Maternal & Child Health Nursing NCLEX part 4
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PDF format, Answers and Rationales are available at the end of this questions.
Antepartum
1. A nursing instructor is conducting a lecture and is
reviewing the functions of the female reproductive system. She asks Mark to
describe the follicle-stimulating hormone (FSH) and the luteinizing hormone
(LH). Mark accurately responds by stating that:
A. FSH and LH are released from the anterior pituitary
gland.
B. FSH and LH are secreted by the corpus luteum of the
ovary
C. FSH and LH are secreted by the adrenal glands
D. FSH and LH stimulate the formation of milk during
pregnancy.
2. A nurse is describing the process of fetal
circulation to a client during a prenatal visit. The nurse accurately tells the
client that fetal circulation consists of:
A. Two umbilical veins and one umbilical artery
B. Two umbilical arteries and one umbilical vein
C. Arteries carrying oxygenated blood to the fetus
D. Veins carrying deoxygenated blood to the fetus
3. During a prenatal visit at 38 weeks, a nurse
assesses the fetal heart rate. The nurse determines that the fetal heart rate
is normal if which of the following is noted?
A. 80 BPM
B. 100 BPM
C. 150 BPM
D. 180 BPM
4. A client arrives at a prenatal clinic for the first
prenatal assessment. The client tells a nurse that the first day of her last
menstrual period was September 19th, 2013. Using Naegele’s rule, the nurse
determines the estimated date of confinement as:
A. July 26, 2013
B. June 12, 2014
C. June 26, 2014
D. July 12, 2014
5. A nurse is collecting data during an admission
assessment of a client who is pregnant with twins. The client has a healthy 5
year old child that was delivered at 37 weeks and tells the nurse that she
doesn’t have any history of abortion or fetal demise. The nurse would document
the GTPAL for this client as:
A. G = 3, T = 2, P = 0, A = 0, L =1
B. G = 2, T = 0, P = 1, A = 0, L =1
C. G = 1, T = 1. P = 1, A = 0, L = 1
D. G = 2, T = 0, P = 0, A = 0, L = 1
6. A nurse is performing an assessment of a primipara
who is being evaluated in a clinic during her second trimester of pregnancy.
Which of the following indicates an abnormal physical finding necessitating
further testing?
A. Consistent increase in fundal height
B. Fetal heart rate of 180 BPM
C. Braxton Hicks contractions
D. Quickening
7. A nurse is reviewing the record of a client who has
just been told that a pregnancy test is positive. The physician has documented
the presence of a Goodell’s sign. The nurse determines this sign indicates:
A. A softening of the cervix
B. A soft blowing sound that corresponds to the
maternal pulse during auscultation of the uterus.
C. The presence of hCG in the urine
D. The presence of fetal movement
8. A nursing instructor asks a nursing student who is
preparing to assist with the assessment of a pregnant client to describe the
process of quickening. Which of the following statements if made by the student
indicates an understanding of this term?
A. “It is the irregular, painless contractions that
occur throughout pregnancy.”
B. “It is the soft blowing sound that can be heard
when the uterus is auscultated.”
C. “It is the fetal movement that is felt by the
mother.”
D. “It is the thinning of the lower uterine segment.”
9. A nurse midwife is performing an assessment of a
pregnant client and is assessing the client for the presence of ballottement.
Which of the following would the nurse implement to test for the presence of
ballottement?
A. Auscultating for fetal heart sounds
B. Palpating the abdomen for fetal movement
C. Assessing the cervix for thinning
D. Initiating a gentle upward tap on the cervix
10. A nurse is assisting in performing an assessment
on a client who suspects that she is pregnant and is checking the client for
probable signs of pregnancy. Select all probable signs of pregnancy.
A. Uterine enlargement
B. Fetal heart rate detected by nonelectric device
C. Outline of the fetus via radiography or ultrasound
D. Chadwick’s sign
E. Braxton Hicks contractions
F. Ballottement
11. A pregnant client calls the clinic and tells a
nurse that she is experiencing leg cramps and is awakened by the cramps at
night. To provide relief from the leg cramps, the nurse tells the client to:
A. Dorsiflex the foot while extending the knee when
the cramps occur
B. Dorsiflex the foot while flexing the knee when the
cramps occur
C. Plantar flex the foot while flexing the knee when
the cramps occur
D. Plantar flex the foot while extending the knee when
the cramps occur.
