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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 tunaB. Light white tuna, salmonC. Haddock, halibutD. 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 vaccinesB. Rabies post-exposure prophylaxisC. Tetanus-diphtheriaD. Hepatitis B

Not transmittable or reproducible with written permission of Teddie Joe Snodgrass, MBA, MSN, FNP of 42


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.



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.



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 amountsB. An increase in fat intakeC. A decrease in carbohydrate intakeD. Restriction of fluid intake after 7 p.m.



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 warm-water 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.



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’ gestationB. At 12 weeks’ gestationC. At 20 weeks’ gestationD. 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 at15–18 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



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 calculiB. Acute cystitis



C. Acute pyelonephritisD. 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 diameterB. Femur lengthC. Abdominal circumferenceD. 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.



1-22 Which of the following should be avoided by the pregnant woman who is constipated?

A. Bulk-forming laxativesB. Mineral oilC. 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



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 weeksB. 8 weeksC. 12 weeksD. 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.



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 intervalB. A 50-g OGTT, with plasma glucose measurement fasting and at 1 and 2 hC. A 75-g OGTT, with plasma glucose measurement fasting and at 1 and 2 hD. 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



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.



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 testB. Rh statusC. Direct Coombs’ testD. 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 lbB. 3.5 lbC. 5 lbD. 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



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 signB. Chadwick’s signC. Goodrich’s signD. 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. IntercourseB. SwimmingC. DouchingD. 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



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 weeksB. Women age 40 or olderC. All women with threatened miscarriageD. 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



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 anomaliesB. Musculoskeletal weaknessC. Pulmonary hypertensionD. 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 pregnancyB. During the first 16 weeks of pregnancyC. During the last trimesterD. 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



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 toneB. Fetal tone, breathing, motion, and contraction stress testC. Amniotic fluid composition, contraction challenge test, fetal breathing, and motionD. 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 non-stress 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 at18–22 weeks gestation).



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. IncompleteB. ThreatenedC. InevitableD. 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 non-stress test (NST). What is the criterion for a reactive NST?

A. A minimum of two fetal activity patterns in a 20-minute test periodB. The presence of two contractions with no fetal heart decelerations in a 20-minute test periodC. At least two fetal heart rate accelerations in response to fetal movement in a 20-minute test periodD. The absence of uterine contractions following fetal stimulation during a 20-minute 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.



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 multi-parameter 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 milkB. Two cups of yogurtC. Four slices of cheddar cheeseD. 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.



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 AB. AnemiaC. Vitamin KD. 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 tuberclesB. Colostrum secretionC. MelasmaD. 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 grievingB. DisorientationC. Reorganization



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 childrenC. 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



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 intakeNot transmittable or reproducible with written permission of Teddie Joe Snodgrass, MBA, MSN, FNP

of 42


B. Cocaine abuseC. Chain smokingD. 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 30B. June 16C. June 1D. 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).



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 globulinB. Chloroquine for malaria prophylaxisC. Yellow feverD. 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



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 diseaseB. HemophiliaC. Sickle cell anemiaD. 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.



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’ gestationB. At 10–12 weeks’ gestationC. At 18–20 weeks’ gestationD. 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 signB. Piskaçek’s signC. Spalding’s signD. 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



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 pregnancyB. Anxiety, related to effects of hyperemesis on fetal well-beingC. Anticipatory grieving, related to inevitable pregnancy lossD. 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. DilantinB. LamictalC. DepakoteD. 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. Stop their seizure medicationB. Switch to DilantinC. Switch to LamictalD. 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.



PregnancyFirst Trimester –- Conception – 14 Weeks

APEA-1 Why is it so important to establish a due date?

A. To insure adequate prenatal careB. To measure fetal weightC. To measure fetal lengthD. To establish timing of prenatal interventions and monitoring prenatal

growth

APEA-2 Ideally, prenatal care should be started by what time frame?

A. 6 WeeksB. 8 WeeksC. 10 WeeksD. 12 Weeks

APEA-3 Ideally, when should a prenatal vitamin be started?

A. As soon as possible after conceptionB. Within the first trimesterC. It is not necessary if she eats a healthy dietD. 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 conceptionC. History and physical exam are highly sensitive methods of diagnosesD. False positive pregnancy tests outnumber false negative tests

Estimated Date of Delivery (EDD)o EDD should be calculated based on LMPo 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)



Know you community resourceso Persona and family historyo Past surgical historyo Genetic Historyo Menstrual and gynecological historyo Current pregnancy history o 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.

