A client in the first trimester of pregnancy arrives at a health care clinic

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1. A nursing instructor is conducting lecture and is reviewing the functions of the female reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Mark accurately responds by stating that:

1. FSH and LH are released from the anterior pituitary gland.
2. FSH and LH are secreted by the corpus luteum of the ovary
3. FSH and LH are secreted by the adrenal glands
4. FSH and LH stimulate the formation of milk during pregnancy.

2. A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse accurately tells the client that fetal circulation consists of:

1. Two umbilical veins and one umbilical artery
2. Two umbilical arteries and one umbilical vein
3. Arteries carrying oxygenated blood to the fetus
4. Veins carrying deoxygenated blood to the fetus

3. During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines that the fetal heart rate is normal if which of the following is noted?

1. 80 BPM
2. 100 BPM
3. 150 BPM
4. 180 BPM

4. 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 period was September 19th, 2013. Using Naegele’s rule, the nurse determines the estimated date of confinement as:

1. July 26, 2013
2. June 12, 2014
3. June 26, 2014
4. July 12, 2014

5. 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 37 weeks and tells the nurse that she doesn’t have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as:

1. G = 3, T = 2, P = 0, A = 0, L =1
2. G = 2, T = 0, P = 1, A = 0, L =1
3. G = 1, T = 1. P = 1, A = 0, L = 1
4. G = 2, T = 0, P = 0, A = 0, L = 1

6. 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?

1. Consistent increase in fundal height
2. Fetal heart rate of 180 BPM
3. Braxton hicks contractions
4. Quickening

7. 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 a Goodell’s sign. The nurse determines this sign indicates:

1. A softening of the cervix
2. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus.
3. The presence of hCG in the urine
4. The presence of fetal movement

8. 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 indicates an understanding of this term?

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

9. 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?

1. Auscultating for fetal heart sounds
2. Palpating the abdomen for fetal movement
3. Assessing the cervix for thinning
4. Initiating a gentle upward tap on the cervix

10. A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy.

1. Uterine enlargement
2. Fetal heart rate detected by nonelectric device
3. Outline of the fetus via radiography or ultrasound
4. Chadwick’s sign
5. Braxton Hicks contractions
6. Ballottement

11. A pregnant client calls the clinic and tells a nurse that she is experiencing leg cramps and is awakened by the cramps at night. To provide relief from the leg cramps, the nurse tells the client to:

1. Dorsiflex the foot while extending the knee when the cramps occur
2. Dorsiflex the foot while flexing the knee when the cramps occur
3. Plantar flex the foot while flexing the knee when the cramps occur
4. Plantar flex the foot while extending the knee when the cramps occur.

12. A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to:

1. Avoid wearing a bra
2. Wash the nipples and areola area daily with soap, and massage the breasts with lotion.
3. Wear tight-fitting blouses or dresses to provide support
4. Wash the breasts with warm water and keep them dry

13. A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for:

1. Any bleeding, such as in the gums, petechiae, and purpura.
2. Enlargement of the breasts
3. Periods of fetal movement followed by quiet periods
4. Complaints of feeling hot when the room is cool

14. A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education?

1. “I will maintain strict bedrest throughout the remainder of pregnancy.”
2. “I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding.”
3. “I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad.”
4. “I will watch for the evidence of the passage of tissue.”

15. A prenatal nurse is providing instructions to a group of pregnant client regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions?

1. “I need to cook meat thoroughly.”
2. “I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat.”
3. “I need to drink unpasteurized milk only.”
4. “I need to avoid contact with materials that are possibly contaminated with cat feces.”

16. A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician?

1. Blood pressure reading is at the prenatal baseline
2. Urinary output has increased
3. The client complains of a headache and blurred vision
4. Dependent edema has resolved

17. A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education?

1. “I need to stay on the diabetic diet.”
2. “I will perform glucose monitoring at home.”
3. “I need to avoid exercise because of the negative effects of insulin production.”
4. “I need to be aware of any infections and report signs of infection immediately to my health care provider.”

18. A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse?

1. Urinary output of 20 ml since the previous assessment
2. Deep tendon reflexes of 2+
3. Respiratory rate of 10 BPM
4. Fetal heart rate of 120 BPM

19. A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse’s first action is to:

1. Administer magnesium sulfate intravenously
2. Assess the blood pressure and fetal heart rate
3. Clean and maintain an open airway
4. Administer oxygen by face mask

20. A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)?

1. Elevated blood pressure
2. Negative urinary protein
3. Facial edema
4. Increased respirations

21. Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following?

