Chapter 1: Trends and Issues

Chapter 1: Trends and Issues

Multiple Choice

1. Since 1995 there has been a significant decrease in the rate of infant death related to
which of the following:
a. Disorders associated with short gestation and low birth weight
b. Accidents
c. Sudden infant death
d. Newborns affected by complications of placenta, cord, and membranes

ANS: c
Feedback
a. The rates of prematurity and low birth weight are increasing.
b. The rates of accidents have increased.
c. Correct. The rate of infant death related to SIDS has decreased from 87.1 to 47.2. The
decrease in rate is partially attributed to placing infants on their backs when sleeping.
d. The rates of newborns affected by complications of placenta, cord, and membranes have
increased.

2. Tobacco use during pregnancy is associated with adverse effects on the unborn infant
such as intrauterine growth restriction, preterm births, and respiratory problems. By
race, which has the highest percentages of smokers?
a. American Indian and Alaskan Natives
b. Asian or Pacific Islanders
c. Non-Hispanic blacks
d. Non-Hispanic whites

ANS: a
Feedback
a. 36% of American Indian and Native American women are cigarette smokers.
b. 4.3% of Asian or Pacific Islander women are cigarette smokers.
c. 17.1% of non-Hispanic black women are cigarette smokers.
d. 19.6% of non-Hispanic white women are cigarette smokers.
3. Which of the following women is at the highest risk for health disparity?
a. A white, middle-class, 16-year-old woman
b. An African American, middle-class, 25-year-old woman
c. An African American, upper-middle-class, 19-year-old woman
d. An Asian, low-income, 30-year-old woman

ANS: d
Feedback
a. Although age is a risk factor, income contributes to disparity.
b. Although African American women are at increased risk, income accounts for the largest
disparity.
c. Although age and race contribute to increased risk, income accounts for the largest disparity.
d. Although age and race contribute to increased risk, income accounts for the largest disparity.

4. A neonate born at 36 weeks gestation is classified as which of the following?

a. Very premature

b. Moderately premature
c. Late premature
d. Term

ANS: c
Feedback
a. Very premature is less than 32 weeks’ gestation.
b. Moderately premature is 32 to 33 completed weeks’ gestation.
c. Correct. Late premature is 34 to 36 completed weeks’ gestation.
d. Term is 37 to 42 weeks’ gestation.

5. The perinatal nurse explains to the student nurse that a goal of the Healthy People
2020 report is to:
a. Increase proportion of infants who are breastfed to 93.1%.
b. Increase proportion of infants who are breastfed to 90.7%.
c. Increase proportion of infants who are breastfed to 85.6%.
d. Increase proportion of infants who are breastfed to 83.9%.

ANS: d
A goal of Healthy People 2020 is to increase the proportion of infants who are breastfed from
74% to 81.9%.
6. The perinatal nurse explains to the student nurse that __________ is the leading cause of
infant death in the United States.
a. Sudden Infant Death Syndrome
b. Respiratory distress of newborns
c. Disorders related to short gestation and low birth weight
d. Congenital malformations and chromosomal abnormalities

ANS: d

Multiple Response

7. Which of the following statements are true related to teen pregnancies? (Select all that
apply.)
a. Teen mothers are at higher risk for HIV.
b. Teen mothers are at higher risk for hypertensive problems.
c. The birth rate for teenaged women has increased in the past 15 years.
d. Infants born to teen mothers are at higher risk for health problems.

ANS: a, b, d
Health statistics report higher risk for HIV, for hypertensive problems, and for health problems
to infants born to teen mothers. Birth rates for teen mothers in all age categories have
decreased since 1991.

Chapter 2: Ethics and Standards of Practice

Issues
Chapter 2: Ethics and Standards of Practice Issues

Multiple Choice

1. An ethical dilemma unique to perinatal nursing is the:

a. Innate conflict between maternal and fetal rights

b. Intensive use of technology

c. Shortage of health-care resources

d. Risk of violation of the principle of veracity

ANS: a
Feedback
a. A unique aspect of maternity nursing is that the nurse advocates for 2 individuals: the
woman & the fetus.
b. The use of technology is not unique to perinatal nursing.
c. Currently, in the United States, decisions in perinatal nursing are not based on resources
available.
d. In perinatal nursing, the obligation to tell the truth is generally adhered to.

2. The American Nurses Association Code of Ethics for Nurses directs nurses to provide
patient care that is:

a. Curative

b. Utilitarian

c. Negotiable

d. Respectful

ANS: d
Feedback
a. Adaptation rather than cure is the goal of nursing.
b. Nursing does not define the value of a person by his or her utility.
c. The Code of Ethics outlines the nursing profession’s nonnegotiable ethical standard.
d. Respect for the inherent dignity, worth, and uniqueness of every individual is part of the
Code of Ethics.

3. Evidence-based practice is the integration of the best:

a. Randomized clinical trials, clinical expertise, and patients’ requests

b. Research evidence, clinical expertise, and patients’ values

c. Quantitative research, clinical expertise, and patients’ preferences

d. Research findings, clinical experience, and patients’ preferences

ANS: b
Feedback
a. Evidence-based practice is the use of evidence that may include research beyond
randomized clinical trials.
b. These elements are the accepted definition of evidence-based practice.
c. Qualitative research, as well as quantitative research, contributes to evidence-based practice.
d. Clinical expertise, as well as clinical experience, defines evidence-based practice.

Multiple Response

4. Infants whose mothers were obese during pregnancy are at higher risk for which of
the following? (Select all that apply.)
a. Childhood diabetes
b. Heart defects
c. Hypospadias
d. Respiratory distress

ANS: a, b, c
Fetuses and/or infants of women who were obese during pregnancy are at higher risk for spina
bifida, health defects, anorectal atresia, hypospadias, intrauterine fetal death, birth injuries
related to macrosomia, and childhood obesity and diabetes.

Chapter 3: Genetics, Conception, Fetal

Development, and Reproductive Technology
Chapter 3: Genetics, Conception, Fetal Development, and Reproductive Technology

Multiple Choice

1. The color of a person’s hair is an example of which of the following?

a. Genome

b. Sex-link inheritance

c. Genotype

d. Phenotype
ANS: d
Feedback
a. Genome is an organism’s complete set of DNA.
b. Sex-link inheritance refers to genes or traits that are located only on the X chromosome.
c. Genotype refers to a person’s genetic makeup.
d. Correct. Phenotype refers to how genes are outwardly expressed, such as eye color, hair
color, and height.

2. Which of the following statements by a pregnant woman indicates she needs

additional teaching on ways to reduce risks to her unborn child from the potential
effects of exposure to toxoplasmosis?

a. “I will avoid rare lamb.”

b. “I will wear a mask when cleaning my cat’s litter box.”

c. “I understand that exposure to toxoplasmosis can cause blindness in the baby.”

d. “I will avoid rare beef.”

ANS: b
Feedback
a. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef
and lamb is ingested.
b. Correct. Pregnant women and women who are attempting pregnancy should avoid contact
with cat feces. Exposure occurs when the protozoan parasite found in cat feces and uncooked
or rare beef and lamb is ingested. Wearing a mask will not decrease the risk through ingestion
of the parasite.
c. Exposure to toxoplasmosis can cause fetal death, mental retardation, and blindness.
d. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef
and lamb is ingested.

3. The fetal circulatory structure that connects the pulmonary artery with the
descending aorta is known as which of the following?

a. Ductus venosus

b. Foramen ovale

c. Ductus arteriosus
d. Internal iliac artery

ANS: c
Feedback
a. The ductus venosus connects the umbilical vein to the inferior vena cava.
b. The foramen ovale is the opening between the right and left atria.
c. Correct.
d. The internal iliac artery connects the external iliac artery to the umbilical artery.

4. A woman at 40 weeks’ gestation has a diagnosis of oligohydramnios. Which of the

following statements related to oligohydramnios is correct?

a. It indicates that there is a 25% increase in amniotic fluid.

b. It indicates that there is a 25% reduction of amniotic fluid.

c. It indicates that there is a 50% increase in amniotic fluid.

d. It indicates that there is a 50% reduction of amniotic fluid.

ANS: d
Feedback
a. Oligohydramnios is a decrease, not an increase in amniotic fluid.
b. Oligohydramnios is a 50% reduction in amniotic fluid.
c. Oligohydramnios is a decrease, not an increase in amniotic fluid.
d. Correct. Oligohydramnios refers to a decreased amount of amniotic fluid of less than 500 mL
at term or 50% reduction of normal amounts.

5. A diagnostic test commonly used to assess problems of the fallopian tubes is:

a. Endometrial biopsy

b. Ovarian reserve testing

c. Hysterosalpingogram

d. Screening for sexually transmitted infections

ANS: c
Feedback
a. Endometrial biopsy provides information on the response of the uterus to hormonal signals.
b. Ovarian reserve testing is used to assess ovulatory functioning.
c. Correct. Hysterosalpingogram provides information on the endocervical canal, uterine cavity,
and fallopian tubes.
d. STIs can cause adhesions within the fallopian tubes, but screening cannot confirm that
adhesions are present.

6. The nurse is interviewing a gravid woman during the first prenatal visit. The woman
confides to the nurse that she lives with a number of pets. The nurse should advise the
woman to be especially careful to refrain from coming in contact with the stool of which
of the pets?
a. Cat
b. Dog
c. Hamster
d. Bird

ANS: a
Feedback
a. The patient should refrain from coming in direct contact with cat feces. Cats often harbor
toxoplasmosis, a teratogenic illness.
b. No pathology has been associated with the feces of pet dogs.
c. No pathology has been associated with the feces of pet hamsters.
d. No pathology has been associated with the feces of pet birds.

7. A client is to take Clomiphene Citrate for infertility. Which of the following is the
expected action of this medication?
a. Decrease the symptoms of endometriosis
b. Increase serum progesterone levels
c. Stimulate release of FSH and LH
d. Reduce the acidity of vaginal secretions

ANS: c
Feedback
a. Clomiphene Citrate will not reduce a client’s symptoms of endometriosis.
b. Clomiphene Citrate will not increase a client’s progesterone levels.
c. Clomiphene Citrate stimulates release of FSH and LH.
d. Clomiphene Citrate will not reduce the acidity of vaginal secretions.
8. The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is
referred to a genetic counselor, due to her previous child having a diagnosis of __________.
a. Unilateral amblyopia
b. Subdural hematoma
c. Sickle cell anemia
d. Glomerular nephritis

ANS: c
Feedback
a. Amblyopia rarely results from a genetic predisposition.
b. A subdural hematoma does not result from a genetic defect.
c. Sickle cell anemia is an autosomal recessive illness. This client needs to be seen by a genetic
counselor.
d. Glomerular nephritis does not result from a genetic defect.

9. A nurse is teaching a woman about her menstrual cycle. The nurse states that __________
is the most important change that happens during the secretory phase of the menstrual
cycle.
a. Maturation of the graafian follicle
b. Multiplication of the fimbriae
c. Secretion of human chorionic gonadotropin
d. Proliferation of the endometrium

ANS: d
Feedback
a. The maturation of the graafian follicle occurs during the follicular phase.
b. There is no such thing as the multiplication of the fimbriae.
c. Human chorionic gonadotropin is secreted by the fertilized ovum during the early weeks of a
pregnancy.
d. The proliferation of the endometrium occurs during the secretory phase of the menstrual
cycle.

10. An ultrasound of a fetus’ heart shows that “normal fetal circulation is occurring.”
Which of the following statements is consistent with the finding?
a. A right to left shunt is seen between the atria.
b. Blood is returning to the placenta via the umbilical vein.
c. Blood is returning to the right atrium from the pulmonary system.
d. A right to left shunt is seen between the umbilical arteries.
ANS: a
Feedback
a. This is correct. The foramen ovale is a duct between the atria. In fetal circulation, there is a
right to left shunt through the duct.
b. Blood returns to the placenta via the umbilical arteries.
c. Most of the blood bypasses the pulmonary system. The blood that does enter the pulmonary
system returns to the left atrium.
d. There is no duct between the umbilical arteries.

11. The clinic nurse knows that the part of the endometrial cycle occurring from
ovulation to just prior to menses is known as the:
a. Menstrual phase
b. Proliferative phase
c. Secretory phase
d. Ischemic phase

ANS: c
Feedback
a. The menstrual phase is the time of vaginal bleeding, approximately days 1 to 6.
b. The proliferative phase ends the menses through ovulation, approximately days 7 to 14.
c. The secretory phases occurs from the time of ovulation to the period just prior to menses, or
approximately days 15 to 26.
d. The ischemic phase occurs from the end of the secretory phase to the onset of menstruation,
approximately days 27 to 28.

