Chapter 03: Fetal Development
MULTIPLE CHOICE
Download All chapters here: Gloria Leifer's Introduction to maternity
1. What is the total number of chromosomes contained in a mature sperm or ovum? a. 22
b. 23
c. 44
d. 46
ANS: B
Gametes (sex chromosomes) contain 23 chromosomes.
DIF: Cognitive Level: Knowledge REF: Page 31 OBJ: 2
TOP: Gametogenesis KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
2. A pregnant woman states, My husband hopes I will give him a boy because we have three girls. What will the nurse explain to this woman?
a. The sex chromosome of the fertilized ovum determines the gender of the child.
b. When the sperm and ovum are united, there is a 75% chance the child will be a girl.
c. When the pH of the female reproductive tract is acidic, the child will be a girl.
d. If a sperm carrying a Y chromosome fertilizes an ovum, then a boy is produced.
ANS: D
When a Y-bearing sperm fertilizes an ovum, a male child is produced.
DIF: Cognitive Level: Comprehension REF: Page 33 OBJ: 3
TOP: Sex Determination KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
3. What is the most common site for fertilization?
a. Lower segment of the uterus
b. Outer third of the fallopian tube near the ovary
c. Upper portion of the uterus
d. Area of the fallopian tube farthest from the ovary
ANS: B
Fertilization takes place in the outer third of the fallopian tube, which is closest to the ovary.
DIF: Cognitive Level: Knowledge REF: Page 33 OBJ: 3
TOP: Fertilization KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
4. The embryo is termed a fetus at which stage of prenatal development? a. 2 weeks
b. 4 weeks
c. 9 weeks
d. 16 weeks
ANS: C
The fetus (third stage of prenatal development) begins at the ninth week and continues until the 40th week of gestation or until birth.
DIF: Cognitive Level: Knowledge REF: Page 36 OBJ: 4
TOP: Prenatal Developmental Milestones
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
5. The nurse is reviewing fetal circulation with a pregnant patient and explains that blood circulates through the placenta to the fetus. What vessel(s) carry blood to the fetus? a. One umbilical vein
b. Two umbilical veins
c. One umbilical artery
d. Two umbilical arteries
ANS: A
The umbilical vein transports richly oxygenated blood from the placenta to the fetus.
DIF: Cognitive Level: Knowledge REF: Page 39-40 OBJ: 7
TOP: Fetal Circulation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
6. Where is the usual location for implantation of the zygote?
a. Upper section of the posterior uterine wall
b. Lower portion of the uterus near the cervical os
c. Inner third of the fallopian tube near the uterus
d. Lateral aspect of the uterine wall
ANS: A
The zygote usually implants in the upper section of the posterior uterine wall.
DIF: Cognitive Level: Knowledge REF: Page 35 OBJ: 3
TOP: Implantation KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
7. What is the embryonic membrane that contains fingerlike projections on its surface, which attach to the uterine wall? a. Amnion
b. Yolk sac
c. Chorion
d. Decidua basalis
ANS: C
The chorion is a thick membrane with fingerlike projections (villi) on its outermost surface.
DIF: Cognitive Level: Knowledge REF: Page 35 OBJ: 4
TOP: Accessory Structures of Pregnancy KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
8. Which hormone is responsible for converting the endometrium into decidual cells for implantation? a. Estrogen
b. Human chorionic gonadotropin
c. Human placental lactogen
d. Progesterone
ANS: D
At high levels, progesterone maintains the endometrial lining for implantation of the zygote.
DIF: Cognitive Level: Knowledge REF: Page 39 OBJ: 6
TOP: Placenta KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
9. A patient asks the nurse when her infants heart will begin to pump blood. What will the nurse reply? a. By the end of week 3
b. Beginning in week 8
c. At the end of week 16
d. Beginning in week 24
ANS: A
The fetal heart begins to pump by week 3 of gestation.
DIF: Cognitive Level: Knowledge REF: Page 36 OBJ: 5
TOP: Prenatal Development KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
10. What organ does the ductus venosus shunt blood away from in fetal circulation? a. Liver
b. Heart
c. Lungs
d. Kidneys
ANS: A
Fetal blood bypasses the liver through the ductus venosus by carrying blood directly to the inferior vena cava.
