1. On what day during pregnancy does the embryo implant on the uterine surface?

A) the 14th day of a "typical" menstrual cycle

B) eight days after ovulation
C) ten days after the start of the menstrual flow
D) four days after ovulation
Ans: B

2. Implantation generally occurs at which place on the uterus?

A) the lower anterior surface
B) the upper posterior surface
C) directly over the cervical os
D) directly over an opening to a fallopian tube
Ans: B

3. Amniotic fluid does not grow stagnant because:

A) amniotic fluid is constantly formed by the amnion.
B) amniotic fluid is constantly absorbed by the chorion.
C) the fetal urine increases the bulk of amniotic fluid.
D) amniotic fluid circulates through the chorionic villi.
Ans: A

4. An 18-year-old pregnant woman asks the nurse why she has to have a routine alpha-fetoprotein
serum level drawn. The nurse explains that this:
A) is a screening test for placental function.
B) tests the ability of her heart to accommodate the pregnancy.
C) may reveal chromosomal abnormalities.
D) measures the fetal liver function.
Ans: C

5. The purpose of a circulatory shunt, such as the ductus arteriosus, is to:

A) allow blood to bypass the fetal heart, which does not function as a pump until birth.
B) allow fetal blood and maternal blood to mix freely.
C) direct blood flow to the lungs to supply nutrients necessary for growth and maturation.
D) permit oxygenated blood to supply the most important fetal organs.
Ans: D

6. A nurse is reviewing a journal article about fetal development and the formation of various body
systems. When reading about the development of the digestive system, the nurse finds information
related to the developmental abnormality of omphalocele. The nurse demonstrates understanding of
this information by identifying which situation as the reason for an omphalocele?
A) Fetus suffered a bowel obstruction at an early point in life.
B) Fetal abdomen formed with a smaller internal cavity than normal.
C) Intestines formed without sufficient nerve innervation for contraction.
D) Intestines failed to return to the abdominal cavity during intrauterine life.
Ans: D

7. Assessment for surfactant level is a primary estimation of fetal maturity. The purpose of surfactant
is to:
A) prevent alveoli from collapsing on expiration.
B) increase lung resistance on inspiration.
C) encourage immunologic competence of lung tissue.
D) promote maturation of lung alveoli.
Ans: A
8. A fetus is capable of producing antibodies. The finding of IgM antibodies in an infant at birth implies
that:
A) antibodies were transferred to the fetus during pregnancy.
B) the fetus contracted an infection during intrauterine life.
C) the fetus's liver has reached developmental maturity.
D) the mother contracted an infection during pregnancy.
Ans: B

9. A pregnant woman tends not to eat for long periods of time because of her busy work schedule.
What process safeguards her fetus from becoming hypoglycemic during this time?
A) The brain is too undeveloped to use glucose.
B) Women naturally ingest complex carbohydrates to last for long periods during pregnancy.
C) Somatomammotropin helps to regulate glucose levels.
D) Fetal oxygen interferes with the metabolism of glucose and prolongs its action.
Ans: C

10. A nurse is providing care to a woman early in her pregnancy. The woman is scheduled for a
sonogram to confirm the presence of the gestational sac. Which instruction would the nurse include
when teaching the woman about this test?
A) "Do not to drink any fluid 1 hour prior to the study."
B) "Be prepared for a catheter to be inserted prior to the study."
C) "You'll need to empty your bladder just prior to the study.
D) "Make sure to drink a large amount of fluid prior to the study."
Ans: D

11. Which precaution should the nurse take with a pregnant woman following an amniocentesis?
A) Remind her not to raise her head for 4 hours.
B) Assess fetal heart rate and possible uterine contractions.
C) Perform a vaginal examination for a ferning pattern.
D) Assess for increased abdominal distention.
Ans: B

12. A pregnant woman is asked to observe fetal movements as a fetal assessment technique. The
nurse would instruct her to:
A) report if she feels no movement for any half-hour period.
B) count only movements that are strong enough to hurt.
C) count fetal movements for 1 hour at the same time each day.
D) choose a different time frame each day to count movements.
Ans: C