12. A nurse is providing instructions to a client in
the first trimester of pregnancy regarding measures to assist in reducing
breast tenderness. The nurse tells the client to:
A. Avoid wearing a bra
B. Wash the nipples and areola area daily with soap,
and massage the breasts with lotion.
C. Wear tight-fitting blouses or dresses to provide
support
D. Wash the breasts with warm water and keep them dry
13. A pregnant client in the last trimester has been
admitted to the hospital with a diagnosis of severe preeclampsia. A nurse
monitors for complications associated with the diagnosis and assesses the
client for:
A. Any bleeding, such as in the gums, petechiae, and
purpura.
B. Enlargement of the breasts
C. Periods of fetal movement followed by quiet periods
D. Complaints of feeling hot when the room is cool
14. A client in the first trimester of pregnancy
arrives at a health care clinic and reports that she has been experiencing
vaginal bleeding. A threatened abortion is suspected, and the nurse instructs
the client regarding management of care. Which statement, if made by the
client, indicates a need for further education?
A. “I will maintain strict bedrest throughout the
remainder of the pregnancy.”
B. “I will avoid sexual intercourse until the bleeding
has stopped, and for 2 weeks following the last evidence of bleeding.”
C. “I will count the number of perineal pads used on a
daily basis and note the amount and color of blood on the pad.”
D. “I will watch for the evidence of the passage of
tissue.”
15. A prenatal nurse is providing instructions to a
group of pregnant client regarding measures to prevent toxoplasmosis. Which
statement if made by one of the clients indicates a need for further
instructions?
A. “I need to cook meat thoroughly.”
B. “I need to avoid touching mucous membranes of the
mouth or eyes while handling raw meat.”
C. “I need to drink unpasteurized milk only.”
D. “I need to avoid contact with materials that are
possibly contaminated with cat feces.”
16. A homecare nurse visits a pregnant client who has
a diagnosis of mild Preeclampsia and who is being monitored for pregnancy
induced hypertension (PIH). Which assessment finding indicates a worsening of
the Preeclampsia and the need to notify the physician?
A. Blood pressure reading is at the prenatal baseline
B. Urinary output has increased
C. The client complains of a headache and blurred
vision
D. Dependent edema has resolved
17. A nurse implements a teaching plan for a pregnant
client who is newly diagnosed with gestational diabetes. Which statement if
made by the client indicates a need for further education?
A. “I need to stay on the diabetic diet.”
B. “I will perform glucose monitoring at home.”
C. “I need to avoid exercise because of the negative
effects of insulin production.”
D. “I need to be aware of any infections and report
signs of infection immediately to my health care provider.”
18. A primigravida is receiving magnesium sulfate for
the treatment of pregnancy induced hypertension (PIH). The nurse who is caring
for the client is performing assessments every 30 minutes. Which assessment
finding would be of most concern to the nurse?
A. Urinary output of 20 ml since the previous
assessment
B. Deep tendon reflexes of 2+
C. Respiratory rate of 10 BPM
D. Fetal heart rate of 120 BPM
19. A nurse is caring for a pregnant client with Preeclampsia.
The nurse prepares a plan of care for the client and documents in the plan that
if the client progresses from Preeclampsia to eclampsia, the nurse’s first
action is to:
A. Administer magnesium sulfate intravenously
B. Assess the blood pressure and fetal heart rate
C. Clean and maintain an open airway
D. Administer oxygen by face mask
20. A nurse is monitoring a pregnant client with
pregnancy induced hypertension who is at risk for Preeclampsia. The nurse
checks the client for which specific signs of Preeclampsia (select all that
apply)?
A. Elevated blood pressure
B. Negative urinary protein
C. Facial edema
D. Increased respirations
21. Rho (D) immune globulin (RhoGAM) is prescribed for
a woman following delivery of a newborn infant and the nurse provides
information to the woman about the purpose of the medication. The nurse
determines that the woman understands the purpose of the medication if the
woman states that it will protect her next baby from which of the following?
A. Being affected by Rh incompatibility
B. Having Rh-positive blood
C. Developing a rubella infection
D. Developing physiological jaundice
22. A pregnant client is receiving magnesium sulfate
for the management of preeclampsia. A nurse determines the client is
experiencing toxicity from the medication if which of the following is noted on
assessment?
