Question 1

A nurse midwife is creating a teaching plan for a G1P0 client at 12 weeks' gestation. The nurse midwife focuses on breast care once colostrum secretion begins. Which of the following teachings is not included in the teaching plan?

Accepted Answer

The client should wash her breasts with clear tap water daily, without soap, to remove the colostrum and minimize the risk of infection. A firm supportive bra with wide straps is recommended because it can spread the weight across the shoulders. If colostrum secretion becomes excessive, the client may place gauze squares inside the bra and change them frequently to keep the breasts dry.

Question 2

A client at 32 weeks' gestation complains of easy fatigability. During the history taking, the client tells the nurse midwife that she has been frequently awakened from sleep almost every night for the past week due to the activity of the fetus. The client also reports shortness of breath every time she sleeps flat in bed. Which of the following instructions given by the nurse midwife is the least appropriate when managing the client's sleeping problems?

Accepted Answer

The least appropriate instruction is to keep the client's knees sharply bent when sitting or lying down. This position can increase the risk of venous stasis below the knee. The client should not lie in a supine position as it increases the risk of supine hypotension. The client may instead sleep on two pillows or on a couch with an arm rest. Sleeping in a modified Sims' position, with the top leg forward, allows the weight of the fetus to rest on the bed. A rest period during the afternoon may alleviate fatigue.

Question 3

A client at 34 weeks' gestation is ordered to have a lecithin/sphingomyelin, or L/S, ratio. The nurse midwife informs the client that this test will determine:

Accepted Answer

The lecithin/sphingomyelin ratio is used to assess the maturity of the baby's lungs. To measure the L/S ratio, a sample of amniotic fluid is obtained. The surfactant, which contains lecithin and sphingomyelin, is needed to reduce the surface tension of the alveolar lining, preventing alveolar collapse. This test is usually performed at 35 weeks' gestation. The risk of the baby of developing neural tube defects may be determined as early as 12 weeks' gestation through chorionic villi sampling. A contraction stress test is performed to determine the baby's tolerance of labor.

Question 4

A lecithin/sphingomyelin ratio is ordered for a client who is being considered for induced labor. The client is 37 weeks pregnant. The nurse midwife reviews the result of the test and notes that the client's L/S ratio is 2.5. Based on this finding, the nurse midwife determines that:

Accepted Answer

Based on the L/S ratio, the nurse midwife determines that the fetus is not likely to develop respiratory distress syndrome during birth. An L/S ratio greater than 2.2 indicates fetal lung maturity. If the ratio is less than 2.2, the fetal lungs are most likely immature, and if induced labor is continued, supplemental oxygen therapy is a priority intervention at birth.

Question 5

A contraction stress test is ordered to a client at 35 weeks' gestation. After half an hour, the client's uterus begins to contract and the nurse midwife observes three 40-second-long contractions in a 10-minute window. The client has two contractions within the next five minutes. The nurse midwife notes that the fetal heart rate decreases toward the end of the contraction and afterward. This happens during more than 50% of the contractions. After stopping the oxytocin, which of the following is the next action of the nurse midwife?

Accepted Answer

The next action of the nurse is to turn the client onto her left side after stopping the oxytocin. Turning to the left side alleviates vena cava compression, which improves the flow of oxygenated blood to the fetus. After turning, the nurse midwife administers oxygen. The client will be referred to the physician after the initial interventions. Assessing the client's blood pressure is an appropriate intervention, but it is not the priority action for the nurse midwife.

Question 6

A nurse midwife is seeing four clients in the clinic. Which of the following clients should be seen first?

Accepted Answer

The nurse midwife should see the client at 18 weeks' gestation complaining of blurring of vision. Blurring of vision indicates that the client is most likely experiencing pregnancy-induced hypertension. Increased urinary frequency is a normal complaint of women in the first trimester. Intermittent, painless contractions around the 20th week of gestation are referred to as Braxton Hicks contractions. The client who is coming for her first prenatal check up does not demonstrate any signs of abnormality.

Question 7

A client in her first trimester tells a nurse midwife that she has developed tortuous veins in her lower extremities. Which of the following instructions given by the nurse midwife is the least effective?

Accepted Answer

The client should put on elastic support stockings before getting out of bed in the morning. Once she is on her feet, the blood has already started pooling in the lower extremities, and the stockings will be ineffective. To prevent the development or worsening of varicosities, the client should eat foods high in vitamin C, as it can be beneficial in reducing the size of the varicosities. Vitamin C is involved in the formation of collagen and endothelium of the blood vessels. Exercising stimulates venous return, alleviating the varicosities. Lying on the back with the legs raised against the wall for 15 minutes, twice a day, relieves varicosities.

