Download Pregnancy Exam - Teddie Joe Snodgrass

Pregnancy
Chapter 1
December 25, 2014
Health Couseling
1-1 Which of the following seafoods do you not recommend for women who might
become pregnant, are pregnant, or are nursing?
A. Swordfish, albacore tuna
B. Light white tuna, salmon
C. Haddock, halibut
D. Shrimp, Pollock
1-1 Answer A: The Environmental Protection Agency/Food and Drug Administration
(EPA/FDA) recommends that pregnant women not eat swordfish, tilefish, shark, or king
mackerel and no more than 6 oz per week of albacore tuna because of moderate to
high levels of methyl mercury found in these fish. All seafood contains some amount of
this environmental contaminant. Light white tuna, salmon, haddock, halibut, shrimp, and
pollock have much lower amounts of methyl mercury. These fish are excellent sources
of protein and contribute to healthy fetal neurodevelopment. Women should be
encouraged to eat these types of fish.
1-2 Alicia, age 22, is in your office for her first prenatal visit. Recommended preventive
services for all pregnant women include
A. blood typing and HIV and hypertensive screening.
B. assessment of height and weight and screening for HIV and asymptomatic
bacteriuria.
C. Chlamydia screening, hypertension screening, and Rh(D) incompatibility
screening with blood typing.
D. screening for syphilis, Chlamydia, hepatitis B, alcohol and tobacco
abuse, asymptomatic bacteriuria, and Rh(D) incompatibility; blood typing;
and discussing the importance of breastfeeding.
1-2 Answer D: The U.S. Preventive Services Task Force recommends the following for
all pregnant women: screening for Chlamydia, syphilis, hepatitis B, and asymptomatic
bacteriuria; interventions to reduce alcohol abuse with screening and behavioral
counseling; counseling to prevent tobacco use and tobacco-caused disease; blood
typing and assessment for Rh(D) incompatibility; and behavioral interventions to
promote breastfeeding.
1-3 You should advise any client who has received which of the following immunizations
to use contraception for the next 3 months to avoid pregnancy?
A. MMR, yellow fever, or varicella vaccines
B. Rabies post-exposure prophylaxis
C. Tetanus-diphtheria
D. Hepatitis B
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1-3 Answer A: Delay pregnancy for 3 months following vaccines for measles, mumps,
and rubella (MMR); yellow fever; or varicella. These are all live attenuated vaccines.
The others are not.
1-4 Jill, who is 8 months pregnant, calls you because her father has told her that her
mother is gravely ill. Her parents live on the opposite coast of the continental United
States from Jill and she would have to take a 4- to 5-hour flight to see her mother. How
would you advise Jill?
A. Tell her that she should not travel at this point in her pregnancy.
B. Evaluate her risk and make your recommendation on the basis of her
risk factors and hemoglobin level.
C. Tell her that it is OK for her to make this flight.
D. Evaluate her risk and make your recommendation on the basis of an
electrocardiogram.
1-4 Answer B: Most airlines do not allow pregnant women to travel if they are at more
than 35 – 36 weeks’ gestation without a letter from their physician or healthcare
provider. Commercial aircraft cruising at high altitude are able to pressurize only up to
5,000 – 8,000 ft above sea level. Women with moderate anemia (hemoglobin less than
8.5 g/dL) or with compromised oxygen saturation may need oxygen supplementation.
Women with sickle cell disease may experience a crisis during the desaturation. Other
medical risk factors include congenital or acquired heart disease, history of
thromboembolic disease, hemoglobin less than 8.5 g/dL, chronic lung disease such as
asthma, and medical disease requiring ongoing assessment and medication. Obstetric
risk factors include history of miscarriage, threatened abortion or vaginal bleeding
during the present pregnancy, history of ectopic pregnancy (rule out with ultrasound
before flying), primigravida older than 35 or younger than 15 years of age, history of
diabetes with pregnancy, hypertension, toxemia, multiple gestation in present
pregnancy, incompetent cervix, history of infertility, or difficulty becoming pregnant. An
electrocardiogram would be indicated only related to a specific risk factor, whereas it
would be essential to check the hemoglobin level in making your decision. Even those
with sickle cell trait may experience hematuria or renal microthrombosis during
desaturation. The fetal circulation and fetal hemoglobin protect the fetus against
desaturation during flight.
1-5 Helen is 24 weeks pregnant and needs to take a trans-Atlantic flight to attend to a
sick parent. What recommendation do you make regarding her plane flight?
A. Tell her to be sure to eat enough while traveling to avoid any drop in blood
sugar.
B. Encourage her to decrease her fluid intake because it may be difficult to use
the bathroom facilities and her bladder is over-distended as a result of her
pregnancy.
C. Tell her to request an aisle seat so that she can ambulate frequently, and
advise her to do isometric exercises.
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Pregnancy
Chapter 1
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D. She should monitor her blood pressure before and after the flight.
1-5 Answer C: An alteration in clotting factors and venous dilation during pregnancy
may predispose pregnant women to superficial and deep venous thrombosis, or
“economy class syndrome.” Pregnant women have a rate of acute iliofemoral venous
thrombosis that is six times greater than that of non-pregnant women. The pregnant
traveler should request an aisle seat and should walk in the aisles at least once an hour
during long airplane flights whenever it is safe to do so. General stretching and
isometric leg exercises should be encouraged on long flights. Pregnant women should
also be encouraged to drink nonalcoholic beverages to maintain hydration and to wear
seat belts low around the pelvis throughout the entire flight. They should avoid heavy
eating because intestinal gas expansion can be particularly uncomfortable for the
pregnant traveler. Monitoring of blood pressure is not essential unless there is an
identified underlying risk factor.
1-6 Mandy is pregnant with her first baby. She asks you what is the safest drug to use in
pregnancy. What do you tell her?
A. Acetylsalicylic acid (aspirin)
B. Acetaminophen (Tylenol)
C. Erythromycin (E-Mycin, Eryc)
D. Tetracycline (Achromycin, Sumycin)
1-6 Answer C: Erythromycin (E-Mycin, Eryc) has been found to be the safest drug to
use in pregnancy because it has no teratogenic effects on the fetus. Acetylsalicylic acid
(aspirin) alters platelet function and can cause maternal and newborn bleeding;
acetaminophen (Tylenol) can be toxic to the liver; and tetracycline (Achromycin,
Sumycin), if given to a pregnant mother between the fourth month of pregnancy and
delivery, will cause abnormalities in tooth development, including brown spotting and
unusual shape.
Pulmonary
1-7 Which of the following statements regarding the respiratory status of the pregnant
woman is true?
A. The thoracic cage may appear wider.
B. The costal angle may feel narrower.
C. Respirations may be shallow.
D. Oxygenation is decreased.
1-7 Answer A: In the pregnant woman, the thoracic cage may appear wider and the
costal angle may feel wider than in the non-pregnant state. Respirations may be
deeper, although this can be quantified only with pulmonary function tests. Oxygenation
is not decreased.
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1-8 Marisa, who is pregnant, has just been given a diagnosis of tuberculosis. What do
you do?
A. Wait until Marisa delivers and then begin therapy immediately.
B. Begin therapy with isoniazid (Nydrazid), rifampin (Rimactane), and
pyrazinamide now.
C. Begin therapy with isoniazid, rifampin, and ethambutol (Myambutol)
now.
D. Begin therapy with isoniazid now, wait to see how Marisa tolerates it, and then
add rifampin, pyrazinamide, or ethambutol.
1-8 Answer C: Treatment of tuberculosis in pregnant women is essential and should
not be delayed; therefore, Marisa’s treatment should begin now. The preferred initial
treatment is isoniazid (Nydrazid), rifampin (Rimactane), and ethambutol (Myambutol).
The teratogenicity of pyrazinamide is undetermined, so it is not wise to use this drug
unless resistance to the other drugs is demonstrated or is likely.
1-9 How does pregnancy affect asthma?
A. During pregnancy, asthma usually improves.
B. During pregnancy, asthma usually worsens.
C. Symptoms in about one-third of pregnant women with asthma improve,
about one-third are unchanged, and about one-third worsen.
D. Symptoms in about one-half of pregnant women improve; those of the other
half worsen.
1-9 Answer C: Symptoms in about one-third of pregnant women with asthma will
improve during pregnancy; about one-third will be unchanged; and about one-third will
worsen. Pregnancy is associated with changes in lung volume. There is an increase in
tidal volume and a 20% – 50% increase in minute ventilation. The clinical course of
asthma during pregnancy may be predicted by the course during the first trimester, and
most clients have the same pattern of response with repeated pregnancies. The
treatment of asthma during pregnancy follows the same principles as with other clients.
Medications not specifically required should not be given in the first trimester, and all
medications should be given at their minimal effective dose and frequency.
Emerging Family Care
1-10 Which of the following dietary changes would you recommend to Heather, who is
experiencing nausea during her first trimester?
A. A bland diet taken frequently and in small amounts
B. An increase in fat intake
C. A decrease in carbohydrate intake
D. Restriction of fluid intake after 7 p.m.
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1-10 Answer A: Nausea during pregnancy may be helped somewhat by dietary
changes, such as eating a bland diet taken frequently and in small amounts, increasing
carbohydrate intake, decreasing fat intake, and trying to stay away from food odors.
Good hydration is important in pregnancy; therefore, fluid restriction is never
recommended.
1-11 Which of the following instructions should be included in the discharge teaching
plan to assist the postpartal (management of the patient who has recently given birth)
woman in recognizing early signs of complications?
A. The passage of clots as large as an orange is expected.
B. Call the office to report any decrease in the amount of brownish-red lochia.
C. Palpate the fundus daily to make sure it is soft.
D. Notify your health-care provider of a return to bright red vaginal
bleeding.
1-11 Answer D: A return to bright red vaginal bleeding is a sign of a complication and
potentially a late postpartum hemorrhage. The client should not be passing clots. It is
expected that the amount of lochia will decrease over time. The fundus should be firm; a
soft uterine fundus would result in increased vaginal bleeding.
1-12 Pregnant women should know that folic acid can help to prevent neural tube
defects. For folic acid to be most effective, women should take it
A. before becoming pregnant.
B. during the second trimester.
C. during the third trimester.
D. soon after a positive pregnancy test.
1-12 Answer A: Folic acid should be taken before getting pregnant and during the first
few weeks of pregnancy, often before a woman may even know she is pregnant. Folic
acid is important throughout pregnancy, but to be most effective in preventing neural
tube defects it needs to be taken prior to becoming pregnant.