12. A clinic nurse explains to the pregnant woman that the amount of amniotic fluid
present at 24 weeks’ gestation is approximately:
a. 500 mL
b. 750 mL
c. 800 mL
d. 1000 mL

ANS: c
Amniotic fluid first appears at about 3 weeks. There are approximately 30 mL of amniotic fluid
present at 10 weeks’ gestation, and this amount increases to approximately 800 mL at 24
weeks’ gestation. After that time, the total fluid volume remains fairly stable until it begins to
decrease slightly as the pregnancy reaches term.
13. Information provided by the nurse that addresses the function of the amniotic fluid is
that the amniotic fluid helps the fetus to maintain a normal body temperature and also:
a. Facilitates asymmetrical growth of the fetal limbs
b. Cushions the fetus from mechanical injury
c. Promotes development of muscle tone
d. Promotes adherence of fetal lung tissue

ANS: b
Feedback
a. Amniotic fluid allows for symmetrical fetal growth.
b. Amniotic fluid cushions the fetus from mechanical injury.
c. Amniotic fluid does not promote muscle tone.
d. Amniotic fluid prevents adherence of the amnion to the fetus.

14. During preconception counseling, the clinic nurse explains that the time period when
the fetus is most vulnerable to the effects of teratogens occurs from:
a. 2 to 8 weeks
b. 4 to12 weeks
c. 5 to 10 weeks
d. 6 to 15 weeks

ANS: a
The period of organogenesis lasts from approximately the second until the eighth week of
gestation during which time the embryo undergoes rapid growth and differentiation. During
organogenesis, the embryo is extremely vulnerable to teratogens such as medications, alcohol,
tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections.
Structural fetal defects are most likely to occur during this period because exposure to
teratogens either before or during a critical period of development of an organ can cause a
malformation.

15. A major fetal development characteristic at 16 weeks’ gestation is:

a. The average fetal weight is 450 grams
b. Lanugo covers entire body
c. Brown fat begins to develop
d. Teeth begin to form

ANS: d
Feedback
a. The average fetal weight at 16 weeks is 200 grams.
b. Lanugo is present on the head.
c. Brown fat begins to develop at 20 weeks.
d. This is the correct answer.

16. Karen, a 26-year-old woman, has come for preconception counseling and asks about
caring for her cat as she has heard that she “should not touch the cat during pregnancy.”
The clinic nurse’s best response is:
a. It is best if someone other than you changes the cat’s litter pan during pregnancy so
that you have no risk of toxoplasmosis during pregnancy.
b. It is important to have someone else change the litter pan during pregnancy and also
avoid consuming raw vegetables.
c. Have you had any “flu-like” symptoms since you got your cat? If so, you may have
already had toxoplasmosis and there is nothing to worry about.
d. Toxoplasmosis is a concern during pregnancy, so it is important to have someone else
change the cat’s litter pan and also to avoid consuming uncooked meat.

ANS: d
Feedback
a. The nurse should also explain that the patient should not eat uncooked meat as it is a
potential source for toxoplasmosis.
b. Raw vegetables are not a source for toxoplasmosis.
c. This is not an accurate way to diagnose if the woman has had toxoplasmosis.
d. Women need to be aware that Toxoplasma gondii, a single-celled parasite, is responsible for
the infection toxoplasmosis. The majority of individuals who become infected with
toxoplasmosis are asymptomatic, although when present, symptoms are described as “flu like”
and include glandular pain and enlargement and myalgia. Severe toxoplasmosis infection may
cause damage to the fetal brain, eyes, or other organs. Toxoplasmosis is usually acquired by
consuming raw or poorly cooked meat that has been contaminated with T. gondii.
Toxoplasmosis may also be acquired through close contact with feces from an infected animal
(usually cats) or soil that has been contaminated with T. gondii.

17. A couple who has sought infertility counseling has been told that the man’s sperm
count is very low. The nurse advises the couple that spermatogenesis is impaired when
which of the following occur?
a. The testes are overheated.
b. The vas deferens is ligated.
c. The prostate gland is enlarged.
d. The flagella are segmented.

ANS: a
Feedback
a. Spermatogenesis occurs in the testes. High temperatures harm the development of the
sperm.
b. When the vas deferens is ligated, a man has had a vasectomy and is sterile. The sterility is not
due to impaired spermatogenesis, but rather to the inability of the sperm to migrate to the
woman’s reproductive track.
c. The enlarged prostrate has no effect on spermatogenesis.
d. The flagella are the “tails” of the sperm. They are normally divided into the middle segment
and an end segment.

18. A nurse working with an infertile couple has made the following nursing diagnosis:
Sexual dysfunction related to decreased libido. Which of the following assessments is the
likely reason for this diagnosis?
a. The couple has established a set schedule for their sexual encounters.
b. The couple has been married for more than 8 years.
c. The couple lives with one set of parents.
d. The couple has close friends who gave birth within the last year.

ANS: a
Feedback
a. Couples who “schedule” intercourse often complain that their sexual relationship is
unsatisfying.
b. Years of marriage are not directly related to a couple’s sexual relationship.
c. The fact that the couple lives with one set of parents is unlikely related to their sexual
relationship.
d. Although it can be very difficult to be around couples who have become pregnant or have
healthy babies, this factor is not usually related to a couple’s sexual relationship.

True/False

19. The perinatal nurse explains to the student nurse that in the fetal circulation, the
lowest level of oxygen concentration is found in the umbilical arteries.

ANS: True
The highest oxygen concentration (PO2 = 30–35 mm Hg) is found in the blood returning from
the placenta via the umbilical vein; the lowest oxygen concentration occurs in blood shunted to
the placenta where reoxygenation takes place. The blood with the highest oxygen content is
delivered to the fetal heart, head, neck, and upper limbs, and the blood with the lowest oxygen
content is shunted toward the placenta.

Fill-in-the-Blank

20. After birth, the perinatal nurse explains to the new mother that __________ is the
hormone responsible for stimulating milk production.
ANS: prolactin
Following birth and delivery of the placenta, there is an abrupt decrease in estrogen. This event
triggers an increased secretion of prolactin (the hormone that stimulates milk production) by
the anterior pituitary gland. The posterior pituitary and hypothalamus play a role in the
production and secretion of oxytocin, a hormone that causes release of milk from the alveoli.

21. During prenatal class, the childbirth educator describes the two membranes that
envelop the fetus. The __________ contains the amniotic fluid, and the __________ is the thick,
outer membrane.

ANS: amnion; chorion

The embryonic membranes (chorion and amnion) are early protective structures that begin to
form at the time of implantation. The thick chorion, or outer membrane, forms first. It develops
from the trophoblast and encloses the amnion, embryo, and yolk sac. The amnion arises from
the ectoderm during early embryonic development. The amnion is a thin, protective structure
that contains the amniotic fluid. With embryonic growth, the amnion expands and comes into
contact with the chorion. The two fetal membranes are slightly adherent and form the amniotic
sac.

22. The perinatal nurse is teaching nursing students about fetal circulation and explains
that fetal blood flows through the superior vena cava into the right __________ via the
__________.

ANS: atrium; foramen ovale

Blood flows through the vein from the placenta to the fetus. Most of the blood bypasses the
liver and then enters the inferior vena cava by way of the ductus venosus, a vascular channel
that connects the umbilical vein to the inferior vena cava. The blood then empties into the right
atrium, passes through the foramen ovale (an opening in the septum between the right and left
atrium) into the left atrium, and then moves into the right ventricle and on into the aorta. From
the aorta, blood travels to the head, upper extremities, and lower extremities.

23. The perinatal nurse explains to the student nurse that the growing embryo is called a
__________ beginning at 8 weeks of gestational age.
ANS: fetus
Major organs are being formed (organogenesis) during the first weeks following fertilization.
During this time, the developing organism is called an embryo. By the end of 8 weeks, the
embryo has sufficiently developed to be called a fetus.

24. The perinatal nurse defines a __________ as any substance that adversely affects the
growth and development of the embryo/fetus.

ANS: teratogen
Teratogens (drugs, radiation, and infectious agents that can cause development of abnormal
structures in an embryo) and a variety of internal and external developmental events may
cause structural and functional defects.

25. __________ __________ __________ is when sperm and oocytes are mixed outside the woman’s
body and then placed into the fallopian tube via laparoscopy.

ANS: Gamete intrafallopian transfer

Gamete intrafallopian transfer, also referred to as GIFT, is used when there is a history of failed
infertility treatment for anovulation, or unexplained infertility, or low sperm count.

Multiple Response

26. A woman seeks care at an infertility clinic. Which of the following tests may this
woman undergo to determine what, if any, infertility problem she may have? (Select all
that apply.)
a. Chorionic villus sampling
b. Endometrial biopsy
c. Hysterosalpingogram
d. Serum FSH analysis

ANS. b, c, d
Feedback
a. Chorionic villus sampling is done to assess for genetic disorders of the fetus.
b. Endometrial biopsy is performed about 1 week following ovulation to detect the
endometrium’s response to progesterone.
c. Hysterosalpingogram is used to determine if fallopian tubes are patent.
d. Serum FSH levels are used to assess ovarian function.
27. A couple who has been attempting to become pregnant for 5 years is seeking
assistance from an infertility clinic. The nurse assesses the clients’ emotional responses
to their infertility. Which of the following responses would the nurse expect to find?
(Select all that apply.)
a. Anger at others who have babies.
b. Feelings of failure because they cannot make a baby.
c. Sexual excitement because they want to conceive a baby.
d. Guilt on the part of one partner because he or she is unable to give the other a baby.

ANS: a, b, d
Feedback
a. Infertile couples often feel anger toward couples who have babies.
b. Infertile couples often express feelings of personal failure.
c. Infertile couples undergoing infertility testing and treatment often express an aversion to sex.
d. Guilt is often expressed by the couple.

28. Which of the following places a couple at higher risk for conceiving a child with a
genetic abnormality? (Select all that apply.)
a. Maternal age over 35 years
b. Partner who has a genetic disorder
c. Maternal type 1 diabetes
d. Paternal heart disease

ANS: a, b
Fertility decreases after 35 years. A partner contributes half of the chromosomal makeup, and
genetic disorders can be inherited. Maternal diabetes can have an effect on the fetus/neonate,
such as causing complications such as macrosomia and hypoglycemia, but these are not
genetic disorders. Paternal heart disease can place the neonate at risk for heart disease later in
life, but this is not referred to as a genetic disorder, such as is trisomy 21 and hemophilia.

29. The ovarian cycle includes which of the following phases? (Select all that apply.)
a. Follicular phase
b. Secretory phase
c. Ovulatory phase
d. Luteal phase
e. Menstrual phase
ANS: a, c, d
Follicular phase, ovulatory phase, and luteal phase are part of the ovarian cycle. Secretory and
menstrual phases are part of the endometrial cycle.

30. A couple is undergoing an infertility workup. The semen analysis indicates a

decreased number of sperm and immature sperm. Which of the following factors can
have a potential effect on sperm maturity? (Select all that apply.)

a. The man rides a bike to and from work each day.

b. The man takes a calcium channel blocker for the treatment of hypertension.
c. The man drinks 6 cups of coffee a day.
d. The man was treated for prostatitis 12 months ago and has been symptom free since
treatment.

ANS: a, b
The daily riding of a bike can be the cause of prolonged heat exposure to the testicles.
Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel
blockers, can have an effect on sperm production. Coffee has not been associated with low
sperm counts. Prostatitis or other infections within the last 3 months may have an effect on the
sperm analysis. This man’s episode of prostatitis was 12 months prior.

31. The clinic nurse recognizes that pregnant women who are in particular need of
support are those who (select all that apply):
a. Are experiencing a second pregnancy
b. Are awaiting genetic testing results
c. Are experiencing a first pregnancy
d. Are trying to conceal this pregnancy as long as possible

ANS: b, d
A second pregnancy is not an indication of a woman in need of additional support. A support
system may be lacking for women who are trying to conceal a pregnancy or for women who are
trying to keep the news of their pregnancy from relatives or friends until results from genetic
tests are known. These individuals may need additional support from their nurses and other
health-care providers, as they are placed in a powerless situation while awaiting results and
face a pregnancy that may be in jeopardy.
Chapter 4: Physiological Aspects of Antepartum
Care
Chapter 4: Physiological Aspects of Antepartum Carea

Multiple Choice

1. Folic acid supplementation during pregnancy is to:

a. Improve the bone density of pregnant women

b. Decrease the incidence of neural tube defects in the fetus

c. Decrease the incidence of Down syndrome in the fetus

d. Improve calcium uptake in pregnant women

ANS: b
Feedback
a. Folic acid is not related to bone density.
b. Correct. The use of folic acid has decreased the incidence of neural tube defects by 50%.
c. The use of folic acid is not associated with a reduction in Down syndrome.
d. Folic acid is not related to calcium uptake in women.