DIF: Cognitive Level: Knowledge REF: Page 39 OBJ: 7
TOP: Prenatal Development KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
11. What complication can result from untreated respiratory distress in the newborn? a. Esophageal atresia
b. Gastric dilation
c. Cold stress
d. Reopening of the foramen ovale
ANS: D
Respiratory distress can cause increased pressure in the right ventricle, causing reopening of the foramen ovale
DIF: Cognitive Level: Comprehension REF: Page 40 OBJ: 7
TOP: Fetal Circulation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
12. During an ultrasound, two amnions and two placentas are observed. What will be the most likely result of this pregnancy?
a. Dizygotic twins
b. Monozygotic twins
c. Conjoined twins
d. High birth-weight twins
ANS: A
Dizygotic twins always have two amnions and two chorions (placentas).
DIF: Cognitive Level: Comprehension REF: Page 42 OBJ: 8
TOP: Multifetal Pregnancy KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
13. A woman who is 25 weeks pregnant asks the nurse what her fetus looks like. What does the nurse explain is one physical characteristic present in a 25-week-old fetus? a. Lanugo covering the body
b. Constant motion
c. Skin that is pink and smooth
d. Eyes that are closed
ANS: A
By 25 weeks, the body of the fetus is covered with lanugo, the eyes are open, the skin is wrinkled, and the fetus has definite periods of movement and sleeping.
DIF: Cognitive Level: Comprehension REF: Page 37-38, Table 3-1
OBJ: 5 TOP: Prenatal Development
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
14. At what point in prenatal development do the lungs begin to produce surfactant? a. 17 weeks
b. 20 weeks
c. 25 weeks
d. 30 weeks
ANS: C
During week 25, the alveoli begin to produce surfactant, which enables the alveoli to stay open for adequate lung oxygenation to occur.
DIF: Cognitive Level: Knowledge REF: Page 37, Table 3-1
OBJ: 5 TOP: Prenatal Development KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
15. A woman missed her menstrual period 1 week ago and has come to the doctors office for a pregnancy test. Which placental hormone is measured in pregnancy tests? a. Progesterone
b. Estrogen
c. Human chorionic gonadotropin
d. Human placental lactogen
ANS: C
Human chorionic gonadotropin is the basis for most pregnancy tests. It is detectable in maternal blood as soon as implantation occurs, usually 7 to 9 days after fertilization.
DIF: Cognitive Level: Knowledge REF: Page 39 OBJ: 6
TOP: Accessory Structures of Pregnancy KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
16. When preparing to teach a class about prenatal development, the nurse would include information about folic acid supplementation. What is folic acid known to prevent? a. Congenital heart defects
b. Neural tube defects
c. Mental retardation
d. Premature birth
ANS: B
It is now known that folic acid supplements can prevent neural tube defects such as spina bifida.
DIF: Cognitive Level: Comprehension REF: Page 37 OBJ: 5
TOP: Prenatal Development KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
17. The nurse is educating a class of expectant parents about fetal development. What is considered fetal age of viability?
a. 14 weeks
b. 20 weeks
c. 25 weeks
d. 30 weeks
ANS: B
By 20 weeks of gestation, the lungs have matured enough for the fetus to survive outside the uterus (age of viability).
DIF: Cognitive Level: Knowledge REF: Page 37 OBJ: 5
TOP: Prenatal Developmental Milestones KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
18. The nurse is presenting a conference on gene dominance. What does the nurse report as the percentage of children carrying the dominant gene if one parent has a dominant gene and the other parent does not? a. 10%
b. 25%
c. 50%
d. 100%
ANS: C
If one parent has a dominant trait and the other does not, then 50% of the children will inherit the trait.
DIF: Cognitive Level: Comprehension REF: Page 34 OBJ: 4
TOP: Dominant Traits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
19. The nurse explains that the birth weight of monozygotic twins is frequently below average. What is the most likely cause?
a. Inadequate space in the uterus
b. Inadequate blood supply
c. Inadequate maternal health
d. Inadequate placental nutrition
ANS: D
The single placenta may not be able to provide adequate nutrition to two fetuses.
DIF: Cognitive Level: Comprehension REF: Page 42 OBJ: 8
TOP: Low Birth-weight Twins KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
20. The school nurse is counseling a group of adolescent girls. What does the nurse explain about sperm ejaculated near the cervix?
a. They are destroyed by the acidic pH of the vagina.
b. They survive up to 5 days and can cause pregnancy.
c. They lose their motility in about 12 hours after intercourse.
d. They are usually pushed out of the vagina by the muscular action of the vaginal wall.
