Deck 29: The Pregnant Female

Question 1

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

Answer 1

3
The nausea,vomiting,and fatigue of pregnancy improve by weeks 12 to 16.

Question 2

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

Answer 2

3
Because of the increase in blood volume,a functional systolic murmur,grade II/IV or less,can be heard in 95% of pregnant women.

Question 3

When auscultating the anterior thorax of a pregnant woman,the nurse notes 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 knows that this is:
1)the murmur of aortic stenosis.
2)most likely a mammary souffle.
3)associated with aortic insufficiency.
4)indication of a patent ductus arteriosis.

Answer 3

2
Often blood flow through the blood vessels,specifically the internal mammary artery,can be heard over the second,third,and fourth intercostal spaces.This is called a mammary souffle,but it may be mistaken for a cardiac murmur.

Question 4

When performing the examination of a woman who is 8 weeks' pregnant,the nurse notes that the cervix is a bluish color.The nurse would document this finding as:
1)Hegar's sign.
2)Homan's sign.
3)Chadwick's sign.
4)Goodell's sign.

Question 5

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 heart beat.The nurse should reply:
1)"The baby's heart beat is not usually heard until the second trimester."
2)"The baby's heart beat may be heard anywhere from the ninth to the twelfth week."
3)"It is often difficult to hear the heart beat at this point,but we can try."
4)"It is normal to hear the heart beat at 6 weeks.We may be able to hear it today."

Question 6

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 the following is true?
1)High levels of estrogen cause shortness of breath.
2)Feelings of shortness of breath are abnormal during pregnancy.
3)The hormones of pregnancy cause an increased respiratory effort.
4)She should get more exercise in an attempt to increase her respiratory reserve.

Question 7

When one is assessing the deep tendon reflexes (DTRs)on a 32-week pregnant woman,which of the following would be considered a normal finding on a 0-4+ scale?
1)Absent DTRs
2)2+
3)4+
4)Brisk reflexes and the presence of clonus

Question 8

When palpating the fundus,the nurse knows that:
1)it should be hard and slightly tender to palpation during the first trimester.
2)fetal movement should be felt by the examiner at the beginning of the second trimester.
3)after 20 weeks' gestation,the number of centimeters should approximate the number of weeks' gestation.
4)fundal height is usually less than the number of weeks' gestation,unless there is an abnormal condition such as too much amniotic fluid present.

Question 9

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 blood pressure.The nurse would:
1)consider this a normal finding.
2)expect the blood pressure to decrease as the estrogen levels increase throughout the pregnancy.
3)consider this an abnormal finding because blood pressure is typically lower at this point in the pregnancy.
4)recommend that she decrease her salt intake in an attempt to decrease her peripheral vascular resistance.

Question 10

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.What should the nurse recommend to her?
1)"You will be at risk for development of varicose veins when your legs are edematous."
2)"I would like to listen to your heart sounds.Edema can indicate a problem with your heart."
3)"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."
4)"As your baby grows,it slows blood return from your legs,causing the swelling.This often occurs with prolonged standing."

Question 11

A woman in her second trimester of pregnancy complains of heartburn and indigestion.The nurse should offer which explanation for these problems?
1)Tone and motility of the gastrointestinal tract increase during the second trimester.
2)Sluggish emptying of the gallbladder,resulting from the effects of progesterone,often causes heartburn.
3)Lower blood pressure at this time decreases blood flow to the stomach and gastrointestinal tract.
4)The enlarging uterus and altered esophageal sphincter tone predispose the woman to have heartburn.

Question 12

Which of the following is considered a normal and expected finding when the nurse is performing a physical examination on a pregnant woman?
1)A palpable,full thyroid
2)Spontaneously bleeding gingiva
3)Significant diffuse enlargement of the thyroid
4)Pale,hypertrophied mucous membranes of the mouth

Question 13

Which of the following best describes the action of the hormone progesterone during pregnancy?
1)It produces the hormone human chorionic gonadotropin.
2)It stimulates duct formation in the breast.
3)It promotes sloughing of the endometrial wall.
4)It maintains the endometrium around the fetus.

Question 14

The nurse is palpating the abdomen of a woman who is 35 weeks' pregnant and notes that the fetal head is facing downward toward the pelvis.The nurse would document this as:
1)fetal lie.
2)fetal variety.
3)fetal attitude.
4)fetal presentation.