13. A nonstress test is an assessment test based on which phenomenon?

A) Braxton-Hicks contractions cause fetal heart-rate alterations.
B) Fetal heart rate slows in response to a uterine contraction.
C) Fetal movement causes an increase in maternal heart rate.
D) Fetal heart sounds increase in connection with fetal movement.
Ans: D

14. The fetal-assessment technique of a rhythm strip refers to:

A) a fetal EKG, because it is effected by glucose stimulation.
B) a tracing of fetal heart rate and pattern.
C) the rhythm of fetal heart rate compared to maternal pulse.
D) the response of fetal heart rate to oxytocin-stimulated contractions.
Ans: B
15. The nurse is explaining the process of fertilization to a patient who has just learned of being
pregnant. On which day during pregnancy should the nurse explain that the embryo implants on the
uterine surface?
A) Four days after fertilization
B) Eight to 10 days after fertilization
C) The 14th day of a "typical" menstrual cycle
D) Ten days after the start of the menstrual flow
Ans: B

16. A patient who learns of being 9 weeks pregnant asks the nurse to explain the changes that are
occurring with her body. The woman states, "I'm really interested in learning what is happening so I
can do the best for my baby." Which nursing diagnosis should the nurse identify as being appropriate
for the patient at this time?
A) Anxiety
B) Impaired coping
C) Deficient knowledge
D) Readiness for enhanced knowledge
Ans: D

17. The nurse is teaching a patient in the first trimester of pregnancy about the importance of folic
acid in the diet and how folic acid supplements might be beneficial. For which reason is the nurse
teaching the patient about this vitamin?
A) Maintains energy throughout the pregnancy
B) Controls the risk of hypertension while pregnant
C) Prevents neural tube disorders in the developing fetus
D) Sustains a slow and steady weight gain while pregnant
Ans: C

18. A pregnant patient asks why an a-fetoprotein serum level has been ordered. What should the
nurse explain to the patient about this test?
A) It screens for placenta function.
B) It measures the fetal liver function.
C) It may reveal chromosomal abnormalities.
D) It tests the ability of the patient's heart to accommodate the pregnancy.
Ans: C

19. The nurse teaches the importance of avoiding nonessential substances to a young adult female
who is 6 weeks pregnant. Which patient statement indicates that teaching has been effective?
A) "I can drink on weekends only."
B) "Smoking is bad for me and my baby."
C) "Smoking is permitted as long as I do it outdoors."
D) "Only one beer or one glass of wine is permitted while pregnant."
Ans: B

20. The nurse is completing a physical assessment with a patient who has just learned of being
pregnant. The patient's last menstrual period was August 15. When should the nurse instruct the
patient that the baby will be due?
A) July 15
B) June 22
C) May 22
D) April 15
Ans: C
21. A patient who is 28 weeks pregnant is demonstrating signs of placental insufficiency. The health
care provider prescribes betamethasone. When teaching the patient about this drug's purpose, which
information would the nurse include?
A) It stops premature labor.
B) It improves functioning of the placenta.
C) It potentiates the formation of surfactant.
D) It improves immunologic function of the fetus.
Ans: C

22. During a physical assessment, the nurse palpates a pregnant patient's fundus at the level of the
umbilicus. What statement should the nurse make to the patient about this assessment finding?
A) "You are at 12 weeks of your pregnancy."
B) "You are at 20 weeks of your pregnancy."
C) "You are at 36 weeks of your pregnancy."
D) "You can go into labor at any time now."
Ans: B

23. The nurse is planning to instruct a patient who is 12 weeks pregnant on interventions to stop
smoking. What should the nurse include in these instructions? Select all that apply.
A) Purchase nicotine chewing gum.
B) Follow a smoking cessation plan.
C) Ask a friend to help with smoking cessation actions.
D) Apply a nicotine patch when the cravings become severe.
E) Ask the physician if a smoking cessation medication can be used.
Ans: B, C, E