2. The positive signs of pregnancy are:

a. All physiological and anatomical changes of pregnancy

b. All subjective signs of pregnancy

c. All those physiological changes perceived by the woman herself

d. The objective signs of pregnancy that can only be attributed to the fetus

ANS: d
Feedback
a. Physiological and anatomical changes of pregnancy are presumptive signs of pregnancy.
b. All subjective signs of pregnancy are the probable signs of pregnancy.
c. All those physiological changes perceived by the woman herself are presumptive signs of
pregnancy.
d. Correct. Positive signs of pregnancy are the objective signs of pregnancy that can only be
attributed to the fetus, such as fetal heart tones.

3. During a routine prenatal visit in the third trimester, a woman reports she is dizzy and
lightheaded when she is lying on her back. The most appropriate nursing action would be
to:

a. Order an EKG.
b. Report this abnormal finding immediately to her care provider.
c. Teach the woman to avoid lying on her back and to rise slowly because of supine
hypotension.
d. Order a nonstress test to assess fetal well-being.

ANS: c
Feedback
a. This is a normal occurrence in pregnancy and does not indicate pathology. The probable
cause of the problem is supine hypotension.
b. This is a normal finding that does not warrant immediate notification to her care provider.
c. Correct. Teaching the woman to avoid lying on her back because of occlusion of the vena
cava with the gravid uterus causes supine hypotension syndrome.
d. Antenatal testing is not indicated with supine hypotension.

4. Blood volume expansion during pregnancy leads to:

a. Iron-deficiency anemia

b. Maternal iron stores being insufficient to meet the demands for iron in fetal
development

c. Plasma fibrin increase of 40% and fibrinogen increase of 50%

d. Physiological anemia of pregnancy

ANS: d
Feedback
a. Iron-deficiency anemia is treated with iron supplementation. Iron-deficiency anemia is
defined as hemoglobin of less than 11 g/dL and hematocrit less than 33%.
b. Maternal iron stores that are insufficient to meet the demands for iron in fetal development
result in iron-deficiency anemia.
c. Hypercoagulation that occurs during pregnancy is to decrease the risk of postpartum
hemorrhage. These changes taking place are not related to blood volume expansion.
d. Correct. Physiological anemia of pregnancy, also referred to as pseudo-anemia of pregnancy,
is due to hemodilution. The increase in plasma volume is relatively larger than the increase in
RBCs that results in decreased hemoglobin and hematocrit values.

5. Intimate partner violence (IPV) against women consists of actual or threatened

physical or sexual violence and psychological and emotional abuse. Screening for IPV
during pregnancy is recommended for:

a. Pregnant women with a history of domestic violence

b. All pregnant women

c. All low-income pregnant women

d. Pregnant adolescents

ANS: b
Feedback
a. Intimate partner violence is underreported by women, necessitating universal screening.
b. Correct. AWHONN advocates for universal screening for domestic violence for all pregnant
women. Homicide is the most likely cause of death for pregnant or recently pregnant women,
and a significant portion of those homicides are committed by their intimate partners. One in
six pregnant women reported physical or sexual abuse during pregnancy, seriously impacting
maternal and fetal health and infant birth weight.
c. IPV crosses all ethnic, racial, religious, and socioeconomic levels.
d. IPV crosses all ethnic, racial, religious, and socioeconomic levels.

6. A woman presents to the prenatal clinic at 30 weeks’ gestation reporting dysuria,

frequency, and urgency with urination. Appropriate nursing actions include:

a. Obtain clean-catch urine to assess for a possible urinary tract infection.

b. Reassure the woman that the signs are normal urinary changes in the third trimester.

c. Teach the woman to decrease fluid intake to manage these symptoms.

d. Perform a Leopold’s maneuver to assess fetal position and station.

ANS: a
Feedback
a. Correct. Dysuria, frequency, and urgency with urination are signs and symptoms of a urinary
tract infection, necessitating further assessment and testing.
b. These are abnormal urinary symptoms in the third trimester.
c. Pregnant women need to increase their fluid intake during pregnancy, and dysuria and
urgency are abnormal.
d. Assessment of fetal position and station is not an appropriate response to reported signs
and symptoms of a urinary tract infection.

7. At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse
and tells you shyly that she wants to maintain a sexual relationship with her partner.
The best response is to:

a. Reassure woman/couple of normalcy of response

b. Suggest alternative positions for sexual intercourse and alternative sexual activity to
sexual intercourse

c. Recommend cessation of intercourse until after delivery due to advanced gestation

d. Suggest woman discuss this with her care provider at her next appointment

ANS: b
Feedback
a. Although this is a normal response, providing reassurance is not enough. Further
intervention is indicated.
b. Although shy to discuss this, she wants to maintain a sexual relationship with her partner.
Suggesting alternative positions for sexual intercourse and alternative sexual activity to sexual
intercourse provides the woman with information to maintain sexual relations.
c. She wants to maintain a sexual relationship with her partner, and there are no
contraindications to intercourse during a healthy pregnancy.
d. The patient is seeking out information and to defer her to her care provider at her next
appointment is inappropriate. Additionally, she may not be comfortable discussing this with
anyone else.

8. The clinic nurse talks to a 30-year-old woman at 34 weeks’ gestation who complains of
having difficulty sleeping. Jayne has noticed that getting back to sleep after she has been
up at night is difficult. The nurse’s best response is:
a. “This is abnormal; it is important that you describe this problem to the doctor.”
b. “This is normal, and many women have this same problem during pregnancy; try
napping for several hours each morning and afternoon.”
c. “This is abnormal; tell the doctor about this problem because diagnostic testing may
be necessary.”
d. “This is normal in pregnancy, particularly during the third trimester when you also feel
fetal movement at night; try napping once a day.”

ANS: d
Feedback
a. This sleep pattern is a normal finding.
b. Sleeping for several hours in the morning and afternoon would contribute to further sleep
disturbances at night.
c. This sleep pattern is a normal finding.
d. Pregnancy sleep patterns are characterized by reduced sleep efficiency, fewer hours of night
sleep, frequent awakenings, and difficulty going to sleep. Nurses can advise patients that
afternoon napping may help alleviate the fatigue associated with the sleep alterations.

9. A 26-year-old woman at 29 weeks’ gestation experienced epigastric pain following the

consumption of a large meal of fried fish and onion rings. The pain resolved a few hours
later. The most likely diagnosis for this symptom is:
a. Cholelithiasis
b. Influenza
c. Urinary tract infection
d. Indigestion

ANS: a
Feedback
a. The progesterone-induced prolonged emptying time of bile from the gallbladder, combined
with elevated blood cholesterol levels, may predispose the pregnant woman to gallstone
formation (cholelithiasis). Pain in the epigastric region following ingestion of a high-fat meal
constitutes the major symptom of these conditions. The pain is self-limiting and usually
resolves within 2 hours.
b. The symptoms described are not associated with influenza.
c. The symptoms described are not associated with urinary tract infection.
d. Prolonged emptying time of bile from the gallbladder, combined with elevated blood
cholesterol levels, make cholelithiasis a more probable diagnosis than indigestion.
10. The clinic nurse reviews the complete blood count results for a 30-year-old woman
who is now 33 weeks’ gestation. Tamara’s hemoglobin value is 11.2 g/dL, and her
hematocrit is 38%. The clinic nurse interprets these findings as:
a. Normal adult values
b. Normal pregnancy values for the third trimester
c. Increased adult values
d. Increased values for 33 weeks’ gestation

ANS: b
Feedback
a. The values are low normal for adults but represent normal findings for pregnant women.
b. During pregnancy the woman’s hematocrit values may appear low due to the increase in
total plasma volume (on average, 50%). Because the plasma volume is greater than the increase
in erythrocytes (30%), the hematocrit decreases by about 7%. This alteration is termed
“physiologic anemia of pregnancy,” or “pseudo-anemia.” The hemodilution effect is most
apparent at 32 to 34 weeks. The mean acceptable hemoglobin level in pregnancy is 11 to 12
g/dL of blood.
c. The values are not increased; they are low normal for adults but represent normal findings
for pregnant women.
d. The values are not increased; they are low normal for adults but represent normal findings
for pregnant women.

11. The clinic nurse is aware that the pregnant woman’s blood volume increases by:
a. 20% to 25%
b. 30% to 35%
c. 40% to 45%
d. 50% to 55%

ANS: c
Feedback
a. An increase in maternal blood volume begins during the first trimester and peaks at term.
The increase approaches 40% to 45%, not 20% to 25%.
b. An increase in maternal blood volume begins during the first trimester and peaks at term.
The increase approaches 40% to 45, not 30% to 35%.
c. An increase in maternal blood volume begins during the first trimester and peaks at term.
The increase approaches 40% to 45% and is primarily due to an increase in plasma and
erythrocyte volume. Additional erythrocytes, needed because of the extra oxygen requirements
of the maternal and placental tissue, ensure an adequate supply of oxygen to the fetus. The
elevation in erythrocyte volume remains constant during pregnancy.
d. An increase in maternal blood volume begins during the first trimester and peaks at term.
The increase approaches 40% to 45%, not as high as 50% to 55%.
12. The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and
position. The nurse’s hands are placed on the maternal abdomen to gently palpate the
fundal region of the uterus. This action is best described as the:
a. First maneuver
b. Second maneuver
c. Third maneuver
d. Fourth maneuver

ANS: a
Feedback
a. Leopold maneuvers are a four-part clinical assessment method used to determine the lie,
presentation, and position of the fetus. The first maneuver determines which fetal body part
(e.g., head or buttocks) occupies the uterine fundus. The examiner faces the patient’s head and
places the hands on the abdomen, using the palmar surface of the hands to gently palpate the
fundal region of the uterus. The buttocks feel soft, broad, and poorly defined and move with
the trunk. The fetal head feels firm and round and moves independently of the trunk.
b. Leopold maneuvers are a four-part clinical assessment method used to determine the lie,
presentation, and position of the fetus. The first maneuver is described in this scenario.
c. Leopold maneuvers are a four-part clinical assessment method used to determine the lie,
presentation, and position of the fetus. The first maneuver is described in this scenario.
d. Leopold maneuvers are a four-part clinical assessment method used to determine the lie,
presentation, and position of the fetus. The first maneuver is described in this scenario.

13. The clinic nurse talks with Kathy about her possible pregnancy. Kathy has
experienced amenorrhea for 2 months, nausea during the day with vomiting every other
morning, and breast tenderness. These symptoms are best described as:
a. Positive signs of pregnancy
b. Presumptive signs of pregnancy
c. Probable signs of pregnancy
d. Possible signs of pregnancy

ANS: b
Feedback
a. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements
palpated by the examiner.
b. Presumptive signs of pregnancy include amenorrhea, nausea and vomiting, frequent
urination, breast tenderness, perception of fetal movement, skin changes, and fatigue.
Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell
sign, Braxton Hicks sign, positive pregnancy test, and ballottement. Positive signs include fetal
heartbeat, visualization of the fetus, and fetal movements palpated by the examiner.
c. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign,
Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement.
d. Possible signs of pregnancy may vary widely.

14. Lina is an 18-year-old woman at 20 weeks’ gestation. This is her first pregnancy. Lina
is complaining of fatigue and listlessness. Her vital signs are within a normal range: BP =
118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina’s fundal height is at
the umbilicus, and she states that she is beginning to feel fetal movements. Her weight
gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches.
The perinatal nurse’s best approach to care at this visit is to:
a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week.
b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not
worry.
c. Teach Lina about the expected normal weight gain during pregnancy (approximately
20 pounds by 20 weeks’ gestation).
d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy,
including the risk of gestational diabetes.