1-13 Which of the following is the best description of the Lamaze method of childbirth
education?
A. It focuses on the birth event and requires a dimly lighted room and a warmwater bath.
B. It uses no medical interventions such as fetal monitors, intravenous fluids, or
medications.
C. It uses the child’s father as a birthing coach and relies on deep abdominal
breathing to handle the contractions.
D. It uses a focal point for concentration while the woman does controlled
breathing techniques.
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1-13 Answer D: The Lamaze method of childbirth education uses patterned, controlled
breathing with concentration on a visual focal point during labor. A focus on birth in a
dimly lighted room and a warm water bath is the Leboyer method. Natural childbirth
uses no medical interventions. The Bradley method is father-coached childbirth.
1-14 When is the brain configuration of a fetus roughly complete?
A. At 4 weeks’ gestation
B. At 12 weeks’ gestation
C. At 20 weeks’ gestation
D. At 24 weeks’ gestation
1-14 Answer B: The brain configuration of a fetus is roughly complete at 12 weeks’
gestation. Therefore, it is important to teach the pregnant client to avoid all drugs,
alcohol, smoking, and other teratogenic agents that may cause neurological harm to the
infant, unless the client checks first with her health-care provider.
1-15 Mindy, age 42, is pregnant for the first time. She wants a chorionic villus
sampling (CVS) performed for genetic testing. Which statement is true regarding CVS?
A. CVS may be offered at 11–14 weeks’ gestation.
B. CVS detects only chromosomal anomalies and not anatomical
aberrations such as open neural tube defects.
C. CVS is extremely safe.
D. CVS can be done in the physician’s office.
1-15 Answer B: Chorionic villus sampling (CVS) detects only chromosomal anomalies
and not anatomical aberrations such as open neural tube defects. CVS may be
performed at 10–12 weeks’ gestation, whereas amniocentesis may be performed at
15–18 weeks’ gestation. Although safe, CVS has a slightly higher risk of loss of the
pregnancy than does amniocentesis and is performed only in large facilities that offer
experienced practitioners and real-time ultrasound imaging.
1-16 Sally, who is 18 weeks pregnant, had a maternal serum alpha-fetoprotein
(MSAFP) level done. The results are elevated. What is the meaning of an elevated
MSAFP level?
A. The fetus has trisomy 21.
B. There is an increased risk that the fetus has an open neural tube defect.
C. The infant will be born with hydrocephalus.
D. The fetus has an increased risk of developing cerebral palsy.
1-16 Answer B: Maternal serum alpha-fetoprotein (MSAFP) testing is a screening
procedure used to detect an increased risk for neural tube defects and ventral wall
defects. MSAFP screening should be considered for all pregnant women at 16–18
weeks’ gestation because 90% of neural tube defects occur in the absence of a positive
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history. MSAFP is elevated in 80%–90% of women whose fetuses have open neural
tube defects or other fetal anomalies, such as omphalocele, congenital nephrosis, and
fetal bowel obstruction, and in women with multiple fetuses. MSAFP levels are not
elevated with closed neural tube defects such as hydrocephalus. Birth trauma is the
most common cause of cerebral palsy, so there is no available screening test. It is
diagnosed after birth. An MSAFP is part of a triple screening test, and low values on
triple screening testing are indicative of an increased risk for trisomy 21.
1-17 Sandra, who is 5 months pregnant and of average height and weight, asks you
how many extra calories she should be adding to her diet per day. You tell her to add
A. 200 calories.
B. 300 calories.
C. 500 calories.
D. 700 calories.
1-17 Answer B: A woman of average height and weight needs an additional 300
calories a day during pregnancy and an additional 500 calories a day when
breastfeeding to ensure an adequate intake of essential nutrients for the child.
1-18 Jack and Jill present for a preconception health counseling session. Jack is 34, Jill
is 33, and they have a 5-year-old son, Jake. Jake is the product of an uncomplicated
pregnancy and labor. At birth, Jake had an open neural tube defect and now has spina
bifida with a loss of function of his lower extremities. Jack and Jill want another child
and ask if there is anything they can do to prevent the recurrence of a neural tube
defect in future pregnancies. What is your best response to this couple?
A. “Take 60 mg a day of an iron supplement to enhance stores to support fetal
development.”
B. “It is a matter of genetics, and there is nothing you can do.”
C. “Have a CVS performed at 12–14 weeks’ gestation to determine the health of
the fetus.”
D. “Take 4 mg/day of folic acid, beginning before conception.”
1-18 Answer D: Adequate levels of folic acid supplements before conception and
during the early stages of pregnancy have been shown to decrease the incidence of
neural tube defects. Iron stores and supplementation do not affect neural tube
development. A CVS procedure can identify chromosomal alterations but not structural
abnormalities.
1-19 Mildred is 6 months pregnant and presents with symptoms of urinary frequency,
urgency, dysuria, and suprapubic discomfort. Her urine is cloudy and malodorous. She
has no chills, fever, nausea, or vomiting. What is your diagnosis?
A. Urinary calculi
B. Acute cystitis
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C. Acute pyelonephritis
D. Interstitial cystitis
1-19 Answer B: Symptoms of urinary frequency, urgency, dysuria, and suprapubic
discomfort in the absence of chills, fever, nausea, and vomiting, along with cloudy,
malodorous urine, are clinically diagnostic of acute cystitis. Acute cystitis and acute
pyelonephritis are common renal disorders in pregnancy. Renal calculi may cause
intermittent flank pain or pain that radiates around to the abdomen. Maternal symptoms
of pyelonephritis include fever, shaking chills, malaise, flank pain, nausea and vomiting,
headache, increased urinary frequency, and dysuria. Interstitial cystitis is a chronic,
painful bladder disorder in which the course is unpredictable. The symptoms include
urinary frequency, urgency, nocturia, and suprapubic pain in the absence of urinary
pathogens. Although the etiology of interstitial cystitis is unknown, most attribute it to an
initial insult to the bladder wall by a toxin, allergen, or immunologic agent that causes an
inflammatory response.
1-20 Aida, who is 29 weeks pregnant, received a blunt trauma to the abdomen during
an argument with her boyfriend. She has no obvious injuries and denies pain. Aida
needs to be monitored for the occurrence of
A. abruptio placentae.
B. liver hemorrhage.
C. ruptured spleen.
D. placenta previa.
1-20 Answer A: Trauma to the pregnant abdomen can result in abruptio placentae
(premature separation of the placenta). Abruptio placentae is a life-threatening event.
The enlarged uterus and its contents actually provide some protection to the other
abdominal organs from trauma.
1-21 Lynne comes to the clinic for her initial prenatal visit. Based on her menstrual
history, the client is at 9 weeks’ gestation and is scheduled to have an ultrasound for
estimation of the gestational age of the fetus. Which fetal measurement is the best
indicator of gestational age at this time?
A. Biparietal diameter
B. Femur length
C. Abdominal circumference
D. Crown-rump measurement
1-21 Answer D: Before 12 weeks’ gestation, length as measured from crown to rump is
the most accurate measure of gestational age. Biparietal diameter and femur length are
used to monitor fetal growth in the second trimester of pregnancy. Abdominal
circumference is useful in identifying some congenital anomalies.
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1-22 Which of the following should be avoided by the pregnant woman who is
constipated?
A. Bulk-forming laxatives
B. Mineral oil
C. Stool softeners such as docusate sodium (Colace)
D. Drinking warm fluids on arising
1-22 Answer B: Mineral oil should be avoided by the pregnant woman who is
constipated because it decreases the absorption of fat-soluble vitamins. Cathartics are
also contraindicated because they may cause preterm labor. Bulk-forming laxatives and
stool softeners can be used along with dietary interventions, such as drinking warm
fluids on arising, eating foods high in bulk, and drinking 6–8 glasses of water per day to
stimulate bowel motility.
1-23 Minnie is experiencing Braxton Hicks contractions. What should she do?
A. Take a cold shower.
B. Immediately call her health-care provider.
C. Go for a walk.
D. Lie down with her feet elevated.
1-23 Answer C: Braxton Hicks contractions (painless uterine contractions felt as
tightening or pressure), which usually begin at about 28 weeks’ gestation, usually
disappear with walking or exercise. If they were true labor contractions, they would
become more intense.
1-24 What is the rationale for anemia seen throughout gestation?
A. Iron stores are depleted by the fetus.
B. It is difficult for the mother to consume as much iron as needed.
C. Mild dilutional anemia is seen as a result of an increased circulating
blood volume.
D. Hepatic function is affected by the growing fetus.
1-24 Answer C: Mild dilutional anemia is seen throughout gestation as the result of an
increased circulating blood volume. Plasma volume expansion, which begins at 6–8
weeks’ gestation, precedes and exceeds red cell volume. The circulating blood volume
of a pregnant woman increases by 45%. Iron stores are not depleted by the fetus and
hepatic function is not affected during gestation.
1-25 Marci has had several abortions in the past and has been unable to carry a
pregnancy to full term because of an incompetent cervix. She states that the physician
mentioned cerclage to her and asks you what that means. You tell her that cerclage is
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A. a treatment of bedrest with frequent pelvic exams to make sure the cervix is
not dilated.
B. a method in which an apparatus resembling a diaphragm is placed over the
cervix to help it stay “tight.”
C. a purse-string type of stitch placed around the cervix.
D. a treatment using intravaginal medicated sponges.
1-25 Answer C: Cerclage is a purse-string type of stitch placed around the cervix. A
variety of suture materials can be used to create the stitch around an incompetent
cervix. Cerclage is used in conjunction with restriction of activities and should be used
cautiously when there is advanced cervical dilation or membranes are prolapsed into
the vagina. Rupture of the membranes and infection are specific contraindications to
cerclage.
1-26 During Kim’s first prenatal visit, she denies having had rubella or the rubella
vaccine. Based on this information, which of the following is the most appropriate
action?
A. Administer the rubella vaccine.
B. Take a blood sample to assess the rubella titer.
C. Tell the client to avoid infection with rubella during her pregnancy because it
will result in a preterm birth.
