Deck 21: Assessing the Pregnant Woman

Question 1

The nurse is performing an assessment of a patient who is 38 weeks pregnant with her first child. The nurse notes a thin, brown, pigmented area on the abdomen starting at the top of the uterus and extending downward to the top of the pubis. The most appropriate response is:

A) Call the advanced practice provider.
B) Reassure the patient that this is a normal finding called linea nigra.
C) Advise the patient that this line will disappear immediately after delivery.
D) Caution the patient to monitor for itching, rashes, or pain.

Answer 1

Reassure the patient that this is a normal finding called linea nigra.

Question 2

A pregnant patient calls the triage nurse complaining of generalized itching, especially on the palms of her hands and soles of her feet. She is 34 weeks pregnant and has had an uneventful pregnancy to this point. Her last appointment was 2 weeks ago. The triage nurse should:

A) Advise the patient to come into the office for further evaluation.
B) Ask the patient about possible exposures including to environmental allergens, sun, new lotions, or clothing.
C) Reassure the patient that all pregnant women have itching. Tell her to use a hydrating lotion and keep her next appointment in 2 weeks.
D) Both 1 and 2.

Answer 2

Both 1 and 2.

Question 3

The nurse is examining a pregnant patient who is 36 weeks pregnant with twins. When the patient stands to leave the examination room, the nurse notes that she is having difficulty standing up straight. Which of the following is likely to be the cause?

A) New onset of scoliosis
B) Pregnancy-related lordosis
C) Uterine size is enlarged due to twin gestation
D) Spinal tumor

Answer 3

Pregnancy-related lordosis

Question 4

A woman presents to the clinic because she missed her last menstrual period and thinks she may be pregnant. She reports fatigue, breast tenderness, urinary frequency, nausea, and vomiting in the morning. The health-care provider will interpret these findings as which of the following changes of pregnancy?

A) Positive
B) Presumptive
C) Probable
D) Possible

Question 5

Which of the following changes in respiratory functioning during pregnancy are considered normal?

A) Increased tidal volume?
B) Decreased tidal volume
C) Decreased inspiratory capacity?
D) Decreased oxygen consumption

Question 6

The nurse visits a pregnant woman at 34 weeks gestation. The woman is very concerned because she notices pain in her groin, especially when walking. This complaint may be explained as:

A) Normal, because the uterus is very heavy at 34 weeks.
B) Normal, because pain in the round ligaments of the uterus is very common.
C) Abnormal, it could be a sign of preterm labor.
D) Abnormal, it shows that the fetus is in a breech position.

Question 7

When performing a physical assessment of a pregnant patient at 28 weeks gestation, the student nurse notes a yellow discharge coming from one of the nipples. The student nurse correctly identifies this as:

A) Montgomery's glands
B) Breast cancer
C) Mastitis
D) Colostrum

Question 8

During a focused health history, the pregnant patient expresses concern about her breast size. She worries that her breasts are "too large" and will not fit in her current bras. The best response to this concern is:

A) "Don't worry about it, big breasts are good."
B) "I hear your concerns. It is not uncommon for breasts to enlarge during pregnancy and some women find that uncomfortable."
C) "I have a friend who had breasts that were two cup sizes larger during pregnancy."
D) "Let's see if we can find some resources so that you can find some bras that are more comfortable."
E) Both 2 and 4.

Question 9

A normal adaptation of pregnancy is increased blood supply to the pelvic region resulting in a blue discoloration of the cervix. This change is known as:

A) Ladin's sign.
B) Hegar's sign.
C) Goodell's sign.
D) Chadwick's sign.

Question 10

The nurse is assessing a pregnant patient who is at 38 weeks gestation and thinks she is in labor. The patient states that she has had irregular contractions every few hours. The contractions are not painful. The nurse tells the patient:

A) "Labor has not yet begun and it will be awhile."
B) "Braxton-Hicks contractions are normal at this stage of pregnancy."
C) "Observing contractions can be helpful in determining when labor starts."
D) All of the above.

Question 11

A pregnant woman is concerned about sleeping positions. She is only comfortable lying flat on her back. The nurse advises the woman:

A) In the third trimester, side-lying positions are the safest.
B) In the first trimester, pregnant women should not lie prone.
C) In the second trimester, pillows are necessary to prop up the legs.
D) In the third trimester, supine positions help to promote fetal blood flow.

Question 12

You are assessing a 23-year-old patient who is 6 weeks pregnant and diagnosed with hyperemesis gravidarum. Untreated hyperemesis gravidarum can often result in which of the following conditions?