A. Presence of deep tendon reflexes
B. Serum magnesium level of 6 mEq/L
C. Proteinuria of +3
D. Respirations of 10 per minute
23. A woman with preeclampsia is receiving magnesium
sulfate. The nurse assigned to care for the client determines that the
magnesium therapy is effective if:
A. Ankle clonus in noted
B. The blood pressure decreases
C. Seizures do not occur
D. Scotomas are present
24. A nurse is caring for a pregnant client with
severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing
interventions that apply in the care for the client.
A. Monitor maternal vital signs every 2 hours
B. Notify the physician if respirations are less than
18 per minute.
C. Monitor renal function and cardiac function closely
D. Keep calcium gluconate on hand in case of a
magnesium sulfate overdose
E. Monitor deep tendon reflexes hourly
F. Monitor I and O’s hourly
G. Notify the physician if urinary output is less than
30 ml per hour.
25. In the 12th week of gestation, a client completely
expels the products of conception. Because the client is Rh negative, the nurse
must:
A. Administer RhoGAM within 72 hours
B. Make certain she receives RhoGAM on her first
clinic visit
C. Not give RhoGAM, since it is not used with the
birth of a stillborn
D. Make certain the client does not receive RhoGAM,
since the gestation only lasted 12 weeks.
26. In a lecture on sexual functioning, the nurse
plans to include the fact that ovulation occurs when the:
A. Oxytocin is too high
B. Blood level of LH is too high
C. Progesterone level is high
D. Endometrial wall is sloughed off.
27. The chief function of progesterone is the:
A. Development of the female reproductive system
B. Stimulation of the follicles for ovulation to occur
C. Preparation of the uterus to receive a fertilized
egg
D. Establishment of secondary male sex characteristics
28. The developing cells are called a fetus from the:
A. Time the fetal heart is heard
B. Eighth week to the time of birth
C. Implantation of the fertilized ovum
D. End of the send week to the onset of labor
29. After the first four months of pregnancy, the
chief source of estrogen and progesterone is the:
A. Placenta
B. Adrenal cortex
C. Corpus luteum
D. Anterior hypophysis
30. The nurse recognizes that an expected change in
the hematologic system that occurs during the 2nd trimester of pregnancy is:
A. A decrease in WBC’s
B. In increase in hematocrit
C. An increase in blood volume
D. A decrease in sedimentation rate
31. The nurse is aware than an adaptation of pregnancy
is an increased blood supply to the pelvic region that results in a purplish
discoloration of the vaginal mucosa, which is known as:
A. Ladin’s sign
B. Hegar’s sign
C. Goodell’s sign
D. Chadwick’s sign
32. A pregnant client is making her first Antepartum
visit. She has a two year old son born at 40 weeks, a 5 year old daughter born
at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous
abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should
identify that the client is:
A. G4 T3 P2 A1 L4
B. G5 T2 P2 A1 L4
C. G5 T2 P1 A1 L4
D. G4 T3 P1 A1 L4
33. An expected cardiopulmonary adaptation experienced
by most pregnant women is:
A. Tachycardia
B. Dyspnea at rest
C. Progression of dependent edema
D. Shortness of breath on exertion
34. Nutritional planning for a newly pregnant woman of
average height and weighing 145 pounds should include:
A. A decrease of 200 calories a day
B. An increase of 300 calories a day
C. An increase of 500 calories a day
D. A maintenance of her present caloric intake per day
35. During a prenatal examination, the nurse draws
blood from a young Rh negative client and explain that an indirect Coombs test
will be performed to predict whether the fetus is at risk for:
A. Acute hemolytic disease
B. Respiratory distress syndrome
C. Protein metabolic deficiency
D. Physiologic hyperbilirubinemia
36. When involved in prenatal teaching, the nurse
should advise the clients that an increase in vaginal secretions during
pregnancy is called leukorrhea and is caused by increased:
A. Metabolic rates
B. Production of estrogen
C. Functioning of the Bartholin glands
D. Supply of sodium chloride to the cells of the
vagina
37. A 26-year old multigravida is 14 weeks’ pregnant
and is scheduled for an alpha-fetoprotein test. She asks the nurse, “What does
the alpha-fetoprotein test indicate?” The nurse bases a response on the
knowledge that this test can detect:
A. Kidney defects
B. Cardiac defects
C. Neural tube defects
D. Urinary tract defects
38. At a prenatal visit at 36 weeks’ gestation, a
client complains of discomfort with irregularly occurring contractions. The
nurse instructs the client to:
A. Lie down until they stop
B. Walk around until they subside
C. Time contraction for 30 minutes
D. Take 10 grains of aspirin for the discomfort
39. The nurse teaches a pregnant woman to avoid lying
on her back. The nurse has based this statement on the knowledge that the
supine position can:
A. Unduly prolong labor
B. Cause decreased placental perfusion
C. Lead to transient episodes of hypotension
D. Interfere with free movement of the coccyx
40. The pituitary hormone that stimulates the
secretion of milk from the mammary glands is:
A. Prolactin
B. Oxytocin
C. Estrogen
D. Progesterone
41. Which of the following symptoms occurs with a
hydatidiform mole?