ANS: B
Sperm ejaculated near the cervix can survive up to 5 days and cause pregnancy even before ovulation.
DIF: Cognitive Level: Comprehension REF: Page 33 OBJ: 3
TOP: Fertilization KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
21. What does the nurse explain can affect the survival of the X- and Y-bearing sperm after intercourse? a. Age
b. Estrogen level
c. Body temperature
d. Level of feminine hygiene
ANS: B
Estrogen levels and the pH of the female reproductive tract can affect the survival of the X- and Y-bearing sperm as well as their motility.
DIF: Cognitive Level: Knowledge REF: Page 33 OBJ: 3
TOP: Fertilization KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
22. Of what is the normal umbilical cord comprised?
a. 1 artery carrying blood to the fetus and 1 vein carrying blood away from the fetus
b. 1 artery carrying blood to the fetus and 2 veins carrying blood away from the fetus
c. 2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus
d. 2 arteries carrying blood to the fetus and 2 veins carrying blood away from the fetus
ANS: C
The umbilical cord is comprised of 2 arteries carrying blood away from the fetus and 1 vein carrying blood to the fetus.
DIF: Cognitive Level: Knowledge REF: Page 39 OBJ: 6
TOP: Fetal Circulation KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
23. What part of the fetal body derives from the mesoderm? a. Nails
b. Oil glands
c. Muscles
d. Lining of the bladder
ANS: C
The mesoderm is responsible for the development of muscles. Nails and oil glands derive from the ectoderm. The lining of the bladder derives from the endoderm.
DIF: Cognitive Level: Knowledge REF: Page 35, Box 3-1
OBJ: 4 TOP: Embryonic development KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
24. A couple just learned they are expecting their first child and are curious if they are having a boy or a girl. At what point of development can the couple first expect to see the sex of their child on ultrasound? a. 4 weeks gestational age
b. 6 weeks gestational age
c. 10 weeks gestational age
d. 16 weeks gestational age
ANS: C
The fetal period begins at the ninth week, and by the tenth week the external genitalia are visible to ultrasound examination.
DIF: Cognitive Level: Knowledge REF: Page 37 OBJ: 5
TOP: Fetal Development KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
MULTIPLE RESPONSE
25. A nurse is teaching a lesson on fetal development to a class of high school students and explains the primary germ layers. What are the germ layers? (Select all that apply.) a. Ectoderm
b. Endoderm
c. Mesoderm
d. Plastoderm
e. Blastoderm
ANS: A, B, C
The zygote transforms its embryonic disc into three layers: the ectoderm, the mesoderm, and the endoderm.
DIF: Cognitive Level: Knowledge REF: Page 35, Box 3-1
OBJ: 4 TOP: Primary Germ Layers
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
26. What are the functions of amniotic fluid? (Select all that apply.)
a. Maintaining an even temperature
b. Impeding excessive fetal movement
c. Lubricating fetal skin
d. Acting as a reservoir for nutrients
e. Acting as a cushion for the fetus
ANS: A, E
The amniotic fluid provides maintenance of even temperature; prevents amnion from adhering to fetal skin; allows buoyancy, symmetrical growth, and fetal movement; and acts as a cushion for the fetus. Although the fetus does swallow amniotic fluid, it has no nutritional value.
DIF: Cognitive Level: Knowledge REF: Page 35, Box 3-1
OBJ: 6 TOP: Amniotic Fluid
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
27. A patient at the obstetric office has just learned she is pregnant with dizygotic twins. What facts will the nurse include when educating this patient? (Select all that apply.)
a. Dizygotic twins are the same sex.
b. Dizygotic twins share a placenta.
c. Dizygotic pregnancies tend to repeat in families.
d. Dizygotic twins have separate chorions.
e. Dizygotic twin incidence decreases with maternal age.
ANS: C, D
Dizygotic twins tend to repeat in families and have separate chorions. They can be the same sex or different sexes and have their own placenta. Incidence increases with maternal age.
DIF: Cognitive Level: Comprehension REF: Page 42 OBJ: 8
TOP: Dizygotic Twins KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
COMPLETION
28. The nurse explains that prior to fertilization each cell is reduced from 46 chromosomes to 23 chromosomes
This is referred to as the number.
ANS:
haploid
When each cell reduces its chromosomes from 46 to 23, it is called the haploid number.