ANS: a
Feedback
a. Nutrition and weight management play an essential role in the development of a healthy
pregnancy. Not only does the patient need to have an understanding of the essential nutritional
elements, she must also be able to assess and modify her diet for the developing fetus and her
own nutritional maintenance. To facilitate this process, it is the nurse’s responsibility to provide
education and counseling concerning dietary intake, weight management, and potentially
harmful nutritional practices. To facilitate this process, it is the nurse’s responsibility to gather
more information on the woman’s dietary practices through a food diary.
b. Nutrition and weight management play an essential role in the development of a healthy
pregnancy. To facilitate this process, it is the nurse’s responsibility to provide education and
counseling concerning dietary intake, weight management, and potentially harmful nutritional
practices.
c. Nutrition and weight management play an essential role in the development of a healthy
pregnancy. Not only does the patient need to have an understanding of the essential nutritional
elements, she must also be able to assess and modify her diet for the developing fetus and her
own nutritional maintenance. To facilitate this process, it is the nurse’s responsibility to provide
education and counseling concerning dietary intake, weight management, and potentially
harmful nutritional practices, not just inform the patient of expected normal weight gain.

d. Nutrition and weight management play an essential role in the development of a healthy
pregnancy. Not only does the patient need to have an understanding of the essential nutritional
elements, she must also be able to assess and modify her diet for the developing fetus and her
own nutritional maintenance. To facilitate this process, it is the nurse’s responsibility to provide
education and counseling concerning dietary intake, weight management, and potentially
harmful nutritional practices.
15. A woman presents to a prenatal clinic appointment at 10 weeks’ gestation, in the first
trimester of pregnancy. Which of the following symptoms would be considered a normal
finding at this point in pregnancy?
a. Occipital headache
b. Urinary frequency
c. Diarrhea
d. Leg cramps

ANS: b
Feedback
a. Headaches may be benign or, especially if noted after 20 weeks’ gestation, may be a
symptom of pregnancy-induced hypertension (PIH).
b. Urinary frequency is a common complaint of women during their first trimester.
c. Diarrhea is rarely seen in pregnancy. Constipation is a common complaint.
d. Leg cramps are commonly seen during the second and third trimesters.

16. The nurse is providing prenatal teaching to a group of diverse pregnant women. One
woman, who indicates she smokes two to three cigarettes a day, asks about its impact
on her pregnancy. The nurse explains that the most significant risk to the fetus is:
a. Respiratory distress at birth
b. Severe neonatal anemia
c. Low neonatal birth weight
d. Neonatal hyperbilirubinemia

ANS: C
Feedback
a. Respiratory distress is not the most significant risk to the fetus unless the fetus is also
premature.
b. Severe neonatal anemia is not associated with pregnancies complicated by cigarette
smoking.
c. Low neonatal birth weight is the most common complication seen in pregnancies
complicated by cigarette smoking.
d. Neonatal hyperbilirubinemia is not associated with pregnancies complicated by cigarette
smoking.

17. While performing Leopold’s maneuvers on a woman in early labor, the nurse palpates
a flat area in the fundal region, a hard round mass on the left side, a soft round mass on
the right side, and small parts just above the symphysis. The nurse concludes which of
the following?
a. The fetal position is right occiput posterior.
b. The fetal attitude is flexed.
c. The fetal presentation is scapular.
d. The fetal lie is vertical.

ANS: c
Feedback
a. This is a shoulder presentation.
b. It is not possible to determine whether the attitude is flexed or not when doing Leopold’s
maneuvers.
c. This is a shoulder presentation.
d. The lie is transverse or horizontal.

18. A nurse is reviewing diet with a pregnant woman in her second trimester. Which of
the following foods should the nurse advise the patient to avoid consuming during her
pregnancy?
a. Brie cheese
b. Bartlett pears
c. Sweet potatoes
d. Grilled lamb

ANS: a
Feedback
a. Soft cheese may harbor Listeria. The patient should avoid consuming uncooked soft cheese.
b. A pear is an excellent food for a pregnant woman to consume.
c. Sweet potatoes are an excellent food for a pregnant woman to consume.
d. Grilled lamb is an excellent food for a pregnant woman to consume, although it should be
well cooked.

19. The nurse is working in a prenatal clinic caring for a patient at 14 weeks’ gestation, G2
P1001. Which of the following findings should the nurse highlight for the nurse midwife?
a. Body mass index of 23
b. Blood pressure of 100/60
c. Hematocrit of 29%
d. Pulse rate of 76 bpm

ANS: c
Feedback
a. A body mass index of 23 is normal.
b. A blood pressure of 100/60 is normal.
c. A hematocrit of 29% indicates that the patient is anemic. The nurse should highlight the
finding for the nurse-midwife.
d. A pulse rate of 76 bpm is a normal rate.

20. A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm
above the symphysis. She denies experiencing quickening. Which of the following nursing
conclusions made by the nurse is correct?
a. The woman is experiencing a normal pregnancy.
b. The woman may be having difficulty accepting this pregnancy.
c. The woman must see a nutritionist as soon as possible.
d. The woman will likely miscarry the conceptus.

ANS: a
Feedback
a. The patient is experiencing a normal pregnancy.
b. Quickening is not felt until 16 to 20 weeks’ gestation.
c. There is no apparent need for a nutritionist to see this patient.
d. There is no indication in the scenario that this patient is at high risk for a miscarriage.

21. A patient at 37 weeks’ gestation is being seen in the prenatal clinic. Where would the
nurse expect the fundal height to be palpated?
a. At the xiphoid process
b. At a point between the umbilicus and the xiphoid
c. At the umbilicus
d. At a level directly above the symphysis pubis

ANS: a
Feedback
a. At 36 weeks’ gestation, the fundus should be felt at the xiphoid process.
b. At 36 weeks’ gestation, the fundus should be felt at the xiphoid process.
c. At 20 weeks’ gestation, the fundus should be felt at the umbilicus.
d. At 12 weeks’ gestation, the fundus should be felt directly above the symphysis pubis.

22. A nurse is performing an assessment on a pregnant woman during a prenatal visit.

Which of the following findings would lead the nurse to report to the obstetrician that
the patient may be experiencing intrauterine growth restriction (IUGR)?
a. Leopold’s maneuvers: Hard round object in the fundus, flat object on left of uterus,
small parts on right of uterus, soft round object above the symphysis
b. Weight gain: 6-pound increase over 4-week period
c. Fundal height measurement: 22 cm at 26 weeks’ gestation
d. Alpha-fetoprotein assessment: level is one-half normal, accompanied by complaints of
severe nausea and vomiting

ANS: c
Feedback
a. This baby is in the breech position. This is not a sign of IUGR.
b. This weight gain is slightly above normal. This is not a sign of IUGR.
c. The fundal height at 26 weeks should be approximately 26 cm. The fundal height, therefore,
is below expected. This patient may be experiencing intrauterine growth restriction.
d. A low AFP level is seen in patients whose babies have spina bifida and other central nervous
system defects.

23. A pregnant woman informs the nurse that her last normal menstrual period was on
July 6, 2007. Using Naegele’s rule, which of the following would the nurse determine to be
the patient’s estimated date of delivery (EDC)?
a. January 9, 2008
b. April 13, 2008
c. April 20, 2008
d. September 6, 2008

ANS: b
Feedback
a. The EDC is calculated as April 13, 2008.
b. The EDC is calculated as April 13, 2008. Naegele’s rule: subtract 3 months and add 7 days to
the first day of the last normal menstrual period.

c. The EDC is calculated as April 13, 2008.

d. The EDC is calculated as April 13, 2008.

24. Which of the following findings, seen in pregnant women in the third trimester,
would the nurse consider to be within normal limits?
a. Diplopia
b. Epistaxis
c. Bradycardia
d. Oliguria
ANS: b
Feedback
a. Diplopia is sometimes seen in patients with pregnancy-induced hypertension (PIH).
b. Epistaxis is commonly seen in pregnant patients. The bleeding is related to the increased
vascularity of the mucous membranes. Unless the blood loss is significant, it is a normal finding.
c. Bradycardia is often seen immediately after delivery but not during the third trimester.
d. Oliguria is seen in patients with PIH.

25. A primigravida patient is 39 weeks pregnant. Which of the following symptoms would
the nurse expect the patient to exhibit?
a. Nausea
b. Dysuria
c. Urinary frequency
d. Intermittent diarrhea

ANS: c
Feedback
a. Nausea is usually not seen in the third trimester.
b. Dysuria is not a normal finding at any time during a pregnancy. The possibility of a urinary
traction infection (UTI) should be considered.
c. Urinary frequency recurs at the end of the third trimester. As the uterus enlarges, it again
compresses the bladder causing urinary frequency.
d. Diarrhea is not a normal finding at any time during a pregnancy.

26. The nurse has taken a health history on four multigravida patients at their first
prenatal visits. It is high priority that the patient whose first child was diagnosed with
which of the following diseases receives nutrition counseling?
a. Development dysplasia of the hip
b. Achondroplastic dwarfism
c. Spina bifida
d. Muscular dystrophy

ANS: c
Feedback
a. The etiology of developmental dysplasia of the hip is unrelated to the mother’s nutritional
status.
b. Achondroplasia is an inherited defect. Its etiology is unrelated to the mother’s nutritional
status.
c. The incidence of spina bifida is much higher in women with poor folic acid intakes. It is a
priority that this patient receives nutrition counseling.
d. Most forms of muscular dystrophy are inherited. Their etiologies are unrelated to the
mother’s nutritional status.

27. A nurse working in a prenatal clinic is caring for a woman who asks advice on foods
that are high in vitamin C because “I hate oranges.” The nurse states that 1 cup of which
of the following raw foods will meet the patient’s daily vitamin C needs?
a. Strawberries
b. Asparagus
c. Iceberg lettuce
d. Cucumber

ANS: a

Feedback
a. Strawberries are an excellent source of vitamin C.
b. Although asparagus has some vitamin C, it is not an excellent source.
c. Iceberg lettuce is a poor source of vitamin C.
d. Cucumber is a poor source of vitamin C.

28. The nurse notes each of the following findings in a woman at 10 weeks’ gestation.
Which of the findings would enable the nurse to tell the woman that she is probably
pregnant?
a. Fetal heart rate via Doppler
b. Positive pregnancy test
c. Positive ultrasound assessment
d. Absence of menstrual period

ANS: b
Feedback
a. A fetal heart rate is a positive sign of pregnancy.
b. A positive pregnancy test is a probable sign of pregnancy. It is not a positive sign because the
hormone tested for—human chorionic gonadatropin (hCG)—may be being produced by, for
example, a hydatidiform mole.
c. A positive ultrasound is a positive sign of pregnancy.
d. Amenorrhea is a presumptive sign of pregnancy.

29. A nurse who is discussing serving sizes of foods with a new prenatal patient would
state that which of the following is equal to 1 (one) serving from the dairy food group?
a.. 1 cup low-fat milk
b. ½ cup vanilla yogurt
c. ½ cup cottage cheese
d.. 1 ounce cream cheese

ANS: a
Feedback
a. 1 cup of any milk (e.g., whole milk, skim milk, buttermilk, chocolate milk) is equal to 1 serving
size from the dairy group.
b. 1 cup of yogurt is equal to 1 serving size from the dairy group.
c. 1 ½ cup of cottage cheese is equal to 1 serving size from the dairy group.
d. Cream cheese is not included in the dairy group. It is a fat product.

30. The nurse who is assessing a G2 P1 palpates the fundal height at the location noted
on the picture below.
The nurse concludes that the fetus is equal to which of the following gestational ages?
a. 12 weeks
b. 20 weeks
c. 28 weeks
d. 36 weeks

ANS: b
Feedback
a. At 12 weeks’ gestation, the fundus should be felt at the level of the symphysis pubis.
b. The fundus at the level of the umbilicus indicates 20 weeks’ gestation. In this question, the
fact that this patient is a multigravida is not relevant. Uterine growth should be consistent for
both primigravidas and multigravidas.
c. At 28 weeks’ gestation, the fundus should be felt 8 cm above the level of the umbilicus.
d. At 36 weeks’ gestation, the fundus should be felt at the xiphoid process.

31. A patient at 28 weeks’ gestation was last seen in the prenatal clinic at 24 weeks’
gestation. Which of the following changes should the nurse bring to the attention of the
Certified Nurse Midwife?
a. Weight change from 128 pounds to 132 pounds
b. Pulse change from 88 bpm to 92 bpm
c. Blood pressure change from 110/70 to 140/90
d. Respiratory change from 16 rpm to 20 rpm

ANS: c
Feedback
a. A weight change of approximately 4 pounds in 4 weeks is normal in the second and third
trimesters of pregnancy.
b. This pulse rate change is within normal limits.
c. A blood pressure elevation to 140/90 is a sign of mild preeclampsia.
d. This respiratory rate change is within normal limits.

32. The clinic nurse includes screening for domestic violence in the first prenatal visit for
all patients. An appropriate question would be:
a. This is something that we ask everyone. Do you feel safe in your current living
environment and relationships?
b. This is something we ask everyone. Do you have any abuse in your life right now?
c. Is your partner threatening or harming you in any way right now?
d. I need to ask you, do you feel safe from abuse right now?

