce blood flow through the vena
cava. The client should avoid exercises that raise
the heart rate over 140 beats/minute because the
cardiovascular system already is stressed by
increased blood volume during pregnancy.
2. Answer C. During the third trimester, the
pregnant client typically perceives the fetus as a
separate being. To verify that this has occurred, the important because the client’s psychological
nurse should ask whether she has made
appropriate changes at home such as obtaining
infant supplies and equipment. The type of
anesthesia planned doesn’t reflect the client’s
preparation for parenting. The client should have
begun prenatal classes earlier in the pregnancy.
The nurse should have obtained dietary
information during the first trimester to give the
client time to make any necessary changes.
3. Answer A. In the first trimester, fetal heart
sounds are loudest in the area of maximum
intensity, just above the client’s symphysis pubis
at the midline. Fetal heart sounds aren’t heard as
well in the other locations.
4. Answer B. Castor oil can initiate premature
uterine contractions in pregnant women. It also
can produce other adverse effects, but it doesn’t
promote sodium retention. Castor oil isn’t known
to increase absorption of fat-soluble vitamins,
although laxatives can decrease absorption if
intestinal motility is increased.
5. Answer B. The nurse must determine whether high blood pressure and proteinuria — other signs
placenta previa or abruptio placentae is the
problem. (Fifty percent of all clients with
hypertension will develop abruptio placenta.) In
this case, the presenting symptoms are highly
suggestive of an abruption, so the nurse must
determine the level of the uterus and mark that
level on the client’s abdomen. She must also check
the consistency of the uterus; a uterus that is filling
is rigid. Bleeding from a placental previa is
usually painless. A vaginal examination is
nurses haven’t been taught how to perform an
birth will most likely be by cesarean section.
6. Answer B. Recent breast reduction surgeries
are done in a way to protect the milk sacs and
ducts, so breast-feeding after surgery is possible.
Still, it’s good to check with the surgeon to
determine what breast reduction procedure was
done. There is the possibility that reduction
surgery may have decreased the mother’s ability to
meet all of her baby’s nutritional needs, and some
supplemental feeding may be required. Preparing
the mother for this possibility is extremely
adaptation to mothering may be dependent on how
successfully she breast-feeds.
7. Answer D. Maternal alcohol use during
pregnancy may cause fetal and neonatal central
nervous system deficits such as learning
disabilities. It also may lead to characteristic
physical anomalies and growth retardation.
Maternal alcohol use doesn’t cause alcohol
addiction in the fetus or neonate. Anencephaly
occurs when the cranial end of the neural tube fails
to fuse before the 26th day of gestation; this
condition isn’t related to maternal alcohol use.
Down syndrome results from a chromosomal
disorder.
8. Answer: D. Transmission of HIV can occur
through breast milk, so breast-feeding should be
discouraged in this case.
9. Answer A. During each prenatal checkup, the
nurse should evaluate the client for edema, a
possible sign of pregnancy-induced hypertension
(PIH). If edema exists, the nurse should assess for
of PIH. Hb is measured during the first prenatal
visit and again at 24 to 28 weeks’ gestation and at
36 weeks’ gestation. The pelvis is measured and
the Rh factor determined during the first prenatal
visit.
10. Answer A. The best instruction is to
encourage the client to increase her intake of high-
fiber foods (roughage) and to drink at least six
glasses of water per day. Mild laxatives and stool
softeners may be needed, but dietary changes
should be tried first. Straining during defecation
and diarrhea can stimulate uterine contractions,
but telling the client to go to the evaluation unit
doesn’t address her concern.
11. Answer B. During pregnancy, increasing
levels of estrogen — not progesterone — cause
vascularization of the eustachian tubes, leading to
such problems as earaches, impaired hearing, and
a constant feeling of fullness in the ears. Nothing
in the question implies that the client has a serious
neurologic disorder or an ear infection.
12. Answer D. For a client with hyperemesis
gravidarum, the goal of nursing care is to achieve
optimal fetal growth, which can be evaluated by
monitoring uterine growth through fundal height
assessment. The nurse shouldn’t assume that
excessive vomiting signifies the client doesn’t
accept the pregnancy. Clients with hyperemesis
gravidarum rarely gain weight according to the
expected pattern. They may be hospitalized briefly
to regulate fluid and electrolyte status, but they
don’t require hospitalization for the duration of
pregnancy. In fact, hospitalization may add to the
stress of pregnancy by causing family separation
and financial concerns.