DIF: Cognitive Level: Knowledge REF: Page 32 OBJ: 2
TOP: Haploid Number KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
29. The component of development that programs the genetic code into the nucleus of the cell is
.
ANS: DNA
The DNA programs the genetic code to the nucleus of the cell to be replicated.
DIF: Cognitive Level: Knowledge REF: Page 31 | Page 34
OBJ: 4 TOP: DNA KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
30. The vessels comprising the umbilical cord are cushioned and protected by a substance called
.
ANS:
Whartons jelly
Whartons jelly is a substance in the umbilical cord that cushions and protects the vessels.
DIF: Cognitive Level: Knowledge REF: Page 39 OBJ: 1
TOP: Fetal Circulation KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
31. The normal volume of amniotic fluid is approximately 
mL at 37 weeks gestation.
ANS:
1000
The volume of amniotic fluid steadily increases from about 30 mL at 10 weeks of pregnancy to 350 mL at 20 weeks. The volume of fluid is about 1000 mL at 37 weeks. In the latter part of pregnancy the fetus may swallow up to 400 mL of amniotic fluid per day and normally excretes urine into the fluid.
DIF: Cognitive Level: Knowledge REF: Page 35 OBJ: 6
TOP: Amniotic Fluid KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
32. Organize the developmental stages in the correct order. Put a comma and space between each answer choice (a, b, c, d, etc.)
a. Fetus
b. Zygote
c. Embryo
d. Blastocyst
e. Morula
ANS:
B, E, D, C, A
The development follows these stages: zygote, morula, blastocyst, embryo, and fetus.
DIF: Cognitive Level: Comprehension REF: Page 34-37 OBJ: 4
TOP: Fetal Development KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
33. Put the embryonic/fetal characteristics in the correct order of occurrence from week 3 to week 36 of gestation. Put a comma and space between each answer choice (a, b, c, d, etc.)
a. Subcutaneous fat is present.
b. Bone marrow forms blood cells.
c. Spinal cord and brain appear.
d. Skull and jaw ossify.
e. Neural tube closes.
ANS:
C, E, D, B, A
Primitive spinal cord and brain appear at 3 weeks. Neural tube closes at 4 weeks. Skull and jaw ossify at 6 weeks. Spleen stops forming blood cells and bone marrow takes over at 29 weeks. Subcutaneous fat is present at 36 weeks.
DIF: Cognitive Level: Comprehension REF: Page 35-38, Table 3-1
OBJ: 5 TOP: Fetal Development
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
Chapter 04: Prenatal Care and Adaptations to Pregnancy
MULTIPLE CHOICE
1. A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a 2-year-old son and had one previous spontaneous abortion. 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.
DIF: Cognitive Level: Application REF: Page 48, Box 4-1
OBJ: 1 TOP: Definition of Terms
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
2. 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.
DIF: Cognitive Level: Application REF: Page 46 OBJ: 2 | 3
TOP: Prenatal Visits KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
3. 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.
DIF: Cognitive Level: Knowledge REF: Page 49 OBJ: 7
TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. 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.
DIF: Cognitive Level: Comprehension REF: Page 49 OBJ: 6 | 7
TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
5. The nurse has explained physiological changes that occur during pregnancy. Which 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.
DIF: Cognitive Level: Comprehension REF: Page 52 OBJ: 7 | 13
TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
6. A woman reports that her last normal menstrual period began on August 5, 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.
DIF: Cognitive Level: Analysis REF: Page 48, Box 4-2
OBJ: 5 TOP: Determining Estimated Date of Delivery
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
7. During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an electronic Doppler device. 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.
DIF: Cognitive Level: Knowledge REF: Page 50 OBJ: 3 | 7
TOP: Normal Physiological Changes in Pregnancy
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. 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.
DIF: Cognitive Level: Application REF: Page 50 OBJ: 3
TOP: Assessing Fetal Heart Tone KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation
9. 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.
DIF: Cognitive Level: Knowledge REF: Page 57 OBJ: 8
TOP: Nutrition in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
10. When the nurse tells a pregnant woman that she needs 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.
DIF: Cognitive Level: Application REF: Page 60 OBJ: 8 | 13
TOP: Nutrition for Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk
11. A pregnant woman is experiencing nausea in the early morning. What recommendations would the nurse offer to alleviate this symptom?
a. Eat three well-balanced meals per day and limit snacks.
b. Drink a full glass of fluid at the beginning of each meal.
c. Have crackers handy at the bedside, and eat a few before getting out of bed.
d. Eat a bland diet and avoid concentrated sweets.