A. Heavy, bright red bleeding every 21 days
B. Fetal cardiac motion after 6 weeks gestation
C. Benign tumors found in the smooth muscle of the
uterus
D. “Snowstorm” pattern on ultrasound with no fetus or
gestational sac
42. Which of the following terms applies to the tiny,
blanched, slightly raised end arterioles found on the face, neck, arms, and
chest during pregnancy?
A. Epulis
B. Linea nigra
C. Striae gravidarum
D. Telangiectasias
43. Which of the following conditions is common in
pregnant women in the 2nd trimester of pregnancy?
A. Mastitis
B. Metabolic alkalosis
C. Physiologic anemia
D. Respiratory acidosis
44. A 21-year old client, 6 weeks’ pregnant is
diagnosed with hyperemesis gravidarum. This excessive vomiting during pregnancy
will often result in which of the following conditions?
A. Bowel perforation
B. Electrolyte imbalance
C. Miscarriage
D. Pregnancy induced hypertension (PIH)
45. Clients with gestational diabetes are usually
managed by which of the following therapies?
A. Diet
B. NPH insulin (long-acting)
C. Oral hypoglycemic drugs
D. Oral hypoglycemic drugs and insulin
46. The antagonist for magnesium sulfate should be
readily available to any client receiving IV magnesium. Which of the following
drugs is the antidote for magnesium toxicity?
A. Calcium gluconate
B. Hydralazine (Apresoline)
C. Narcan
D. RhoGAM
47. Which of the following answers best describes the
stage of pregnancy in which maternal and fetal blood are exchanged?
A. Conception
B. 9 weeks’ gestation, when the fetal heart is well
developed
C. 32-34 weeks gestation
D. maternal and fetal blood are never exchanged
48. Gravida refers to which of the following
descriptions?
A. A serious pregnancy
B. Number of times a female has been pregnant
C. Number of children a female has delivered
D. Number of term pregnancies a female has had.
49. A pregnant woman at 32 weeks’ gestation complains
of feeling dizzy and lightheaded while her fundal height is being
measured. Her skin is pale and
moist. The nurse’s initial response
would be to:
A. Assess the woman’s blood pressure and pulse
B. Have the woman breathe into a paper bag
C. Raise the woman’s legs
D. Turn the woman on her left side.
50. A pregnant woman’s last menstrual period began on
April 8, 2005, and ended on April 13.
Using Naegele’s rule her estimated date of birth would be:
A. January 15, 2006
B. January 20, 2006
C. July 1, 2006
D. November 5, 2005
Answers and Rationale
1. Answer: A. FSH and LH are released from the
anterior pituitary gland.
FSH and LH, when stimulated by the
gonadotropin-releasing hormone from the hypothalamus, are released from the
anterior pituitary gland to stimulate follicular growth and development, the
growth of the Graafian follicle, and production of progesterone.
2. Answer: B. Two umbilical arteries and one umbilical
vein.
Blood pumped by the embryo’s heart leaves the embryo
through two umbilical arteries. Once oxygenated, the blood then is returned by
one umbilical vein. Arteries carry deoxygenated blood and waste products from
the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to
the fetus.
3. Answer: C. 150 BPM.
The fetal heart rate depends on in gestational age and
ranges from 160-170 BPM in the first trimester but slows with fetal growth to
120-160 BPM near or at term. At or near term, if the fetal heart rate is less
than 120 or more than 160 BPM with the uterus at rest, the fetus may be in
distress.
4. Answer: C. June 26, 2014.
Accurate use of Naegele’s rule requires that the woman
has a regular 28-day menstrual cycle. Add 7 days to the first day of the last
menstrual period, subtract three months, and then add one year to that date.
5. Answer: B. G = 2, T = 0, P = 1, A = 0, L =1.
Pregnancy outcomes can be described with the acronym
GTPAL.
