Preview Extract
Chapter 10
1) The pregnant patient has completed the prenatal questionnaire and asks the nurse why this
form had to be completed. The best response by the nurse is:
1. “Some people have things that have happened in the past that could impact their current
pregnancy.”
2. “The doctor wants all of the pregnant patients to complete the form so that our records are
complete.”
3. “We occasionally identify a health problem that puts the current pregnancy at higher risk.”
4. “This form is designed to predict who will develop problems with their pregnancy or
delivery.”
Answer: 3
Rationale 1:
Although this is true, this statement is too vague to be the best response. It is best to explain
specifically that the impact on the current pregnancy might put the pregnancy at higher risk.
Rationale 2:
The purpose of the form is to identify which patients have risk factors; the fact that records
are complete is less important than identifying at risk pregnancies.
Rationale 3:
This is the reason for risk assessment during pregnancy, whether it is a patient-completed
questionnaire or a nurse assessment form.
Rationale 4:
The form will identify those patients who have risk factors based on their medical history;
prediction implies seeing into the future without a basis for the concern.
2) The pregnant patient's prenatal record indicates that she is a gravida 4 para 2022. The
nurse understands that this indicates the patient had four pregnancies and:
1. Has four living children.
2. Delivered two infants preterm.
3. Is pro-abortion.
4. Delivered two term infants.
Answer: 4
Rationale 1:
In the four digit number, the fourth number indicates the number of living children, which is
2.
Rationale 2:
In the four digit number, the second digit indicates the number of preterm births, so the
patient has had no preterm births.
Rationale 3:
In the four digit number, the third digit indicates the number of abortions the patient has
experienced. Because abortion may be spontaneous or therapeutic, this number does not does
not necessarily reflect a woman's stance on surgical abortion.
Rationale 4:
In the four digit number, the first digit indicates the number of term infants born, which is
two.
3) A multigravida gave birth to an 18-week fetus last week. She is in the clinic for follow-up
and notices that her chart states she has had one abortion. The patient is upset over the use of
this word. How can the nurse best explain this terminology to the patient?
1. “Abortion is the medical term for all pregnancies that end before 28 weeks.”
2. “Abortion is the word we use when someone has miscarried.”
3. “Abortion is how we label pregnancies that end in the second trimester.”
4. “Abortion is what we call all babies who are stillborn.”
Answer: 1
Rationale 1:
Abortions are fetal losses prior to the onset of the third trimester and include elective induced
(medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or
miscarriages.
Rationale 2:
Abortions are fetal losses prior to the onset of the third trimester and include elective induced
(medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or
miscarriages.
Rationale 3:
Abortions are fetal losses prior to the onset of the third trimester and include elective induced
(medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or
miscarriages.
Rationale 4:
Third-trimester losses are considered fetal death in utero, and the term abortion is not used.
4) Which of the following patients would be considered a multipara?
1. A patient at 34 weeks’ gestation who previously had one spontaneous abortion
2. A patient at 13 weeks’ gestation who previously delivered two term infants
3. A patient at 28 weeks’ gestation with no previous pregnancies
4. A patient at 32 weeks’ gestation who previously delivered one term infant
Answer: 2
Rationale 1:
A woman who has had no births at more than 20 weeks' gestation is considered a nullipara.
Rationale 2:
A woman who has had two or more births at more than 20 weeks’ gestation is considered a
multipara.
Rationale 3:
A woman who has had no births at more than 20 weeks' gestation is considered a nullipara.
Rationale 4:
A woman who has had one birth at more than 20 weeks’ gestation, regardless of whether the
infant was born alive or dead, is considered a primipara.
5) The patient has delivered her first child at 39 weeks. The nurse would explain this to the
patient as what type of delivery?
1. Preterm
2. Post-term
3. Term
4. Near term
Answer: 3
Rationale 1:
Preterm deliveries are those that occur prior to 37 completed weeks’ gestation.
Rationale 2:
Post-term applies to birth that occur after 42 weeks' gestation.
Rationale 3:
Term births are those that occur from between gestation weeks 38 and 42.
Rationale 4:
Near term is not terminology used to describe birth.
6) The prenatal clinic nurse is designing a new prenatal intake information form for pregnant
patients. Which question is best to include on this form?
1. Where was the father of the baby born?
2. Do genetic diseases run in the family of the baby’s father?
3. What is the name of the baby’s father?
4. Are you married to the father of the baby?
Answer: 2
Rationale 1:
This is not important information for pregnancy.
Rationale 2:
This question has the highest priority because it gets at the physiologic issue of inheritable
genetic diseases that might directly impact the baby.
Rationale 3:
Although it is helpful for the nurse to know the name of the father’s baby to include him in
the prenatal care, this is psychosocial information and much less important than possible
genetic diseases that the baby might have inherited.
