A 25-year-old client believes she may be pregnant with her first child. She schedules an obstetric
examination with the nurse practitioner to determine the status of her possible pregnancy. Her last
menstrual period began May 20, and her estimated date of confinement using Nägele’s rule is:
C
Explanation:
(A)March 27 is a miscalculation. (B) February 1 is a miscalculation. (C) February 27 is the correct
answer. To calculate the estimated date of confinement using Nagele’s rule, subtract 3 months from
the date that the last menstrual cycle began and then add 7 days to the result. (D) January 3 is a
miscalculation.
The nurse practitioner determines that a client is approximately 9 weeks’ gestation. During the visit,
the practitioner informs the client about symptoms of physical changes that she will experience
during her first trimester, such as:
A
Explanation:
(A) Nausea and vomiting are experienced by almost half of all pregnant women during the first 3
months of pregnancy as a result of elevated human chorionic gonadotropin levels and changed
carbohydrate metabolism. (B) Quickening is the mother’s perception of fetal movement and
generally does not occur until 18–20 weeks after the last menstrual period in primigravidas, but it
may occur as early as 16 weeks in multigravidas. (C) During the first trimester there should be only a
modest weight gain of 2–4 lb. It is not uncommon for women to lose weight during the first trimester
owing to nausea and/or vomiting. (D) Physical changes are not apparent until the second trimester,
when the uterus rises out of the pelvis.
A client is 6 weeks pregnant. During her first prenatal visit, she asks, “How much alcohol is safe to
drink during pregnancy?” The nurse’s response is:
D
Explanation:
(A, B, C) No amount of alcohol has been determined safe for pregnant women. Alcohol should be
avoided owing to the risk of fetal alcohol syndrome. (D) The recommended safe dosage of alcohol
consumption during pregnancy is none.
A 38-year-old pregnant woman visits her nurse practitioner for her regular prenatal checkup. She is
30 weeks’ gestation. The nurse should be alert to which condition related to her age?
D
Explanation:
(A) Iron-deficiency anemia can occur throughout pregnancy and is not age related. (B) STDs can occur
prior to or during pregnancy and are not age related. (C) Intrauterine growth retardation is an
abnormal process where fetal development and maturation are delayed. It is not age related. (D)
Physical risks for the pregnant client older than 35 include increased risk for PIH, cesarean delivery,
fetal and neonatal mortality, and trisomy.
A client returns for her 6-month prenatal checkup and has gained 10 lb in 2 months. The results of
her physical examination are normal. How does the nurse interpret the effectiveness of the
instruction about diet and weight control?
B
Explanation:
(A) She is probably not compliant with her diet and exercise program. Recommended weight gain
during second and third trimesters is approximately 12 lb. (B) Because of her excessive weight gain of
10 lb in 2 months, she needs re-evaluation of her eating habits and reinforcement of proper dietary
habits for pregnancy. A 2200-calorie diet is recommended for most pregnant women with a weight
gain of 27–30 lb over the 9-month period. With rapid and excessive weightgain, PIH should also be
suspected. (C) She does not need to increase her caloric intake, but she does need to re-evaluate
dietary habits. Ten pounds in 2 months is excessive weight gain during pregnancy, and health
teaching is warranted. (D) Restrictive dieting is not recommended during pregnancy.
Pregnant women with diabetes often have problems related to the effectiveness of insulin in
controlling their glucose levels during their second half of pregnancy. The nurse teaches the client
that this is due to:
D
Explanation:
(A) There is a rise in glomerular filtration rate in the kidneys in conjunction with decreased tubular
glucose reabsorption, resulting in glycosuria. (B) Insulin is inhibited by increased levels of estrogen.
(C) Insulin is inhibited by increased levels of progesterone. (D) Human placental lactogen levels
increase later in pregnancy. This hormonal antagonist reduces insulin’s effectiveness, stimulates
lipolysis, and increases the circulation of free fatty acids.
Diabetes during pregnancy requires tight metabolic control of glucose levels to prevent perinatal
mortality. When evaluating the pregnant client, the nurse knows the recommended serum glucose
range during pregnancy is:
A
Explanation:
(A) The recommended range is 70–120 mg/dL to reduce the risk of perinatal mortality. (B, C, D)
These levels are not recommended. The higher the blood glucose, the worse the prognosis for the
fetus. Hypoglycemia can also have detrimental effects on the fetus.
When assessing fetal heart rate status during labor, the monitor displays late decelerations with
tachycardia and decreasing variability. What action should the nurse take?
D
Explanation:
(A) This is not a normal occurrence. Late decelerations need prompt intervention for immediate
infant recovery. (B) To increase O2 perfusion to the unborn infant, the mother should be placed on
her left side. (C) IV fluids should be increased, not decreased. (D) Immediate action is warranted,
such as reporting findings, turning mother on left side, administering O2, discontinuing oxytocin
(Pitocin), assessing maternal blood pressure and the labor process, preparing for immediate
cesarean delivery, and explaining plan of action to client.