ANS: C
The nurse can recommend eating dry toast or crackers before getting out of bed in the morning to alleviate nausea during pregnancy.
DIF: Cognitive Level: Application REF: Page 65, Table 4-6
OBJ: 10 TOP: Common Discomforts in Pregnancy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
12. 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.
DIF: Cognitive Level: Application REF: Page 53 OBJ: 4
TOP: Gestational Hypertension KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
13. 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.
DIF: Cognitive Level: Application REF: Page 55 OBJ: 8
TOP: Nutrition in Pregnancy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
14. The nurse encourages adequate intake of folic acid 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.
DIF: Cognitive Level: Knowledge REF: Page 45 | Page 61
OBJ: 8 TOP: Nutrition for Pregnancy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk
15. 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.
DIF: Cognitive Level: Knowledge REF: Page 50 OBJ: 6 | 7
TOP: Physiological Changes During Pregnancy
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
16. 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.
DIF: Cognitive Level: Knowledge REF: Page 50 OBJ: 7
TOP: Physiological Changes During Pregnancy
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
17. A woman pregnant for the first time asks the nurse, When will I begin to feel the baby move? 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.
DIF: Cognitive Level: Knowledge REF: Page 49 OBJ: 7
TOP: Physiological Changes During Pregnancy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
18. 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.
DIF: Cognitive Level: Comprehension REF: Page 62 OBJ: 9 | 13
TOP: Exercise During Pregnancy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation
19. 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.
DIF: Cognitive Level: Comprehension REF: Page 69 OBJ: 12
TOP: Psychological Adaptations to Pregnancy
KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
20. 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.
DIF: Cognitive Level: Knowledge REF: Page 69 OBJ: 12
TOP: Elderly Primip KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Physical Adaptation
21. 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.
DIF: Cognitive Level: Knowledge REF: Page 49 OBJ: 1 | 6 | 7
TOP: Goodells Sign KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physical Adaptation
22. 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.
DIF: Cognitive Level: Comprehension REF: Page 46, Table 4-1
OBJ: 3 TOP: Prenatal laboratory tests
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prenatal Care
23. 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.
DIF: Cognitive Level: Application REF: Page 72 OBJ: 4
TOP: Immunizations KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prenatal Care
24. 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.
DIF: Cognitive Level: Comprehension REF: Page 53 OBJ: 7
TOP: Physiological Changes KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prenatal Care
MULTIPLE RESPONSE
25. 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.
DIF: Cognitive Level: Application REF: Page 64-65 OBJ: 10
TOP: Flight Precautions KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk
26. 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.
DIF: Cognitive Level: Comprehension REF: Page 55 OBJ: 7
TOP: Joint Changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation
27. 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.
DIF: Cognitive Level: Comprehension REF: Page 68-69 OBJ: 11
TOP: Stages of Fatherhood KEY: Nursing Process Step: Data Collection MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
28. 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.
DIF: Cognitive Level: Comprehension REF: Page 44-45 OBJ: 2 | 3
TOP: Goals of Prenatal Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
29. 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.
DIF: Cognitive Level: Comprehension REF: Page 67 OBJ: 11
TOP: Behaviors of First Trimester KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation
COMPLETION
30. 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.
DIF: Cognitive Level: Comprehension REF: Page 61 OBJ: 1
TOP: Gynecological Age KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
31. 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.
DIF: Cognitive Level: Comprehension REF: Page 59 OBJ: 8
TOP: Nutrition During Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Growth and Development
32. 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.
DIF: Cognitive Level: Comprehension REF: Page 61 OBJ: 8
TOP: Pica KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
33. 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.
DIF: Cognitive Level: Comprehension REF: Page 47 OBJ: 3
TOP: Leopolds Maneuver KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk
34. 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.
DIF: Cognitive Level: Comprehension REF: Page 69 OBJ: 3
TOP: Impact on the Father KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Developmental Stages and Transitions
Chapter 05: Nursing Care of Women with Complications During Pregnancy
MULTIPLE CHOICE
1. A pregnant patient tells the nurse that she has been nauseated and vomiting. How will the nurse explain that hyperemesis gravidarum is distinguished from morning sickness?
a. Hyperemesis gravidarum usually lasts for the duration of the pregnancy.
b. Hyperemesis gravidarum causes dehydration and electrolyte imbalances.
c. Sensitivity to smells is usually the cause of vomiting in hyperemesis gravidarum.
d. The woman with hyperemesis gravidarum will have persistent vomiting without weight loss.