Question 8

A client at 28 weeks' gestation complains of back pain. The client's urinalysis reveals normal findings. Which of the following instructions from the nurse midwife would be least effective at alleviating the client's back pain?

Accepted Answer

The least effective strategy in relieving back pain is walking with the pelvis tilted backward. The client must be instructed to walk with the pelvic tilted forward because this position puts pelvic support under the weight of the fetus. As pregnancy advances, women develop lumbar lordosis, a condition in which lower back's curvature increases. Lumbar lordosis causes a change in posture to maintain balance, resulting in back pain. Wearing shoes with low to moderate heels reduces the spinal curvature. Pelvic rocking is an exercise that relieves back pain. Sleeping on a firm mattress also alleviates back pain. To achieve a firmer sleeping surface, the client may slide a board under her mattress.

Question 9

A client learns that she is pregnant with twins after an ultrasound. The client asks the nurse midwife how much weight she should gain during the pregnancy. Which of the following statements made by the nurse midwife is the most accurate?

Accepted Answer

A client who is pregnant with twins should be encouraged to gain at least one pound per week, for a total of 40 to 45 pounds, during the pregnancy. Women who are pregnant with one fetus and weigh within the normal range may gain 25 to 40 pounds during the pregnancy. Mothers who are pregnant with twins or obese are not encouraged to go on a diet.

Question 10

A movie actress comes to the clinic for her first prenatal visit. The client is 7 weeks pregnant. The client has a BMI of 28. The nurse midwife informs the client that she needs to add 300 calories to her daily diet. The client is concerned about getting fat. She asks the nurse why it is important to add calories to her diet during pregnancy. Which of the following responses made by the nurse midwife is the least appropriate?

Accepted Answer

Women who are obese and pregnant should not go on a diet and should never consume fewer than 1500 calories per day. About 300 calories per day are added to meet the increased needs of pregnancy. The added calories are needed to supply energy for the fetus and placenta and to help a pregnant woman keep up with the increasing metabolic rate due to increased thyroid function and increased workload caused by the added weight of conceptus products.

Question 11

A nurse midwife tells a client who is trying to get pregnant to eat fresh fruits and green and leafy vegetables before conceiving. The nurse midwife also recommends 400 mcg of folic acid a day. Once she gets pregnant, the nurse midwife may recommend that the client increase her folic acid intake to 600 mcg per day during the first trimester. Which of the following is not a benefit of folic acid supplementation before and during pregnancy?

Accepted Answer

Iodine, not folic acid, improves thyroid function. The other options are all benefits of folic acid supplementation. As the blood volume doubles during pregnancy, the body's need for folic acid increases. Without supplementation, the mother may develop megaloblastic anemia, which is manifested by the formation of large but ineffective red blood cells. Folic acid is essential for the production, repair and functioning of DNA. Folic acid deficiency may cause neural tube defects and other birth defects like cleft lip, cleft palate and heart defects.

Question 12

A nurse midwife is creating a teaching plan for a group of adolescent girls who are pregnant for the first time. The main purpose of the teaching session is to promote nutritional health during pregnancy. Which of the following consideration is least important when creating the teaching plan?

Accepted Answer

When teaching a group of adolescent girls who are pregnant, the nurse midwife should mainly consider the involvement of the clients' families, the financial status of the clients and the clients' cultures. Even a client who is receptive to changing her eating habits may have some difficulties if her family resists the changes. In adolescents, it is most important that the food preparers are willing to effect the change. If a client belongs to a low-income group, the client should be helped to secure financial assistance during her pregnancy. Food intake and eating habits are greatly influenced by culture.

Question 13

A client who is 8 weeks pregnant tells a nurse midwife that she has a strange craving for laundry starch. The client says, "I think I am losing my mind, but I need to tell someone about this odd behavior." Which of the following interventions is the most appropriate for the client?

Accepted Answer

The most appropriate intervention is to initiate iron supplementation. The client is demonstrating pica, an abnormal craving for nonfood substances. Pica is a symptom that is often seen in pregnant women who are deficient in iron. Encouraging the client to stop eating laundry starch may not be effective because it is usually a habit that results from a physiologic need. The attitude that cravings are an indirect way of calling attention to a pregnancy is out of date; recent research shows that cravings are the result of physiological needs

Question 14

A nurse midwife is managing the nutritional status of a 13-year-old client at 12 weeks' gestation. When working with an adolescent client, which of the following interventions is the most effective?