ANS: a
Feedback
a. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or
psychologically hurting the patient more. A nonthreatening approach is to ask patients directly
whether they feel safe going home and whether they have been hurt physically, emotionally, or
sexually by a past or present partner.
b. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or
psychologically hurting the patient more. A nonthreatening approach is to ask patients directly
whether they feel safe going home rather than asking if they have any abuse, as women may
define abuse differently than care providers.
c. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or
psychologically hurting the patient more. A nonthreatening approach is to ask patients directly
whether they feel safe going home and whether they have been hurt physically, emotionally, or
sexually by a past or present partner.
d. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or
psychologically hurting the patient more. A nonthreatening approach is to ask patients directly
whether they feel safe going home rather than asking if they have any abuse, as women may
define abuse differently than care providers.

Multiple Response

33. An 18-year-old woman at 23 weeks’ gestation tells the nurse that she has fainted two
times. The nurse teaches about the warning signs that often precede syncope so that she
can sit or lie down to prevent personal injury. Warning signs include (select all that
apply):
a. Sweating
b. Nausea
c. Chills
d. Yawning
ANS: a, b, d
Sweating is a warning sign that often precedes syncope. Syncope (a trandient loss of
consciousness and postural tone with spontaneous recovery) during pregnancy is frequently
attributed to orthostatic hypotension or inferior vena cava compression by the gravid uterus.
Nausea and yawning are warning signs that often precede syncope. Lightheadedness, sweating,
nausea, yawning, and feelings of warmth are warning signs that often precede syncope. Chills
are not a warning sign that often precede syncope.

34. The perinatal nurse teaches the student nurse about the physiological changes in
pregnancy that most often contribute to the increased incidence of urinary tract
infections. These changes include (select all that apply):
a. Relaxation of the smooth muscle of the urinary sphincter
b. Relaxation of the smooth muscle of the bladder
c. Inadequate emptying of the bladder
d. Increased incidence of bacteriuria

ANS: a, b, c, d
Ascension of bacteria into the bladder can cause asymptomatic bacteriuria (ASB), or urinary
tract infections (UTIs). These infections occur more frequently in pregnancy due to relaxation of
the smooth muscle of the bladder and urinary sphincter and inadequate emptying of the
bladder, changes that allow bacterial ascent into the bladder.

35. The clinic nurse discusses normal bladder function in pregnancy with a 22-year-old
pregnant woman who is now in her 29th gestational week. The nurse explains that at
this time in pregnancy, it is normal to experience (select all that apply):
a. Urinary frequency
b. Urinary urgency
c. Nocturia
d. Incontinence

ANS: a, b, c
During pregnancy, the bladder, a pelvic organ, is compressed by the weight of the growing
uterus. The added pressure, along with progesterone-induced relaxation of the urethra and
sphincter musculature, leads to urinary urgency, frequency, and nocturia. Incontinence of urine
is not a normal change during pregnancy.
36. A 32-year-old woman now at 32 weeks’ gestation is complaining of right-sided sharp
abdominal pain. The patient is examined by the clinic nurse and given information about
abdominal discomfort in pregnancy. She is also instructed to seek immediate attention if
she (select all that apply):
a. Has heartburn
b. Has chills or a fever
c. Feels decreased fetal movements
d. Has increased abdominal pain

ANS: b, c, d
Heartburn is a common discomfort throughout pregnancy. Because the appendix is pushed
upward and posterior by the gravid uterus, the typical location of pain is not a reliable indicator
for a ruptured appendix during pregnancy. The pain should gradually subside, but if it persists
or is accompanied by fever, a change in bowel habits, or decreased fetal movement, the patient
should promptly contact her medical provider.

37. The clinic nurse talks with Suzy, a pregnant woman at 9 weeks’ gestation who has just
learned of her pregnancy. Suzy’s nausea and vomiting are most likely caused by (select
all that apply):
a. Increased levels of estrogen
b. Increased levels of progesterone
c. An altered carbohydrate metabolism
d. Increased levels of human chorionic gonadotropin

ANS: c, d
Nausea and vomiting during the first trimester most likely are related to rising levels of human
chorionic gonadotropin (hCG) and altered carbohydrate metabolism. Changes in taste and
smell, due to alterations in the oral and nasal mucosa, can further aggravate the
gastrointestinal discomfort.

38. The clinic nurse encourages all pregnant women to increase their water intake to at
least 8 to 10 glasses per day in order to (select all that apply):
a. Decrease the risk of constipation
b. Decrease the risk of bile stasis
c. Decrease their feelings of fatigue
d. Decrease the risk of urinary tract infections

ANS: a, b, c, d
Patients should be encouraged to drink at least 8 to 10 glasses of water each day and empty
their bladders at least every 2 to 3 hours and immediately after intercourse. These measures
will help prevent stasis of urine and the bacterial contamination that leads to infection, as well
as constipation. Some women experience symptoms of fatigue that can be alleviated by
remaining adequately hydrated.

39. The perinatal nurse examines the thyroid gland as part of the physical examination
of Savannah, a pregnant woman who is now at 16 weeks’ gestation. The perinatal nurse
informs Savannah that during pregnancy (select all that apply):
a. Increased size of the thyroid gland is normal
b. Increased function of the thyroid gland is normal
c. Decreased function of the thyroid gland is normal
d. The thyroid gland will return to its normal size and function during the postpartal
period

ANS: a, b, d
The thyroid gland changes in size and activity during pregnancy. Enlargement is caused by
increased circulation from the progesterone-induced effects on the vessel walls, and by
estrogen-induced hyperplasia of the glandular tissue. The thyroid gland increases not
decreases in size and activity during pregnancy. The thyroid gland returns to normal size and
activity postpartum.

40. The clinic nurse describes the respiratory system changes common to pregnancy to
the new nurse. These changes include (select all that apply):
a. An increased tidal volume
b. A decreased airway resistance
c. An increased chest circumference
d. An increased airway resistance

ANS: a, b, c
During pregnancy, a number of changes occur to meet the woman’s increased oxygen
requirements. The tidal volume (amount of air breathed in each minute) increases 30% to 40%.
The enlarging uterus creates an upward pressure that elevates the diaphragm and increases
the subcostal angle. The chest circumference may increase by as much as 6 centimeters, and
airway resistance decreases. Although the “up and down” capacity of diaphragmatic movement
is reduced, lateral movement of the chest and intercostal muscles accommodates for this loss
of movement and keeps pulmonary functions stable. There is no increase in airway resistance
during pregnancy.

41. The clinic nurse teaches the new nurse about pregnancy-induced blood clotting
changes. The nurse explains that a pregnant woman is at risk for venous thrombosis due
to (select all that apply):
a. Increased fibrinogen volume
b. Increased blood factor V
c. Increased blood factor X
d. Venous stasis

ANS: a, c, d
Although the platelet cell count does not change significantly during pregnancy, fibrinogen
volume has been shown to increase by as much as 50%. This alteration leads to an increase in
the sedimentation rate. Blood factors VII, VIII, IX, and X are also increased, and this change
causes hypercoagulability. The hypercoagulability state, coupled with venous stasis (poor blood
return from the lower extremities) places the pregnant woman at an increased risk for venous
thrombosis, embolism, and, when complications are present, disseminated intravascular
coagulation (DIC). Blood factor V does not increase.

42. The clinic nurse describes possible interventions for the pregnant woman who is
experiencing pain and numbness in her wrists. The nurse suggests (select all that apply):
a. Elevating the arms and wrists at night
b. Reassessment during the postpartum period
c. The use of “cock splints” to prevent wrist flexion
d. Massaging the hands and wrists with alcohol

ANS: a, b, c
Edema from vascular permeability can lead to a collection of fluid in the wrist that puts
pressure on the median nerve lying beneath the carpal ligament, leading to carpal tunnel
syndrome. Elevation of the hands at night may help to reduce the edema. Occasionally, a
woman may need to wear a “cock splint” to prevent the wrist from flexing. Reassessment in the
postpartum period is indicated because although carpal tunnel syndrome usually subsides
after the pregnancy has ended, some women may require surgical treatment if symptoms
persist. Massaging the hands and wrists with alcohol does not improve pain and numbness.

43. The clinic nurse advocates for smoking cessation during pregnancy. Potential harmful
effects of prenatal tobacco use include (select all that apply):
a. Preterm birth
b. Gestational hypertension
c. Gestational diabetes
d. Low birth weight

ANS: a, d
Nurses can help to improve the fetal environment by educating women about the dangers of
direct and passive smoking during pregnancy. Effects of tobacco use during pregnancy are well
documented and predispose to premature rupture of the membranes, preterm labor, placental
abruption, placenta previa, and infants who are low birth weight or small for gestational age
(SGA). Gestational hypertension and diabetes are not associated with smoking during
pregnancy.

44. Asking the pregnant woman about her use of recreational drugs is an essential
component of the prenatal history. Harmful fetal effects that may occur from
recreational drugs include (select all that apply):
a. Miscarriage/spontaneous abortion
b. Low birth weight
c. Macrosomia
d. Post-term labor/birth

ANS: a, b
Illegal or recreational drug use can have a number of detrimental effects on maternal and fetal
health, including spontaneous abortion, low birth weight, placental abruption, and preterm
labor.

45. The clinic nurse schedules Tracy for her first prenatal appointment with the certified
nurse-midwife (CNM) in the clinic. Tracy has appropriate questions for her potential
health-care provider that include (select all that apply):
a. Complementary and alternative methods used during labor and birth
b. An opportunity to meet other providers in the practice
c. Beliefs and practices concerning an episiotomy and an epidural anesthetic
d. Whether the nurse-midwife will be continually available for support during labor

ANS: a, b, c
A woman’s journey through the pregnancy experience can have long-term effects on her self-
perception and self-concept. Therefore, it is especially important that the patient choose a care
provider and group with whom she can openly relate and who shares the same philosophical
views on the management of pregnancy. At the first prenatal visit, it is not common to explore
whether the nurse-midwife will be continually available for support during labor.

46. The clinic nurse explains to Margaret, a newly diagnosed pregnant woman at 10
weeks’ gestation, that her rubella titer indicates that she is not immune. Margaret
should be advised to (select all that apply):
a. Avoid contact with all children
b. Be retested in 3 months
c. Receive the rubella vaccine postpartum
d. Report signs or symptoms of fever, runny nose, and generalized red rash to the health-
care provider
ANS: c, d
Testing for rubella (German measles) is not necessary as titers are reliable indicators of
immunity. Rubella (German measles) is one of the most commonly recognized viral infections
known to cause congenital problems. If a woman contracts rubella during the first 12 weeks of
pregnancy, the fetus has a 90% chance of being adversely affected. A maternity patient who is
not immune to rubella should be offered the rubella immunization following childbirth, ideally
prior to hospital discharge. The patient should report signs or symptoms of rubella during
pregnancy to her health-care provider. It is not realistic for a woman to avoid contact with all
children.

47. An overweight or obese pre-pregnancy weight increases the risk for which poor
maternal outcomes? (Select all that apply.)
a. Preeclampsia
b. Hemorrhage
c. Difficult delivery
d. Vaginal infections

ANS: a, b, c
Being overweight or obese can substantially increase perinatal risk; however, no data support
an increase in vaginal infections for the obese pregnant population.

48. Presumptive signs of pregnancy include (select all that apply):

a. Nausea
b. Fatigue
c. Ballottement
d. Amenorrhea

ANS: a, b, d
Nausea and vomiting, fatigue, and amenorrhea are all common during pregnancy and are the
presumptive signs of pregnancy. Ballottement is a probably sign, noted during a vaginal exam.

49. Physiologic changes that occur in the renal system during pregnancy predispose the
pregnant woman to urinary tract infections (UTIs). Symptoms of a UTI include (select all
that apply):
a. Dysuria
b. Hematuria
c. Urgency
d. Delayed urination
ANS: a, b, c
Urinary tract infection (UTI) symptoms include dysuria, hematuria, and urgency.

50. Urinary tract infection (UTI) prevention measures during pregnancy include
counseling the pregnant woman to (select all that apply):
a. Delay urination until bladder is full
b. Limit hydration
c. Wipe from front to back
d. Urinate after intercourse

ANS: a, c, d
Anticipatory guidance for urinary tract infection prevention includes delaying urination, wipe
front to back, and maintaining adequate hydration.

51. Interventions for low back pain during pregnancy should include (select all that
apply):
a. Utilizing proper body mechanics
b. Applying ice or heat to affected area
c. Avoiding pelvic rock and pelvic tilt
d. Using additional pillows for support during sleep

ANS: a, b, d
Interventions for back pain during pregnancy include utilizing proper body mechanics, applying
heat or ice to the area, using additional pillows during sleep, and not avoiding pelvic rock/tilt,
but encouraging pelvic rock/tilt.