24. A pregnant patient is scheduled for an abdominal ultrasound. What should the nurse instruct the
patient about this procedure?
A) Avoid drinking fluid 1 hour prior to the procedure.
B) Expect to have a catheter inserted prior to the procedure.
C) Empty the bladder 1 hour and just prior to the start of the procedure.
D) Drink a glass of water every 15 minutes starting 90 minutes before the procedure.
Ans: D

25. A pregnant patient scheduled for an amniocentesis asks the nurse how the placenta is not
punctured during the procedure. What should the nurse respond to the patient?
A) "A uterus feels soft over the placenta site."
B) "A sonogram to locate it will be done first."
C) "It would not be harmful even if it were punctured."
D) "Placentas always form on the posterior uterine wall."
Ans: B

26. A pregnant patient is concerned that the baby is going to drown in the uterus because of the fluid.
What should the nurse respond about fetal respiration?
A) "You are breathing for the baby."
B) "The baby's breathing is very minor until delivery."
C) "The baby's lungs can accommodate all of the fluid."
D) "Oxygen is provided to the baby through the placenta."
Ans: D

27. A pregnant patient is directed to perform a daily fetal movement count. What should the nurse
instruct the patient about this count? Select all that apply.
A) Lie down to do the count after eating a meal.
B) Count only movements that are strong enough to hurt.
C) Report if no movement is felt for any half-hour period.
D) Choose a different time frame each day to count movements.
E) Count fetal movements until a total of 10 are counted and record the time.
Ans: A, E

28. The nurse determines that a fetal nonstress test is nonreactive for over 20 minutes. The nurse
interprets this result as suggesting which situation? Select all that apply.
A) The patient is sleeping.
B) The patient is hypoglycemic.
C) The patient is using an illicit drug.
D) The patient is exercising too much.
E) The patient is smoking while pregnant.
Ans: B, C, E

29. The nurse is evaluating the fetal heart rate rhythm strip and determines that the amplitude varies
with a rate 15 to 20 beats/min. What does this assessment finding indicate to the nurse about
variability?
A) Variability is absent.
B) Variability is minimal.
C) Variability is normal.
D) Variability is marked.
Ans: C

Reproductive Life Planning

Includes all decisions an individual or a couple make about having children, including:
- If & when to have children
- How many children to have
- The length of time btwn having children

Counseling may include the topics of avoiding conception, increasing fertility, and/or what to do if
contraception has failed.

Teens are at increased risk of unintended pregnancy (high risk babies like low birth weight/death of
newborn in first year or impoverish lifestyle)

Contraceptives: An ideal contraceptive should be... (7)

1. Safe
2. Effective
3. Compatible w/ religious & cultural belifs & personal preferences for user & partner
4. Free of bothersome side effects
5. Convenient to use & easy to obtain
6. Affordable & needing few instructions for use
7. Free of effects on future pregnancies after discontinuation

Categories of Commonly Used Birth Control Methods (5)

1. Natural family planning
2. Barrier methods
3. Hormonal contraceptives
4. Intrauterine devices (IUDs)
5. Surgical methods

Natural Family Planning

Also called "periodic abstinence methods"
- no chemical or foreign materials into body
- failure rate ranges from 2% to 25%
- Need for couple to be conscious of time period when woman is most likely to be fertile

Abstinence =
- 0% failure rate
- Most effective preventive method of STIs
Natural Family Planning: Lactation Amenorrhea Method (LAM)
Safe method w/ failure rate of 1% to 5% IF
- infant < 6 months
- breastfeeding w/ no supplements
- menses has not returned

Coitus Interruptus
82% effective; doesn't prevent STIs

Natural Family Planning:

Postcoital Douching
Ineffective

Fertility Awareness Methods (8)