Labso Establish if pregnant (hCG doubles every 48-60 hours)o Screen for anemia. Look for delutional anemia (more fluid)o Blood type and Rh, antibody screening – Rh negative requires RhoGamo Urinalysis – screen for bacteria, protein, and glucoseo Rubella Immunity (+ titer does not require repeating)o Varicella Immunityo 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. Urine screeningB. Serum Hepatitis B surface antigenC. Serum Hepatitis B surface antibodyD. Serum Hepatitis B sAg/sAB

APEA-6 When do symptoms of an ectopic pregnancy typically occur?

A. 2-4 weeks after conceptionB. 4-6 weeks after conceptionC. 6-8 weeks after LMPD. 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



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 pregnancyo 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 uteruso 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. 24 hours of nauseaB. Leakage of fluid from the vaginaC. Decreased fetal activityD. Vaginal bleeding

Schedule visits of uncomplicated pregnancyo Every 4 weeks until 28 weeks gestation, theno Every 2 weeks until 36 weeks gestation, theno 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. At diagnosis of pregnancy and after deliveryB. During the first trimester onlyC. During the second trimester and after deliveryD. During each trimester

Assessmento BP, weight, fundal height, fetal heart auscultationo CBC for anemiao Urinalysis as indicated (glucosuria, proteinuria, ketonuria)o Dysuria (asymptomatic bacteriuria – pyelonephritis)

Gestational Diabetes Screeningo All pregnant womeno When: 24-28 weekso 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 become pregnant, then develops DM then it is termed “Gestational DM”.

McDonald’s Rule: Fundal Heighto 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 weekso AFP: Alpha fetoproteino Estriol (uE3): unconjugated estriolo Beta-hCG: human chorionic gonadotropino Inhibin A (inhA)o Follow up abnormal with US and / or amniocentesis

Chromosomal Abnormalitieso 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 weekso Subsesequent pregnancies: 15-16 weeks

Third Trimester –- 28 to 40 Weeks

Assessmento 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 studieso 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 pregnancyPregnancy CategoriesFDA system to rank drugs



o Category A: Safe use during pregnancy Folic acid, B6, levothyroxine

o Category B: Appear to be safe during pregnancy and have been used a lot during pregnancy without problems

PCN, cephalosporins, acetaminophen, prednisone, insulino 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. Repeat urinalysis in 1 weekB. Have patient notify HCP if she becomes symptomaticC. Order a urine culture and treat empiricallyD. 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. Add a long acting beta agonistB. Use only the inhaled steroidC. Start oral prednisoneD. 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. Amoxicillin-clavulanateB. LevofloxacinC. Trimethoprim-sufamethoxazoleD. 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 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. It is safe: Category AB. It is safe: Category BC. It might be safe: Category CD. 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 Previao Improper implantation of the placenta into the lower uterine segmento 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. Painless vaginal bleedingB. Abdominal pain and vaginal bleedingC. Scant bloody vaginal dischargeD. 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)

Termso 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 pre-

eclampsiao Chronic HTN

Diagnostic Criteriao Sudden elevation in BP (usually occurs close to due date)o BP > 140/90 on 2 occasions 4-6 hours aparto BP 30 points higher systolically or 15 points higher diastolically if already

hypertensiveo Excretion of > 300 mg/dL of protein over 24 hours; dipstick reading ≥ + 1

(30 mg/dL) or END ORGAN dysfunctiono Edema more than 2 kg weigh gain in one weeko 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 earliero Bedrest left lateral recumbent position to decrease pressure on vena cavao Well-balanced diet with moderate protein intakeo Avoid excessive salt, but sodium restriction is NOT recommendedo 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



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. Cleft palateB. Spina bifida (NTD)C. Anencephaly (NTD)D. Encephalocele (NTD)

APEA-15 A patient has fundal height measurement of 20 cm at 20 weeks. This gives a good estimate of:

A. Her due dateB. The gestational age of the fetusC. The weight of the fetusD. 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. Fasting blood glucoseB. A1CC. Random blood glucoseD. 3 hour glucose tolerance test

APEA-17 A woman at 38 weeks gestation has pre-eclampsia. What must be present for this diagnosis?

A. Proteinuria onlyB. EdemaC. Elevated BPD. Proteinuria plus elevated BP

APEA-18 A pregnant patient is found to have Chlamydia. How should she be treated?

