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Antepartum Study Guide-ANSWERSTheory Test 1

1. Which of the following, if exhibited by a pregnant woman, represents a positive sign of pregnancy?

A. Morning sicknessB. QuickeningC. Positive pregnancy testD. Fetal heart beat auscultated with Doppler/fetoscope

CORRECT ANSWER: DRATIONALE: Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy— subjective findings suggestive, but not diagnostic of pregnancy. A positive pregnancy test is still considered to be a probable sign of pregnancy (objective findings more suggestive of but not yet diagnostic of pregnancy) since error can occur in performing the test or in rare cases hCG may be detected in the urine of nonpregnant women. Chances of error are less likely to occur today since pregnancy tests used are easy to perform and are very sensitive to the presence of the hCG associated with pregnancy. Other probable signs include changes in integument, enlargement of the uterus, and Chadwick sign. Detection of a fetal heart beat, palpation of fetal movements and parts by an examiner, and detection of embryo/fetus with sonographic examination would be positive signs diagnostic of pregnancy.

2. A pregnant woman is the mother of 2 children. Her first pregnancy ended in a still birth at 32 weeks' gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman's current obstetric history, the nurse would record:

A. 4-1-2-0-2B. 3-1-2-0-2C. 4-2-1-0-1D. 3-1-1-1-3

CORRECT ANSWER: ARATIONALE: Gravida (the first number) is 4 since this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and would be described as:T: 1 = Term birth at 41 weeks' gestation (son)P: 2 = Preterm birth at 32 weeks' gestation (stillbirth) and 36 weeks' gestation (daughter)A: 0 = Abortion - none occurredL: 2 = Living children - her son and her daughterCognitive Level: Application

3. Which of the following hematocrit (HCT) and hemoglobin (HGB) results represent(s) the lowest acceptable values for a woman in the third trimester of pregnancy?

A. 38% HCT; 14 gm/dl HGBB. 35% HCT; 13 gm/dl HGBC. 33% HCT; 11 gm/dl HGBD. 32% HCT; 10.5 gm/dl HGB

CORRECT ANSWER: CRATIONALE: Responses 1 and 2 are within the normal range for a nonpregnant woman. Response 3 represents the lowest acceptable value during the first and the third trimesters while 4 represents the lowest acceptable value for the second trimester when the hemodilution effect of blood volume expansion is at its peak.

4. When assessing the fetal heart rate (FHR) of a woman at 30 weeks' gestation, the nurse counts a rate of 82 BPM. Initially, the nurse should:

A. Recognize that the rate is within normal limits and record itB. Assess the woman's radial pulseC. Notify the physicianD. Allow the woman to hear the heart beat

CORRECT ANSWER: B


RATIONALE: The expected FHR is 120 to 160 beats per minute. The nurse may have inadvertently counted the uterine souffle, the beat-like sound of blood flowing through the uterine blood vessels, which corresponds to the mother's heart beat. The physician should be notified if the FHR is confirmed to be 82 beats per minute. Allow the woman to hear the heart beat as soon as a full assessment is made.

5. During the first trimester, the pregnant woman would be most motivated to learn about:

A. Fetal developmentB. Impact of a new baby on family membersC. Measures to reduce nausea and fatigue so she can feel betterD. Location of childbirth preparation and breastfeeding classes

CORRECT ANSWER: CRATIONALE: During the first trimester, a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Fetal development and the impact of a new baby on the family would be appropriate topics for the second trimester when the fetus becomes "real" as its movements are felt and its heart beat heard. During this trimester a woman works on the task of "I am going to have a baby." Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

6. An expectant father confides in the nurse that his pregnant wife, 10 weeks' gestation, is driving him crazy. "One minute she seems happy and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response would be:

A. "This is normal behavior and should begin to subside by the second trimester." B. "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor

that I know."C. "This is called emotional lability and is related to hormone changes and anxiety

during pregnancy — the mood swings will eventually subside as she adjusts to being pregnant."