D. Tell the client that, because rubella has little effect on the fetus, she should not
worry about exposure to the disease.
1-26 Answer B: You need to determine immune status. Rubella during pregnancy can
cause miscarriage or congenital anomalies. The woman should not be vaccinated
during pregnancy because the fetus can be affected by the live virus. Immunity is best
determined by assessing the rubella titer.
1-27 What is a fetus’s gestational age when its mother’s uterus is palpable just above
the pubic symphysis?
A. 4 weeks
B. 8 weeks
C. 12 weeks
D. 16 weeks
1-27 Answer C: The gestational age when the uterus is palpable just above the pubic
symphysis is 12 weeks. At 12 weeks, the uterus becomes an abdominal organ, and at
15 weeks, it is usually at the midpoint between the pubic symphysis and umbilicus. The
uterus is palpable at the umbilicus at 20 weeks, and after that, the fundal size correlates
roughly with the gestational age up until about 36 weeks. At 36 weeks, the fundal height
may decrease as the fetal head descends into the pelvis.
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1-28 Which of the following tests is the diagnostic criteria for gestational diabetes
according to the International Association of Diabetes and Pregnancy Study Group?
A. The presence of glycosuria on two urine samples within a 24-hour interval
B. A 50-g OGTT, with plasma glucose measurement fasting and at 1 and 2 h
C. A 75-g OGTT, with plasma glucose measurement fasting and at 1 and 2 h
D. A 100-g OGTT, with plasma glucose measurement fasting and at 1 and 2 h
1-28 Answer C: After deliberations in 2008–2009, the International Association of
Diabetes and Pregnancy Study Group developed revised diagnostic criteria
recommendations. The diagnostic standard for the diagnosis of gestational diabetes is
an abnormal 75-g OGTT with plasma glucose measurement fasting and at 1 and 2 h.
1-29 Danger signs in the first trimester of pregnancy include
A. vaginal bleeding and absence of fetal movement.
B. edema extending to the upper extremities and vomiting.
C. presence of proteinuria and elevated blood pressure.
D. vaginal bleeding and persistent vomiting.
1-29 Answer D: Vaginal bleeding may be a sign of impending pregnancy loss;
persistent vomiting may result in dehydration and ketosis, which, in turn, can affect
organogenesis during the first trimester. During the first trimester, fetal movement is not
perceptible. Quickening (the perception of fetal movement) occurs at 18–20 weeks’
gestation. Edema of the hands and face is a sign of a constricted intravascular space
and worsening pregnancy-induced hypertension (PIH), which occurs in the last trimester
of pregnancy. Other signs of PIH are proteinuria and elevated blood pressure. In the
first trimester, there is no change in the maternal blood pressure.
1-30 Heather, who is 5 weeks pregnant, is nauseous. She asks you how long this will
last. You tell her the nausea usually disappears by the
A. 12th week.
B. 16th week.
C. 20th week.
D. 24th week.
1-30 Answer C: Nausea and vomiting affect 50%–90% of all pregnant women. Nausea,
ranging from mild to severe, typically begins at about the 4th week of pregnancy, peaks
around weeks 8–12, and disappears by the 20th week of pregnancy. Severe nausea,
known as hyperemesis gravidarum, affects about 1%–2% of all pregnant women.
1-31 Ginny, who is planning on getting pregnant, is taking phenytoin (Dilantin). She
states that she knows the drug is in category D and asks what that means. You know
FDA category D indicates that
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A. positive evidence of human fetal risk exists, but benefits may outweigh
risks in certain situations.
B. animal studies have not demonstrated a fetal risk, but there are no human
studies in pregnant women; or animal studies have shown an adverse effect that
was not confirmed in human studies.
C. studies or experience have shown fetal risk that clearly outweighs any
possible benefits.
D. controlled studies in women failed to demonstrate a risk to the fetus in the first
trimester, and fetal harm appears remote.
1-31 Answer A: The Food and Drug Administration (FDA) has five categories into
which it ranks drugs for their potential to harm a fetus if taken during pregnancy.
Category D indicates that there is positive evidence that the drug has risk for the
human fetus, but the benefits of the drug for the pregnant woman may outweigh risks in
certain situations, such as when the pregnant woman is using phenytoin (Dilantin).
The other four FDA pregnancy categories are as follows: Category A indicates that
controlled studies in women failed to demonstrate that the drug poses a risk to the fetus
in the first trimester and fetal harm appears remote. Category B indicates that animal
studies have not demonstrated a fetal risk, but there are no human studies in pregnant
women; or animal studies have shown an adverse effect that was not confirmed in
human studies. Category C indicates that animal studies show that the drug causes
adverse effects on the fetus, and there are no controlled studies in women. Category E
indicates that studies or experience have shown that the drug causes fetal risk that
clearly outweighs any possible benefits.
1-32 Spontaneous abortion refers to the loss of a fetus of less than
A. 12 weeks’ gestation.
B. 18 weeks’ gestation.
C. 22 weeks’ gestation.
D. 26 weeks’ gestation.
1-32 Answer C: Spontaneous abortion refers to the loss of a fetus of younger than 22
weeks’ gestation and a weight less than 500 g. A delivered fetus of about 22–28 weeks’
gestation and weighing 500–1,000 g is called immature. A delivered fetus of about 28–
36 weeks’ gestation and weighing 500–2,000 g is called premature. A full-term fetus is
one that has attained 37 weeks’ gestation and weighs at least 3,500 g.
1-33 When evaluating Marge during her first obstetric visit, you assess the shape of her
pelvis. While drawing her a picture of her android-type pelvis, you explain that it has
A. a rounded, slightly ovoid, or elliptical inlet with a well-rounded forepelvis
(anterior segment).
B. a wedge-shaped inlet, a narrow fore-pelvis, a flat posterior segment, and
a narrow sacrosciatic notch with the sacrum inclining forward.
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C. a long, narrow, oval inlet; an extended and narrow anterior and posterior
segment; a wide sacrosciatic notch; and a long, narrow sacrum.
D. a distinct oval inlet with a very wide, rounded retropubic angle and a wider, flat
posterior segment.
1-33 Answer B: An android-type pelvis has a wedge-shaped inlet, a narrow fore-pelvis,
a flat posterior segment, and a narrow sacrosciatic notch with the sacrum inclining
forward. A woman’s pelvis may be one of four types or a combination of them. A
gynecoid-type pelvis has a rounded, slightly ovoid or elliptical inlet with a well-rounded
fore-pelvis (anterior segment). An anthropoid-type pelvis has a long, narrow, oval
inlet; an extended and narrow anterior and posterior segment; a wide sacrosciatic
notch; and a long, narrow sacrum, often with six sacral segments. A platypelloid-type
pelvis has a distinct oval inlet with a very wide, rounded, retropubic angle and a wider,
flat posterior segment.
1-34 Early in pregnancy, all pregnant women need which of the following tests?
A. 3-hour glucose challenge test
B. Rh status
C. Direct Coombs’ test
D. Pap smear
1-34 Answer B: Early in pregnancy, all pregnant women need their blood type and Rh
status determined and need an atypical antibody titer (indirect Coombs’ test) done.
Although there are more than 400 antigens of the Rh factor, 90% of cases of Rh
isoimmunization are caused by the D antigen. Women lacking antigenic determinant D
require two exposures to the Rh antigen to produce significant sensitization, unless the
first exposure was massive. A direct Coombs’ test is performed on a blood specimen
from the fetus/neonate, usually obtained from the umbilical cord. The 3-hour glucose
challenge is diagnostic of gestational diabetes and is done in the second half of
pregnancy. A Pap smear is performed only if the woman has not recently had one. As a
result of normal pregnancy-related changes to the pregnant cervix, the reliability of the
Pap smear is changed during pregnancy.
1-35 What is the recommended first-trimester weight gain for an underweight woman?
A. 2 lb
B. 3.5 lb
C. 5 lb
D. 7 lb
1-35 Answer C: An underweight woman (less than 90% of ideal body weight) should
gain 5 lb during the first trimester, for a total recommended weight gain of 28–40 lb.
A woman of normal weight should gain 3.5 lb during the first trimester, for a total
recommended weight gain of 25–35 lb. An overweight woman (greater than 120% of
desirable pregravid weight for height) should gain 2 lb during the first trimester, with a
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total recommended weight gain of 15–25 lb. A severely overweight (greater than
135% of desirable pregravid weight) woman should gain 2 lb during the first trimester,
for a total recommended weight gain of at least 15 lb during the pregnancy. These
recommendations are from the U.S. Institute of Medicine, Subcommittee on Nutritional
Status and Weight Gain During Pregnancy.
1-36 Marta asks you how pregnancy will affect her rheumatoid arthritis. You respond,
A. “There is a one-third rule: One-third get better, one-third remain the same, and
one-third get worse.”
B. “Pregnancy will have no effect on your rheumatoid arthritis.”
C. “Seventy-five percent of women experience remission of the disease
during pregnancy.”
D. “It is advised that you don’t get pregnant with this condition.”
1-36 Answer C: For women with rheumatoid arthritis, 75% will experience remission of
their disease during pregnancy. Activities of daily living are easier to perform because of
decreased joint stiffness and swelling and an increase in grip strength. However,
women with rheumatoid arthritis usually do experience major fatigue, and during labor
and delivery, joint contracture may limit their positioning. Pain needs to be carefully
assessed, and 95% of these women will experience a flare-up of their condition during
labor and delivery.
1-37 An asymmetric, softened enlargement of the uterine corner caused by placental
development is a probable sign of pregnancy. What is it called?
A. Hegar’s sign
B. Chadwick’s sign
C. Goodrich’s sign
D. Piskaçek’s sign
1-37 Answer D: A probable sign of pregnancy—Piskaçek’s sign—is an asymmetric,
softened enlargement of the uterine corner caused by placental development. Hegar’s
sign is softening of the uterine isthmus. Chadwick’s sign is a bluish or cyanotic color
to the cervix and upper vagina. There is no Goodrich’s sign.
1-38 Kim states that she has heard many old wives’ tales of harmful things during
pregnancy. Which of the following is harmful late in pregnancy?