1. Being affected by Rh incompatibility
2. Having Rh positive blood
3. Developing a rubella infection
4. Developing physiological jaundice

22. A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?

1. Presence of deep tendon reflexes
2. Serum magnesium level of 6 mEq/L
3. Proteinuria of +3
4. Respirations of 10 per minute

23. A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if:

1. Ankle clonus in noted
2. The blood pressure decreases
3. Seizures do not occur
4. Scotomas are present

24. A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client.

1. Monitor maternal vital signs every 2 hours
2. Notify the physician if respirations are less than 18 per minute.
3. Monitor renal function and cardiac function closely
4. Keep calcium gluconate on hand in case of a magnesium sulfate overdose
5. Monitor deep tendon reflexes hourly
6. Monitor I and O’s hourly
7. Notify the physician if urinary output is less than 30 ml per hour.

25. In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must:

1. Administer RhoGAM within 72 hours
2. Make certain she receives RhoGAM on her first clinic visit
3. Not give RhoGAM, since it is not used with the birth of a stillborn
4. Make certain the client does not receive RhoGAM, since the gestation only lasted 12 weeks.

26. In a lecture on sexual functioning, the nurse plans to include the fact that ovulation occurs when the:

1. Oxytocin is too high
2. Blood level of LH is too high
3. Progesterone level is high
4. Endometrial wall is sloughed off.

27. The chief function of progesterone is the:

1. Development of the female reproductive system
2. Stimulation of the follicles for ovulation to occur
3. Preparation of the uterus to receive a fertilized egg
4. Establishment of secondary male sex characteristics

28. The developing cells are called a fetus from the:

1. Time the fetal heart is heard
2. Eighth week to the time of birth
3. Implantation of the fertilized ovum
4. End of the send week to the onset of labor

29. After the first four months of pregnancy, the chief source of estrogen and progesterone is the:

1. Placenta
2. Adrenal cortex
3. Corpus luteum
4. Anterior hypophysis

30. The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is:

1. A decrease in WBC’s
2. In increase in hematocrit
3. An increase in blood volume
4. A decrease in sedimentation rate

31. The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as:

1. Ladin’s sign
2. Hegar’s sign
3. Goodell’s sign
4. Chadwick’s sign

32. A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is:

1. G4 T3 P2 A1 L4
2. G5 T2 P2 A1 L4
3. G5 T2 P1 A1 L4
4. G4 T3 P1 A1 L4

33. An expected cardiopulmonary adaptation experienced by most pregnant women is:

1. Tachycardia
2. Dyspnea at rest
3. Progression of dependent edema
4. Shortness of breath on exertion

34. Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include:

1. A decrease of 200 calories a day
2. An increase of 300 calories a day
3. An increase of 500 calories a day
4. A maintenance of her present caloric intake per day

35. During a prenatal examination, the nurse draws blood from a young Rh negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for:

1. Acute hemolytic disease
2. Respiratory distress syndrome
3. Protein metabolic deficiency
4. Physiologic hyperbilirubinemia

36. When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased:

1. Metabolic rates
2. Production of estrogen
3. Functioning of the Bartholin glands
4. Supply of sodium chloride to the cells of the vagina

37. A 26-year old multigravida is 14 weeks’ pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, “What does the alpha-fetoprotein test indicate?” The nurse bases a response on the knowledge that this test can detect:

1. Kidney defects
2. Cardiac defects
3. Neural tube defects
4. Urinary tract defects

38. At a prenatal visit at 36 weeks’ gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to:

1. Lie down until they stop
2. Walk around until they subside
3. Time contraction for 30 minutes
4. Take 10 grains of aspirin for the discomfort

39. The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine position can:

1. Unduly prolong labor
2. Cause decreased placental perfusion
3. Lead to transient episodes of hypotension
4. Interfere with free movement of the coccyx

40. The pituitary hormone that stimulates the secretion of milk from the mammary glands is:

1. Prolactin
2. Oxytocin
3. Estrogen
4. Progesterone

41. Which of the following symptoms occurs with a hydatidiform mole?

1. Heavy, bright red bleeding every 21 days
2. Fetal cardiac motion after 6 weeks gestation
3. Benign tumors found in the smooth muscle of the uterus
4. “Snowstorm” pattern on ultrasound with no fetus or gestational sac

42. Which of the following terms applies to the tiny, blanched, slightly raised end arterioles found on the face, neck, arms, and chest during pregnancy?

