Question 1

The nurse is explaining the process of fertilization to a patient who has just learned of being pregnant. On which day during pregnancy should the nurse explain that the embryo implants on the uterine surface?

A) Four days after fertilization
B) Eight to 10 days after fertilization
C) The 14th day of a "typical" menstrual cycle
D) Ten days after the start of the menstrual flow

Eight to 10 days after fertilization

Accepted Answer

Implantation, or contact between the growing structure and the uterine endometrium, occurs approximately 8 to 10 days after fertilization. Four days after fertilization the structure is a zygote. Implantation does not occur on the 14th day of a typical menstrual cycle or 10 days after the start of a menstrual flow.

Question 2

A patient who learns of being 9 weeks pregnant asks the nurse to explain the changes that are occurring with her body. Which nursing diagnosis should the nurse identify as being appropriate for the patient at this time?

A) Anxiety
B) Impaired coping
C) Deficient knowledge
D) Readiness for enhanced knowledge

Readiness for enhanced knowledge

Accepted Answer

The patient asks the nurse to explain the changes that are occurring, which indicates that the patient is ready for more information or enhanced knowledge. Deficient knowledge would be appropriate if the patient where participating in some action or activity that would be harmful and would need information to correct that action. The patient's request for more information is not consistent with the diagnoses of anxiety or impaired coping.

Question 3

The nurse is teaching a patient in the first trimester of pregnancy about the importance of folic acid in the diet and how folic acid supplements might be beneficial. For which reason is the nurse teaching the patient about this vitamin?

A) Maintains energy throughout the pregnancy
B) Controls the risk of hypertension while pregnant
C) Prevents neural tube disorders in the developing fetus
D) Sustains a slow and steady weight gain while pregnant

Prevents neural tube disorders in the developing fetus

Accepted Answer

Folic acid deficiency in pregnancy can lead to midline closure defects such neural tube disorders. One of the 2020 National Health Goals addresses an adequate folic acid intake while pregnant, and the nurse can help the nation achieve this goal by urging women to have an optimum folic acid level. Folic acid is not encouraged in the pregnant patient to maintain energy, control the risk of hypertension, or sustain a slow and steady weight gain while pregnant.

Question 4

A pregnant patient asks why an $\alpha$-fetoprotein serum level has been ordered. What should the nurse explain to the patient about this test?&#10;A) It screens for placenta function.&#10;B) It measures the fetal liver function.&#10;C) It may reveal chromosomal abnormalities.&#10;D) It tests the ability of the patient's heart to accommodate the pregnancy.

Accepted Answer

$\bullet$-Fetoprotein (AFP) is a substance produced by the fetal liver that can be found in both amniotic fluid and maternal serum. The level is abnormally high if the fetus has an open spinal or abdominal wall defect because the open defect allows more AFP to enter the mother's circulation. Although the reason is unclear, the level is low if the fetus has a chromosomal defect such as Down syndrome. Between 85% and 90% of neural tube anomalies, and 80% of Down syndrome babies can be detected by this method. The
$\bullet$-fetoprotein level is not used to screen for placenta functioning, measure fetal liver function, or test the ability of the patient's heart to accommodate the pregnancy.

Question 5

The nurse teaches the importance of avoiding nonessential substances to a young adult female who is 6 weeks pregnant. Which patient statement indicates that teaching has been effective?&#10;A) &#34;I can drink on weekends only.&#34;&#10;B) &#34;Smoking is bad for me and my baby.&#34;&#10;C) &#34;Smoking is permitted as long as I do it outdoors.&#34;&#10;D) &#34;Only one beer or one glass of wine is permitted while pregnant.&#34;

Accepted Answer

Because almost all drugs are able to cross into the fetal circulation, it is important that a woman take no nonessential drugs, including alcohol and nicotine, during pregnancy.
Alcohol perfuses across the placenta and can cause fetal alcohol sequence disorders. Because it is difficult to tell what quantity is "safe," pregnant women are advised to drink no alcohol during pregnancy. The statement that "smoking is bad for me and my baby" indicates that teaching has been effective. The patient should be instructed to avoid all alcohol intakes while pregnant and to not smoke.

Question 6

The nurse is completing a physical assessment with a patient who has just learned of being pregnant. The patient's last menstrual period was August 15. When should the nurse instruct the patient that the baby will be due?

A) July 15
B) June 22
C) May 22
D) April 15

Accepted Answer

When using Naegele's rule, the nurse should count backward 3 calendar months from the first day of the patient's last menstrual period and then add 7 days. For August 15, the month would be May and the day would be 15 plus 7 or 22. May 22 is when the patient's baby is due. July 15, June 22, and April 15 are inappropriate applications of Naegele's rule.

Question 7

A patient who is 28 weeks pregnant is demonstrating signs of placental insufficiency. The health care provider prescribes betamethasone. What should the nurse inform the patient regarding the purpose of this medication?

A) It stops premature labor.
B) It improves functioning of the placenta.
C) It potentiates the formation of surfactant.
D) It improves immunologic function of the fetus.