D. "You seem impatient with her — perhaps this is precipitating her behavior."

CORRECT ANSWER: CRATIONALE: Response 1, while correct, does not provide the essential information found in response 3. Responses 2 and 4 ascribe an incorrect rationale for the mood changes (emotional lability) described.

7. Which of the following, if exhibited by an expectant father, would be a warning sign of ineffective adaptation to his partner's first pregnancy?

A. Views pregnancy with pride as a confirmation of his virilityB. Consistently changes the subject when the topic of the fetus/newborn is raisedC. Expresses concern that he might faint at the birth of his babyD. Experiences nausea and fatigue, along with his partner, during the first trimester

CORRECT ANSWER: BRATIONALE: Responses 1, 3, and 4 are all expected behaviors of an expectant father,

especially in a first pregnancy. Persistent refusal to talk about the fetus-newborn may be a sign of a problem and should be assessed further

8. Which of the following laboratory results would be a cause for concern if exhibited by a woman at her first prenatal visit during the second month of her pregnancy?

A. Hematocrit 38%, Hemoglobin 13 gm/dlB. White blood cell count 6,000/mm3

C. Platelets 300,000/mm3

D. Rubella titre 1:6

CORRECT ANSWER: DRATIONALE: Responses 1, 2, and 3 are all within the expected ranges for pregnant women. A rubella titre of less than 1:10 indicates a lack of immunity to rubella, a viral


infection that has the potential to cause teratogenic effects on fetal development. Arrangements should be made to administer the rubella vaccine after birth during the postpartum period since administration of rubella, a live vaccine, would be contraindicated during pregnancy. Women receiving the vaccine during the postpartum period should be cautioned to avoid pregnancy for 3 months.

9. A Chinese-American expectant father tells the nurse that he does not view his role during childbirth to be that of a coach. The nurse recognizes that this behavior is most likely a reflection of:

A. Limited interest in the well being of his wifeB. EmbarrassmentC. CouvadeD. Ambivalence regarding the pregnancy

CORRECT ANSWER: CRATIONALE: Couvade refers to the culturally determined guidelines for the father to follow during pregnancy and childbirth. There is not enough data in the stem of the question to support options 1, 2, or 4 as an answer.

10. A maternal serum alpha-fetoprotein (MsAFP) test is performed at 16 to 18 weeks' gestation. An elevated level has been associated with:

A. Down syndromeB. Sickle cell anemiaC. Cardiac defectsD. Open neural tube defects such as spina bifida

CORRECT ANSWER: DRATIONALE: Response 1 is associated with a decreased MsAFP level; 2 and 3 are not detected with this blood test. A triple marker test determines the levels of MsAFP along with serum levels of estriol and human chorionic gonadotropin. It is used as a screen for Down syndrome.

11. An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple:

A. Intercourse should be avoided if any spotting from the vagina occurs afterwardsB. Intercourse is safe until the third trimesterC. Safer sex practices should be used once the membranes ruptureD. Intercourse and orgasm are often contraindicated if a history of or signs of preterm

labor are present

CORRECT ANSWER: DRATIONALE: Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer sex practices are always recommended. Rupture of the membranes may require abstaining from intercourse. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman was at risk for or had a history of preterm labor.

12. A pregnant woman at 32 weeks' gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to:

A. Assess the woman's blood pressure and pulseB. Have the woman breathe into a paper bagC. Raise the woman's legsD. Turn the woman on her side

CORRECT ANSWER: DRATIONALE: During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure. Then vital signs can be assessed. Raising


her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation.

13. A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she:

A. Wiggles and points her toes during the crampB. Applies cold compresses to the affected legC. Extends her leg and dorsiflexes her foot during the crampD. Avoids weight bearing on the affected leg during the cramp

CORRECT ANSWER: CRATIONALE: Pointing toes can aggravate rather than relieve the cramp. Application of heat is recommended. An alternative to extension of the leg with dorsiflexion of the foot is to stand and lean forward, bearing weight on the affected leg.

14. A pregnant woman's last menstrual period began on April 8, 2005, and ended on April 13. Using Nägele's rule her estimated date of birth would be:

A. January 15, 2006B. January 20, 2006C. July 1, 2006D. November 5, 2005

CORRECT ANSWER: ARATIONALE: Nägele's rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman's last menstrual period. When this rule, is used with April 8, 2005, the estimated date of birth is January 15, 2006.