ANS: B
Dehydration and electrolyte imbalances result from persistent nausea and vomiting associated with hyperemesis gravidarum. Dehydration impairs the perfusion to the placenta.
DIF: Cognitive Level: Comprehension REF: Page 79 | Page 82
OBJ: 4 TOP: Hyperemesis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
2. A woman is 9 weeks pregnant and experiencing heavy bleeding and cramping. She reports passing some tissue. Cervical dilation is noted on examination. What is the most likely cause of these symptoms? a. Inevitable abortion
b. Incomplete abortion
c. Complete abortion
d. Missed abortion
ANS: B
Signs and symptoms of an incomplete abortion are similar to those of an inevitable abortion, but some tissue is passed.
DIF: Cognitive Level: Comprehension REF: Page 84, Table 5-2 | Page 82, Figure 5-2
OBJ: 4 TOP: Incomplete Abortion
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
3. The nurse finds a woman crying after she has undergone a dilation and evacuation (D&E) for a missed abortion. What is the most appropriate statement by the nurse?
a. There is usually something wrong with the fetus when this happens early in pregnancy.
b. Now there. You can try to conceive on your next cycle.
c. Im here if you need to talk.
d. You are young and strong. I know you can have a healthy pregnancy.
ANS: C
An effective technique when communicating with a woman experiencing pregnancy loss is to say, Im here if you need to talk. The nurse listens and acknowledges the womans grief.
DIF: Cognitive Level: Application REF: Page 85 OBJ: 4
TOP: Dilation and Evacuation (D&E) KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
4. A woman who is 8 weeks pregnant becomes concerned when she has light vaginal bleeding accompanied by abdominal pain. An ectopic pregnancy is confirmed by ultrasound. Which statement indicates that the woman understands the explanation of an ectopic pregnancy?
a. The chorionic villi develop vesicles within the uterus.
b. The placenta develops in the lower part of the uterus.
c. The fetus dies in the uterus during the first half of the pregnancy.
d. The embryo is implanted in the fallopian tube.
ANS: D
Ectopic pregnancy occurs when the fertilized ovum is implanted outside of the uterine cavity.
DIF: Cognitive Level: Comprehension REF: Page 86 OBJ: 4
TOP: Ectopic Pregnancy KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
5. An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the entire cervical os. What does the nurse understand best describes this condition? a. Low-lying placenta
b. Marginal placenta previa
c. Partial placenta previa
d. Total placenta previa
ANS: D
A total placenta previa describes a condition in which the placenta completely covers the cervical opening.
DIF: Cognitive Level: Comprehension REF: Page 88-89 OBJ: 4
TOP: Placenta Previa KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
6. What symptom presented by a pregnant women is indicative of abruptio placentae? a. Painless vaginal bleeding
b. Uterine irritability with contractions
c. Vaginal bleeding and back pain
d. Premature rupture of membranes
ANS: C
Bleeding accompanied by abdominal or lower back pain is a typical manifestation of abruptio placentae.
DIF: Cognitive Level: Knowledge REF: Page 89 OBJ: 4
TOP: Abruptio Placenta KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
7. What situation would concern the nurse about the presence of Rh incompatibility?
a. Rh-negative mother, Rh-positive fetus
b. Rh-positive mother, Rh-negative fetus
c. Rh-negative mother, Rh-negative fetus
d. Rh-positive mother, Rh-positive fetus
ANS: A
Rh incompatibility can occur only if the mother is Rh negative and the fetus is Rh positive.
DIF: Cognitive Level: Analysis REF: Page 95 OBJ: 4
TOP: Rh Incompatibility KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. A primigravida in her first trimester is Rh negative. What will this woman receive to prevent anti-Rh antibodies from forming?
a. Rh immune globulin during labor
b. Intrauterine transfusions with O-negative blood
c. Rh immune globulin at 28 weeks and within 72 hours after the birth of an Rh-positive infant
d. Rh immune globulin now and again in the last trimester
ANS: C
An Rh-negative woman would receive Rh immune globulin at 28 weeks of gestation and within 72 hours after the birth of an Rh-positive infant or abortion.
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