Leifer Ch 4 Text Bank questions for this Chapter RE: Leifer 8th Edition PDF

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Chapter 04: Prenatal Care and Adaptations to Pregnancy Leifer: Introduction to Maternity and Pediatric Nursing, 8th Edition MULTIPLE CHOICE 1. A woman who is 7 weeks pregnant tells the nurse that this is not her first pregnancy. She has a

2-year-old son and had one previous spontaneous abortion. How would the nurse document the patient’s obstetric history using the TPALM system? a. Gravida 2, para 20120 b. Gravida 3, para 10011 c. Gravida 3, para 10110 d. Gravida 2, para 11110 ANS: C

Refer to Box 4-1 in the textbook for the TPALM system of identifying gravida and para. DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 51|Box 4-1 1 TOP: Definition of Terms Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. A woman calls her health care provider to schedule prenatal visits in an uncomplicated

pregnancy. How frequently will the nurse assist the patient to schedule these appointments? a. Every 3 weeks until the 6th month, then every 2 weeks until delivery b. Every 4 weeks until the 7th month, after which appointments will become more

frequent c. Monthly until the 8th month d. Every 2 to 3 weeks for the entire pregnancy ANS: B

Monthly visits are scheduled up to 28 weeks, and then visits increase to every 2 to 3 weeks through 36 weeks. From 36 weeks until delivery, visits are weekly. DIF: Cognitive Level: Application REF: p. 49 OBJ: 2 | 3 TOP: Prenatal Visits KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 3. During the physical examination for the first prenatal visit, it is noted that Chadwick’s sign is

present. What is Chadwick’s sign? Bluish or purplish discoloration of the vulva, vagina, and cervix Presence of early fetal movements Darkening of the areola and breast tenderness Palpation of the fetal outline

a. b. c. d.

ANS: A

Chadwick’s sign is the purplish or bluish discoloration of the cervix, vulva and vagina. DIF: Cognitive Level: Knowledge

REF: p. 53

OBJ: 7

TOP: Normal Physiological Changes in Pregnancy KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. After the examination is completed, the patient asks the nurse why Chadwick’s sign occurs

during pregnancy. What would the nurse explain as the cause of Chadwick’s sign? Enlargement of the uterus Progesterone action on the breasts Increasing activity of the fetus Vascular congestion in the pelvic area

a. b. c. d.

ANS: D

Chadwick’s sign is caused by increased vascular congestion in the cervical and vaginal area. DIF: TOP: KEY: MSC:

Cognitive Level: Comprehension REF: p. 53 OBJ: 6 | 7 Normal Physiological Changes in Pregnancy Nursing Process Step: Implementation NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse has explained physiological changes that occur during pregnancy. Which statement

indicates that the woman understands the information? “Blood pressure goes up toward the end of pregnancy.” “My breathing will get deeper and a little faster.” “I’ll notice a decreased pigmentation in my skin.” “There will be a curvature in the upper spine area.”

a. b. c. d.

ANS: B

The pregnant woman breathes more deeply, and her respiratory rate may increase slightly. DIF: TOP: KEY: MSC:

Cognitive Level: Comprehension REF: p. 56 OBJ: 7 | 13 Normal Physiological Changes in Pregnancy Nursing Process Step: Evaluation NCLEX: Physiological Integrity: Physiological Adaptation

6. A woman reports that her last normal menstrual period began on August 5, 2013. What is this

woman’s expected delivery date using Nägele’s rule? April 30, 2014 May 5, 2014 May 12, 2014 May 26, 2014

a. b. c. d.

ANS: C

To determine the expected date of delivery, count backward 3 months from the first day of the last menstrual period, then add 7 days and change the year if necessary. DIF: OBJ: KEY: MSC:

Cognitive Level: Analysis REF: p. 52|Box 4-2 5 TOP: Determining Estimated Date of Delivery Nursing Process Step: Data Collection NCLEX: Health Promotion and Maintenance: Growth and Development

7. During the second prenatal visit, the nurse attempts to locate the fetal heartbeat with an

electronic Doppler device. How early might fetal heart tones be detected with an electronic Doppler device? a. 4 weeks b. 8 weeks c. 10 weeks d. 14 weeks ANS: C

The fetal heartbeat can be detected as early as 10 weeks of pregnancy using a Doppler device. DIF: TOP: KEY: MSC:

Cognitive Level: Knowledge REF: p. 54 OBJ: 3 | 6 Normal Physiological Changes in Pregnancy Nursing Process Step: Data Collection NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. In a routine prenatal visit, the nurse examining a patient who is 37 weeks pregnant notices that

the fetal heart rate (FHR) has dropped to 120 beats/minute from a rate of 160 beats/minute earlier in the pregnancy. What is the nurse’s first action? a. Ask if the patient has taken a sedative. b. Notify the physician. c. Turn the patient to her right side. d. Record the rate as a normal finding. ANS: D

The FHR at term ranges from a low of 110 to 120 beats/minute to a high of 150 to 160 beats/minute. This should be recorded as normal. The FHR drops in the late stages of pregnancy. DIF: Cognitive Level: Application REF: p. 54 OBJ: 3 TOP: Assessing Fetal Heart Tone KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Physiological Adaptation 9. A woman’s prepregnant weight is determined to be average for her height. What will the nurse

advise the woman regarding recommended weight gain during pregnancy? 10 to 20 pounds 15 to 25 pounds 25 to 35 pounds 28 to 40 pounds

a. b. c. d.