A) Miscarriage of pregnancy
B) Dehydration
C) Bowel obstruction
D) Hypertension

Question 13

You are providing patient education to a pregnant woman. Prenatal vitamins are important during pregnancy because:

A) Pregnant women get frequent colds and need to take extra vitamin C.
B) Pregnant women need less calcium from dietary sources.
C) Pregnant women need extra electrolytes to avoid dehydration.
D) Pregnant women are at risk for iron deficiency anemia and need extra iron.

Question 14

The patient is 30 weeks pregnant and you are going to assess the fundal height of the uterus. How should you position the patient?

A) High Fowler's with knees straight
B) Supine with knees bent
C) Semi-sitting with knees slightly bent
D) Semi-Fowler's with knees at a 90-degree angle

Question 15

You are assessing a woman who is 30 weeks pregnant. You are palpating her abdomen for fundal height. Where should her uterus be located?

A) Between the umbilicus and the suprapubic bone
B) Just rising above the suprapubic bone
C) Between the suprapubic bone and the xiphoid process
D) Between the umbilicus and the xiphoid process

Question 16

A patient who is pregnant calls the office with concerns that she has not felt fetal movement. She is at 17 weeks gestation and is a G1P0. She says, "My friend is as pregnant as I am and she feels movement." The nurse explains to the patient:

A) "Pregnant women should feel fetal movement by 12 weeks gestation. You should go to the hospital."
B) "You should wait to feel movements and when you do you should time the movements."
C) "The fetus is still very small and sometimes movement is not felt until 20 weeks gestation."
D) "Sometimes when there are problems with fetal development you don't feel movements so early."

Question 17

The nurse is assessing a woman on the second day after a normal, spontaneous vaginal birth without complications. The woman tells the nurse that she feels very sad and she begins to cry. She states that she is happy about the baby but she does not know why she is so sad. The best response the nurse can give is:

A) "Your baby is perfect. You have nothing to be sad about."
B) "You have postpartum depression. It is very common. You should try medications that can make it better."
C) "It is very common to feel sad after the delivery. Usually these feelings resolve over a few days. If they don't, please follow up with your health-care provider."
D) "Postpartum depression is normal and I would like you to fill out this questionnaire so that I can help you more."

Question 18

A pregnant woman is 20 weeks pregnant and is having a routine assessment. You are assessing the fetal heart rate and place the Doppler below the umbilicus in the left lower quadrant. The patient asks you why you are listening to the heart rate at that particular place. How should the nurse respond?

A) "This is the only location that the heartbeat is heard at this time."
B) "You are 20 weeks pregnant and this is where the heartbeat always is."
C) "Your baby's position affects where I will be able to hear the heartbeat."
D) "It does not matter where I place the Doppler because I will hear your baby's heartbeat."

Question 19

You are going to assess the fetal heart rate. What should be done first just prior to auscultating the heart rate?

A) Perform Leopold maneuvers before fetal auscultation.
B) Encourage the mother to take some deep breaths.
C) Take the mother's blood pressure and pulse for comparison.
D) Assess the fundal height to determine the number of weeks of gestation.

Question 20

A pregnant woman is 14 weeks pregnant and asks how fast her uterus will enlarge throughout her pregnancy. Which of the following is the nurse's best response?

A) "Your uterus will grow faster after 20 weeks, about 4 cm each week."
B) "Your uterus will grow about 1 cm per week of pregnancy until you are 36 weeks."
C) "The growth of your uterus will depend on how much amniotic fluid is retained."
D) "I am sorry but there are no specific guidelines that tell us how much your uterus will grow."

Question 21

A new mother in her first trimester comes to the outpatient clinic for her monthly assessment. She reports that she is nauseous and vomits every morning. She asks, "What causes morning sickness?" The nurse should respond:

A) "Morning sickness occurs because the fetus presses on your stomach when lying down."
B) "Don't worry about the reason. Morning sickness will go away when you are 12 weeks pregnant."
C) "Morning sickness occurs due to increasing hormone levels during pregnancy."
D) "Increasing levels of the human chorionic gonadotropin causes morning sickness."

Question 22

During a routine prenatal assessment, a pregnant woman who is 32 weeks pregnant complains that she is having more episodes of heartburn and problems with constipation. The nurse knows that these symptoms are related to:

A) Increased estrogen levels.
B) Increased progesterone levels.
C) Increased human chorionic gonadotropin levels.
D) All of the above.

Question 23

A woman has just found out that her pregnancy test was positive. She reported that her last menstrual date was August 15. Using Naegele's Rule, when is her due date?

A) November 8
B) April 23
C) May 8
D) May 23

Question 24

The health-care provider recently confirmed that a woman is pregnant. The new mother to be is so happy because she has been trying to get pregnant for the past year. She told the nurse that her menstrual cycles have been very irregular and unpredictable, making it very hard to conceive. She "thinks her last menstrual cycle started in early September." What would be a reliable predictor of gestational age for this woman?