Rationale 4:
Although the marital status of the patient might have cultural significance, this is
psychosocial information and much less important than possible genetic diseases that the
baby might have inherited.
7) The nurse is assessing a primiparous patient. The patient indicates that her religion is
Judaism. This information is important for the nurse to assess because:
1. Religious and cultural background can impact what a patient eats during pregnancy.
2. It provides a baseline from which to ask questions about the patient’s religious and cultural
background.
3. Knowing what the patient’s beliefs and behaviors regarding pregnancy are is important.
4. Patients sometimes encounter problems in their pregnancies based on what religion they
practice.
Answer: 2
Rationale 1:
Although this is true, much more than diet is impacted by religious and cultural background;
values, beliefs, expectations for the birth, and acceptance or refusal of medical treatment are
also influenced by religious or cultural background.
Rationale 2:
This is the best explanation because not all people interpret or live out their religious or
cultural backgrounds the same way. It is imperative to avoid stereotyping patients. Thus, the
nurse should use the information on the patient’s background as an educated starting point
from which to base further questions about how this specific patient enacts her religious or
cultural background.
Rationale 3:
Not all people interpret or live out their religious or cultural backgrounds the same way. It is
imperative to avoid stereotyping patients based on what their background is. The nurse must
use the information on the patient’s background as an educated starting point from which to
base further questions about how this specific patient enacts her religious or cultural
background.
Rationale 4:
How a patient enacts her religion occasionally will cause problems with pregnancy. But the
most important reason for asking a patient for her religious or cultural background is to have
a starting point from which to base further questions on the specifics of how this patient is
impacted by or enacts her cultural or religious background as a unique individual.
8) The clinic nurse is assisting with an initial prenatal assessment. The following findings are
present: spider nevi present on lower legs; dark pink, edematous nasal mucosa; mild
enlargement of the thyroid gland; mottled skin and pallor on palms and nail beds; heart rate
88 with murmur present. What is the best action for the nurse to take based on these findings?
1. Document the findings on the prenatal chart.
2. Have the physician see the patient today.
3. Instruct the patient to avoid direct sunlight.
4. Analyze previous thyroid hormone lab results.
Answer: 2
Rationale 1:
These abnormalities must be reported to the physician immediately.
Rationale 2:
Mottling of the skin is indicative of poor oxygenation and a circulation problem. Skin and
nail bed pallor can indicate either hypoxia or anemia. These abnormalities must be reported
to the physician immediately.
Rationale 3:
Spider nevi are common in pregnancy due to the increased vascular volume and high
estrogen levels. Nasal passages can be inflamed during pregnancy from edema, caused by
increased estrogen levels.
Rationale 4:
The thyroid gland increases in size during pregnancy due to hyperplasia.
9) A 25-year-old primigravida is 20 weeks pregnant. At the clinic, her nurse begins a prenatal
assessment and obtains the following vital signs. Which finding would require the nurse to
contact the physician?
1. Pulse 88/min
2. Respirations 30/min
3. Temperature 37.4°C (99.3°F)
4. Blood pressure 134/82
Answer: 2
Rationale 1:
A slight increase in pulse is an expected finding during pregnancy due to the increased
oxygen consumption to support fetal metabolism.
Rationale 2:
Tachypnea is not a normal finding and requires medical care.
Rationale 3:
Temperature is an expected finding during pregnancy due to the increased oxygen
consumption to support fetal metabolism.
Rationale 4:
The blood pressure is within normal limits.
10) The nurse is seeing prenatal patients in the clinic. Which patient is exhibiting expected
findings?
1. Primip at 12 weeks with fetal heart tones heard by Doppler fetoscope
2. Multip at 22 weeks who reports no fetal movement felt yet
3. Primip at 26 weeks with fundal height of 30 cm
4. Multip at 12 weeks reports bright red vaginal bleeding.
Answer: 1
Rationale 1:
This is an expected finding because fetal heart tones should be heard by 12 weeks using an
ultrasonic Doppler fetoscope.
Rationale 2:
This is an abnormal finding. Fetal movement should be felt by 20 weeks.
Rationale 3:
This is an abnormal finding. Beginning in the second trimester, the fundal height should
correlate with weeks of gestation; thus, at 26 weeks’ gestation, the fundal height should be
about 26 cm.
Rationale 4:
This is an abnormal finding. Bright red bleeding during pregnancy is never expected.
11) The nurse receives a phone call from a patient who thinks she is pregnant. The patient
reports that she has regular menses that occur every 28 days and last 5 days. The first day of
her last menses was April 10. What is the patient’s estimated date of delivery (EDD)?
1. November 13
2. January 17
3. January 10
4. December 3
Answer: 2
Rationale 1:
Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP
is April 10; therefore, January 17 is the EDD.
Rationale 2:
Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP
is April 10; therefore, January 17 is the EDD.
Rationale 3:
Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP
is April 10; therefore, January 17 is the EDD.