A client has been diagnosed as being preeclamptic. The physician orders magnesium sulfate.
Magnesium sulfate (MgSO4) is used in the management of preeclampsia for:
A
Explanation:
(A) MgSO4 is classified as an anticonvulsant drug. In preeclampsia management, MgSO4 is used for
prevention of seizures. (B) MgSO4 has been used to inhibit hyperactive labor, but results are
questionable. (C) Negative side effects such as respiratory depression should not be confused with
generalized sedation. (D) MgSO4 does not affect lung maturity. The infant should be assessed for
neuromuscular and respiratory depression.
The predominant purpose of the first Apgar scoring of a newborn is to:
C
Explanation:
(A) Apgar scores are not related to the infant’s care, but to the infant’s physical condition. (B) Apgar
scores assess the current physical condition of the infant and are not related to future environmental
adaptation. (C) The purpose of the Apgar system is to evaluate the physical condition of the newborn
at birth and to determine if there is an immediate need for resuscitation. (D) Congenital
malformations are not one of the areas assessed with Apgar scores.
Provide the 1-minute Apgar score for an infant born with the following findings: Heart rate: Above
100 Respiratory effort: Slow, irregular Muscle tone: Some flexion of extremities Reflex irritability:
Vigorous cry Color: Body pink, blue extremities
A
Explanation:
(A) Seven out of a possible perfect score of 10 is correct. Two points are given for heart rate above
100; 1 point is given for slow, irregular respiratory effort; 1 point is given for some flex- ion of
extremities in assessing muscle tone; 2 points are given for vigorous cry in assessing reflex irritability;
1 point is assessed for color when the body is pink with blue extremities (acrocyanosis). (B) For a
perfect Apgar score of 10, the infant would have a heart rate over 100 but would also have a good
cry, active motion, and be completely pink. (C) For an Apgar score of 8 the respiratory rate, muscle
tone, or color would need to fall into the 2-point rather than the 1-point category. (D) For this infant
to receive an Apgar score of 9, four of the areas evaluated would need ratings of 2 points and one
area, a rating of 1 point.
A pregnant woman at 36 weeks’ gestation is followed for PIH and develops proteinuri
a. To increase protein in her diet, which of the following foods will provide the greatest amount of
protein when added to her intake of 100 mL of milk?
B
Explanation:
(A) This choice would provide more unwanted fat and sugar than protein. (B) Skim milk would add
protein. Eggs are good sources of protein while low in fat and calories. (C) The benefit of protein
from ice cream would be outweighed by the fat content. Chocolate syrup has caffeine, which is
contraindicated or limited in pregnancy. (D) Although most animal proteins are higher in protein than
plant proteins, gelatin is not. It loses protein during the processing for food consumption.
The physician recommends immediate hospital admission for a client with PIH. She says to the nurse,
“It’s not so easy for me to just go right to the hospital like that.” After acknowledging her feelings,
which of these approaches by the nurse would probably be best?
B
Explanation:
(A) This answer does not hold the client accountable for her own health. (B) The nurse should explore
potential reasons for the client’s anxiety: are there small children at home, is the husband out of
town? The nurse should aid the client in seeking support or interventions to decrease the anxiety of
hospitalization. (C) Repeating the physician’s reason for recommending hospitalization may not aid
the client in dealing with her reasons for anxiety. (D) The concern for self and welfare of baby may be
secondary to a woman who is in a crisis situation. The nurse should explore the client’s potential
reasons for anxiety. For example, is there another child in the home who is ill, or is there a husband
who is overseas and not able to return on short notice?
Which of the following findings would be abnormal in a postpartal woman?
D
Explanation:
(A) Frequently the mother experiences a shaking chill immediately after delivery, which is related to
a nervous response or to vasomotor changes. If not followed by a fever, it is clinically innocuous. (B)
The pulse rate during the immediate postpartal period may be low but presents no cause for alarm.
The body attempts to adapt to the decreased pressures intra-abdominally as well as from the
reduction of blood flow to the vascular bed. (C) Urinary output increases during the early postpartal
period (12–24 hours) owing to diuresis. The kidneys must eliminate an estimated 2000–3000 mL of
extracellular fluid associated with a normal pregnancy. (D) A temperature of 100.4F (38C) may occur
after delivery as a result of exertion and dehydration of labor. However, any temperature greater
than 100.4F needs further investigation to identify any infectious process.
What is the most effective method to identify early breast cancer lumps?
D
Explanation:
(A) Mammograms are less effective than breast self-examination for the diagnosis of abnormalities
in younger women, who have denser breast tissue. They are more effective forwomen older than 40.
(B) Up to 15% of early-stage breast cancers are detected by physical examination; however, 95% are
detected by women doing breast self-examination. (C) Ultrasound is used primarily to determine the
location of cysts and to distinguish cysts from solid masses. (D) Monthly breast self-examination has
been shown to be the most effective method for early detection of breast cancer. Approximately 95%
of lumps are detected by women themselves.