A) Fundal height measurements
B) Ultrasound in the first trimester
C) Levels of the human chorionic gonadotropin (hCG)
D) Using Naegele's Rule for expected date of delivery

Question 25

You are assessing the fetal heart rate of a woman who is 30 weeks pregnant. The woman asks what a normal fetal heart rate should be at this stage of pregnancy. The nurse's best response is:

A) A fetal heart rate ranges between 120 and 160 beats per minute (bpm).
B) A normal fetal heart rate averages about 140 bpm.
C) A normal fetal heart rate should always be between 100 and 140 bpm.
D) A fetal heart rate depends on the gestational age.

Question 26

You are a nurse working in an outpatient obstetric clinic. You should know that a key task during the health assessment of the pregnant woman is to emphasize:

A) Healthy eating patterns.
B) Normal changes during pregnancy.
C) Weight gain throughout the pregnancy.
D) Regular wellness check-ups.

Question 27

The pregnant women is 24 weeks pregnant and having a routine assessment. Her weight prior to getting pregnant was 149 lb. The nurse weighs the patient today at 162 lb and measures a fundal height at 23 cm. The patient states, "I am worried that I am going to put on too much weight and then I have to take it off." Which of the following should be the nurse's appropriate response?

A) "You can never put on too much weight when you are feeding a child too."
B) "You should try to cut down on how much you eat because you are gaining too much weight."
C) "Your weight is fine. You should be gaining about 2 lb per week."
D) "You are doing good. You should gain about 25 to 35 lb throughout the pregnancy."

Question 28

A pregnant woman who is 18 weeks pregnant was telling the nurse during an assessment visit that she loves cats. She says, "I have five beautiful long-haired cats at home." What would be an appropriate response by the nurse?

A) "Now that you are pregnant, you should have someone else take care of your cats until you deliver your baby."
B) "Why do you have five cats? Isn't that going to be too much for you to handle with a new baby?"
C) "You will have to get rid of the cats because it can be dangerous when the baby arrives."
D) "You should avoid cat litter because the cats' feces may contain a parasite that can cause birth defects."

Question 29

You are assessing a pregnant woman's vital signs. The blood pressure (BP) in her right arm is 148/88 and in her left arm is 148/90. As a nurse, you know that:

A) Pregnant women's blood supply increases, causing an increase in blood pressure readings.
B) Pregnant women may develop pregnancy-induced hypertension and be at risk for pre-eclampsia.
C) Pregnant women's blood pressure fluctuates as the fetus grows in utero.
D) Pregnant women's blood pressure is directly related to their fluid intake and weight gain.

Question 30

The patient comes to the office stating that she is having "severe" contractions. The nurse palpates for contractions and assesses contractions that feel moderate. How would you describe the feeling of a moderate contraction?

A) The feeling of the cheek
B) The feeling of the tip of the nose
C) The feeling of the thigh
D) The feeling of the forehead

Question 31

A pregnant woman who is 20 weeks pregnant reports that she has not felt her baby move in the past 24 hours. You assess the fetal heart rate at 124. You put a fetal monitor on the woman to assess fetal movement for 60 minutes. There are only five confirmations of fetal movement. What should you do?

A) Call the health-care provider immediately.
B) Tell the mother that her baby was active in the past hour.
C) Assess the fetal heart rate on the infant.
D) Put in a referral to a high-risk obstetrician.

Question 32

Routine diagnostic blood testing during pregnancy includes which of the following? Select all that apply.

A) Complete blood count
B) Rubella and varicella titers
C) Human immunodeficiency virus
D) Blood type
E) Chlamydia
F) Gonorrhea
G) Syphilis
H) Hepatitis

Question 33

A pregnant woman is 36 weeks pregnant. She comes to her health-care provider's office stating that she is having contractions. How will you assess for contractions? Select all that apply.

A) Using the ulnar surface of both hands
B) Using the palmar surface of your hand
C) Using the fingertips of both hands
D) Using the finger pads of both hands

Question 34

You are performing Leopold's Maneuver. Put in order the sequence of how you would perform this technique (1-4). (Enter the number of each step in the proper sequence. Do not use punctuation or spaces. Example: 1234.)
____1. Each side of the maternal abdomen is palpated to determine which side is the fetal spine and which is the extremities.
____2. The area above the symphysis pubis is palpated to locate the fetal presenting part and thus determine how far the fetus has descended and whether the fetus is engaged.
____3. The uterine fundus is palpated to determine which fetal part occupies the fundus.
____4. One hand applies pressure on the fundus while the index finger and thumb of the other hand palpate the presenting part to confirm presentation and engagement.

Question 35

Look at the picture. Identify this probable sign of pregnancy that indicates increased vascularity of the vagina and vulva. It is called ____________________ ____________________. (two words)