1. Calendar (rhythm) method = involves counting out days of cycle to id date of ovulation where
fertility is most prevalent. Takes planning & commitment
2. Basal body temperature (BBT) method: body temp rops by 0.5 degrees on date of ovulation &
throughout
3. Cervical mucus (Billing's) method: mucus is thick prior, but on day of ovulation, it becomes thick,
watery, copious
(first 3 are most common)
4. Two-day method
5. Symptothermal method
6. Standard days metho: CycleBeads
7. Ovulation detection: kits av in pharmacies
8. Marquette model

Contraceptives: Barrier Methods (4 types)

barrier methods are thse that place chemical or latex barrier btwn cervix & advancing sperm
- Spermicides
- Male & female condoms
- Diaphragm
- Cervical cap

*Diaphragms & cervical caps need to be fitted/ prescribed (if weight fluctuation experiences, come in
for another consult to be re-fitted & measured)

Contraceptives: Hormonal Contraceptives (6 Types)

Hormones that cause fluctuations in the normal menstrual cycle to prevent ovulation or normal
transport
- Oral
- Combined oral contraceptives (COCs)
(monophasic, biphasic, triphasic)
- Transdermal
- Intravaginal
- IM
- Subdermal Hormone Implants

3 Types of Combined Oral Contraceptives

1. Monophasic: fixed dose of estrogen & progesterone for 21 day cycle
2. Biphasic: constant estrogen that varies in amt during cycle
3. Triphasic: estrogen & progesterone that varies thru out cycle
Hormonal Contraceptives: Oral (combined or nah), Transdermal patches, Vaginal RIngs, IM Injections
& CONTRAINDICATIONS
Contra for estrogen contraceptives:
-not typically prescribed for women w/ migraine w/ an aura, smokers, ppl w/ thrombo-embolitic
disease, cerebral or cardiac accidents)
-Make aware of drug interactions (antibiotics can make COC less effective or ineffective)
-regular administration like meekhill requires constant attention & consistency in dose & time)

Depo-Provera shots = IM injections

Vaginal Rings need to be appropriately sized
Transdermal Patches - advise as to placement. Make sure patch is removed before adding another.
Rotate sites
Oral contraceptives - can have progesterone or estrogen or both

With any of these, when pts become sexually active or would like to start a fam, should have regular
gynecological exams

Contraceptives: IUDs (Types)

A small plastic device inserted into the uterus to prevent fertilization and/or decrease sperm motility
o Copper T380
o Levonorgestrel-releasing intrauterine system (Mirena or Liletta)
o Levonorgestrel-releasing intrauterine system 13.5 mg (Skyla)
o Levonorgestrel-releasing intrauterine system 19.5 mg (Kyleena)

Smaller ones are typically used more for younger population

Caution: have seen baby born from woman w/ IUD -> need to have checked. They do not protect
against STIs

Surgical Contraceptive Methods

Tubal Ligation: fallopian tube being occluded through cautery, clamping, or crushing
Vasectomy: vas deferens are cut, cauterized, or clamped

Emergency Postcoital Contraception

Plan B
For use in emergency only (such as rape)
- High dose progestin-based pills
- Insertion of copper IUD
- Ulipristal acetate (known as ella)

Elective Termination of Pregnancy (Induced Abortion)

Termination of pregnancy performed by a knowledgeable healthcare provider to end a pregnancy
before fetal viability (w/i 24 week gestation)

*Might want to get interdisciplinary referral or referral to counseling service

Areas to Assess in Making Choices About Contraceptive Methods

- Personal Values
-Ability to use method correctly
- Impact on sexual enjoyment
-Financial factors
- Length of projected relationship (LT or ST)
- Past experience w/ contraception
- Future plans regarding pregnancy
- Vital signs, pap smear, gonococcal & chlamydial screening
- Obstetric hx (STIs, past preg, previous elective abortions, failure of previously used methods, &
compliance hx w/ past methids
- Pt's beliefs, needs, feelings, & understanding of contraception
- Current & anticipated sexual practices , # of partners (recommend barrier method), feelings, &
body image