A. Intercourse
B. Swimming
C. Douching
D. Dental visits
1-38 Answer C: Douching, which is seldom necessary, may be harmful during
pregnancy. Intercourse late in the pregnancy may initiate labor, possibly because an
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orgasm might cause a uterine contraction reflex. Intercourse is usually cautioned
against only in women who have had a previous premature delivery or are currently
experiencing uterine bleeding. Water does not enter the vagina; therefore, swimming is
not contraindicated. However, diving should be avoided because of the possibility of
trauma. Good dental care is important during pregnancy; however, the dentist should be
told that the woman is pregnant.
1-39 According to the International Association of Diabetes and Pregnancy Study
Group, screening for gestational diabetes mellitus (GDM) should be done on which of
the following clients?
A. All pregnant women at 24–28 weeks
B. Women age 40 or older
C. All women with threatened miscarriage
D. Women who report hypoglycemic symptoms
1-39 Answer A: After deliberations in 2008–2009, the International Association of
Diabetes and Pregnancy Study Group recommend screening for GDM for all women not
known to have diabetes at 24–28 weeks. Age 40 or older is considered a risk factor.
Other risk factors include obesity, history of miscarriage or fetal death, history of
premature infant, family history of diabetes, polyhydramnios, history of infant with
macrosomia (greater than 4,000 g) or congenital malformation, pre-eclampsia,
excessive weight gain, and glycosuria. A threatened miscarriage without a history of a
previous miscarriage is not a risk factor. The term hypoglycemic could be interpreted in
a variety of ways. This complaint would have to be evaluated before a decision about
screening is made.
1-40 Lois is complaining of leg cramps during her pregnancy. What would you suggest
to relieve them?
A. Take a calcium supplement daily.
B. Do several quick stretches to relieve the cramping.
C. Massage the cramping muscle.
D. Point your toes when exercising.
1-40 Answer A: For a pregnant woman complaining of leg cramps, use of a daily
calcium supplement may help. Leg cramps are a normal discomfort experienced during
pregnancy. They are caused by a lack of calcium, pressure of the enlarged uterus on
the blood vessels, fatigue or chilling, sudden stretching or overextension of the foot,
and/or excessive phosphorus in the diet. Some nursing suggestions that might relieve
the leg cramps are using calcium supplements, practicing gentle steady stretching to
relieve the cramp, avoiding massage of the cramping muscle, and avoiding toe pointing
when exercising.
1-41 The drug of choice for the pregnant woman with diabetes is
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A. insulin.
B. glyburide (DiaBeta, Glynase, Micronase).
C. glipizide (Glucotrol).
D. metformin (Glucophage).
1-41 Answer A: If medication is needed, the drug of choice for pregnant women with
diabetes is insulin. Oral hypoglycemics such as glyburide, glipizide, and metformin
should be avoided because they are all teratogenic. Diet remains the cornerstone of
treatment for pregnant women with diabetes.
1-42 NSAID use during pregnancy has been linked to which condition in newborns?
A. Cardiac anomalies
B. Musculoskeletal weakness
C. Pulmonary hypertension
D. Central nervous system disorders
1-42 Answer C: NSAID use during pregnancy has been linked to pulmonary
hypertension in newborns. Women commonly use these drugs during pregnancy. Other
research studies have indicated a connection between NSAID use and an increased
risk of miscarriage.
1-43 Sarah, who just found out she is pregnant, is taking prenatal vitamins with extra
daily supplements of iron. She may be a candidate for
A. a high-birth-weight baby.
B. vaginal spotting during the second trimester.
C. premature delivery.
D. excessive skin bruising.
1-43 Answer C: Excessive iron intake during pregnancy may result in premature
delivery and low-birth-weight babies. Healthy, non-anemic women who are planning to
become pregnant should take 60 mg of iron once weekly and then double that dose to
120 mg weekly during pregnancy.
1-44 When is a pregnant woman at risk for developing congenital rubella syndrome?
A. During the first 4 weeks of pregnancy
B. During the first 16 weeks of pregnancy
C. During the last trimester
D. Any time during the pregnancy
1-44 Answer B: A pregnant woman is at risk for developing congenital rubella
syndrome during the first 16 weeks of pregnancy. The risk of congenital rubella
syndrome is related to the gestational age of the fetus at the time the pregnant woman
is exposed to the infection. If the infection occurs 0–12 weeks after conception, there is
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a 51% chance the infant will be affected. If the infection occurs 13–26 weeks after
conception, there is a 23% chance the infant will be affected. Infants are not generally
affected if rubella is contracted during the third trimester, or 26–40 weeks after
conception. Prenatal testing should be performed to determine if a woman is
seronegative, in which case she should avoid anyone with a rash or viral illness.
1-45 Rh o (D) immune globulin (RhoGAM) should be administered
A. when an infant is in distress at birth.
B. after a mother gives birth to a macrosomic infant.
C. when a D-negative mother has received a transfusion of D-positive
blood.
D. when an infant with type A blood is born to a mother with type O blood.
1-45 Answer C: RhoGAM (Rh o [D] immune globulin) should be administered when a
D-negative mother has been given a transfusion of D-positive blood and whenever a
potential for mixing Rh-positive fetal and Rh-negative maternal blood exists, such as
with an abortion, ectopic pregnancy, amniocentesis, antepartum hemorrhage, fetal
blood sampling, fetal death, or fetal surgery. If there is any doubt about whether or
not to administer RhoGAM, it should be given.
1-46 What components make up the biophysical profile (BPP)?
A. Non-stress test, amniotic fluid composition, fetal breathing, and fetal tone
B. Fetal tone, breathing, motion, and contraction stress test
C. Amniotic fluid composition, contraction challenge test, fetal breathing, and
motion
D. Fetal tone, breathing, motion, amniotic fluid volume, and non-stress test
1-46 Answer D: The biophysical profile (BPP) consists of the four parameters of fetal
well-being—fetal tone, breathing, motion, and amniotic fluid volume—along with a nonstress test (NST). In high-risk pregnancies, the BPP is necessary for a comprehensive
fetal assessment.
1-47 Hegar’s sign, a physiological sign of pregnancy, is
A. cervical blueness.
B. softness of the uterus and ballottement at the isthmus.
C. cervical softness.
D. quickening.
1-47 Answer B: Hegar’s sign is softness of the uterus and ballottement at the isthmus.
Other physiological signs of pregnancy are Chadwick’s sign (cervical blueness),
Goodell’s sign (cervical softness), and quickening (feeling fetal movement, usually at
18–22 weeks gestation).
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1-48 Susie, who is 16 weeks pregnant, is having mild cramps with persistent and
excessive bleeding. On examination, you find that some portion of the products of
conception (placental) remain in the uterus, but the fetus has been expelled. What type
of abortion is Susie having?
A. Incomplete
B. Threatened
C. Inevitable
D. Missed
1-48 Answer A: An incomplete abortion occurs when some portion of the products of
conception (usually placental) remains in the uterus. Usually, only mild cramps are
reported, but bleeding is persistent and often excessive. A threatened abortion occurs
when there is bleeding or cramping but the pregnancy continues. The cervix is not
dilated. An inevitable abortion occurs when the cervix is dilated. The membranes may
be ruptured, but passage of the products of conception has not occurred. Bleeding and
cramping persist and passage of the products of conception is considered inevitable. A
missed abortion occurs when the pregnancy has ceased to develop, but the conceptus
has not been expelled. There is no bleeding, but a brownish vaginal discharge is
present. Usually no pain is involved. Symptoms of pregnancy disappear and the uterus
becomes smaller and irregularly softened, with the adnexa being normal.
1-49 Liza is 34 weeks pregnant and has mild hypertension. You are performing a nonstress test (NST). What is the criterion for a reactive NST?
A. A minimum of two fetal activity patterns in a 20-minute test period
B. The presence of two contractions with no fetal heart decelerations in a 20minute test period
C. At least two fetal heart rate accelerations in response to fetal movement
in a 20-minute test period
D. The absence of uterine contractions following fetal stimulation during a 20minute test period
1-49 Answer C: A non-stress test (NST) examines fetal heart reactivity in response to
fetal movement. The criterion for a reactive test is the presence of at least two fetal
heart-rate accelerations of at least 15 beats in amplitude and lasting at least 15 seconds
in response to fetal movement during a 20-minute testing window. The relationship
between uterine contraction and fetal heart response is the basis of a contraction stress
test.
1-50 What is the best description of Bishop’s score?
A. It is a series of four maneuvers to determine fetal position.
B. It is a multi-parameter evaluation of fetal condition following a nonreactive
non-stress test.
C. It is an assessment of the cervix’s readiness for elective induction.
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D. It is an evaluation of fetal lung maturity and readiness for birth.
1-50 Answer C: Bishop’s score is an assessment of the cervix’s readiness for elective
induction. Leopold’s maneuvers are used to determine fetal position. The multiparameter evaluation following a nonreactive non-stress test is a biophysical profile. A
lethicin/sphignomyelin (L/S) ratio is used to evaluate fetal lung maturity.
1-51 To obtain the daily calcium intake recommended during pregnancy, what should a
woman consume per day?
A. One quart of cow’s milk
B. Two cups of yogurt
C. Four slices of cheddar cheese
D. One cup of cottage cheese
1-51 Answer A: To obtain the daily calcium intake recommended during pregnancy, a
woman should consume at least 1 quart of cow’s milk per day. Calcium must be
supplemented during pregnancy to meet fetal needs and preserve maternal calcium
stores. Milk is relatively inexpensive, and 1 quart of cow’s milk contains 1 g of
calcium, which is almost the 1.2 g recommended daily during pregnancy. The milk can
be in forms other than liquid, such as in custards. However, caution your client that
large quantities of milk, meat, cheese, and dicalcium phosphate (a supplement) may
cause excessive phosphorus levels, which may result in leg cramps. If a woman is
lactose intolerant, as in the case of many Native Americans, foreign-born African
Americans, and certain Asians, protein, calcium, and vitamins must be supplied in other
forms.
1-52 Susan is keeping a basal body temperature (BBT) graph as part of her infertility
treatment. Today she shares the BBT graph with you. The BBT graph shows a nearly
straight line. Which of the following is the best interpretation of Susan’s BBT graph?
A. The client is not ovulating.
B. The client is not having intercourse.
C. The client is ovulating late in her menstrual cycle.
D. The client is not taking her temperature correctly.
1-52 Answer A: A flat BBT graph indicates lack of ovulation. If ovulation were
occurring, the BBT would rise 0.5°F–1.0°F 24–48 hours after ovulation.