1. Epulis
2. Linea nigra
3. Striae gravidarum
4. Telangiectasias

43. Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy?

1. Mastitis
2. Metabolic alkalosis
3. Physiologic anemia
4. Respiratory acidosis

44. A 21-year old client, 6 weeks’ pregnant is diagnosed with hyperemesis gravidarum. This excessive vomiting during pregnancy will often result in which of the following conditions?

1. Bowel perforation
2. Electrolyte imbalance
3. Miscarriage
4. Pregnancy induced hypertension (PIH)

45. Clients with gestational diabetes are usually managed by which of the following therapies?

1. Diet
2. NPH insulin (long-acting)
3. Oral hypoglycemic drugs
4. Oral hypoglycemic drugs and insulin

46. The antagonist for magnesium sulfate should be readily available to any client receiving IV magnesium. Which of the following drugs is the antidote for magnesium toxicity?

1. Calcium gluconate
2. Hydralazine (Apresoline)
3. Narcan
4. RhoGAM

47. Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged?

1. Conception
2. 9 weeks’ gestation, when the fetal heart is well developed
3. 32-34 weeks gestation
4. maternal and fetal blood are never exchanged

48. Gravida refers to which of the following descriptions?

1. A serious pregnancy
2. Number of times a female has been pregnant
3. Number of children a female has delivered
4. Number of term pregnancies a female has had.

49. 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:

1. Assess the woman’s blood pressure and pulse
2. Have the woman breathe into a paper bag
3. Raise the woman’s legs
4. Turn the woman on her side.

