Deck 29: The Pregnant Woman

Question 1

When examining the face of a woman who is 28 weeks pregnant,the nurse notices the presence of a butterfly-shaped increase in pigmentation on the face.The proper term for this finding in the documentation is:

A) striae.
B) chloasma.
C) linea nigra.
D) the mask of pregnancy.

Answer 1

chloasma.

Question 2

When performing an examination of a woman who is 34 weeks pregnant,the nurse notices that as the woman raises her head and shoulders off of the bed there is a midline linear protrusion in the abdomen over the area of the rectus abdominis muscles.Which response by the nurse is correct?

A) Document the presence of diastasis recti.
B) Discuss this condition with the physician because it will most likely need to be surgically repaired.
C) Suspect that the woman has a hernia from the increased pressure within the abdomen from pregnancy.
D) Tell the woman that she may have a difficult time with delivery because of the weakness in her abdominal muscles.

Answer 2

Document the presence of diastasis recti.

Question 3

A patient is being seen at the clinic for her 10-week prenatal visit.She asks when she will be able to hear the baby's heartbeat.The nurse should reply:

A) "The baby's heartbeat is not usually heard until the second trimester."
B) "The baby's heartbeat may be heard anywhere from the ninth to the twelfth week."
C) "It is often difficult to hear the heartbeat at this point, but we can try."
D) "It is normal to hear the heartbeat at six weeks. We may be able to hear it today."

Answer 3

"The baby's heartbeat may be heard anywhere from the ninth to the twelfth week."

Question 4

During the examination of a woman in her second trimester of pregnancy,the nurse notices the presence of a small amount of yellow drainage from the nipples.The nurse knows that this is:

A) an indication that the woman's milk is coming in.
B) a sign of possible breast cancer in a pregnant woman.
C) most likely colostrum and considered a normal finding at this stage of the pregnancy.
D) too early in the pregnancy for lactation to begin, and refers the woman to a specialist.

Question 5

When the nurse is assessing the deep tendon reflexes (DTRs)on a woman who is 32 weeks pregnant,which of these would be considered a normal finding on a 0 to 4+ scale?

A) Absent DTRs
B) 2+
C) 4+
D) Brisk reflexes and the presence of clonus

Question 6

A patient who is in her first trimester of pregnancy tells the nurse that she is experiencing significant nausea and vomiting and asks when it will improve.The nurse should reply:

A) "Did your mother have significant nausea and vomiting?"
B) "Many women experience nausea and vomiting until the third trimester."
C) "Usually, by the beginning of the second trimester, the nausea and vomiting improve."
D) "At about the time you begin to feel the baby move, the nausea and vomiting will subside."

Question 7

The nurse knows that the best time to assess a woman's blood pressure during an initial prenatal visit is:

A) at the end of the examination when she will be the most relaxed.
B) at the beginning of the interview as a nonthreatening method of gaining rapport.
C) during the middle of the physical examination when she is the most comfortable.
D) before beginning the pelvic examination because her blood pressure will be higher after the pelvic examination.

Question 8

When auscultating the anterior thorax of a pregnant woman,the nurse notices the presence of a murmur over the second,third,and fourth intercostal spaces.It is continuous but can be obliterated by pressure with the stethoscope or finger on the thorax just lateral to the murmur.The nurse interprets this finding to be:

A) the murmur of aortic stenosis.
B) most likely a mammary souffle.
C) associated with aortic insufficiency.
D) an indication of a patent ductus arteriosus.

Question 9

The nurse auscultates a functional systolic murmur,grade II/IV,on a woman in week 30 of her pregnancy.The remainder of her physical assessment is within normal limits.The nurse would:

A) consider this an abnormal finding and refer her for additional consultation.
B) ask the woman to run in place briefly and then assess for an increase in intensity of the murmur.
C) know that this is a normal finding resulting from the increase in blood volume during pregnancy.
D) ask the woman to restrict her activities and return to the clinic in 1 week for re-evaluation.

Question 10

A woman who is 8 weeks pregnant is visiting the clinic for a checkup.Her systolic blood pressure is 30 mm Hg higher than her prepregnancy systolic blood pressure.The nurse should:

A) consider this a normal finding.
B) expect the blood pressure to decrease as the estrogen levels increase throughout the pregnancy.
C) consider this an abnormal finding because blood pressure is typically lower at this point in the pregnancy.
D) recommend that she decrease her salt intake in an attempt to decrease her peripheral vascular resistance.