1-53 A low-risk woman who is 16 weeks pregnant should be instructed to return to the
prenatal clinic in
A. 1 week.
B. 2 weeks.
C. 3 weeks.
D. 4 weeks.
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1-53 Answer D: The low-risk client is seen every 4 weeks until the 28th week of
pregnancy. Between 28 and 34 weeks, the woman is seen every 2 weeks. After 34
weeks, she is seen weekly until delivery.
1-54 Pregnancy following the rapid weight loss and weight stabilization phase of
bariatric surgery appears to be safe. Which nutritional deficiency is the most common
problem related to pregnancy following bariatric surgery?
A. Vitamin A
B. Anemia
C. Vitamin K
D. Vitamin C
1-54 Answer B: Anemia is the most common problem. Vitamin K, C, and A deficiencies
are uncommon. All nutrient deficiencies should be identified before pregnancy if
possible and corrected.
1-55 What is the presumptive symptom of pregnancy that involves tingling or frank pain
of the breasts?
A. Montgomery’s tubercles
B. Colostrum secretion
C. Melasma
D. Mastodynia
1-55 Answer D: The presumptive symptom of pregnancy that involves tingling or frank
pain of the breasts is called mastodynia. Mastodynia (breast tenderness) may range
from tingling to frank pain and is caused by hormonal responses of the mammary ducts
and alveolar system. Similar symptoms may also occur just before menses. Other
presumptive symptoms, or early manifestations of pregnancy, are as follows.
Montgomery’s tubercles (enlargement of the circumlacteal sebaceous glands of the
areola) occur at 6–8 weeks’ gestation and are caused by hormonal stimulation.
Colostrum secretion is a symptom that may begin after 16 weeks’ gestation. Melasma
(the mask of pregnancy) is darkening of the skin over the forehead, bridge of the nose,
or cheekbones and is most marked in women with dark complexions. It usually occurs
after 16 weeks’ gestation and is more prevalent in women who spend a lot of time in the
sun.
1-56 During the 6-week visit after a stillbirth, Mary states, “Sometimes I feel like I left my
baby somewhere, and I can’t remember where she is. Then I remember that she isn’t
alive.” What is this is an example of?
A. Anticipatory grieving
B. Disorientation
C. Reorganization
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D. Searching and yearning
1-56 Answer D: This is characteristic of the searching and yearning phase. The parent
yearns for the deceased infant, is preoccupied with thoughts of the lost child, and may
have physical manifestations such as aching arms, hearing the infant’s cry, or looking
for the infant.
1-57 Samantha, who has genital herpes, just found out that she is pregnant. Although
she has not had a recurrence in years, she states that she has heard that genital herpes
might cause a spontaneous abortion. You know that genital herpes
A. might cause a spontaneous abortion at any time if the client has an active
occurrence.
B. might cause a spontaneous abortion if the primary infection was early in
the pregnancy.
C. might cause a spontaneous abortion if the recurrence is during the second
trimester.
D. will not cause a spontaneous abortion.
1-57 Answer B: If a primary infection of genital herpes simplex occurs early in a
pregnancy, a spontaneous abortion may result. Primary infection or a recurrence later in
a pregnancy is not associated with an increase in pregnancy loss or fetal malformation.
Before the initiation of labor, a woman who has a history of genital herpes simplex
should have a thorough inspection of the vulva and lower genital tract. If active lesions
are found, a cesarean section should be performed.
1-58 You see G5P4015 written on a client’s history form. You surmise that
A. the woman has been pregnant five times and has five living children.
B. the woman has five living children, including a set of twins, and she has
had one abortion.
Gravidity | Parity | Full-term births | Preemies | Abortions | Living children
C. the woman has four living children and had one abortion, for a total of five
pregnancies.
D. the woman is pregnant now and has five living children, including a set of
twins.
1-58 Answer B: G5P4015 written on the client’s chart indicates that the woman has
been pregnant five times (G for gravidity or total number of pregnancies), had four
delivery experiences (P for parity or birth [alive or dead] of an infant or infants weighing
more than 500 g; multiple gestation is counted as a single occurrence), and had one
abortion. Because she has five living children, she must have had a set of twins
because one of the pregnancies ended in an abortion. An abortion is a pregnancy that
terminates before the 22nd gestational week or in which the fetus weighed less than
500 g. Another way to remember this is to think of FPAL (Florida Power and Light) as
the four numbers following P. The first number (F) stands for full-term births (with
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multiple gestation counted as a single occurrence), P for premature births (preemies),
A for abortions, and L for the number of living children.
1-59 Allie, who has asthma, just found out she is pregnant. She is wondering whether
she should continue taking her medications. Which of the following is true regarding
asthma and pregnancy?
A. Only inhaled (rather than oral) medications should be used.
B. In the event of an acute exacerbation, glucocorticoids should not be used.
C. Management differs little from management in non-pregnant women.
D. All medications may be used except for theophylline.
1-59 Answer C: The management of asthma in pregnant women differs little from
management in non-pregnant women. Beta-2 agonists, theophylline, epinephrine,
cromolyn, and glucocorticoids are all safe to use. Whenever possible, inhalation rather
than oral medications should be used. During exacerbations, IV and oral glucocorticoids
may be used in the usual manner. Typically, asthma during pregnancy follows the
one-third rule: One-third of the women have improved symptoms; one-third have no
change; and one-third have worse symptoms.
1-60 A newborn delivered by a mother with no prenatal care exhibits the following:
dysmorphic (difference of body structure) facial features including short palpebral
fissures (opening between the eye lids), a thin upper lip, an elongated and flattened
philtrum (the vertical groove on the surface of the upper lip, below the septum of the
nose), and a flattened midface region. You suspect that the mother engaged in what
behavior during pregnancy?
A. Excessive alcohol intake
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B. Cocaine abuse
C. Chain smoking
D. Excessive high-impact aerobics
1-60 Answer A: An infant with dysmorphic facial features, including short palpebral
fissures, a thin upper lip, an elongated and flattened philtrum, and a flattened midface
region, has fetal alcohol syndrome (FAS). A diagnosis of FAS typically is warranted
when a baby or child exhibits growth deficiency, the dysmorphic facial features, central
nervous system effects, and a history of prenatal alcohol exposure. Maternal cocaine
abuse may result in premature labor and delivery, lower birth weight, smaller head
circumference, and decreased length at birth. Maternal smoking will result in a lower
birth weight. High-intensity exercise programs result in decreased birth weight,
whereas low- to moderate-intensity exercise programs may increase the birth weight.
1-61 Which of the following antibiotics is the best choice for acute pyelonephritis when it
occurs during the seventh month of pregnancy?
A. Nitrofurantoin (Furadantin)
B. Trimethoprim and sulfamethoxazole (Bactrim, Septra)
C. Ampicillin (Principen, Polycillin)
D. Tetracycline (Panmycin, Achromycin V)
1-61 Answer C: The antibiotic of choice for acute pyelonephritis occurring during the
seventh month of pregnancy is ampicillin (Principen, Polycillin) because the most
common offending pathogen is Escherichia coli. Ampicillin is safe for the mother and
fetus and has minimal side effects. Earlier in the pregnancy, sulfonamides,
nitrofurantoin, and cephalosporins may be prescribed along with ampicillin.
Nitrofurantoin should be avoided in the last trimester because it may induce
hemolytic anemia in the newborn. Sulfa drugs must be avoided in mothers with
glucose-6-phosphatase deficiency and are best avoided late in pregnancy
because of the increased likelihood of neonatal hyperbilirubinemia. Trimethoprim
is a folic acid antagonist; therefore, trimethoprim-sulfamethoxazole should be
avoided in pregnancy.
1-62 According to Naegele’s rule, if a woman’s last normal menstrual period (LNMP)
was September 23, what is her estimated date of delivery?
A. June 30
B. June 16
C. June 1
D. May 30
1-62 Answer A: According to Nagele’s rule, the estimated date of delivery (EDD) can
be figured by adding 7 days to the first day of the last normal menstrual period
(LNMP) and then subtracting 3 months. If a woman’s LNMP was September 23, her
EDD would be June 30 (23 + 7 = 30; 9 – 3 = 6; = 6/30).
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1-63 Nettie, who is pregnant, is suffering from an exacerbation of peptic ulcer disorder.
Which is the best medication to order for her?
A. Cimetidine (Tagamet)
B. Ranitidine (Zantac)
C. Sucralfate (Carafate)
D. Bellergal-S
1-63 Answer A: H 2 -receptor antagonists such as cimetidine can be prescribed for
pregnant clients who have peptic ulcer disease. Ranitidine should not be used during
the first trimester of pregnancy because of possible teratogenicity. Sucralfate
should be avoided because it has not been adequately studied during pregnancy.
Bellergal-S, an anticholinergic agent, contains phenobarbital and is
contraindicated. Symptoms of peptic ulcer disease should be treated initially by
avoidance of irritating foods and by antacids. Supportive advice may be given regarding
cessation of smoking; eating small, bland meals; avoidance of stress; and so forth.
1-64 After 28 weeks’ gestation, all women should perform fetal movement counts
(FMCs). Which of the following statements is true regarding FMCs?
A. Counts should be done as the woman is going about her work.
B. Ten movements should be obtained in 1 hour.
C. Ten movements should be obtained in 2 hours.
D. If decreased activity is perceived, a non-stress test (NST) should be
performed at the next obstetric visit.
1-64 Answer C: After 28 weeks’ gestation, when the woman is performing fetal
movement counts (FMCs), 10 movements should be obtained in 2 hours. Usually, 10
movements are felt within 30 minutes, but 10 movements in 2 hours are considered
acceptable. FMCs should be performed at the same time every day, preferably after a
meal or when the fetus is most active. The woman should be lying in the left lateral
position when doing the FMCs. If the woman senses decreased activity, a non-stress
test (NST) or, at the very least, fetal surveillance should be initiated within 12 hours.
1-65 Cydney, who is 30 weeks pregnant, is planning to travel outside of the United
States. She asks you which immunizations she should or should not have. Which
immunization do you recommend she NOT receive?