“G” is Gravidity, the number of pregnancies.
“T” is term births, the number of born at term (38 to
41 weeks).
“P” is preterm births, the number born before 38 weeks
gestation.
“A” is abortions or miscarriages, included in “G” if
before 20 weeks gestation, included in parity if past 20 weeks AOE.
“L” is live births, the number of births of living children.
Therefore, a woman who is pregnant with twins and has
a child has a gravida of 2. Because the child was delivered at 37 weeks, the
number of preterm births is 1, and the number of term births is 0. The number
of abortions is 0, and the number of live births is 1.
6. Answer: B. Fetal heart rate of 180 BPM.
The normal range of the fetal heart rate depends on
gestational age. The heart rate is usually 160-170 BPM in the first trimester
and slows with fetal growth, near and at term, the fetal heart rate ranges from
120-160 BPM. The other options are expected.
7. Answer: A. A softening of the cervix.
In the early weeks of pregnancy, the cervix becomes
softer as a result of increased vascularity and hyperplasia, which causes the
Goodell’s sign.
8. Answer: C. “It is the fetal movement that is felt
by the mother.”
Quickening is fetal movement and may occur as early as
the 16th and 18th week of gestation, and the mother first notices subtle fetal
movements that gradually increase in intensity.
A thinning of the lower uterine segment occurs about the 6th week of
pregnancy and is called Hegar’s sign.
Option A: Braxton Hicks contractions are irregular,
painless contractions that may occur throughout the pregnancy.
9. Answer: D. Initiating a gentle upward tap on the
cervix.
Ballottement is a technique of palpating a floating
structure by bouncing it gently and feeling it rebound. In the technique used
to palpate the fetus, the examiner places a finger in the vagina and taps
gently upward, causing the fetus to rise. The fetus then sinks, and the
examiner feels a gentle tap on the finger.
10. Answers: A, D, E, and F.
The probable signs of pregnancy include:
Uterine Enlargement
Hegar’s sign or softening and thinning of the uterine
segment that occurs at week 6.
Goodell’s sign or softening of the cervix that occurs
at the beginning of the 2nd month
Chadwick’s sign or bluish coloration of the mucous
membranes of the cervix, vagina, and vulva. Occurs at week 6.
Ballottement or rebounding of the fetus against the
examiner’s fingers of palpation
Braxton-Hicks contractions
Positive pregnancy test measuring for hCG.
Positive signs of pregnancy include:
Fetal Heart Rate detected by electronic device
(Doppler) at 10-12 weeks
Fetal Heart rate detected by nonelectronic device
(fetoscope) at 20 weeks AOG
Active fetal movement palpable by the examiners
Outline of the fetus via radiography or ultrasound
11. Answer: A. Dorsiflex the foot while extending the
knee when the cramps occur.
Legs cramps occur when the pregnant woman stretches
the leg and plantar flexes the foot. Dorsiflexion of the foot while extending
the knee stretches the affected muscle, prevents the muscle from contracting,
and stops the cramping.
12. Answer: D. Wash the breasts with warm water and
keep them dry.
The pregnant woman should be instructed to wash the
breasts with warm water and keep them dry.
Option A: Wearing a supportive bra with wide
adjustable straps can decrease breast tenderness.
Option B: The woman should be instructed to avoid
using soap on the nipples and areola area to prevent the drying of tissues.
Option C: Tight-fitting blouses or dresses will cause
discomfort.
13. Answer: A. Any bleeding, such as in the gums,
petechiae, and purpura.
Severe Preeclampsia can trigger disseminated
intravascular coagulation because of the widespread damage to vascular
integrity. Bleeding is an early sign of DIC and should be reported to the M.D.
14. Answer: A. “I will maintain strict bedrest
throughout the remainder of the pregnancy.”
Strict bed rest throughout the remainder of pregnancy
is not required.
Option B: The woman is advised to curtail sexual
activities until the bleeding has ceased, and for 2 weeks following the last
evidence of bleeding or as recommended by the physician.
Option C: The woman is instructed to count the number
of perineal pads used daily and to note the quantity and color of blood on the
pad.
Option D: The woman also should watch for the evidence
of the passage of tissue.
15. Answer: C. “I need to drink unpasteurized milk
only.”
All pregnant women should be advised to do the
following to prevent the development of toxoplasmosis.