52. Jorgina is a 24-year-old pregnant woman at 26 weeks’ gestation. This is Jorgina’s third
pregnancy, and her obstetrical history includes one full-term birth, one preterm birth,
and two living children. Today Jorgina arrives at the clinic with complaints of fatigue,
insomnia, and backache. She reports that she is a nurse on an oncology unit and is
worried about continuing with working her 12-hour shifts. The perinatal nurse identifies
concerns in Jorgina’s history and work environment including (select all that apply):
a. Risk of preterm birth
b. Presence of chemotherapeutic agents
c. Requirement for heavy lifting
d. History of diabetes

ANS: a, b, c
Women who are currently experiencing pregnancy complications and those who have a history
of pregnancy complications (such as history of preterm birth) or other preexisting health
disorders may be required to reduce their hours or stop working. The potential for maternal
exposure to toxic substances such as chemotherapeutic agents, lead, and ionizing radiation
(found in laboratories and health-care facilities); heavy lifting; and use of heavy machinery and
other hazardous equipment should prompt reassignment to a different work area. If
reassignment is not possible, Jorgina may need to stop working until the pregnancy has been
completed. In this scenario there is no history of diabetes.

53. The clinic nurse is assessing the complete blood count results for Kim-Ly, a 23-year-
old pregnant woman. Kim-Ly’s hemoglobin is 9.8 g/dL. This laboratory finding places Kim-
Ly’s pregnancy at risk for (select all that apply):
a. Preterm birth
b. Placental abruption
c. Intrauterine growth restriction
d. Thrombocytopenia

ANS: a, c
True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10
g/dL. The blood’s decreased oxygen-carrying capacity causes a reduction in oxygen transport to
the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine
growth restriction (IUGR) and preterm birth. There is not a risk factor for abruption or
thrombocytopenia.

54. Teera is a 22-year-old woman who is experiencing her third pregnancy. Her
obstetrical history includes one first-trimester elective abortion and one first-trimester
spontaneous abortion. Teera is a semi-vegetarian who drinks milk and eats yogurt and
fish as part of her daily intake. The perinatal nurse discusses Teera’s diet with her as she
may be deficient in (select all that apply):
a. Iron
b. Magnesium
c. Zinc
d. Vitamin B12

ANS: a, c
Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork and
have adequate intake of magnesium. Pregnant women who adhere to this diet may consume
inadequate amounts of iron and zinc. Because strict vegetarians (vegans) consume only plant
products, their diets are deficient in vitamin B12, found only in foods of animal origin.

55. During the initial antenatal visit, the clinic nurse asks questions about the woman’s
nutritional intake. Specific questions should include information pertaining to (select all
that apply):
a. Preferred foods
b. The presence of cravings
c. Use of herbal supplements
d. Aversions to certain foods and odors

ANS: a, b, c, d
The nurse should obtain a nutritional history on all pregnant patients and patients of
childbearing age to gain specific information related to the pregnancy, including foods that are
preferred while pregnant (which may provide information about cultural and environmental
dietary factors), special diets (which will assist the nurse in planning for education or
interventions for risk factors associated with dietary practices), cravings or aversions to specific
foods, and use of herbal supplements.

56. The perinatal nurse talks to the prenatal class attendees about guidelines for
exercise in pregnancy. Recommended guidelines include (select all that apply):
a. Stopping if the woman is tired
b. Bouncing and slowly arching the back
c. Increasing fluid intake throughout the physical activity
d. Maintaining the ability to walk and talk during exercise

ANS: a, c, d
Women should adhere to some basic safety guidelines when formulating their exercise
program, including monitoring the breathing rate and ensuring that the ability to walk and talk
comfortably is maintained during physical activity, stopping exercise when the woman becomes
tired, and maintaining adequate fluid intake. Pregnant women should avoid exercises that can
cause any degree of trauma to the abdomen or those that include rigorous bouncing, arching
of the back, or bending beyond a 45-degree angle.

Short Answer

57. Lesions at the gum line that bleed easily

ANS: Epulis gravidarum

58. Anterior convexity of the lumbar spine

ANS: Lumbar lordosis

59. Increased saliva production

ANS: Ptyalism

60. Reflux of the stomach contents into the esophagus

ANS: Pyrosis

61. Severe itching due to stasis of bile in the liver

ANS: Pruritis gravidarum

62. Nosebleeds

ANS: Epistaxis

True/False

63. The clinic nurse speaks with the student nurse prior to the physical examination of a
pregnant woman who is 32 weeks’ gestation. The clinic nurse explains that the heart
sounds heard in pregnancy are usually S1 and S3 with a possible murmur related to
increased cardiac output.

ANS: True
Exaggerated first and third heart sounds and systolic murmurs are common findings during
pregnancy. The murmurs are usually asymptomatic and require no treatment.

64. Cecilia, a pregnant woman at 30 weeks’ gestation, has her vital signs assessed during
a routine prenatal visit. Cecilia’s blood pressure has remained at 110/70 for the last few
visits, and her pulse rate has increased from 70 to 80 beats per minute. These findings
would be considered normal at this time in pregnancy.

ANS: True
During the first trimester, blood pressure normally remains the same as prepregnancy levels
but then gradually decreases up to around 20 weeks’ of gestation. After 20 weeks, the vascular
volume expands and the blood pressure increases to reach prepregnant levels by term.
65. The clinic nurse knows that every time a woman of childbearing age comes in to the
office for a health maintenance visit, she should be counseled about the benefits of daily
folic acid supplementation.

ANS: True
Because of the strong connection between folic acid deficiency and the subsequent
development of neural tube defects, all women of childbearing age should take a folic acid
supplement of at least 400 mcg/day.

66. The perinatal nurse recommends strengthening exercises during pregnancy, as this
can improve posture and increase energy levels.

ANS: True
Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy,
which include weight gain and postural changes. Muscle strengthening exercises also help to
decrease the risk of ligament and joint injury.

67. The perinatal nurse explains to the new nurse that ptyalism is a condition more acute
than the normal nausea and vomiting of pregnancy and is often associated with
dehydration, hypokalemia, and weight loss.

ANS: False
Hyperemesis gravidarum is a pregnancy-related condition characterized by persistent,
continuous, severe nausea and vomiting, often accompanied by dry retching. Hyperemesis
gravidarum results in weight loss and fluid and electrolyte imbalance. Ptyalism is an excessive
production of saliva.

Fill-in-the-Blank

68. The clinic nurse explains to the new nurse that during pregnancy, the maternal
metabolism is altered to support the pregnancy by the hormones __________ and __________,
which are produced by the anterior __________ gland.

ANS: thyrotropin; adrenotropin; pituitary

Maternal metabolism is altered to support the pregnancy by thyrotropin and adrenotropin.
These hormones, produced by the anterior pituitary gland, exert their effects on the thyroid
and adrenal glands. Thyrotropin causes an increased basal metabolism, and adrenotropin
alters adrenal gland function to increase fluid retention by the kidneys.

69. During the prenatal class, the perinatal nurse describes factors that may initiate the
process of labor. One of these factors is the production of __________, which are found in
the uterine __________ and are released from the __________ at term as it softens and dilates.

ANS: prostaglandins; decidua or lining; cervix

Prostaglandins are lipid substances found in high concentrations in the female reproductive
tract and in the uterine decidua during pregnancy. Their exact function in pregnancy is
unknown, although they may maintain a reduced placental vascular resistance. A decrease in
prostaglandin levels may contribute to hypertension and preeclampsia. At term, an increased
release of prostaglandins from the cervix as it softens and dilates may contribute to the onset
of labor.

70. The perinatal nurse describes common complaints of pregnancy to the prenatal class
attendees. Nasal __________, medically termed “__________ of pregnancy,” is caused by
increased levels of estrogen and progesterone.

ANS: stuffiness; rhinitis

Nasal stuffiness and congestion (rhinitis of pregnancy) are common complaints during
pregnancy. The nurse should educate the patient about these normal changes and offer
reassurance. Increasing oral fluid intake helps to keep the mucus thin and easier to mobilize.

71. The clinic nurse promotes a diet rich in vitamin __________ during the third trimester to
prevent the possibility of __________ rupture of the membranes.

ANS: C; premature
Low levels of vitamin C may predispose women to premature rupture of membranes. As the
cellular availability of vitamin C decreases, the rate of degradation of cervical collagen
increases. With decreased collagen, the cervix more easily ripens, prompting effacement and
dilatation.

72. The clinic nurse monitors the blood pressure and assesses a woman’s urine at each
prenatal visit to assess for signs or symptoms of __________. A previous history or the
presence of a __________ are also risk factors.

ANS: preeclampsia; new partner

A previous history of preeclampsia increases the woman’s likelihood of a recurrence during
subsequent pregnancies. If a woman did not experience preeclampsia with previous
pregnancies but has a new partner for her current pregnancy, her risk of developing
preeclampsia is similar to that of a woman who is pregnant for the first time. Although
preeclampsia is a systemic disorder that occurs only during pregnancy, it is generally
recognized by two classic symptoms: elevated blood pressure and proteinuria.

73. The clinic nurse is aware of the importance of chlamydia screening during pregnancy.
Chlamydia transmission to the infant at __________ may result in __________.

ANS: birth; ophthalmia neonatorum

Chlamydia trachomatis is a bacteria that causes infection that is prevalent in sexually active
populations, especially those in the under-25 age group. Complications of chlamydia infections
include salpingitis, pelvic inflammatory disease, infertility, ectopic pregnancy, premature
rupture of the membranes, and preterm birth. Transmission to the neonate may occur during
birth and results in ophthalmia neonatorum and chlamydial neonatal pneumonia.
74. The prenatal nurse describes the need for __________ and __________ screening at the first
antenatal visit. If the pregnant woman is not immune, she will be counseled to avoid
contact with young children who have a rash and could be infectious.

ANS: rubella; varicella

Some of the routine maternal laboratory tests screen for childhood diseases that are known to
cause congenital anomalies or other pregnancy complications if contracted during early
pregnancy. When contracted during the first trimester, rubella causes a number of fetal
deformities. Varicella (chickenpox) is another common childhood disease that may cause
problems in the developing embryo and fetus. Therefore, all pregnant women are screened for
rubella and varicella.

75. The prenatal nurse cautions a pregnant woman about Caesar salad consumption
during pregnancy or any source of __________ or __________ milk.

ANS: raw eggs; unpasteurized

A word of caution should be provided by health-care providers to pregnant women with regard
to microbial food-borne illness. Raw, or unpasteurized, milk as well as partially cooked eggs and
foods containing raw or partially cooked eggs should be avoided.

76. The clinic nurse describes to the student nurse that __________ is excessive saliva
production in pregnancy. This condition is most likely caused by increased __________
levels.

ANS: ptyalism; hormone

Ptyalism, or excessive salivation, can be quite distressing for the pregnant woman who must
frequently wipe her mouth or spit into a cup. Although the cause of ptyalism is unknown, it is
most likely related to increased hormone levels.

77. The clinic nurse talks with the newly diagnosed pregnant woman about the nausea
that the woman is experiencing in this pregnancy. The clinic nurse suggests eating
__________ meals more often, remaining __________ after eating, and the using __________
techniques.

ANS: smaller; upright; relaxation

Nausea is often one of the first symptoms of pregnancy experienced. Nurses can suggest
strategies to help offset the nausea, such as the avoidance of “trigger foods” (foods that cause
nausea from sight or smell) and tight clothing that constricts the abdomen. The use of
relaxation techniques (i.e., slow, deep breathing, mental imagery) can also help to decrease
nausea. Other techniques that are often helpful include consuming plain, dry crackers or
sucking on peppermint candy before arising; adhering to small, frequent meals; and remaining
in an upright position after eating.
78. The clinic nurse understands that the physiological changes of pregnancy include
vascular relaxation from the effects of __________ and impaired venous circulation from
pressure exerted by the enlarged uterus, predisposing the pregnant woman to __________.

ANS: progesterone; varicose veins

Progesterone results in vascular relaxation which combined with impaired venous return
increases the incidence of varicose veins in pregnant women.

79. The perinatal nurse knows that __________, which is the eating of nonnutritive
substances, is a common __________.

ANS: pica; eating disorder

Pica, the consumption of nonnutritive substances or food, is a common eating disorder that can
affect pregnancy. Substances that are most often ingested include clay, dirt, cornstarch, and ice.