15. When planning a diet with a pregnant woman, the nurse's first action would be to:

A. Review the woman's current dietary intakeB. Teach the woman about the food pyramidC. Caution the woman to avoid large doses of vitamins, especially those that are fat-

solubleD. Instruct the woman to limit the intake of fatty foods

CORRECT ANSWER: ARATIONALE: While 2, 3, and 4 are correct actions on the part of the nurse, the first action should be to assess the client's current dietary pattern and practices, since instruction should be geared to what she already knows and does.

16. A pregnant woman with a BMI of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's best response would be to tell the woman that her pattern of weight gain should be approximately:

A. A pound a week throughout pregnancyB. 2 to 5 pounds during the first trimester, then a pound each week until the end of

pregnancyC. A pound a week during the first two trimesters, then 2 pounds per week during the

third trimesterD. A total of 25 to 35 pounds

CORRECT ANSWER: BRATIONALE: A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 pounds or about 2 to 5 pounds in the first trimester and about one pound per week during the second and third trimesters. While 4 is accurate, 2 gives the woman the guidance she is requesting.

17. A pregnant woman at 7 weeks' gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman:

A. Drink warm fluids with each of her meals


B. Eat a high-protein snack before going to bedC. Keep crackers and peanut butter at her bedside to eat in the morning before

getting out of bedD. Schedule three meals and one mid-afternoon snack a day

CORRECT ANSWER: BRATIONALE: A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. Dry carbohydrates, such as plain toast or crackers, are recommended before getting out of bed. Foods high in fat should be avoided. Jelly with the crackers would be acceptable since it provides glucose. Eating small, frequent meals (about 5 or 6 each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

18. A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual cycle was September 19, 2005. Using Nagele’s rule, the nurse determines the estimated date of confinement as:

A. July 26, 2006B. June 12, 2007C. June 26, 2006D. July 12, 2007

CORRECT ANSWER: CRATIONALE: Accurate use of Nagle’s rule requires that the woman have a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract 3 months, and then add 1 year to that date.

19. A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child that was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. The nurse would document the GTPAL for this client as:

A. G=3, T=2, P=0, A=0, L=1B. G=2, T=0, P=1, A=0, L=1C. G=1, T=1, P=1, A=0, L=1D. G=2, T=0, P=0, A=0, L=1

CORRECT ANSWER: BRATIONALE: Pregnancy outcomes can be described with the acronym GTPAL. G is gravidity, the number of pregnancies. T is term births, the number born at term (40 weeks). P is preterm births, the number born before 40 weeks’ gestation. A is abortions/miscarriages, the number of abortions/miscarriages (included in gravida if before 20 weeks’ gestation; included in parity if past 20 weeks’ gestation). L is live births, the number of live births or living children. Therefore a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1.

20. A nurse is performing an assessment of a primipara who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing?

A. Consistent increase in fundal heightB. Fetal heart rate of 180 beats per minuteC. Braxton Hicks contractionsD. Quickening

CORRECT ANSWER: BRATIONALE: The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 beats per minute in the first trimester and slows with fetal growth. Near and at term, the fetal heart rate ranges from 120 to 160 beats per minute. Options A, C, and D are normal expected findings.


21. A nurse is providing instructions to a pregnant client with genital herpes about the measures that need to be implemented to protect the fetus. The nurse tells the client that:

A. Daily administration of acyclovir (Zovirax) is necessary during the entire pregnancy.

B. Total abstinence from sexual intercourse is necessary during the entire pregnancy.C. Sitz baths need to be taken every 4 hours whole awake if vaginal lesions are

present.D. A cesarean section will be necessary if vaginal lesions are present at the time of

labor.