Exs of Nursing Diagnoses & Outcomes R/t Reproductive Life Planning

Readiness for enhanced knowledge regarding contraception options r/t desire to prevent
pregnancy
- Outcome: pt/partner will id & use contraception option most likely to fit their belief system, needs,
& resources
- Intervention: help pts/partners choose contraceptive method that best fits beliefs, needs, resources.
Teach pt/ partner how to use their chosen contraceptive method
- Outcomes: pt/partner report that they are successfully using their chosen contraception method. Pt/
partner report that they are satisfied w/ chosen contraception method

Deficient knowledge r/t use of diaphragm

- Outcome: pt is able to demonstrate proper diaphragm insertion
- Intervention: teach or review w/ the woman the steps in proper diaphragm insertion

Altered sexuality pattern r/t fear of pregnancy

- Outcome: couple will be able to identify specific factors r/t fear of pregnancy that may contribute to
the altering of their usual patten of sexuality
- explore w/ couple their beliefs, feelings r/t use of various types of contraception. Discuss failure
rates of various contraceptive methods.

QSEN
- Patient Centered Care
- Teamwork & Collab
- Evidence-Based Practice
(want to make sure research & technical expertise correlate (Ex: hormonal contraceptives not
recommended for women over 35 yrs bc they are approaching menopause & experiencing
necessary hormonal decreases)
- Quality Improvement
- Safety
(don't want to give smoker oral contraceptive)
- Informatics
(document everything!! Assessment & what pt decides (informed consent))

1. The term "reproductive life planning" best refers to the counseling of:
A.Only adult married women
B.Couples who are concerned using contraception prior to their first pregnancy
C.Couples with concerns related to conceiving, genetic abnormalities, and child-spacing needs
D.Only couples who are concerned about genetic defects in future children

C. Couples with concerns related to conceiving, genetic abnormalities, and child-spacing needs

2. During a prephysical interview, a patient reports that she and her husband are using the "rhythm
method" of contraception. This method of family planning
A.Requires abstinence from sexual intercourse the week after menstruation
B.Requires abstinence from sexual intercourse 3 to 4 days before ovulation and 3 to 4 days after
ovulation
C.Requires close monitoring of temperature and assessment of cervical mucus
D.Combines abstinence from sexual intercourse 2 days before ovulation and 2 to 3 days after
ovulation in addition to monitoring temperature

B. Requires abstinence from sexual intercourse 3 to 4 days before ovulation and 3 to 4 days after
ovulation
3. When a woman uses a vaginal spermicide, which of the following actions should she be
performing?
A.Insert the product by applicator no more than 1 hour prior to coitus.
B.Use a douche within 6 hours after coitus.
C.Keep a feminine hygiene product available to use in case her supply of spermicide runs out.
D.Place the product near the vaginal orifice instead of further back for immediate contact with sperm.

A. Insert the product by applicator no more than 1 hour prior to coitus.

4. A male patient is interested in learning more about having vasectomy. Which of the following
would you include in your teaching?
A.He will no longer ejaculate.
B.He may notice increased scrotal swelling over time.
C.He will need to continue to use contraception until at least 10 weeks after the procedure.
D.His testes will no longer produce sperm.

C. He will need to continue to use contraception until at least 10 weeks after the procedure.

Genetics
study of the way in which disorders of genes or chromosome structures occur

Cytogenetics
study of chromosomes by light microscopy

How many newborns inherit a genetic disorder

1 out of 20

What percent of pediatric admissions may be for genetic influenced disorders

70

What must nurses consider when talking to patients

if problem is multifactorial, problems with nutrition, sleep, or activity

Most insurance companies approve c-section in 1-4 day but n reality it is

1-3 days

Preterm baby needs steroids then

one dose to moms hip then 24 degrees later another

Through linkage with vital records all newborns are screened shortly after birth for conditions
mandated by their state-sponsored screening program from what percent
21-45 %