Options A and B: Women should be instructed to cook
meats thoroughly, avoid touching mucous membranes and eyes while handling raw
meat; thoroughly wash all kitchen surfaces that come into contact with uncooked
meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs
and unpasteurized milk; wash fruits and vegetables before consumption
Option D: Avoid contact with materials that possibly
are contaminated with cat feces, such as cat litter boxes, sandboxes, and
garden soil.
16. Answer: C. The client complains of a headache and
blurred vision.
If the client complains of a headache and blurred
vision, the physician should be notified because these are signs of worsening
Preeclampsia.
17. Answer: C. “I need to avoid exercise because of
the negative effects of insulin production.”
Exercise is safe for the client with gestational
diabetes and is helpful in lowering the blood glucose level.
18. Answer: C. Respiratory rate of 10 BPM.
Magnesium sulfate depresses the respiratory rate. If
the respiratory rate is less than 12 breaths per minute, the physician or other
health care provider needs to be notified, and continuation of the medication
needs to be reassessed.
Option A: A urinary output of 20 ml in a 30 minute
period is adequate; less than 30 ml in one hour needs to be reported.
Option B: Deep tendon reflexes of 2+ are normal.
Option D: The fetal heart rate is WNL for a resting
fetus.
19. Answer: C. Clean and maintain an open airway.
The immediate care during a seizure (eclampsia) is to
ensure a patent airway. The other options are actions that follow or will be
implemented after the seizure has ceased.
20. Answers: A. Elevated blood pressure and 3 Facial
edema.
The three classic signs of preeclampsia are
hypertension, generalized edema, and proteinuria. Increased respirations are
not a sign of preeclampsia.
21. Answer: A. Being affected by Rh incompatibility.
Rh incompatibility can occur when an Rh-negative mom
becomes sensitized to the Rh antigen. Sensitization may develop when an
Rh-negative woman becomes pregnant with a fetus who is Rh positive. During
pregnancy and at delivery, some of the baby’s Rh positive blood can enter the
maternal circulation, causing the woman’s immune system to form antibodies
against Rh-positive blood. Administration of Rho(D) immune globulin prevents
the woman from developing antibodies against Rh-positive blood by providing
passive antibody protection against the Rh antigen.
22. Answer: D. Respirations of 10 per minute.
Magnesium toxicity can occur from magnesium sulfate
therapy. Signs of toxicity relate to the central nervous system depressant
effects of the medication and include respiratory depression, loss of deep
tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart
rate and blood pressure.
Option B: Therapeutic levels of magnesium are 4-7
mEq/L.
Option C: Proteinuria of +3 would be noted in a client
with preeclampsia.
23. Answer: C. Seizures do not occur.
For a client with preeclampsia, the goal of care is
directed at preventing eclampsia (seizures).
Option A: Ankle clonus indicated hyperreflexia and may
precede the onset of eclampsia.
Option B: Magnesium sulfate is an anticonvulsant, not
an antihypertensive agent. Although a decrease in blood pressure may be noted
initially, this effect is usually transient.
Option D:
Scotomas are areas of complete or partial blindness. Visual
disturbances, such as scotomas, often precede an eclamptic seizure.
24. Answers: C, D, E, F, and G.
When caring for a client receiving magnesium sulfate
therapy, the nurse would monitor maternal vital signs, especially respirations,
every 30-60 minutes and notify the physician if respirations are less than 12,
because this would indicate respiratory depression. Calcium gluconate is kept
on hand in case of magnesium sulfate overdose because calcium gluconate is the
antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly.
Cardiac and renal function are monitored closely. The urine output should be
maintained at 30 ml per hour because the medication is eliminated through the
kidneys.
25. Answer: A. Administer RhoGAM within 72 hours.
RhoGAM is given within 72 hours postpartum if the
client has not been sensitized already.
26. Answer: B. Blood level of LH is too high.
It is the surge of LH secretion in mid cycle that is
responsible for ovulation.
27. Answer: C. Preparation of the uterus to receive a
fertilized egg.
Progesterone stimulates differentiation of the
endometrium into a secretory type of tissue.
28. Answer: B. Eighth week to the time of birth.
In the first 7-14 days, the ovum is known as a
blastocyst; it is called an embryo until the eighth week; the developing cells
are then called a fetus until birth.
29. Answer: A. Placenta.
When the placental formation is complete, around the
16th week of pregnancy; it produces estrogen and progesterone.