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

1. January 15, 2006
2. January 20, 2006
3. July 1, 2006
4. November 5, 2005

1. Answer: A. FSH and LH are released from the anterior pituitary gland. FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the graafian follicle, and production of progesterone.
2. Answer: B. Two umbilical arteries and one umbilical vein. Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus.
3. Answer: C. 150 BPM. The fetal heart rate depends in gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress.
4. Answer: C. June 26, 2014. Accurate use of Naegele’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 three months, and then add one year to that date.
5. Answer: B. G = 2, T = 0, P = 1, A = 0, L =1. Pregnancy outcomes can be described with the acronym GTPAL.
   • “G” is Gravidity, the number of pregnancies.
   • “T” is term births, the number of born at term (38 to 41 weeks).
   • “P” is preterm births, the number born before 38 weeks gestation.
   • “A” is abortions or miscarriages, included in “G” if before 20 weeks gestation, included in parity if past 20 weeks AOE.
   • “L” is live births, the number of births of 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 37 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.
6. Answer: B. Fetal heart rate of 180 BPM. The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected.
7. Answer: A. A softening of the cervix. In the early weeks of pregnancy the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell’s sign.
8. Answer: C. “It is the fetal movement that is felt by the mother.” Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar’s sign.
9. Answer: D. Initiating a gentle upward tap on the cervix. Ballottement 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.
10. Answers: A, D, E, and F. 
    • The probable signs of pregnancy include:
      • Uterine Enlargement
      • Hegar’s sign or softening and thinning of the uterine segment that occurs at week 6.
      • Goodell’s sign or softening of the cervix that occurs at the beginning of the 2nd month
      • Chadwick’s sign or bluish coloration of the mucous membranes of the cervix, vagina and vulva. Occurs at week 6.
      • Ballottement or rebounding of the fetus against the examiner’s fingers of palpation
      • Braxton-Hicks contractions
      • Positive pregnancy test measuring for hCG.
    • Positive signs of pregnancy include:
      • Fetal Heart Rate detected by electronic device (doppler) at 10-12 weeks
      • Fetal Heart rate detected by nonelectronic device (fetoscope) at 20 weeks AOG
      • Active fetal movement palpable by the examiners
      • Outline of the fetus via radiography or ultrasound
11. Answer: A. Dorsiflex the foot while extending the knee when the cramps occur. Legs cramps occur when the pregnant woman stretches the leg and plantar flexes the foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping.
12. Answer: D. Wash the breasts with warm water and keep them dry. The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort.
13. Answer: A. Any bleeding, such as in the gums, petechiae, and purpura. Severe Preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.
14. Answer: A. “I will maintain strict bedrest throughout the remainder of pregnancy.” Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.
15. Answer: C. “I need to drink unpasteurized milk only.” All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption, and avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sandboxes, and garden soil.
16. Answer: C. The client complains of a headache and blurred vision. If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening Preeclampsia.
17. Answer: C. “I need to avoid exercise because of the negative effects of insulin production.” Exercise is safe for the client with gestational diabetes and is helpful in lowering the blood glucose level.
18. Answer: C. Respiratory rate of 10 BPM. Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.
19. Answer: C. Clean and maintain an open airway. The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.
20. Answers: A Elevated blood pressure and 3 Facial edema. The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia.
21. Answer: A. Being affected by Rh incompatibility. Rh incompatibility can occur when an Rh-negative mom becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the baby’s Rh positive blood can enter the maternal circulation, causing the woman’s immune system to form antibodies against Rh positive blood. Administration of Rho(D) immune globulin prevents the woman from developing antibodies against Rh positive blood by providing passive antibody protection against the Rh antigen.
22. Answer: D. Respirations of 10 per minute. Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L. Proteinuria of +3 would be noted in a client with preeclampsia.
23. Answer: C. Seizures do not occur. For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.
24. Answers: C, D, E, F, and G. When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.
25. Answer: A. Administer RhoGAM within 72 hours. RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.
26. Answer: B. Blood level of LH is too high.  It is the surge of LH secretion in mid cycle that is responsible for ovulation.
27. Answer: C. Preparation of the uterus to receive a fertilized egg. Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.
28. Answer: B. Eighth week to the time of birth.  In the first 7-14 days the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.
29. Answer: A. Placenta. When placental formation is complete, around the 16th week of pregnancy; it produces estrogen and progesterone.
30. Answer: C. An increase in blood volume. The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.
31. Answer: D. Chadwick’s sign. A purplish color results from the increased vascularity and blood vessel engorgement of the vagina.
32. Answer: C. G5 T2 P1 A1 L4. 5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.
33. Answer: D. Shortness of breath on exertion. This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm.
34. Answer: B. An increase of 300 calories a day. This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy.
35. Answer: A. Acute hemolytic disease. When an Rh negative mother carries an Rh positive fetus there is a risk for maternal antibodies against Rh positive blood; antibodies cross the placenta and destroy the fetal RBC’s.
36. Answer: B. Production of estrogen. The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells.
37. Answer: C. Neural tube defects. The alpha-fetoprotein test detects neural tube defects and Down syndrome.
38. Answer: B. Walk around until they subside. Ambulation relieves Braxton Hicks.
39. Answer: B. Cause decreased placental perfusion. This is because impedance of venous return by the gravid uterus, which causes hypotension and decreased systemic perfusion.
40. Answer: A. Prolactin. Prolactin is the hormone from the anterior pituitary gland that stimulates mammary gland secretion. Oxytocin, a posterior pituitary hormone, stimulates the uterine musculature to contract and causes the “let down” reflex.
41. Answer: D. “Snowstorm” pattern on ultrasound with no fetus or gestational sac. The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.
42. Answer: D. Telangiectasias. The dilated arterioles that occur during pregnancy are due to the elevated level of circulating estrogen. The linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus during pregnancy.
43. Answer: C. Physiologic anemia. Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production.
44. Answer: B. Electrolyte imbalance. Excessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid, electrolyte, and acid-base imbalances.
45. Answer: A. Diet. Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic agents are contraindicated in pregnancy. NPH isn’t usually needed for blood glucose control for GDM.
46. Answer: A. Calcium gluconate. Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium gluconate is given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients.
47. Answer: D. maternal and fetal blood are never exchanged. Only nutrients and waste products are transferred across the placenta. Blood exchange only occurs in complications and some medical procedures accidentally.
48. Answer: B. Number of times a female has been pregnant. Gravida refers to the number of times a female has been pregnant, regardless of pregnancy outcome or the number of neonates delivered.
49. Answer: D. Turn the woman on her side. 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.
50. Answer: A. January 15, 2006. Naegele’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.