13. Answer D. Glycosuria predisposes the
pregnant diabetic client to vaginal infections
(especially Candida vaginitis) and UTIs, because
the hormonal changes of pregnancy affect vaginal
pH and the bladder. Electrolyte imbalances and
hypoglycemia aren’t associated with vaginal
infections or UTIs. Insulin requirements may
decrease in early pregnancy; however, as the
client’s food intake improves and maternal and
fetal glycogen stores increase, insulin
requirements also rise.
14. Answer C. The cause of hyperemesis
gravidarum isn’t known. However, etiologic
theories implicate hormonal alterations and
allergic or psychosomatic conditions. No evidence
suggests that hyperemesis gravidarum results from
a neurologic disorder, inadequate nutrition, or
hemolysis of fetal RBCs.
15. Answer D. Because all medications can be
potentially harmful to the growing fetus, telling
the client to consult with her health care provider
before taking any medications is the best teaching.
The client needs to understand that any medication
taken at any time during pregnancy can be
teratogenic.
16. Answer D. Being involved in the pregnancy
helps reinforce a child’s position in the family and
minimizes feelings of neglect and abandonment.
Telling the child about the childbirth only 1 month
before the due date wouldn’t allow enough time to
prepare him for the sibling and would prevent him
from conceptualizing the passage of time.
Reassuring him that nothing will change would be
misleading; instead, the parents should discuss
which aspects of family life will be changed by the
upcoming birth and which will remain the same.
Parents should reward mature behavior and ignore
immature behavior.
17. Answer D. Increasing vitamin C enhances
the absorption of iron supplements. Taking an iron
supplement with milk, tea, or an antacid reduces
the absorption of iron.
18. Answer B. Using Doppler ultrasound, fetal
heart tones may be heard as early as the 11th week
of pregnancy. Using a stethoscope, fetal heart
tones may be heard between 17 and 20 weeks of
gestation.
19. Answer B. Use of ritodrine can lead to
pulmonary edema. Therefore, the nurse should
assess for crackles and dyspnea. Blood glucose
levels may temporarily rise, not fall, with
ritodrine. Ritodrine may cause tachycardia, not
bradycardia. Ritodrine may also cause
hypokalemia, not hyperkalemia.
20. Answer B. Prenatal vitamins commonly
cause nausea and taking them on a full stomach
may curb this. Switching brands may not be
helpful and may be more costly. Orange juice
tends to make pregnant women nauseated. The
vitamins may be taken at night, rather than in the
morning, to reduce nausea.
21. Answer A. To prepare a client for
amniocentesis, the nurse should ask her to empty
her bladder to reduce the risk of bladder
perforation. Before transabdominal ultrasound, the
nurse may instruct the client to drink 1 L of fluid
to fill the bladder (unless ultrasound is done before
amniocentesis to locate the placenta). I.V.
anesthesia isn’t given for amniocentesis. The
client should be supine during the procedure;
afterward, she should be placed on her left side to
avoid supine hypotension, promote venous return,
and ensure adequate cardiac output.
22. Answer D. The indirect Coombs’ test
measures the number of antibodies against fetal
Rh-positive factor in maternal blood. The maternal
blood Rh factor is determined before the indirect
Coombs’ test is done. No maternal antibodies
against fetal Rh-negative factor exist.
23. Answer A. To relieve heartburn, the nurse
should advise a pregnant client to eat smaller
meals at shorter intervals; drink six to eight 8-oz
glasses of fluid daily to minimize regurgitation
and reflux of stomach contents; and avoid citrus
juice, which may act as a gastric irritant and
worsen heartburn, and sodium bicarbonate, which
may disrupt the body’s sodium-potassium balance.
24. Answer A. Drug exposure causes 1% of
congenital anomalies.
25. Answer A. Mature pregnant clients are at
increased risk for PIH and are more likely to
require cesarean delivery. Also, their fetuses and
neonates have a higher mortality and a higher
incidence of trisomies. Iron deficiency anemia,
cephalopelvic disproportion, and STDs may occur
in any client regardless of age.