Accepted Answer

The nurse midwife should allow the client to reject traditional foods and respect her decisions. This is the most effective intervention when working with an adolescent client. Adolescents are searching for their identities during this stage, and they have a tendency to reject foods that their primary caregivers or parents see as important for them. The other options would be less effective interventions. The nurse midwife should ensure that the client's diet includes adequate nutrients. Adolescent clients must consume more than 2,500 calories per day. The client should be taught to prepare her snacks early in the day because it is during this time when she has the most energy. The nurse midwife has to work with the client's food preparer because adolescents are not usually in charge of cooking the food they eat.

Question 15

A nurse midwife is managing the nutritional status of a 23-year-old client at 8 weeks' gestation. It is the client's first prenatal visit. The client has a BMI of 18. Which of the following interventions is the most appropriate for the client?

Accepted Answer

When managing the nutritional status of an underweight client, adding between 500 and 1,000 calories per day to the client's total caloric intake is the most appropriate intervention. A high-protein diet should be avoided during pregnancy. High-protein foods add more solute load to the kidneys and may cause acidosis. It is better to advise the client to eat nutritional foods than to advise her to gain as much weight as she can. The nurse midwife may also develop healthy menus with the client for improved compliance.

Question 16

The nurse midwife is creating a dietary plan for a pregnant vegan client. Which of the following interventions for this client is inaccurate?

Accepted Answer

The should go outside the house for 20 to 30 minutes in the midday sun to obtain sufficient amounts of vitamin D. The client must do this at least twice a week. Vegans do not eat animal products or by-products, so vitamin D may be obtained from fortified soymilk or from sunlight. The client must increase her intake of dark green vegetables to meet her calcium needs. Vitamin B12 deficiency is always a concern for vegans who are pregnant, so the nurse midwife may initiate vitamin B12 supplementation. The nurse midwife may recommend that the client combine different protein sources in one meal because some plant sources do not contain all essential amino acids.

Question 17

A client at 11 weeks' gestation complains of severe and extreme nausea and vomiting. During history taking, the nurse midwife learns that the client vomits at least three times a day. An ultrasound is performed and reveals that the client is negative for hydatidiform mole and multiple pregnancy. The nurse midwife suspects a case of hyperemesis gravidarum. The client is admitted for monitoring. Which of the following interventions is the least appropriate for the client?

Accepted Answer

During monitoring for hyperemesis gravidarum, oral fluids are usually withheld for the first 24 hours. If there is no vomiting after the first 24 hours, the client may have small amounts of clear fluids. Intravenous Ringer's lactate is administered, usually with vitamin B1 to increase hydration during monitoring. The nurse midwife may also administer metoclopramide, an anti-emetic. Research has shown that this medication is not linked to congenital anomalies. Fluid intake and urinary output must be monitored to assess the blood volume.

Question 18

A nurse midwife is reviewing the history of a client who is pregnant for the second time. Which of the following details from the client's history indicates an increased risk of gestational diabetes?
I.The client is 30 years old.
II.The client has a BMI of 28.
III.The client gave birth two years ago to a baby boy, who weighed 11 pounds at birth.
IV.The client is a Native American.

Accepted Answer

The client increases her risk for gestational diabetes because she is over 25 years, has a history of giving birth to large baby and she is of Native American descent. The following are the risk factors for gestational diabetes: obesity or having a BMI of 30 or greater, age over 25 years, history of large babies, race - Native American, Asian and Hispanic, history of diabetes, history of congenital anomalies and history of unexplained fetal loss.

Question 19

A client with type 1 diabetes is on her 37th week of pregnancy. The client is scheduled to have a test that will determine the maturity of her baby's lungs. The nurse midwife orders which of the following diagnostic tests?

Accepted Answer

The nurse midwife orders a phophatidyl glycerol test to determine the lung maturity of the fetus. For mothers with type 1 diabetes, the L/S ration may not be an accurate indicator of fetal lung maturity.

Question 20

A nurse midwife is managing the care of four female clients. She should administer RhoGAM to the following clients:
1.A client at 28 weeks' gestation who received a RhoGAM injection 72 hours after the delivery of her first child.
2.A G2P1 client at 28 weeks' gestation who gave birth to an Rh-positive baby two years ago.
3.An Rh-negative client at 15 weeks' gestation who develops bleeding after an amniocentesis.
4.An Rh-negative client at 12 weeks' gestation who is admitted due to ectopic pregnancy.

Accepted Answer

The nurse midwife administers RhoGAM to all four female clients. RhoGAM prevents the Rh-negative mother from producing antibodies to Rh-positive fetal blood cells and threatening the survival of future Rh-positive neonates. RhoGAM must be administered to all pregnant clients between the 26th and 28th weeks of gestation as a prophylaxis and within 72 hours after delivery. Other clients who should receive a RhoGAM injection include women with ectopic pregnancies, women who develop bleeding due to routine tests and women who have just had an abortion.

Quiz 1: Antepartum