30. Answer: C. An increase in blood volume.
The blood volume increases by approximately 40-50%
during pregnancy. The peak blood volume occurs between 30 and 34 weeks of
gestation. The hematocrit decreases as a result of the increased blood volume.
31. Answer: D. Chadwick’s sign.
A purplish color results from the increased
vascularity and blood vessel engorgement of the vagina.
32. Answer: C. G5 T2 P1 A1 L4.
5 pregnancies; 2 term births; twins count as 1; one
abortion; 4 living children.
33. Answer: D. Shortness of breath on exertion.
This is an expected cardiopulmonary adaptation during
pregnancy; it is caused by an increased ventricular rate and elevated
diaphragm.
34. Answer: B. An increase of 300 calories a day.
This is the recommended caloric increase for adult
women to meet the increased metabolic demands of pregnancy.
35. Answer: A. Acute hemolytic disease.
When an Rh negative mother carries an Rh positive
fetus there is a risk for maternal antibodies against Rh-positive blood;
antibodies cross the placenta and destroy the fetal RBC’s.
36. Answer: B. Production of estrogen.
The increase of estrogen during pregnancy causes
hyperplasia of the vaginal mucosa, which leads to increased production of mucus
by the endocervical glands. The mucus contains exfoliated epithelial cells.
37. Answer: C. Neural tube defects.
The alpha-fetoprotein test detects neural tube defects
and Down syndrome.
38. Answer: B. Walk around until they subside.
Ambulation relieves Braxton Hicks.
39. Answer: B. Cause decreased placental perfusion.
This is because the impedance of venous return by the
gravid uterus, which causes hypotension and decreased systemic perfusion.
40. Answer: A. Prolactin.
Prolactin is the hormone from the anterior pituitary
gland that stimulates mammary gland secretion. Oxytocin, a posterior pituitary
hormone, stimulates the uterine musculature to contract and causes the “let
down” reflex.
41. Answer: D. “Snowstorm” pattern on ultrasound with
no fetus or gestational sac.
The chorionic villi of a molar pregnancy resemble a
snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often
dark brown and may occur erratically for weeks or months.
42. Answer: D. Telangiectasias.
The dilated arterioles that occur during pregnancy are
due to the elevated level of circulating estrogen. The linea nigra is a
pigmented line extending from the symphysis pubis to the top of the fundus
during pregnancy.
43. Answer: C. Physiologic anemia.
Hemoglobin and hematocrit levels decrease during
pregnancy as the increase in plasma volume exceeds the increase in red blood
cell production.
44. Answer: B. Electrolyte imbalance.
Excessive vomiting in clients with hyperemesis
gravidarum often causes weight loss and fluid, electrolyte, and acid-base
imbalances.
45. Answer: A. Diet.
Clients with gestational diabetes are usually managed
by diet alone to control their glucose intolerance. Oral hypoglycemic agents
are contraindicated in pregnancy. NPH isn’t usually needed for blood glucose
control for GDM.
46. Answer: A. Calcium gluconate.
Calcium gluconate is the antidote for magnesium
toxicity. Ten ml of 10% calcium gluconate is given IV push over 3-5 minutes.
Hydralazine is given for sustained elevated blood pressures in preeclamptic
clients.
47. Answer: D. maternal and fetal blood are never
exchanged.
Only nutrients and waste products are transferred
across the placenta. Blood exchange only occurs in complications and some
medical procedures accidentally.
48. Answer: B. Number of times a female has been
pregnant.
Gravida refers to the number of times a female has
been pregnant, regardless of pregnancy outcome or the number of neonates
delivered.
49. Answer: D. Turn the woman on her left side.
During a fundal height measurement, the woman is
placed in a supine position. This woman
is experiencing supine hypotension as a result of uterine compression of the
vena cava and abdominal aorta. Turning
her on her side will remove the compression and restore cardiac output and
blood pressure.
Option A: After turning the client on the side, then
vital signs can be assessed.
Option B: Breathing into a paper bag is the solution
for dizziness related to respiratory alkalosis associated with
hyperventilation.
Option C: Raising her legs will not solve the problem
since pressure will remain on the major abdominal blood vessels, thereby
continuing to impede cardiac output.
50. Answer: A. January 15, 2006.
Naegele’s rule requires subtracting 3 months and
adding 7 days and 1 year if appropriate to the first day of a pregnant woman’s
last menstrual period. When this rule is
used with April 8, 2005, the estimated date of birth is January 15, 2006.
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