Accepted Answer

Synthetically increasing steroid levels in the fetus through the use of betamethasone can hurry alveolar maturation and surfactant production without interfering with permanent lung function prior to a preterm birth. Surfactant is formed and excreted by the alveolar cells of the lungs at about the 24th week of pregnancy, decreases alveolar surface tension on expiration, prevents alveolar collapse, and improves the infant's ability to maintain respirations in the outside environment at birth. Betamethasone is not being given to this patient to stop premature labor, improve the function of the placenta, or improve immunologic function of the fetus.

Question 8

During a physical assessment, the nurse palpates a pregnant patient's fundus at the level of the umbilicus. What statement should the nurse make to the patient about this assessment finding?&#10;A) &#34;You are at 12 weeks of your pregnancy.&#34;&#10;B) &#34;You are at 20 weeks of your pregnancy.&#34;&#10;C) &#34;You are at 36 weeks of your pregnancy.&#34;&#10;D) &#34;You can go into labor at any time now.&#34;

Accepted Answer

As a fetus grows, the uterus expands to accommodate its size. Typical fundal measurements are over the symphysis pubis at 12 weeks, at the umbilicus at 20 weeks, and at the xiphoid process at 36 weeks. The patient is not going to go into labor at any time.

Question 9

The nurse is planning to instruct a patient who is 12 weeks pregnant on interventions to stop smoking. What should the nurse include in these instructions? (Select all that apply.)&#10;A) Purchase nicotine chewing gum.&#10;B) Follow a smoking cessation plan.&#10;C) Ask a friend to help with smoking cessation actions.&#10;D) Apply a nicotine patch when the cravings become severe.&#10;E) Ask the physician if a smoking cessation medication can be used.

Accepted Answer

Interventions to help a pregnant patient with smoking cessation include following a smoking cessation plan, asking a friend to help with smoking cessation actions, and asking the physician if a smoking cessation medication can be used. The patient should not be instructed to purchase nicotine chewing gum or a patch because nicotine is a pregnancy category C drug, will cross into the placenta, and adversely affect the developing fetus.

Question 10

A pregnant patient is scheduled for an abdominal ultrasound. What should the nurse instruct the patient about this procedure?&#10;A) Avoid drinking fluid 1 hour prior to the procedure.&#10;B) Expect to have a catheter inserted prior to the procedure.&#10;C) Empty the bladder 1 hour and just prior to the start of the procedure.&#10;D) Drink a glass of water every 15 minutes starting 90 minutes before the procedure.

Accepted Answer

The sound waves reflect best if the uterus can be held stable so it is helpful if the woman has a full bladder at the time of the procedure. To ensure this, ask her to drink a full glass of water every 15 minutes beginning 90 minutes before the procedure and not void until after the procedure. The patient will not have a catheter inserted for this procedure. The patient should not avoid fluids 1 hour prior to the procedure. The bladder should not be emptied until the procedure concludes.

Question 11

A pregnant patient scheduled for an amniocentesis asks the nurse how the placenta is not punctured during the procedure. What should the nurse respond to the patient?&#10;A) &#34;A uterus feels soft over the placenta site.&#34;&#10;B) &#34;A sonogram to locate it will be done first.&#34;&#10;C) &#34;It would not be harmful even if it were punctured.&#34;&#10;D) &#34;Placentas always form on the posterior uterine wall.&#34;

Accepted Answer

The answer of A pregnant patient scheduled for an amniocentesis...

Question 12

A pregnant patient is concerned that the baby is going to drown in the uterus because of the fluid. What should the nurse respond about fetal respiration?&#10;A) &#34;You are breathing for the baby.&#34;&#10;B) &#34;The baby's breathing is very minor until delivery.&#34;&#10;C) &#34;The baby's lungs can accommodate all of the fluid.&#34;&#10;D) &#34;Oxygen is provided to the baby through the placenta.&#34;

Accepted Answer

The answer of A pregnant patient is concerned that the...

Question 13

A pregnant patient is directed to perform a daily fetal movement count. What should the nurse instruct the patient about this count? (Select all that apply.)&#10;A) Lie down to do the count after eating a meal.&#10;B) Count only movements that are strong enough to hurt.&#10;C) Report if no movement is felt for any half-hour period.&#10;D) Choose a different time frame each day to count movements.&#10;E) Count fetal movements until a total of 10 are counted and record the time.

Accepted Answer

The answer of A pregnant patient is directed to perform...

Question 14

The nurse determines that a fetal nonstress test is nonreactive for over 20 minutes. What does the nurse realize as being reasons for this finding? (Select all that apply.)&#10;A) The patient is sleeping.&#10;B) The patient is hypoglycemic.&#10;C) The patient is using an illicit drug.&#10;D) The patient is exercising too much.&#10;E) The patient is smoking while pregnant.

Accepted Answer

The answer of The nurse determines that a fetal nonstress...

Question 15

The nurse is evaluating the fetal heart rate rhythm strip and determines that the amplitude varies with a rate 15 to 20 beats/min. What does this assessment finding indicate to the nurse about variability?

A) Variability is absent.
B) Variability is minimal.
C) Variability is normal.
D) Variability is marked.

Accepted Answer

The answer of The nurse is evaluating the fetal heart...

Deck 9: Nursing Care During Normal Pregnancy and Care of the Developing Fetus 000