Rationale 4:
Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP
is April 10; therefore, January 17 is the EDD.
12) The nurse explains to a pregnant woman that her antepartum assessment will include
assessment of clinical pelvimetry. Which patient response reflects understanding of the
reason for this test?
1. “It will help understand how big a baby I can have.”
2. “It will be used to find out whether my baby has a chromosomal abnormality."
3. “It will help tell whether my pelvis is big enough to deliver my baby vaginally."
4. “It will be used to screen for gestational diabetes.”
Answer: 3
Rationale 1:
Clinical pelvimetry is performed to estimate the adequacy of pelvic size for the purpose of
vaginal delivery; delivery of larger infants may be accommodated via Cesarean section.
Rationale 2:
Clinical pelvimetry involves estimating the adequacy of pelvic size for facilitating vaginal
birth.
Rationale 3:
Clinical pelvimetry is performed to estimate the ease or difficulty associated with vaginal
delivery of an infant.
Rationale 4:
Screening for maternal gestational diabetes requires some form of glucose screening.
13) The nurse is assisting a physician during a prenatal examination. The physician seeks to
estimate the adequacy of the patient’s pelvis for birth. The nurse understands that the
physician will need to perform which measurement vaginally?
1. True conjugate
2. Diagonal conjugate
3. Transverse outlet diameter
4. Obstetrical conjugate
Answer: 2
Rationale 1:
The true conjugate is a measurement of the pelvic inlet and cannot be directly measured.
Rationale 2:
The diagonal conjugate is measured from the lower edge of the symphysis to the sacral
promontory.
Rationale 3:
The transverse outlet diameter is measured externally.
Rationale 4:
The obstetrical is a measurement of the pelvic inlet and cannot be directly measured.
14) The nurse is working with a prenatal patient. Which statement indicates that additional
teaching is necessary?
1. “I will have Rh testing, even though this is my first pregnancy.”
2. My vagina will be cultured at 36 weeks for group B strep.”
3. “Because I am married, I won’t have the STI screening.”
4. “My blood will be checked for hemoglobin level.”
Answer: 3
Rationale 1:
This is a true statement. All patients are screened for blood type, Rh factor, and Rh
antibodies, regardless of how many previous pregnancies (if any) they have had.
Rationale 2:
This is a true statement. Women are tested for group B strep to prevent neonatal infection.
Rationale 3:
All women should be screened for syphilis, gonorrhea, and hepatitis B.
Rationale 4:
This is a true statement. All women will have their hemoglobin assessed.
15) Which phone call should the prenatal clinic nurse return first?
1. Primip at 32 weeks, reports headache and blurred vision
2. Multip at 18 weeks, reports no fetal movement this pregnancy
3. Primip at 16 weeks, reports increased urinary frequency
4. Multip at 40 weeks, reports sudden gush of fluid and contractions
Answer: 1
Rationale 1:
Headache and blurred vision are signs of pre-eclampsia, which is potentially life-threatening
for both mother and fetus. This patient has top priority.
Rationale 2:
Fetal movement should be felt by 19–20 weeks. Multips sometimes feel fetal movement prior
to 19 weeks, but the lack of fetal movement prior to 20 weeks is considered normal. This
patient is a lower priority.
Rationale 3:
Increased urinary frequency is common during pregnancy as the increased size of the uterus
puts pressure on the urinary bladder. Urinary frequency is expected. If the patient were
reporting dysuria or hematuria, a UTI would be suspected, but this patient is only reporting
increased urinary frequency. This patient is a lower priority.
Rationale 4:
A term patient who is experiencing contractions and a sudden gush of fluid is in labor.
Although laboring patients should be in contact with their provider for advice on when to go
to the hospital, labor at term is an expected finding. This patient is a lower priority.
16) The nurse is completing an assessment for a prenatal visit. Which statement indicates that
further teaching is necessary?
1. “Because I’m in my third trimester, I should return to the clinic in a month.”
2. “Now that I’ve felt fetal movement, I should feel movement regularly.”
3. “Before I take any over-the-counter medications, I should contact my doctor.”
4. “Alcohol is possibly harmful to my baby, even at the end of my pregnancy.”
Answer: 1
Rationale 1:
This statement is incorrect because prenatal visits during the third trimester are every two
weeks from 26 to 36 weeks, and every week from 36 weeks to delivery.
Rationale 2:
This is a true statement. Once fetal movement is perceived, it should be felt regularly.
Initially, this might not be every day, but in the third trimester, fetal movement should be
noticeable several times per day.
Rationale 3:
This is a true statement. Regardless of the gestational age, over-the-counter medications can
have deleterious effects on mom or baby; thus, it is important for a pregnant woman to
consult her provider prior to taking any over-the-counter medications throughout the
pregnancy.
Rationale 4:
This is a true statement. Alcohol should be avoided throughout pregnancy and lactation.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