Matching

The clinic nurse understands the meaning of the following terms related to pregnancy care.
Match these terms with the definitions listed below:
Advocacy
Lordosis
Amenorrhea
Ballottement
Striae gravidarum
Preterm birth

80. Passive movement of the unengaged fetus

81. Verbalizing someone else’s wishes if he or she is unable to do so

82. Absence of menses

83. Curvature of the spine

84. Stretch marks

80 ANS: Ballottement, 81 ANS: Advocacy, 82 ANS: Amenorrhea, 83 ANS: Lordosis, 84 ANS: Striae
gravidarum

Chapter 5: Psycho-Social-Cultural Aspects of

the Antepartum Period
Chapter 5: Psycho-Social-Cultural Aspects of the Antepartum Period

Multiple Choice

1. Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is
probably exhibiting signs of:

a. Mental illnes

sb. Delusions

c. Attachment

d. Crisis

ANS: c
Feedback
a. This is normal maternal–fetal adaptation.
b. Delusions are not real, and the fetus is real.
c. Correct, because talking to the fetus is a sign of positive maternal adaptation. All other
answers indicate pathology.
d. Interacting with the fetus in utero represents normal development of attachment to the
fetus.

2. What is the most common expected emotional reaction of a woman to the news that
she is pregnant?

a. Jealousy

b. Acceptance

c. Ambivalence

d. Depression

ANS: c
Feedback
a. Others in the family may be jealous of the fetus, but that is not a common maternal
response.
b. Acceptance of the pregnancy typically occurs later in the pregnancy.
c. Ambivalence is a normal expected reaction to the news of pregnancy, whether or not the
pregnancy is planned or wanted.

3. Which of the following information regarding sexual activity would the nurse give a
pregnant woman who is 35 weeks’ gestation?

a. Sexual activity should be avoided from now until 6 weeks postpartum.

b. Sexual desire may be affected by nausea and fatigue.

c. Sexual desire may be increased due to increased pelvic congestion.

d. Sexual activity may require different positions to accommodate the woman’s comfort.

ANS: d
Feedback
a. There are no contraindications to sexual activity during this time for a normally progressing
pregnancy.
b. Nausea and fatigue affect sexual desire during the first trimester, not the third.
c. Increased sexual desire r/t increased pelvic congestion is a characteristic of the second
trimester, not the third.
d. Correct. An enlarging abdomen creates feelings of awkwardness and bulkiness and may
require couples to modify intercourse positions for the pregnant woman’s comfort.

4. Which statement best exemplifies adaptation to pregnancy in relation to the

adolescent?

a. Adolescents adapt to motherhood in a similar way to other childbearing women.

b. Social support has very little effect on adolescent adaptation to pregnancy.

c. The pregnant adolescent faces the challenge of multiple developmental tasks.

d. Pregnant adolescents of all ages can be capable and active participants in health-care
decisions.

ANS: c
Feedback
a. Adolescents must cope with the conflicting developmental tasks of pregnancy and
adolescence at the same time.
b. Social support has been associated with a more positive adaptation to mothering for
adolescents.
c. Correct. Pregnant adolescents face conflicting and multiple developmental tasks of
pregnancy and adolescence at the same time.
d. By late adolescence (ages 17 to 20) this can occur, but early adolescents are oriented toward
the present and are self-centered, and often pregnancy at this age is a result of abuse or
coercion.

5. Jane’s husband Brian has begun to put on weight. What is this a possible sign of?

a. Culturalism syndrome

b. Couvade syndrome

c. Moratorium phase

d. Attachment

ANS: b
Feedback
a. This is not related to culture.
b. Correct. Couvade syndrome has symptoms that mimic changes of pregnancy.
c. Moratorium phase represents one of the phases of the father’s responses to pregnancy.
d. Attachment is reflected in behaviors.

6. Cathy is pregnant for the second time. Her son, Steven, has just turned 2 years old. She
asks you what she should do to help him get ready for the expected birth. What is the
nurse’s most appropriate response?

a. Steven will probably not understand any explanations about the arrival of the new
baby, so Cathy should do nothing.

b. If Steven’s sleeping arrangements need to be changed, it should be done well in

advance of the birth.

c. Steven should come to the next prenatal visit and listen to the fetal heartbeat to
encourage sibling attachment.

d. Steven should be encouraged to plan an elaborate welcome for the newborn.

ANS: b
Feedback
a. This applies to very young children under the age of 2.
b. Children still sleeping in a crib should be moved to a bed at least 2 months before the baby is
due, as this age group is particularly sensitive to disruptions of the physical environment.
c. This is not appropriate for a 2-year-old but may be appropriate for older age groups.
d. This is not appropriate for a 2-year-old but may be appropriate for older age groups.

7. The nurse is interviewing a pregnant client who states she plans to drink chamomile
tea to ensure an effective labor. The nurse knows that this is an example of:

a. Cultural prescription

b. Cultural taboo

c. Cultural restriction

d. Cultural demonstration

ANS: a
Feedback
a. Correct. Cultural prescription is an expected behavior of the pregnant woman during the
childbearing period.
b. Taboos are cultural restrictions believed to have serious supernatural consequences.
Drinking chamomile tea would not be in this category.
c. Restrictions are activities during the childbearing period which are limited for the pregnant
woman. Drinking chamomile tea would not be in this category.
d. Demonstration is not a term that is used in relation to cultural behaviors.

8. Which of the following would be a priority for the nurse when caring for a pregnant
woman who has recently emigrated from another country?

a. Help her develop a realistic, detailed birth plan.

b. Identify her support system.

c. Teach her about expected emotional changes of pregnancy.

d. Refer her to a doula for labor support.

ANS: b
Feedback
a. A detailed birth plan may not be culturally appropriate and is not first priority.
b. Correct, because lack of social support has been correlated with an increased risk of
pregnancy complications and difficult adaptation to pregnancy. Pregnant women who are
recent immigrants face many challenges in obtaining needed social support, and the nurse
should first identify her support system to plan further interventions and referrals.
c. There may be cultural variations in emotional changes of pregnancy.
d. The nurse should first identify her support system before planning further interventions and
referrals.

9. A pregnant client at 20 weeks’ gestation comes to the clinic for her prenatal visit.
Which of the following client statements would indicate a need for further assessment?

a. “I hate it when the baby moves.”

b. “I’ve started calling my mom every day.”

c. “My partner and I can’t stop talking about the baby.”

d. “I still don’t know much time I’m going to take off work after the baby comes.”

ANS: a
Feedback
a. Experiencing quickening as unpleasant may be a sign of maladaptation to pregnancy and
needs further assessment by the nurse.
b. This is an expected finding in maternal adaptation and development of the maternal role.
c. This is an expected finding in maternal adaptation and development of the maternal role.
d. At 20 weeks’ gestation, the client still has plenty of time to process this decision.

10. A pregnant client asks the nurse why she should attend childbirth classes. The nurse’s
response would be based on which of the following information?

a. Attending childbirth class is a good way to make new friends.

b. Childbirth classes will help new families develop skills to meet the challenges of
childbirth and parenting.

c. Attending childbirth classes will help a pregnant woman have a shorter labor.
d. Childbirth classes will help a pregnant woman decrease her chance of having a
cesarean delivery.

ANS: b
Feedback
a. There may be a beneficial effect of childbirth classes, but this is not the primary goal of
childbirth education.
b. Correct. These are the stated goals of childbirth education (ICEA, Lamaze).
c. Evidence remains inconclusive regarding linking attendance at childbirth classes with a
decreased incidence of cesarean section and shorter labors.
d. Evidence remains inconclusive regarding linking attendance at childbirth classes with a
decreased incidence of cesarean section and shorter labors.

11. A woman presents for prenatal care at 6 weeks’ gestation by LMP. Which of the
following findings would the nurse expect to see?
a. Multiple pillow orthopnea
b. Maternal ambivalence
c. Fundus at the umbilicus
d. Pedal and ankle edema

ANS: b
Feedback
a. Orthopnea is a common complaint of women during the third trimester.
b. Ambivalence is a common feeling of women during the first trimester.
c. The fundus should be at the umbilicus at 20 weeks’ gestation.
d. Dependent edema is a common complaint of women during the third trimester.

12. A first-time father is experiencing couvade syndrome. He is likely to exhibit which of

the following symptoms or behaviors?
a. Urinary frequency
b. Hypotension
c. Bradycardia
d. Prostatic hypertrophy

ANS: a
Feedback
a. Urinary frequency is a common symptom of couvade.
b. The father’s blood pressure is not usually affected.
c. The father’s heart rate is not usually affected.
d. Prostatic changes are not related to couvade.
13. When providing a psychosocial assessment on a pregnant woman at 21 weeks’
gestation, the nurse would expect to observe which of the following signs?
a. Ambivalence
b. Depression
c. Anxiety
d. Happiness

ANS: d
Feedback
a. Ambivalence is often seen during the first trimester.
b. The nurse would not expect to see depression at any time during the pregnancy.
c. The patient may express some anxiety near the time of delivery.
d. The nurse would expect the patient to exhibit signs of happiness at this time.

14. An example of a cultural prescriptive belief during pregnancy is:

a. Remain active during pregnancy
b. Coldness in any form should be avoided
c. Do not have your picture taken
d. Avoid sexual intercourse during the third trimester

ANS: a
The belief that the patient should remain active during pregnancy is the only example of a
cultural prescriptive belief. All of the other answers are examples of cultural restrictive beliefs.

15. Taboos are cultural restrictions that:

a. Have serious supernatural consequences
b. Have serious clinical consequences
c. Have superstitious consequences
d. Are functional and neutral practices

ANS: a
Taboos are believed to have serious supernatural consequences. Taboos are not known to have
clinical or superstitious consequences and are not functional or neutral practices.

16. Jenny, a 21-year-old single woman, comes for her first prenatal appointment at 31
weeks’ gestation with her first pregnancy. The clinic nurse’s most appropriate statement
is:
a. “Jenny, it is late in your pregnancy to be having your first appointment, but it is nice to
meet you and I will try to help you get caught up in your care.”
b. “Jenny, have you had care in another clinic? I can’t believe this is your first
appointment!”
c. “Jenny, by the date of your last menstrual period, you are 31 weeks and now that you
are finally here, we need you to come monthly for the next two visits and then weekly.”
d. “Jenny, by your information, you are 31 weeks’ gestation in this pregnancy. Do you
have questions for me before I begin your prenatal history and information sharing?”

ANS: d
Feedback
a. The initial interview time with the patient should be used to build a positive, nonthreatening
relationship and to gain her confidence by respecting her choices and advocating for continued
prenatal care that is woman centered.
b. The initial interview time with the patient should be used to build a positive, nonthreatening
relationship and to gain her confidence by respecting her choices and advocating for continued
prenatal care and not making assumptions about prior care. The prenatal nurse’s objective is to
provide a user-friendly service that is efficient, effective, caring, and patient centered.
c. The initial interview time with the patient should be used to build a positive, nonthreatening,
and nonjudgmental relationship and to gain her confidence by respecting her choices and
advocating for continued prenatal care.
d. The initial interview time with the patient should be used to build a positive, nonthreatening
relationship and to gain her confidence by respecting her choices and advocating for continued
prenatal care. The prenatal nurse’s objective is to provide a user-friendly service that is efficient,
effective, caring, and patient centered.

17. The clinic nurse visits with Wayne, a 32-year-old man whose partner is pregnant for
the first time and is at 12 weeks. Wayne describes nausea and vomiting, fatigue, and
weight gain. His symptoms are best described as:
a. Influenza
b. Couvade syndrome
c. Acid reflux
d. Cholelithiasis

ANS: b
Feedback
a. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs
and symptoms of pregnancy.
b. In preparation for parenthood, the male partner moves through a series of developmental
tasks. During the first trimester, the father begins to deal with the reality of the pregnancy and
may worry about financial strain and his ability to be a good father. Feelings of confusion and
guilt often surface with the recognition that he is not as excited about the pregnancy as his
partner, and couvade syndrome, the experience of maternal signs and symptoms, may
develop.
c. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs
and symptoms of pregnancy.
d. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs
and symptoms of pregnancy.
Multiple Response

18. The clinic nurse encourages paternal attachment during pregnancy by including the
father in (select all that apply):
a. Prenatal visits
b. Ultrasound appointments
c. Prenatal class information
d. History taking and obtaining prenatal screening information

ANS: b, c, d
Pregnancy is psychologically stressful for men; some enjoy the role of nurturer, but others feel
alienated and begin to stray from the relationship. The nurse can be instrumental in promoting
early paternal attachment. Involvement of the father during examinations and tests and
prenatal classes, along with thorough explanations of the need for them, can minimize the
father’s feelings of being left out. A history and prenatal screening should be conducted at the
first prenatal visit with the woman alone to ensure confidentiality and an open discussion of
any problems or concerns she may have. The history should include information about the
current pregnancy; the obstetric and gynecologic history; and a cultural assessment, and a
medical, nutritional, social, and family (including the father’s) medical history.

