Deck 30: The Pregnant Woman

Question 1

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 any time between 9 and 12 weeks."
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 6 weeks.We may be able to hear it today."

Answer 1

"The baby's heartbeat may be heard any time between 9 and 12 weeks."

Question 2

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

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

Answer 2

It is about the size of an avocado, approximately 8 cm across the fundus.

Question 3

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

Answer 3

2+

Question 4

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's response should be:

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 decrease."
D)"At approximately the time you begin to feel the baby move, the nausea and vomiting will subside."

Question 5

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 finding abnormal, and refer her for additional consultation
B)Ask the woman to run briefly in place and then assess for an increase in intensity of the murmur
C)Know that this finding is normal and is a result of 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 6

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)Enlarging uterus and altered esophageal sphincter tone predispose the woman to have heartburn.

Question 7

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 milk secretion is beginning
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 8

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)Mask of pregnancy

Question 9

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 10

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

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 11

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

A)The presence of diastasis recti should be documented.
B)This condition should be discussed with the physician because it will most likely need to be surgically repaired.
C)The possibility that the woman has a hernia attributable to the increased pressure within the abdomen from the pregnancy should be suspected.
D)The woman should be told that she may have a difficult time with delivery because of the weakness in her abdominal muscles.

Question 12

When assessing an adolescent female who is in her third trimester of pregnancy, the nurse assesses for the classic symptoms associated with pre-eclampsia, 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 13

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 pre-pregnancy systolic blood pressure.The nurse should:

A)Consider this a normal finding
B)Expect the blood pressure to decrease because 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 14

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

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

Question 15

A woman who is 28 weeks pregnant has bilateral edema in her lower legs 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 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 16

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 17

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

A)Progesterone produces the hormone human chorionic gonadotropin.
B)Duct formation in the breast is stimulated by progesterone.
C)Progesterone promotes sloughing of the endometrial wall.
D)Progesterone maintains the endometrium around the fetus.

Question 18

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

A)The fundus 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' gestation, the number of centimetres should approximate the number of weeks of gestation.
D)Fundal height is usually less than the number of weeks of gestation, unless an abnormal condition, such as excessive amniotic fluid, is present.

Question 19

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.The murmur 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)Murmur of aortic stenosis
B)Most likely a mammary soufflé
C)Associated with aortic insufficiency
D)Indication of a patent ductus arteriosus

Question 20

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

A)Before the physical examination but after she has been sitting quietly for some time
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 21

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 cell count.
D)Order thyroid function studies.
E)Offer human immunodeficiency virus (HIV) screening.

Question 22

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

A)Immediately notify the physician and 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 ultrasonography to verify cardiac activity

Question 23

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 24

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 25

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

Question 26

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

A)Fertility does not start to decline until age 40 years.
B)Occurrence of Down's syndrome is significantly more frequent after age 35 years.
C)Genetic counselling and prenatal screening are not routine until after age 40 years.
D)Pregnant women older than 35 years of age have the same rate of pregnancy-related complications as those who are younger than 35 years of age.

Question 27

A woman who is 25 weeks pregnant 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.The woman states that she has had headaches and blurry vision but thought she was just tired.What should the nurse suspect?

A)Eclampsia
B)Pre-eclampsia
C)Diabetes type 1
D)Preterm labour

Question 28

A patient's pregnancy test yields a positive result, 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 29

During auscultation of FHTs, the nurse determines that the heart 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 soufflé
C)Have the patient change positions and count the FHTs again
D)Immediately notify the physician for possible fetal distress

Question 30

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

A)"Kegel exercises help keep your uterus strong during the pregnancy."
B)"Kegel exercises should be performed twice a day."
C)"Kegel exercises should be performed several times a day in sets of 10 or more."
D)"To perform Kegel exercises, identify the correct muscles by stopping the flow of urine midstream."
E)"To perform Kegel exercises, rapidly perform alternating squeeze-release exercises up to the count of eight."

Question 31

During a woman's 34th week of pregnancy, she is told that she has pre-eclampsia.The nurse knows which statement concerning pre-eclampsia is true?

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