A. Pooled gamma globulin
B. Chloroquine for malaria prophylaxis
C. Yellow fever
D. Inactivated polio vaccine (IPV)
1-65 Answer C: Live-virus immunization products, such as yellow fever, measles, and
rubella vaccines, are contraindicated in pregnant women. Pooled gamma globulin to
prevent hepatitis A and chloroquine for malaria prophylaxis have been proved
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safe to administer to a pregnant woman. Inactivated polio vaccine (Salk) can be
administered instead of the oral vaccine. If a woman has a normal, low risk pregnancy,
travel can be accomplished safely between the 18th and 32nd weeks. Commercial
airlines have pressurized cabins that do not pose a threat to the fetus. It is not advisable
to travel to endemic areas of yellow fever in Africa or Latin America or to areas of Africa
or Asia where chloroquine-resistant falciparum malaria is a hazard because
complications of malaria are more common in pregnancy.
1-66 Carrie is due to deliver her second baby. During your work-up, you note that she
hemorrhaged after delivering her first baby 2 years ago, has always had menorrhagia,
and bruises easily. Her lab work reveals a normal blood work-up, including a normal
prothrombin time and activated partial thromboplastin time. What do you suspect?
A. Von Willebrand’s disease
B. Hemophilia
C. Sickle cell anemia
D. Unfortunate coincidences
1-66 Answer A: Von Willebrand’s disease is the most common hereditary bleeding
disorder, occurring in about 1% of the population. It is inherited as an autosomal
dominant trait, so it is equally prevalent in men and women. Hemophilia is usually
diagnosed during the first few years of life, and sickle cell anemia, if not diagnosed
then, is usually diagnosed in childhood. Von Willebrand’s disease is usually not
diagnosed until after a severe hemorrhagic episode following surgery, trauma, dental
procedures, or childbirth. Clients with von Willebrand’s disease should be referred to a
hematologist for coagulation studies. The treatment goal is to prevent bleeding or
achieve hemostasis. Treatment depends on the severity of the disease and may range
from intranasal desmopressin acetate spray (DDAVP nasal spray) to replacement of
factor VIII or blood transfusions.
1-67 Sheila is pregnant and fearful of getting cervical cancer as her sister recently did.
She asks about receiving the HPV vaccine. How do you respond?
A. “Yes, as long as you’re in your first trimester, the HPV vaccine is safe and
effective.”
B. “Research has not shown this vaccine to be effective against preventing
cervical cancer.”
C. “After the age of 20, the HPV vaccine is not recommended.”
D. “You should not receive the vaccination when you’re pregnant.”
1-67 Answer D: HPV vaccination is not recommended for use in pregnant women. The
vaccine is indicated for all teenagers (males and females) at age 11–12. Women who
are lactating or immunocompromised may receive the vaccination.
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1-68 Shana shares concerns about her unborn child. She states, “My sister’s child is
diagnosed with autism.” The clinician knows the following to be true about autism
spectrum disorder (ASD):
A. There is no genetic predisposition to autism.
B. Females are four times more likely to have an ASD than males.
C. About 20%–30% of children with an ASD develop epilepsy by the time
they reach adulthood.
D. Mental retardation occurs in all cases.
1-68 Answer C: About 20%–30% of children with an autism spectrum disorder (ASD)
develop epilepsy by the time they reach adulthood. Males are four times more likely
to have ASD than females. Twin and family studies strongly suggest that some people
have a genetic predisposition to ASD. About 40% of people with ASD have average
to above average intellectual abilities.
1-69 When can you hear fetal heart tones with a conventional fetoscope?
A. At 7–8 weeks’ gestation
B. At 10–12 weeks’ gestation
C. At 18–20 weeks’ gestation
D. At more than 20 weeks’ gestation
1-69 Answer C: Fetal heart tones can be heard with a conventional fetoscope at 18–20
weeks’ gestation. At 7–8 weeks’ gestation, a transabdominal ultrasound will show fetal
heart movement. At 10–12 weeks’ gestation, fetal heart tones can be heard with a
Doppler stethoscope. At 20 or more weeks’ gestation, fetal movements can be felt by
the examiner.
1-70 Patricia presents for her regularly scheduled prenatal visit at 34 weeks’ gestation.
During the interview, you determine that Patricia has not felt fetal movement for the past
week. On examination, you are unable to auscultate the fetal heart tones. Which of the
following would be useful in the diagnosis of an intrauterine fetal death?
A. Chadwick’s sign
B. Piskaçek’s sign
C. Spalding’s sign
D. Homan’s sign
1-70 Answer C: Spalding’s sign is overriding (overlapping) of the fetal cranial bones, as
seen on ultrasound. It is a result of the decreased tissue turgor that occurs after fetal
death. Chadwick’s sign is a deep blue-violet color of the cervix and vagina due to
increased vascularity and is a presumptive sign of pregnancy around the fourth week of
gestation. Piskacek’s sign is a palpable lateral (asymmetrical) bulge or soft
prominence where the uterine tube meets the uterus around the seventh to eighth week
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of gestation. A Homan’s sign of eliciting pain when dorsiflexing the foot is indicative of
a deep vein thrombosis (DVT).
1-71 A woman with hyperemesis gravidarum would most likely benefit from a plan of
care designed to address which of the following nursing diagnoses?
A. Imbalanced nutrition, more than body requirements, related to pregnancy
B. Anxiety, related to effects of hyperemesis on fetal well-being
C. Anticipatory grieving, related to inevitable pregnancy loss
D. Ineffective coping, related to unwanted pregnancy
1-71 Answer B: The woman with hyperemesis gravidarum is anxious about the effect
of her condition on the fetus. The etiology of hyperemesis is unknown, but the incidence
is associated with conditions of elevated hCG levels, such as pregnancy. Although there
may be an emotional component, there is no indication that the pregnancy is unwanted.
With appropriate treatment and support, the fetal prognosis is favorable. Because of the
excessive vomiting, a nursing diagnosis focused on nutrition would be Imbalanced
Nutrition, Less Than Body Requirements.
Neurology
1-72 Which of the following antiepileptic drugs are associated with spina bifida?
A. Dilantin
B. Lamictal
C. Depakote
D. Keppra
1-72 Answer C: Mothers who have taken Depakote during pregnancy have given birth
to babies with spina bifida. Safer medications during pregnancy include Keppra and
Lamictal, but they are still considered pregnancy-risk category C. The benefit from their
use may be acceptable despite the risks.
1-73 Women with a history of seizures who want to become pregnant should
A.
B.
C.
D.
Stop their seizure medication
Switch to Dilantin
Switch to Lamictal
Decrease their seizure medication by two-thirds
1-73 Answer C: Mothers who have taken Depakote during pregnancy have given birth
to babies with spina bifida. Safer medications during pregnancy include Keppra and
Lamictal, but they are still considered pregnancy-risk category C. The benefit from their
use may be acceptable despite the risks.
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Pregnancy
First Trimester –- Conception – 14 Weeks
APEA-1 Why is it so important to establish a due date?
A.
B.
C.
D.
To insure adequate prenatal care
To measure fetal weight
To measure fetal length
To establish timing of prenatal interventions and monitoring prenatal
growth
APEA-2 Ideally, prenatal care should be started by what time frame?
A.
B.
C.
D.
6 Weeks
8 Weeks
10 Weeks
12 Weeks
APEA-3 Ideally, when should a prenatal vitamin be started?
A.
B.
C.
D.
As soon as possible after conception
Within the first trimester
It is not necessary if she eats a healthy diet
Before conception
Folic Acid should be started approximately 3 months prior to conception.
APEA-4 Which statement is true about detecting pregnancy?
A. Urine and serum tests are based on presence of human chorionic
gonadotropin (hcG)
B. Urine and serum tests are of equal conception
C. History and physical exam are highly sensitive methods of diagnoses
D. False positive pregnancy tests outnumber false negative tests
Estimated Date of Delivery (EDD)
o EDD should be calculated based on LMP
o Important for timing screening tests, interventions and monitoring fetal
growth
o Consider Ultra Sound (US), especially if LMP is questionable, irregular
menses, and patients who conceive while on oral contraceptives.
Patient History
o Have you ever been pregnant before?
o Psychosocial information (Domestic Violence)
 Screen all pregnant women – 7%-20% of pregnant women are
abused (usually young and unmarried women)
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Pregnancy
o
o
o
o
o
o
Chapter 1
December 25, 2014
 Know you community resources
Persona and family history
Past surgical history
Genetic History
Menstrual and gynecological history
Current pregnancy history
Must establish a BMI (height and weight) for proper weight gain; Normal
gain is 19-25 lbs. < than normal reqires > weight gain; more > weight than
normal requires < weight gain.
Labs
o
o
o
o
o
o
o
Establish if pregnant (hCG doubles every 48-60 hours)
Screen for anemia. Look for delutional anemia (more fluid)
Blood type and Rh, antibody screening – Rh negative requires RhoGam
Urinalysis – screen for bacteria, protein, and glucose
Rubella Immunity (+ titer does not require repeating)
Varicella Immunity
TSH in pregnant patients being treated for hypothyroidism (their needs
increase in pregnancy); untreated results in delayed neurologic
development in fetus’
o Sickle Cell Anemia (SCA) with electrophoresis (if at risk)
APEA-5 Pregnant women should be routinely screened for Hepatitis B infection. How
should this be done?
A.
B.
C.
D.
Urine screening
Serum Hepatitis B surface antigen
Serum Hepatitis B surface antibody
Serum Hepatitis B sAg/sAB
APEA-6 When do symptoms of an ectopic pregnancy typically occur?
A.
B.
C.
D.
2-4 weeks after conception
4-6 weeks after conception
6-8 weeks after LMP
8 or more weeks after LMP
Ectopic pregnancy usually happens in the felopian tubes. Symptoms are abdominal
pain, vaginal bleeding and amenorrhea. Low grade fever may be present. Risk factors
for ectopic pregnancy include: previous ectopic pregnancy; tubal pathology, tubal
surgery (sticky tubes); current IUD use; previous cervicitis (GC); history of PID; etc.
Pregnant women should not scuba dive, sky dive, or bunji jump.