19. The perinatal nurse screens all pregnant women early in pregnancy for maternal
attachment risk factors, which include (select all that apply):
a. Adolescence
b. Low educational level
c. History of depression
d. A strong support system for the pregnancy

ANS: a, b, c
Maternal attachment to the fetus is an important area to assess and can be useful in identifying
families at risk for maladaptive behaviors. The nurse should assess for indicators such as
unintended pregnancy, domestic violence, difficulties in the partner relationship, sexually
transmitted infections, limited financial resources, substance use, adolescence, poor social
support systems, low educational level, the presence of mental conditions, or adolescence that
might interfere with the patient’s ability to bond with and care for the infant. A strong support
system can facilitate the patient’s ability to bond with and care for the infant.

20. Strategies for culturally responsive care include (select all that apply):
a. Practicing ethnocentrism
b. Applying stereotyping
c. Examining one’s own biases
d. Learning another language
ANS: c, d
The only actions among the choices that are culturally responsive are examining one’s own
biases and learning another language. Ethnocentrism and stereotyping are not culturally
responsive actions.

Fill-in-the-Blank

21. The clinic nurse talks with Becky, a 16-year-old woman who is now 28 weeks’
gestation. Today’s visit is only the second prenatal appointment that Becky has kept. The
nurse wonders if Becky’s failure to come for routine prenatal checks is, in part, related to
an adolescent’s orientation to the __________, rather than to the __________.

ANS: present; future

The adolescent may not seek prenatal care unless pressured by authority figures or peers to do
so. By nature, adolescents are not future oriented. Hence, the pregnant adolescent may not be
able to readily accept the reality of the unborn child.

22. According to Rubin, the mother-to-be needs to accept the pregnancy and incorporate
it into her own reality and __________. This process is known as “__________.”

ANS: self-concept; binding in

The mother-to-be needs to accept the pregnancy and incorporate it into her own reality and
self-concept. This process is known as “binding in.” Acceptance of the child is critical to a
successful adjustment to the pregnancy. Acceptance must come from the expectant woman as
well as from others.

23. The clinic nurse asks pregnant women about their acceptance and planning for this
pregnancy as a component of domestic violence screening. The nurse is aware that a(n)
__________ pregnancy __________ the risk for domestic violence.

ANS: unplanned; increases

Intimate partner violence (IPV) may occur for the first time during pregnancy, or the nurse may
identify evidence during the physical examination that is suspicious of ongoing physical abuse.
Acceptance of pregnancy may be delayed if it was unplanned or unwanted. As a women’s
advocate, nurses have a duty to be observant, to actively listen, and to use communication skills
to gain clarification and understanding.
Chapter 18: Well Women’s Health
Chapter 18: Well Women’s Health

Multiple Response

1. Physical activity can lower a woman’s risk for (select all that apply):
a. Endometriosis
b. Depression
c. Colon cancer
d. Arthritis

ANS: b, c
According to the US Department of Health and Human Services, Office of Women’s Health,
physical activity can lower a woman’s risk for heart disease, type 2 diabetes, colon cancer,
breast cancer, falls, and depression.

2. During a routine physical of a 31-year-old non-Hispanic black woman, it was noted that
the woman’s BMI is 32, her only exercise is taking care of her two children, her last Pap
test was 2 years ago, and her last clinical breast exam was 2 years ago. Based on this
information the woman (select all that apply):
a. Needs to be scheduled for a Pap test
b. Needs to be scheduled for a clinical breast exam
c. Is at risk for type 2 diabetes
d. Is at risk for depression

ANS: c, d
Recommended screenings for women ages 19 to 39 are clinical breast exams and Pap test
every 3 years. Obesity (a BMI of 30 or greater) places the woman at risk for type 2 diabetes;
decreased physical activity places the woman at risk of depression.

3. Excessive drinking places the woman at risk for (select all that apply):
a. Suicide
b. Stroke
c. Breast cancer
d. Menstrual disorders
ANS: a, b, c
Excessive drinking places a woman at risk for alcoholism, elevated blood pressure, obesity,
diabetes, stroke, breast cancer, suicide and accidents.

4. The woman’s health clinic nurse is providing information to a 21-year-old woman who
is being scheduled for a pelvic exam and Pap test. This information should include (select
all that apply):
a. The Pap test is a diagnostic test for cervical cancer.
b. The woman should not use tampons or vaginal medication or engage in sexual
intercourse within 48 hours of the exam.
c. The best time to have a Pap test is 5 days after the menstrual period has ended.
d. The woman should have a yearly Pap test.

ANS: 2, 3
The Pap test is a screening versus a diagnostic test. Women should not douche; use tampons;
use vaginal creams, spermicide foams, creams, or jellies; use vaginal lubricants or moisturizers;
use vaginal medications; or have sexual intercourse for 48 hours prior to the exam. The best
time to obtain a Pap test is 5 days after the period ends. Women ages 19 to 39 should have a
Pap test every 3 years.

5. A 60-year-old woman is scheduled for a dual-energy X-ray absorptiometry scan (DXA).

The woman’s health clinic nurse should provide the following information:
a. DXA is a diagnostic test for osteoporosis.
b. DXA measures the bone density of the hip, spine, and forearm.
c. The T score is a comparison of the woman’s bone density with that of other women her
age.
d. Osteoporosis can cause a stooped posture.

ANS: a, b, d
Answers a, b, and d are true statements. A T-score is a comparison of the woman’s bone
density with that of a woman 30 years of age and the same race.

6. Lesbians are at higher risk for breast, cervical, endometrial, and ovarian cancer than
heterosexual women due to (select all that apply):
a. A higher percentage of lesbians are smokers
b. Lesbians are less likely to have a Pap test
c. A higher percentage of lesbians are obese
d. Lesbians are less likely to exercise
ANS: a, b, c
Lesbians have higher rates of smoking, alcohol use, and obesity. They are also less likely to
follow the recommended frequency of health screening tests. These behaviors place a woman
at higher risk for breast and gynecological cancers.

True/False

7. Lesbian women are at a higher risk for heart disease than heterosexual women.

ANS: True
The rates of smoking and obesity in lesbians are higher than those of heterosexual women
which places them at higher risk for heart disease.

8. Which of the following women is at highest risk for osteoporosis?

a. A 70-year-old non-Hispanic white woman who has smoked for 50 years
b. A 70-year-old non-Hispanic black woman who is a heavy drinker
c. A 60-year-old Asian woman who takes steroids to treat SLE
d. A 70-year-old Hispanic woman who has had weight loss surgery

ANS: a
Each of the women has a risk factor for osteoporosis, but answer (a) has the additional risk
factor of being a non-Hispanic white woman.

9. A 65-year-old woman is complaining of jaw pain, nausea, shortness of breath without

chest pain, and sweating. These are warning signs of:
a. Heart attack
b. Stroke
c. Diabetes
d. Dental disease

ANS: a
Warning signs of heart attack in women are uncomfortable pressure, squeezing, fullness, or
pain in the center of the chest; pain or discomfort in one or both arms; shortness of breath with
or without chest discomfort; nausea; lightheadedness; sweating.

10. Which of the following foods is highest in calcium?

a. An 8 oz. glass of milk
b. A 1.5 oz. piece of cheddar cheese
c. An 8 oz. container of plain, low-fat yogurt
d. A 3 oz. piece of salmon
ANS: c
Milk has 293 mg of calcium; cheddar cheese has 307 mg; yogurt has 415; salmon has 181 mg.

Chapter 19: Alterations in Women’s Health

Chapter 19: Alterations in Women’s Health

Multiple Response

1. Postoperative nursing care for a woman who had a total hysterectomy includes
(select all that apply):
a. Administering hormone replacement therapy as per MD orders
b. Informing the woman that she will experience small amounts of vaginal
bleeding for several days
c. Instructing the woman to use tampons
d. Instructing the woman to increase her ambulation to facilitate return of normal
intestinal peristalsis

ANS: b, d
Feedback
a. Hormone therapy is ordered for women who had a hysterectomy with salpingo-
oophorectomy.
b. Women will experience a few days of vaginal bleeding.
c. Women should not put anything into the vagina until the area has healed.
d. Ambulation decreases the risk for deep vein thrombosis and also facilitates intestinal
peristalsis.

2. Menorrhagia may result from (select all that apply):

a. Anovulatory cycle
b. Metritis
c. Anorexia
d. Emotional distress

ANS: a, b
Metritis can be a cause of menorrhagia.

3. Secondary amenorrhea results from (select all that apply):

a. Polycystic ovary syndrome
b. Diabetes
c. Metritis
d. Pregnancy
ANS: a, b, d
Nutritional disturbances such as anoxia and emotional distress can cause secondary
amenorrhea.

4. During a health visit, a 23-year-old patient shares with her health-care provider that
she has been experiencing a yellowish mucus vaginal discharge, pain during sexual
intercourse, and burning on urination. A culture of the cervical epithelial cells is
obtained. Based on the patient information, the culture is obtained to assist in the
diagnosis of which of the following? (Select all that apply.)
a. Chlamydia
b. Gonorrhea
c. Genital herpes
d. Syphilis

ANS: a, b
These are symptoms that can be related to either chlamydia or gonorrhea. Syphilis is diagnosed
via blood test. Genital herpes has symptoms similar to the flu, and the person usually has an
itching or burning sensation in the genital or anal area.

5. A woman who is receiving radiation therapy for treatment of stage I cervical cancer is
experiencing diarrhea. She contacts the oncology advice nurse. The advice nurse
recommends that the woman (select all that apply):
a. Eat five or six small meals a day instead of three large meals
b. Eat cooked vegetables instead of raw vegetables
c. Use baby wipes instead of toilet paper
d. Reduce fluid intake to four glasses of water

ANS: a, b, c
Radiation damages the cells of the intestines. Interventions are aimed at decreasing stress on
the intestines such as eating small, frequent meals and foods low in fiber. Baby wipes help
reduce irritation to the anal area. A person should increase fluid intake to compensate for fluid
loss caused by the diarrhea.

Multiple Choice

6. A primary topic for health promotion for a 25-year-old woman with a history of
polycystic ovary syndrome is (select the most important topic):
a. The adverse effects of cigarette smoking
b. The adverse effects of excessive alcohol consumption
c. Nutrition
d. Self-esteem issues

ANS: c
Women with PCOS are at higher risk for being obese. Obesity increases the woman’s risk for
type 2 diabetes. Obesity and type 2 diabetes increase the woman’s risk for cardiovascular
disease, hypertension, dyslipidemia, and metabolic syndrome. It is also important to talk about
self-esteem issues related to hirsutism and the effects of smoking and drinking, but the long-
term effects of obesity are a greater risk to a woman with PCOS.

7. Which of the following is correct regarding endometriosis?

a. The physical symptoms of endometriosis can affect the woman’s mental health.
b. The abnormal tissue bleeds into surrounding tissue during the secretory stage of the
menstrual cycle.
c. Endometriosis causes sterility.
d. Metronidazole is used to treat endometriosis.

ANS: a
Feedback
a. The physical symptoms can have an effect on the woman’s mental health. The woman may
experience anger and grief related to loss of fertility. The pain of endometriosis can interfere
with social activities, and dyspareunia can have an effect on intimate relationships.
b. In endometriosis, there is an abnormal tissue response to the changes of hormone levels of
the menstrual cycle and the tissue breaks down and bleeds into surrounding areas during the
menstrual phase.
c. Endometriosis has an effect on fertility but does not cause sterility.
d. Metronidazole is used to treat trichomoniasis.

8. The daughter of an 85-year-old woman informs the doctor that her mother has
suddenly become disoriented/confused and that she is dizzy and having difficulty with
her balance. She is agitated and has fallen twice in the last 24 hours. The patient’s blood
pressure and VS are within normal limits. Her medications include Synthroid, Lisinopril,
and Crestor. Based on this data, the woman is most likely experiencing:
a. Stroke
b. Beginning stages of dementia
c. Urinary tract infection
d. Adverse reaction to her medications
ANS: c
These are classic signs/symptoms of a UTI in older women.

9. A total hysterectomy is the removal of:

a. The uterus
b. The uterus and cervix
c. The uterus, cervix, fallopian tubes, and ovaries
d. The uterus, cervix, fallopian tubes, ovaries, upper portion of the vagina, and lymph
nodes

ANS: b
Feedback
a. This is a supracervical hysterectomy.
b. This constitutes a total hysterectomy.
c. This would be a salpingo-oophorectomy.
d. This is a radical hysterectomy.