Question 11

When assessing a woman who is in her third trimester of pregnancy,the nurse looks for the classic symptoms associated with preeclampsia,which include:

A) edema, headaches, and seizures.
B) elevated blood pressure and proteinuria.
C) elevated liver enzymes and high platelet counts.
D) decreased blood pressure and edema.

Question 12

Which of these is considered a normal and expected finding when the nurse is performing a physical examination on a pregnant woman?

A) A palpable, full thyroid
B) Edema in one lower leg
C) Significant diffuse enlargement of the thyroid
D) Pale mucous membranes of the mouth

Question 13

A woman in her second trimester of pregnancy complains of heartburn and indigestion.When discussing this with the woman,the nurse considers which explanation for these problems?

A) Tone and motility of the gastrointestinal tract increase during the second trimester.
B) Sluggish emptying of the gallbladder, resulting from the effects of progesterone, often causes heartburn.
C) Lower blood pressure at this time decreases blood flow to the stomach and gastrointestinal tract.
D) The enlarging uterus and altered esophageal sphincter tone predispose the woman to have heartburn.

Question 14

The nurse is palpating the fundus of a pregnant woman.Which of these statements about palpation of the fundus is true?

A) It should be hard and slightly tender to palpation during the first trimester.
B) Fetal movement may not be felt by the examiner until the end of the second trimester.
C) After 20 weeks of gestation, the number of centimeters should approximate the number of weeks of gestation.
D) Fundal height is usually less than the number of weeks of gestation, unless there is an abnormal condition such as too much amniotic fluid present.

Question 15

A patient who is 20 weeks pregnant tells the nurse that she feels more shortness of breath as her pregnancy progresses.The nurse recognizes that which of these statements is true?

A) High levels of estrogen cause shortness of breath.
B) Feelings of shortness of breath are abnormal during pregnancy.
C) The hormones of pregnancy cause an increased respiratory effort.
D) She should get more exercise in an attempt to increase her respiratory reserve.

Question 16

Which of these statements best describes the action of the hormone progesterone during pregnancy?

A) It produces the hormone human chorionic gonadotropin.
B) It stimulates duct formation in the breast.
C) It promotes sloughing of the endometrial wall.
D) It maintains the endometrium around the fetus.

Question 17

A female patient has nausea,breast tenderness,fatigue,and amenorrhea.Her last menstrual period was 6 weeks ago.The nurse interprets that this patient is experiencing _____ signs of pregnancy.

A) positive
B) possible
C) probable
D) presumptive

Question 18

A woman who is 28 weeks pregnant has edema in her lower legs bilaterally after working 8 hours a day as a cashier at a local grocery store.She is worried about her legs.What is the nurse's best response?

A) "You will be at risk for development of varicose veins when your legs are edematous."
B) "I would like to listen to your heart sounds. Edema can indicate a problem with your heart."
C) "Edema is usually the result of too much salt and fluids in your diet. You may need to try to cut down on salty foods."
D) "As your baby grows, it slows blood return from your legs, causing the swelling. This often occurs with prolonged standing."

Question 19

When performing the examination of a woman who is 8 weeks pregnant,the nurse notices that the cervix is a bluish color.The nurse would document this finding as _____ sign.

A) Hegar's
B) Homans'
C) Chadwick's
D) Goodell's

Question 20

The nurse is palpating the abdomen of a woman who is 35 weeks pregnant and notices that the fetal head is facing downward toward the pelvis.The nurse would document this as fetal:

A) lie.
B) variety.
C) attitude.
D) presentation.

Question 21

During the assessment of a woman in her 22nd week of pregnancy,the nurse is unable to hear fetal heart tones with the fetoscope.The nurse should:

A) notify the physician immediately, then wait 10 minutes and try again.
B) ask the woman if she has felt the baby move today.
C) wait 10 minutes and try again.
D) use ultrasound to verify cardiac activity.

Question 22

During an internal examination of a woman during her first prenatal visit,the nurse finds that the cervix is soft.This is known as _____ sign.

A) Hegar's
B) Chadwick's
C) Homans'
D) Goodell's

Question 23

A patient who is 24 weeks pregnant asks about wearing a seat belt while driving.Which response by the nurse is correct?

A) "Seat belts should not be worn during pregnancy."
B) "Place the lap belt below the uterus and use the shoulder strap at the same time."
C) "Place the lap belt below the uterus but omit the shoulder strap during pregnancy."
D) "Place the lap belt at your waist above the uterus and use the shoulder strap at the same time."