Complete avoidance of alcohol to prevent fetal ETOH syndrome (FAS)
o Higher incidence of miscarriages in women who comsume alcohol during
pregnancy
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o All pregnant women should be screened for alcohol misuse; counseling is
an effective intervention in decreasing EtOH consumption in pregnant
women and morbidity in their infants
Cramping during pregnancy
o Report if pain increase (> than it was 2 hours ago) with time, cramping
associated with bleeding may indicate ectopic pregnancy or threatened
abortion
o Uterine cramping d/t hormonal changes or growing uterus
o Most ectopics end with miscarriage
APEA-7 In addition to uterine cramping, 3 of the following are very important to report to
the healthcare provider. Which one is LEAST important?
A.
B.
C.
D.
24 hours of nausea
Leakage of fluid from the vagina
Decreased fetal activity
Vaginal bleeding
Schedule visits of uncomplicated pregnancy
o Every 4 weeks until 28 weeks gestation, then
o Every 2 weeks until 36 weeks gestation, then
o Every week after 36 weeks of gestation until delivery
Second Trimester –- 14 to 28 Weeks
APEA-8 Anti(D)-immune globulin (RhoGAM) is routinely given during pregnancy to Rh
negative women. When should this occur?
A.
B.
C.
D.
At diagnosis of pregnancy and after delivery
During the first trimester only
During the second trimester and after delivery
During each trimester
Assessment
o BP, weight, fundal height, fetal heart auscultation
o CBC for anemia
o Urinalysis as indicated (glucosuria, proteinuria, ketonuria)
o Dysuria (asymptomatic bacteriuria – pyelonephritis)
Gestational Diabetes Screening
o All pregnant women
o When: 24-28 weeks
o How: Consume 50g-75g OGGT load. BG>130 comes back another day
 3 hour OGGT
o Up to 18% of pregnant women will gestational diabetes (1:5 have GDM)
 Diabetes diagnosed at initial visit is “Overt Diabetes” - DM
diagnosed before pregnancy then becomes pregnant. If she
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become pregnant, then develops DM then it is termed “Gestational
DM”.
McDonald’s Rule: Fundal Height
o Between 18-34 weeks there is a correlation between fundal height and
gestational age of the fetus.
Maternal Quad Screen: AFP, estriol (uE3), hCG, inhibin A
o Screening timeframe: 15-22 weeks
o AFP: Alpha fetoprotein
o Estriol (uE3): unconjugated estriol
o Beta-hCG: human chorionic gonadotropin
o Inhibin A (inhA)
o Follow up abnormal with US and / or amniocentesis
Chromosomal Abnormalities
o Down syndorm (trisomy 21): most common chromosomal abnormality in
live births (Autosomes)
o Turner syndrome: most common sex-chromosome abnormality in females
(loss of part or all of an x-chromosome): short in stature, square chests
 Do not reproduce (no menses)
 Female infants – all or part of X chromosome is lost. The part that
is lost can’t contribute genetic data to the female infant.
Fetal movement “Quickening”
o Primipara: 17-20 weeks
o Subsesequent pregnancies: 15-16 weeks
Third Trimester –- 28 to 40 Weeks
Assessment
o Urinalysis (looking for proteinuria, ketonuria)
o Screen for STDs-vaginal discharge???
Fetal Activity (Kick counts)
o 3-5 times within one hour (most move more)
Diagnostic studies
o Group B Strept (Strept agalactiae) screen
 Treatment PCN; Ampicillin
 Vaginal and rectal swabs performed
 Common causes of neonatal sepsis – morbidity and
mortality in fetus’
Common Discomforts Associated With Pregnancy
Avoidance of medications which may have negative effects on pregnancy
Pregnancy Categories
FDA system to rank drugs
o Category A: Safe use during pregnancy
 Folic acid, B6, levothyroxine
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o Category B: Appear to be safe during pregnancy and have been used a lot
during pregnancy without problems
 PCN, cephalosporins, acetaminophen, prednisone, insulin
o Category C: OK to use if benefits outweigh risks; or safety studies
incomplete
 Pseudoephedrine, fexofenadine, quinolones, triptans
o Category D: Clear risks for the fetus
 Chemo drugs, phenytoin, tetracyclines
o Category X: Causes birth defects – NEVER USE IN PREGNANCY
 Misoprostol, thalidomide
APEA-9 At the initial visit to diagnose pregnancy, a patient is found to have
asymptomatic bacteruria. How should this be handled?
A.
B.
C.
D.
Repeat urinalysis in 1 week
Have patient notify HCP if she becomes symptomatic
Order a urine culture and treat empirically
Treat with amoxicillin today
Urine cultures are needed to identify the organism to treat with the appropriate
antibiotic. Most probable organism is E. Coli a gram negative organism.
APEA-10 A pregnant client with asthma has been previously well controlled on an
inhaled steroid daily. She has developed an URI and is having wheezing. How should
this be handled?
A.
B.
C.
D.
Add a long acting beta agonist
Use only the inhaled steroid
Start oral prednisone
Stop the steroid and add a beta agonist
Flovent may increased to Advair. Prednisone would cause more elevation of the
patients Blood Glucose.
APEA-11 Which antibiotic could safely be prescribed for a pregnant patient in her third
trimester?
A.
B.
C.
D.
Amoxicillin-clavulanate
Levofloxacin
Trimethoprim-sufamethoxazole
Doxycycline
Levaquin or quinolones can impair bone and cartlidge formation. Sulfa drugs should be
avoid in pregnant women because bacterium kills MRSA it doesn’t let the bacteria make
Folic Acid in the first trimester. Sulfa drugs could be used in the second trimester but
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should be avoided totally. Sulfa drug can decrease amniotic fluid volume in the third
trimester. Doxycycline can cause fetal tooth discoloration of enamel.
APEA-12 A pregnant patient has taken sertraline (Zoloft), a Category C drug, for the
past 10 years with excellent results. She asks if this is safe to take while she is
pregnant. How should this be answered?
A.
B.
C.
D.
It is safe: Category A
It is safe: Category B
It might be safe: Category C
It is not safe: Category D
Common Complications Associated With Pregnancy
Preterm premature rupture of membranes (PPROM)
o Natrazine testing: pH of amniotic fluid = 7.0-7.7 (vaginal pH 3.8-4.2)
 Vaginal secretions has to be acidic
 Natrazine is pH paper initially used by Geologist
o Fern Test (arborization): fluid from posterior vaginal fornix swabbed on a
slide and allowed to dry for a least 10 minutes
o Amniotic fluid has a delicate ferning pattern (so does a fingerprint)
Amniotic Fluid Screening
o Amniotic fluid delicate ferning pattern (presence of crystals)
o Ferning is r/t high estrogen levels
Placenta Previa
o Improper implantation of the placenta into the lower uterine segment
o Assessment findings
 Painless vaginal bleeding usually beginning at the end of the
second trimester or third trimester
 A vaginal examination should NOT be performed if placenta previa
is suspected
o Management
 Cesarean section is required if frequent, recurrent, or profuse
bleeding persists or if fetal well-being jeopardized
 Refer for placenta previa or abruptio placenta
APEA-13 Abruptio placenta can be described as
A.
B.
C.
D.
Painless vaginal bleeding
Abdominal pain and vaginal bleeding
Scant bloody vaginal discharge
Occurring prior to the third trimester
Pre-Eclampsia
o Hypertension that occurs during pregnancy then resolves after pregnancy.
o Can occur anytime after 20th week (usually in the 3rd trimester)
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Terms
o Gestational HTN: HTN without proteinuria (6% of pregnancy’s)
o Pre-Eclampsia: new onset of HTN plus proteinuria after 2o weeks (5-8%
of pregnancy’s)
o Eclampsia: development of seizures with gestational hypertension or preeclampsia
o Chronic HTN
Diagnostic Criteria
o Sudden elevation in BP (usually occurs close to due date)
o BP > 140/90 on 2 occasions 4-6 hours apart
o BP 30 points higher systolically or 15 points higher diastolically if already
hypertensive
o Excretion of > 300 mg/dL of protein over 24 hours; dipstick reading ≥ + 1
(30 mg/dL) or END ORGAN dysfunction
o Edema more than 2 kg weigh gain in one week
o Diagnosis: Must have increase BP and proteinuria, END ORGAN damage:
Heart failure, pulmonary edema, decreased GFR, thrombocytopenia.
Management
o Delivery of infant by 40 weeks or earlier
o Bedrest left lateral recumbent position to decrease pressure on vena cava
o Well-balanced diet with moderate protein intake
o Avoid excessive salt, but sodium restriction is NOT recommended
o Hospitalization recommended if BP 160/110 consistently with bedrest.
o Medication
 Diuretics / ACE inhibitors NOT recommended for treatment
 Antihypertensives
 Methyldopa (Aldomet®)
 Hydralazine (Apresoline®)
 CCBs (nifedipine, verapamil, diltiazem)
 Beta blocker (labetolol)
 Educate for s/sx of worsening pre-eclampsia
 Delivery of infant is definitive treatment
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Knowledge Base
APEA-14 Folic acid is recommend prior to and during the first 2-3 months of pregnancy
to prevent neural tube defects. What is not an example of this?
A.
B.
C.
D.
Cleft palate
Spina bifida (NTD)
Anencephaly (NTD)
Encephalocele (NTD)
APEA-15 A patient has fundal height measurement of 20 cm at 20 weeks. This gives a
good estimate of:
A.
B.
C.
D.
Her due date
The gestational age of the fetus
The weight of the fetus
The length of the fetus
APEA-16 A patient is suspected of having diabetes during her initial prenatal visit (first
trimester). Which screening test is inappropriate for this?
A.
B.
C.
D.
Fasting blood glucose
A1C
Random blood glucose
3 hour glucose tolerance test
APEA-17 A woman at 38 weeks gestation has pre-eclampsia. What must be present for
this diagnosis?
A.
B.
C.
D.
Proteinuria only
Edema
Elevated BP
Proteinuria plus elevated BP
APEA-18 A pregnant patient is found to have Chlamydia. How should she be treated?
A.
B.
C.
D.
Treat today with ceftriaxone
Treat today and screen again in the third trimester
Treat today and treat her partner today
Treat with azithromycin and ceftriaxone
APEA-19 The uterine fundas should be palpable at 16 weeks:
Uterine Size
o 6-8 weeks: small pear
o 8-10 weeks: orange
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Pregnancy
o
o
o
o
A.
B.
C.
D.