Question 15

The nurse knows that classic symptoms associated with preeclampsia include:
1)proteinuria,headaches,and seizures.
2)elevated blood pressure and proteinuria.
3)elevated liver enzymes and high platelets.
4)neurologic signs,elevated blood pressure,and edema.

Question 16

A female patient has nausea,breast tenderness,fatigue,and amenorrhea.Her last menstrual period was 6 weeks ago.The nurse recognizes that this patient is experiencing:
1)positive signs of pregnancy.
2)possible signs of pregnancy.
3)probable signs of pregnancy.
4)presumptive signs of pregnancy.

Question 17

During the examination of a woman in her second trimester of pregnancy,the nurse notes the presence of a small amount of yellow drainage from the nipples.The nurse knows that this is:
1)an indication that the woman's milk is coming in.
2)a sign of possible breast cancer in a pregnant woman.
3)most likely colostrum and considered a normal finding at this stage of the pregnancy.
4)early in the pregnancy to begin lactation.The woman should be referred to a specialist.

Question 18

Which of the following correctly describes the average length of pregnancy?
1)38 weeks
2)9 lunar months
3)280 days from the last day of the last menstrual period
4)280 days from the first day of the last menstrual period

Question 19

When examining the face of a 28-week pregnant woman,the nurse notes the presence of a butterfly-shaped increase in pigmentation on the face.The proper term for this finding in the documentation is:
1)striae.
2)chloasma.
3)linea nigra.
4)the mask of pregnancy.

Question 20

During a health history of a woman who is pregnant with her first child,the woman states,"I just cannot stop crunching on ice! What's wrong with me?" The nurse recognizes that:
1)she is experiencing a common food intolerance.
2)the woman is experiencing pica,craving for nonfood items,which is sometimes associated with anemia.
3)she may be experiencing gastrointestinal changes associated with pregnancy.
4)she probably craved ice before her pregnancy and this is nothing new.

Question 21

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?
1)March 7
2)March 14
3)March 21
4)March 27

Question 22

During a woman's 34th week of pregnancy,she is told that she has preeclampsia.The nurse knows that which of the following statements about preeclampsia is true?
1)Preeclampsia has little effect on the fetus.
2)Edema is one of the main indications of preeclampsia.
3)Eclampsia only occurs before delivery of the baby.
4)Untreated preeclampsia may progress to eclampsia,which is manifested by generalized tonic-clonic seizures

Question 23

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

Question 24

Which of the following is true regarding pregnancy after age 35 years?
1)Women over age 35 years are delivered most often by vaginal delivery.
2)The occurrence of Down syndrome is much more frequent after age 35 years.
3)Genetic counseling and prenatal screening are not routine until after age 40 years.
4)Women over age 35 years who are pregnant have the same rate of pregnancy-related complications as those who are under age 35 years.

Question 25

During a group prenatal teaching session,the nurse teaches Kegel exercises.Which of the following statements would be appropriate for this teaching session? Select all that apply.
1)"Kegel exercises help to keep your uterus strong during the pregnancy."
2)"Kegel exercises should be performed twice a day."
3)"Kegel exercises should be performed 50 to 100 times a day."
4)"To perform Kegel exercises,squeeze slowly to a peak at the count of eight then release slowly to a count of eight."
5)"To perform Kegel exercises,perform rapidly alternating squeeze-release exercises up to the count of eight."

Question 26

A patient,who is 24 weeks pregnant,asks about wearing a seatbelt while driving.The nurse should reply:
1)"Seatbelts should not be worn during pregnancy."
2)"Place the lap belt below the uterus and use the shoulder strap at the same time."
3)"Place the lap belt below the uterus but omit the shoulder strap during pregnancy."
4)"Place the lap belt at your waist above the uterus and use the shoulder strap at the same time."

Question 27

A 25-year-old woman is in the clinic for her first prenatal visit.Which laboratory screening is appropriate at this time?
1)Human chorionic gonadotropin
2)Complete blood cell count
3)Alpha-fetoprotein
4)Carrier screening for cystic fibrosis

Question 28

During the assessment of a woman in her 22nd week of pregnancy,the nurse is unable to hear fetal heart tones with the Doppler device.The nurse should:
1)wait 10 minutes and try again.
2)notify the physician immediately.
3)use a fetoscope to identify fetal heart tones.
4)use ultrasound to verify cardiac activity.

Question 29

During an internal examination of a woman during her first prenatal visit,the nurse notes that the cervix is soft.This is known as:
1)Hegar's sign.
2)Chadwick's sign.
3)Homan's sign.
4)Goodell's sign.