How can you reduce the proportion of children diagnosed with a disorder who experience
developmental delay requiring special education services from 15.1 to 13.3%
through newborn blood spot screening (48 degree screening, guthery test)

Genes
basic units of heredity that determne both physical and cognitive characteristics of people

Chromosomes
composed of DNA woven into strands in the nucleus of all body cells

Phenotypes
refers to outward appearance or expression of genes

Genotype
refers to his or her actual gene omposition

Genome
the compelete set of genes present (50000-100000)

A normal genome is abbreviated as

46xx or 46 xy

homozygous
characterized by having two corresponding genes that are identical a person who has two like
genes for a trait, two healthy genes from example

Heterozygous
if the genes differ, a healthy gene from the mother and an unhealthy gene from the father, or vice
versa, for example

Dominant genes
a characteristic that is apparent even when the gene is inherited from only one parent. huntington
disease in an example

Recessive genes
occurs when both parents have recessive genes for the disease. cystic Fibrosis is an example

Multifactorial (polygenic) inheritance

appear to occu from multiple gene combinations. Type 1 diabetes, heart disease, pyoric stenosis,
cleft lip and palate, neural tube disorders, HTN, and mental illness

Mitochondrial inheritance
male carriers cannot pass a disorder carried in the mitochondria to any of their children. Female
carriers will pass mitochondria disorders to 100% of their children

Imprinting
refers to the differential expression of genetic material and allows researchers to identify if the
chromosomal material has come from the male or female parent

Nondisjunction disorders
disorders that occur in the chromosomal division is uneven

Deletion disorders
part of the chromosome breaks during cell division

Cri-du-chat syndrome
one arm of chromosome 5 is missing

Translocation disorders
an additional chromosome is gined

Mosaicism
the presnece of two or more populations of cells within one person; some with a normal set of
chromosomes and others with extra or missing chromosomes

Isochromosomes
a chromosome accidentally divides by a horizontal separation instead of a vertical separation,
resulting in a new chromosome with mismatched long and short arms
Referral for genetic testing
couples with previous children with congential disorders or errors of metabolism, couples with
close relatives who have genetic disorders, individuals who are known balanced translocation
carriers, individuals with a chromosomal disorder or inborn error of metabolism, Cconsanguineous
couples (closly related), women older that 35 and men older than 55, couples of ethnic backgrounds
where genetics diseases are known to occur

Nuchal traslucency screening

can be detected on a sonogram taken during 1st trimest of pregnancy r/t unusual fat or fluid
deposits at the back of the fetal neck

Karyotyping
sample of venous blood or scraping of buccal membrane cells

Maternal serum screening (MSAFP)

a glycoprotein produced by the fetal liver (down syndrome test)

Chorionic villi sampling

retrieval and analysis taken from the placenta

Amniocentesis
withdrawal of amniotic fluid thru the abdominal wall for analysis

Percutaneous umbilical blood sampling

removal of blood from the fetal umbilical cord @17 weeks using amniocentesis method

Fetal imaging
MRI and U/S to assess fetus for size and structural disorders of internal organs spine and limbs

Fetoscopy
visually inspect fetus for gross disorders using a fiber optic fetoscope via a small incision on moms
abdomen into the uterus

Preimplantation diagnosis
both sperm and ova are assessed for DNA before implantation in the uterus or tubes, possible for
IVF procedures

Aims of genetic counseling

to provide accurate information, to provide reassurance, to assist individual couple to make
informed choices, to educate individual couple about the effects of genetic disorders, to offer
support

A woman with a history of fetal loss due to genetic disorders is seeking information concerning the
use of amniocentesis and chorionic villi sampling (CVS) during her next pregnancy. The nurse
understands which to best advise?
The CVS has a higher risk of miscarriage and fetal damage

Which couple would the nurse least likely refer to genetic counseling
A 28 year old woman and 35 year old man who have traceled extensively worldwide

The majority of genetic disorders are inherited as recessive traits, why is that
Two genes for the disease must be present in an offspring for the disease to occur