Chapter 1
December 25, 2014
10-12 weeks: grapefruit
At 12 weeks: palpable just above the symphysis
At 16 weeks: midway between symphysis and umbilicus
20 weeks: at level of umbilicus
At the level of the umbilicus
Just above the level of the symphysis pubis
Midway between the symphysis and umbilicus
Below the symphysis pubis
APEA-20 A 4 week post-partal patient has a positive screen for depression. What is this
patient’s most likely diagnosis?
A.
B.
C.
D.
Postpartum “blues”
Postpartum depressive disorder
Major depression
Postpartum psychosis
Up until 2 weeks after birth the patient would be diagnosed with postpartum “blues”.
After 2 weeks the diagnoses is postpartum “depression.”
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Pregnancy (Emerging Family Care) Test
4-1 Which oral disease-modifying antirheumatisc durg (DMARD) is considered safe
(Class B) when used in the first and second trimesters of pregnancy?
A.
B.
C.
D.
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
4-2 Marta, aged 18 years, is a primigravida who wants to breastfeed her newborn infant
girl, Tonya. She delivered 8 hours ago. Her temperature spiked to 100.9°F (38.3°C) 4
hours before she delivered and rose to 101.3°F (38.5°C) after delivery. The infant is full
term and doing well. Should the nurse bring the infant to Marta for her to attempt to
breastfeed?
A. Yes, because the infant is healthy and it is important to initiate breastfeeding as
soon as possible.
B. The nurse should allow the infant to be brought to the mother to allow bonding,
but Marta should not breastfeed until she is on antibiotics.
C. No. The baby should be kept isolated from the mother until she is afebrile
for 24 hours.
D. The baby should be kept isolated from the mother, but Marta should be
encouraged to express fluid from her breasts and the colostrum should be
brought to the baby.
4-3 Which complication of labor and delivery (which is more common in a first
pregnancy) occurs more frequently among adolescents than among adult women?
A.
B.
C.
D.
Placenta previa
Abruption placenta
Breech presentation of infant
Pre-eclampsia or eclampsia
4-4 After a normal delivery, where should you expect to palpate the top of the uterus?
A.
B.
C.
D.
At the level of the symphysis pubis
At the level of the umbilicus
One finger’s breadth below the umbilicus
One finger’s breadth above the symphysis pubis
4-5 Sabrina, who is 5 months pregnant and of average height and weight, asks you how
many extra calories she should be adding to her diet per day. You tell her to add an
additional
A. 200 calories
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B. 300 calories
C. 500 calories
D. 700 calories
4-6 Chorionic villus sampling (CVS), which is useful in prenatal evaluation of the
chromosomal, enzymatic, and DNA status of the fetus, generally is performed
A.
B.
C.
D.
After 4 weeks and before 9 weeks of gestation
After 9 weeks and before 14 weeks of gestation
During the second trimester
During the third trimester
4-7 When may heart tones of the fetus be heard with a Doppler?
A.
B.
C.
D.
At 8-10 weeks of gestation
At 10-12 weeks of gestation
At 2-14 weeks of gestation
At 14-16 weeks of gestation
4-8 The safest antibiotic to administer during pregnancy is
A.
B.
C.
D.
Tetracyclines
Fluoroquinolones
Penicillin
Gentamycins
4-9 Dosages of ionizing radiation greater than 5 Rad over an entire pregnancy may
harm the fetus. The greatest risk during gestation is during
A.
B.
C.
D.
The first 2 weeks of pregnancy
The 2nd to 18th week
The second trimester
The third trimester
4-10 Anisocoria, a papillary asymmetry, is often the result of
A.
B.
C.
D.
Strabismus
A congenital condition
Hypoxia
A low APGAR score
4-11 Which dietary deficiency in a mother may lead to neural tube defects in the fetus?
A. Folic acid deficiency
B. Vitamin B12 deficiency
C. Iron deficiency
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D. Vitamin B6 deficiency
4-12 After 28 weeks of gestation, all women should perform fetal movement counts
(FMCs). Which of the following statements is true regarding FMCs?
A.
B.
C.
D.
Counts should be done as the woman is going about her work
Ten movements should be obtained in 1 hour
Ten movements should be obtained in 2 hours
If decreased activity is perceived, at the next OB visit, a nonstress test should be
performed
4-13 On your client’s second postpartum day, you would expect her to describe her
vaginal bleeding as
A.
B.
C.
D.
Brown and thick
Red with clots
Red and moderate
Turning pink
4-14 Helen is considering going to an out-of-hospital birth center for her delivery and
having a midwife perform the delivery. She asks you how midwifery differs from
obstetrics. You respond,
A. “Their educations are the same. It’s really a matter of hospital versus freestanding birthing center.”
B. “The big difference is that midwives are cheaper.”
C. “The outcomes for the mother and baby are the same for a normal delivery,
if not better, in a birth center as compared with a hospital.”
D. “Midwives tend to care more and get involved in family dynamics.”
4-15 Pregnancy is a contraindication for all of the following immunizations except
A.
B.
C.
D.
Rubella vaccine
Measles vaccine
Pneumococcal vaccine
Hepatitis B vaccine
4-16 Lindsay, aged 28 years, is taking isoniazid (INH) because she had a positive
tuberculin skin test (TST). She just gave birth to a baby boy, Nathan. She would like to
breastfeed. You advise her that
A. She can breastfeed without any restrictions
B. She should not breastfeed because the drug might cause peripheral
neuropathies, hepatitis, and vomiting in the infant
C. She should not breastfeed because the drug might cause staining of the teeth
and bone retardation in the infant.
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D. She can breastfeed if she also takes pyridoxine (vitamin B6) to offset the effects
of the isoniazid.
4-17 Mildred is 6 months pregnant and comes in with symptoms of urinary frequency,
urgency, dysuria, and suprapubic discomfort. Her urine is cloudy and malodorous. She
has no chills, fever, nausea, or vomiting. You diagnosis is
A.
B.
C.
D.
Urinary calculi
Acute cystitis
Acute pyelonephritis
Interstitial cystitis
4-18 Safe antibiotics for a woman who is breastfeeding include
A.
B.
C.
D.
Cephalosporins
Fluoroquinolones
Glycylcyclines
Metronidazole
4-19 Which intervention immediately after birth correlates with improved breastfeeding
and a longer duration of lactation?
A.
B.
C.
D.
Keeping the baby warm and dry immediately after birth
Clearing the airway immediately after birth
Placing the infant skin-to-skin on the mother’s abdomen
Providing ventilator assistance with 100% oxygen via face mask
4-20 Jessica, aged 36 years, just a cesarean section, and her temperature is 101°F
(38.3°C) on the third postoperative day. Which of the following potential causes could
be ruled out?
A.
B.
C.
D.
Endometriosis
Atelectasis/pneumonia
Mastitis
A wound infection
4-21 Post-term pregnancy is defined as more than 42 weeks beyond the date of the last
menstrual period. The most common cause of this incorrect dating of the gestation. The
greatest danger associated with this phenomenon is
A.
B.
C.
D.
Oligohydramnios
The greater size of the fetus
The higher incidence of birth trauma and dystocia
The higher incidence of cesarean section
4-22 The pulse of a newborn is approximately
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A.
B.
C.
D.
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December 25, 2014
80-100 beats per minute
100-120 beats per minute
120-170 beats per minute
170-190 beats per minute
4-23 The most common virus known to be transmitted in utero is
A.
B.
C.
D.
Cytomegalovirus
Rubella
Varicella
Toxoplasmosis
4-24 Joy, who experienced some transient emotional disturbances around her third
postpartum day, is just now feeling like herself again after about 2 weeks. Joy probably
experienced
A.
B.
C.
D.
Maternity blues
Postpartum depression
Postpartum psychosis
Postpartum pangs
4-25 Winnie, aged 42 years, suspects that she is pregnant. She wants some counseling
about which prenatal screening tests may be used to detect neural tube defects. Which
one do you not recommend?
A.
B.
C.
D.
Chorionic villus sampling (CVS)
Amniocentesis
Ultrasound examination
Acetylcholinesterase
4-26 Which of the following statements is false concerning gender differences in the
number of conceptions and births?
A. More males are conceived.
B. More male embryos are spontaneously aborted.
C. A female with two X chromosomes has more protection from some of the
hazards of early pregnancy.
D. After birth, a female has a lower survival rate than a male.
4-27 When assessing the hands and fingers of Junior, a Caucasian newborn, you note
macrodactyly. What condition do you further assess for?
A. Chromosomal anomaly
B. Neurofibromatosis
C. Chondrodystrophy
Not transmittable or reproducible with written permission of Teddie Joe Snodgrass, MBA, MSN, FNP
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Pregnancy
Chapter 1
December 25, 2014
D. Hunter’s syndrome
4-28 Angie, aged 24 years, is a primigravida with active hepatitis at the time of the
delivery of her baby boy, Anthony. You recommend that
A. Anthony may room in with Angie as long as good hand washing is
performed, but Angie should not breastfeed.
B. Angie may visit Anthony in the nursery, but he should not room in and she should
not breastfeed.
C. Anthony may room in with Angie, and she should be encouraged to breastfeed.
D. Anthony should receive pooled globulin or hyperimmune globulin and be kept
isolated from Angie for 8 days.
4-29 Millie, aged 38 years, is a primigravida seeing you for her first prenatal care
appointment. Which laboratory tests should be ordered and/or performed at the first
visit?
A. Hematocrit, blood type, antibody screen, a Venereal Disease Research
Laboratory (VDRL) test, hepatitis, and rubella titer
B. Serum alpha-fetoprotein, a urine dipstick, A VDRL test, and a Pap smear
C. Rubella titer, purified protein derivative (PPD), hematocrit, and antibody screen
D. Fasting blood sugar, hematocrit, and antibody screen, and a VDRL test
4-30 The presumptive symptom of pregnancy that involves tingling or frank pain of the
breasts is
A.
B.
C.
D.
Montgomery’s tubercles
Colostrum secretion
Chloasma
Mastodynia
4-31 Which of the following should be avoided by a pregnant woman who is
constipated?
A.
B.
C.
D.
Bulk-forming laxatives
Mineral oil
Stool softners, such as docusate sodium (Colace)
Drinking warm fluids on arising
Not transmittable or reproducible with written permission of Teddie Joe Snodgrass, MBA, MSN, FNP
Page 42 of 42