A. Treat today with ceftriaxoneB. Treat today and screen again in the third trimesterC. Treat today and treat her partner todayD. Treat with azithromycin and ceftriaxone

APEA-19 The uterine fundas should be palpable at 16 weeks:



Uterine Sizeo 6-8 weeks: small pearo 8-10 weeks: orangeo 10-12 weeks: grapefruito At 12 weeks: palpable just above the symphysiso At 16 weeks: midway between symphysis and umbilicuso 20 weeks: at level of umbilicus

A. At the level of the umbilicusB. Just above the level of the symphysis pubisC. Midway between the symphysis and umbilicusD. 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. Postpartum “blues”B. Postpartum depressive disorderC. Major depressionD. Postpartum psychosis

Up until 2 weeks after birth the patient would be diagnosed with postpartum “blues”. After 2 weeks the diagnoses is postpartum “depression.”



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. MethotrexateB. SulfasalazineC. HydroxychloroquineD. 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. Placenta previaB. Abruption placentaC. Breech presentation of infantD. Pre-eclampsia or eclampsia

4-4 After a normal delivery, where should you expect to palpate the top of the uterus?

A. At the level of the symphysis pubisB. At the level of the umbilicusC. One finger’s breadth below the umbilicusD. 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 caloriesB. 300 caloriesC. 500 caloriesD. 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. After 4 weeks and before 9 weeks of gestationB. After 9 weeks and before 14 weeks of gestationC. During the second trimesterD. During the third trimester

4-7 When may heart tones of the fetus be heard with a Doppler?

A. At 8-10 weeks of gestationB. At 10-12 weeks of gestationC. At 2-14 weeks of gestationD. At 14-16 weeks of gestation

4-8 The safest antibiotic to administer during pregnancy is

A. TetracyclinesB. FluoroquinolonesC. PenicillinD. 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. The first 2 weeks of pregnancyB. The 2nd to 18th weekC. The second trimesterD. The third trimester

4-10 Anisocoria, a papillary asymmetry, is often the result of

A. StrabismusB. A congenital conditionC. HypoxiaD. A low APGAR score



4-11 Which dietary deficiency in a mother may lead to neural tube defects in the fetus?

A. Folic acid deficiencyB. Vitamin B12 deficiencyC. Iron deficiencyD. 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. Counts should be done as the woman is going about her workB. Ten movements should be obtained in 1 hourC. Ten movements should be obtained in 2 hoursD. 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. Brown and thickB. Red with clotsC. Red and moderateD. 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 free-standing 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. Rubella vaccineB. Measles vaccineC. Pneumococcal vaccineD. 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 restrictionsB. She should not breastfeed because the drug might cause peripheral

neuropathies, hepatitis, and vomiting in the infantC. She should not breastfeed because the drug might cause staining of the teeth

and bone retardation in the infant.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. Urinary calculiB. Acute cystitisC. Acute pyelonephritisD. Interstitial cystitis

4-18 Safe antibiotics for a woman who is breastfeeding include

A. CephalosporinsB. FluoroquinolonesC. GlycylcyclinesD. Metronidazole

4-19 Which intervention immediately after birth correlates with improved breastfeeding and a longer duration of lactation?

A. Keeping the baby warm and dry immediately after birthB. Clearing the airway immediately after birthC. Placing the infant skin-to-skin on the mother’s abdomenD. 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. EndometriosisB. Atelectasis/pneumoniaC. MastitisD. 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. Oligohydramnios



B. The greater size of the fetusC. The higher incidence of birth trauma and dystociaD. The higher incidence of cesarean section

4-22 The pulse of a newborn is approximately

A. 80-100 beats per minuteB. 100-120 beats per minuteC. 120-170 beats per minuteD. 170-190 beats per minute

4-23 The most common virus known to be transmitted in utero is

A. CytomegalovirusB. RubellaC. VaricellaD. 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. Maternity bluesB. Postpartum depressionC. Postpartum psychosisD. 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. Chorionic villus sampling (CVS)B. AmniocentesisC. Ultrasound examinationD. 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 anomalyB. NeurofibromatosisC. ChondrodystrophyD. 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 smearC. Rubella titer, purified protein derivative (PPD), hematocrit, and antibody screenD. 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. Montgomery’s tuberclesB. Colostrum secretionC. ChloasmaD. Mastodynia

4-31 Which of the following should be avoided by a pregnant woman who is constipated?

A. Bulk-forming laxativesB. Mineral oilC. Stool softners, such as docusate sodium (Colace)D. Drinking warm fluids on arising


dr. teddie joe snodgrass, dnp-bc › fnp › apea-2014 › dis… · web viewaida, who is 29 weeks...

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