Question 24

A woman in the 15th week of pregnancy has had bouts of severe vomiting for 3 weeks.She comes to the clinic today,and the nurse notices that she is showing signs of dehydration.Her blood pressure is lower than usual,and she is extremely fatigued.The nurse recognizes that this patient is experiencing:

A) preeclampsia.
B) polyhydramnios.
C) proteinuria.
D) hyperemesis.

Question 25

A woman in her 25th week of gestation comes to the clinic for her prenatal visit.The nurse notices that her face and lower extremities are swollen,and her blood pressure is 154/94 mm Hg.She states that she has had headaches and blurry vision but thought she was just tired.What should the nurse suspect?

A) Eclampsia
B) Preeclampsia
C) Diabetes type 1
D) Preterm labor

Question 26

Which of these correctly describes the average length of pregnancy?

A) 38 weeks
B) 9 lunar months
C) 280 days from the last day of the last menstrual period
D) 280 days from the first day of the last menstrual period

Question 27

During a prenatal visit at 30 weeks of gestation,the patient mentions to the nurse,"The baby has not moved very much since yesterday." The nurse notices that fetal movement is not as active as it was the last visit,and notifies the physician.What should the nurse prepare to do next?

A) Admit the woman to a hospital.
B) Administer a nonstress test for fetal monitoring.
C) Start an intravenous infusion.
D) Have the patient walk around the hallways and then check fetal movement again.

Question 28

During a woman's 34th week of pregnancy,she is told that she has preeclampsia.The nurse knows that which of these statements about preeclampsia is true?

A) Preeclampsia has little effect on the fetus.
B) Edema is one of the main indications of preeclampsia.
C) Eclampsia only occurs before delivery of the baby.
D) Untreated preeclampsia may contribute to restriction of fetal growth.

Question 29

During a history interview,a 38-year-old woman shares that she is thinking about having another baby.The nurse knows that which statement is true regarding pregnancy after age 35 years?

A) Fertility does not start to decline until age 40 years.
B) The occurrence of Down syndrome is much more frequent after age 35 years.
C) Genetic counseling and prenatal screening are not routine until after age 40 years.
D) Women older than 35 years who are pregnant have the same rate of pregnancy-related complications as those who are younger than 35 years.

Question 30

The nurse is palpating the uterus of a woman who is 8 weeks pregnant.Which of these findings would be considered to be most consistent with this stage of pregnancy?

A) The uterus seems slightly enlarged and softened.
B) It reaches to the pelvic brim and is about the size of a grapefruit.
C) It rises above the pelvic brim and is about the size of a cantaloupe.
D) It is about the size of an avocado, approximately 8 cm across the fundus.

Question 31

A woman in her second trimester of pregnancy states,"I'm so glad the morning sickness is gone,but I feel so tired!" What action by the nurse is appropriate at this time? Select all that apply.

A) Order a test of the woman's vitamin D level.
B) Instruct her to get more rest during the day.
C) Order a complete blood count.
D) Order thyroid function studies.
E) Offer HIV screening.

Question 32

During auscultation of fetal heart tones (FHTs),the nurse determines that the rate is 136 beats per minute.The nurse's next action should be to:

A) document the results, which are within normal range.
B) take the maternal pulse to verify these findings as the uterine souffle.
C) have the patient change positions and count the FHTs again.
D) notify the physician immediately for possible fetal distress.

Question 33

A patient's pregnancy test is positive,and she wants to know when the baby is due.The first day of her last menstrual period was June 14,and that period ended June 20.Using Nägele's rule,what is her expected date of delivery?

A) March 7
B) March 14
C) March 21
D) March 27

Question 34

During a group prenatal teaching session,the nurse teaches Kegel exercises.Which of these statements would be appropriate for this teaching session? Select all that apply.

A) "Kegel exercises help to keep your uterus strong during the pregnancy."
B) "Kegel exercises should be performed twice a day."
C) "Kegel exercises should be performed 50 to 100 times a day."
D) "To perform Kegel exercises, squeeze slowly to a peak at the count of eight, and then release slowly to a count of eight."
E) "To perform Kegel exercises, perform rapidly alternating squeeze-release exercises up to the count of eight."

Question 35

A 25-year-old woman is in the clinic for her first prenatal visit.The nurse will prepare to obtain which laboratory screening test at this time?

A) Urine toxicology
B) Complete blood cell count
C) Alpha-fetoprotein
D) Carrier screening for cystic fibrosis