CORRECT ANSWER: DRATIONALE: For women with active lesions, either recurrent or primary at the time of

labor, delivery should be by cesarean section to prevent the fetus from being in contact with the genital herpes. The safety of acyclovir has not been established during pregnancy, and it should be used only when a life-threatening infection is present. Clients should be advised to abstain from sexual contact while the lesions are present. If this is an initial infection, clients should continue to abstain until they become culture negative, because prolonged viral shedding may occur in such cases. Keeping the genital area clean and dry will promote healing.

22. A nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and expects the findings to be which of the following?

A. 22 cmB. 30 cmC. 36 cmD. 40 cm

CORRECT ANSWER: BRATIONALE: During the second and third trimesters (weeks 18 to 30), fundal height in centimeters approximately equals the fetus’s age in weeks plus or minus 2 cm. At 16 weeks the fundus can be located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks the fundus is at the umbilicus, and at 36 weeks the fundus is at the xiphoid process.

23. A pregnant client is seen in a health care clinic for a regular prenatal visit. The client tells the nurse that she is experiencing irregular contractions, and the nurse determines that she is experiencing Braxton Hicks contractions. Based on this finding, which nursing action is most appropriate?

A. Instruct the client to maintain bed rest for the remainder of the pregnancy.B. Inform the client that these are common and may occur throughout the pregnancy.C. Contact the physician.D. Call the maternity unit and inform them that the client will be admitted in a

prelabor condition.

CORRECT ANSWER: BRATIONALE: Braxton Hicks contractions are irregular, painless contractions that may

occur intermittently throughout pregnancy. Because Braxton Hicks contractions may occur and are normal in some pregnant women during pregnancy, options A, C, and D are unnecessary and inappropriate actions.

24. A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of Goodell’s sign. The nurse determines that this sign indicates:

A. A softening of the cervix.B. A soft blowing sound that corresponds to the maternal pulse during auscultation of

the uterus.C. The presence of human chorionic gonadotropin in the urine.D. The presence of fetal movement.

CORRECT ANSWER: A


RATIONALE: In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes Goodell’s sign. Cervical softening is noted by the examiner during pelvic examination. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus and is due to blood circulation through the placenta. Human chorionic gonadotropin is noted in maternal urine in a positive urine pregnancy test. Goodell’s sign does not indicate the presence of fetal movement.

25. A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicated an understanding of this term?

A. “It is the irregular, painless contractions that occur throughout pregnancy.”B. “It is the soft blowing sound that can be heard when the uterus is auscultated.”C. “It is the fetal movement that is felt by the mother.”D. “It is the thinning of the lower uterine segment.”

CORRECT ANSWER: CRATIONALE: Quickening is fetal movement and may occur as early as the sixteenth to eighteenth week of gestation, and the expectant mother first notices subtle fetal movements that gradually increase in intensity. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus, and this is known as uterine soufflé. This sound is due to the blood circulation to the placenta and corresponds to the maternal pulse. Braxton Hicks contractions are irregular, painless, contractions that may occur throughout the pregnancy. A thinning of the lower uterine segment occurs about the sixth week of pregnancy and is called Hegar’s sign.

26. A nurse midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement?

A. Auscultating for fetal heart soundsB. Palpating the abdomen for fetal movementC. Assessing the cervix for thinningD. Initiating a gentle upward tap on the cervix

CORRECT ANSWER: DRATIONALE: Ballotement is a technique of palpating a floating structure by bouncing it gently and feeling it rebound. In the technique used to palpate the fetus, the examiner places a finger in the vagina and taps gently upward, causing the fetus to rise. The fetus then sinks, and the examiner feels a gentle tap on the finger. Options A, B, and C are incorrect.

27. A pregnant client asks the nurse in the clinic when she will be able to start feeling the fetus move. The nurse responds by telling the mother that fetal movements will be noted between:

A. 6 and 8 weeks of gestation.B. 8 and 10 weeks of gestation.C. 10 and 12 weeks of gestation.D. 14 and 16 weeks of gestation.

CORRECT ANSWER: DRATIONALE: Quickening is fetal movement and may occur as early as the fourteenth to sixteenth week of gestation. The expectant mother first notices subtle fetal movements during this time, which gradually increases in intensity. Options A, B, and C are incorrect.

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