ANS: C

The recommended weight gain for a woman of normal weight before pregnancy is 25 to 35 pounds. DIF: Cognitive Level: Knowledge REF: p. 63 OBJ: 8 TOP: Nutrition in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. When the nurse tells a pregnant woman that she needs 1200 mg of calcium daily during

pregnancy, the woman responds, “I don’t like milk.” What dietary adjustments could the nurse recommend? a. Increase intake of organ meats. b. Eat more green leafy vegetables. c. Choose more fresh fruits, particularly citrus fruits. d. Include molasses and whole-grain breads in the diet. ANS: B

For women who do not like milk, other sources of calcium include enriched cereals, legumes, nuts, dried fruits, green leafy vegetables, and canned salmon and sardines that contain bones. DIF: Cognitive Level: Application REF: p. 65 OBJ: 8 | 13 TOP: Nutrition for Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 11. A pregnant woman is experiencing nausea in the early morning. What recommendations

would the nurse offer to alleviate this symptom? Eat three well-balanced meals per day and limit snacks. Drink a full glass of fluid at the beginning of each meal. Have crackers handy at the bedside, and eat a few before getting out of bed. Eat a bland diet and avoid concentrated sweets.

a. b. c. d.

ANS: C

The nurse can recommend eating dry toast or crackers before getting out of bed in the morning to alleviate nausea during pregnancy. DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 70|Table 4.6 10 TOP: Common Discomforts in Pregnancy Nursing Process Step: Implementation NCLEX: Physiological Integrity: Physiological Adaptation

12. The patient who is 28 weeks pregnant shows a 10-pound weight gain from 2 weeks ago. What

is the nurse’s initial action? a. Assess food intake. b. Weigh the patient again. c. Take the blood pressure. d. Notify the physician. ANS: C

The marked weight gain may be an indication of gestational hypertension. The blood pressure should be assessed before notifying the physician. DIF: Cognitive Level: Application REF: p. 49 OBJ: 4 TOP: Gestational Hypertension KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 13. The patient remarks that she has heard some foods will enhance brain development of the

fetus. The nurse replies that foods high in docosahexaenoic acid–omega 3 fatty acid (DHA) are thought to enhance brain development. What food can the nurse recommend?

a. b. c. d.

Fried fish Olive oil Red meat Leafy green vegetables

ANS: C

Foods rich in DHA are red meat, flounder, halibut, and soybean and canola oil. Frying fish negatively alters the DHA. DIF: Cognitive Level: Application REF: p. 59 OBJ: 8 TOP: Nutrition in Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 14. The nurse encourages adequate intake of folic acid for women of childbearing age before and

during pregnancy. What is folic acid thought to decrease the incidence of in fetal development? a. Structural heart defects b. Craniofacial deformities c. Limb deformities d. Neural tube defects ANS: D

Folic acid can reduce the incidence of neural tube defects such as spina bifida and anencephaly. DIF: Cognitive Level: Knowledge REF: p. 65 OBJ: 8 TOP: Nutrition for Pregnancy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 15. A woman tells the nurse that she is quite sure she is pregnant. The nurse recognizes which as a

positive sign of pregnancy? a. Amenorrhea b. Uterine enlargement c. HCG detected in the urine d. Fetal heartbeat ANS: D

Positive indications are caused only by the developing fetus and include fetal heart activity, visualization by ultrasound, and fetal movements felt by the examiner. DIF: TOP: KEY: MSC:

Cognitive Level: Knowledge REF: p. 54 OBJ: 6 | 7 Physiological Changes During Pregnancy Nursing Process Step: Data Collection NCLEX: Physiological Integrity: Physiological Adaptation

16. At her initial prenatal visit, a woman asks, “When can I hear the baby’s heartbeat?” At what

gestational age can the fetal heartbeat be auscultated with a specially adapted stethoscope or fetoscope? a. 4 weeks b. 12 weeks

c. 18 weeks d. 24 weeks ANS: C

The fetal heartbeat can be heard with a fetoscope between the 18th and 20th weeks of pregnancy. DIF: TOP: KEY: MSC:

Cognitive Level: Knowledge REF: p. 54 OBJ: 7 Physiological Changes During Pregnancy Nursing Process Step: Data Collection NCLEX: Health Promotion and Maintenance: Growth and Development

17. A woman pregnant for the first time asks the nurse, “When will I begin to feel the baby

move?” What is the nurse’s best response? “You may notice the baby moving around the 4th or 5th month.” “Quickening varies with every woman.” “You’ll feel something by the end of the first trimester.” “The baby will be big enough for you to feel in your 8th month.”

a. b. c. d.

ANS: A

Quickening, fetal movement felt by the mother, is first perceived at 16 to 20 weeks of gestation. DIF: TOP: KEY: MSC:

Cognitive Level: Knowledge REF: p. 53 OBJ: 7 Physiological Changes During Pregnancy Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance: Growth and Development

18. A pregnant woman inquires about exercising during pregnancy. What information should the

nurse include when planning to educate this woman? Exercise elevates the mother’s temperature and improves fetal circulation. Exercise increases catecholamines, which can prevent preterm labor. A regular schedule of moderate exercise during pregnancy is beneficial. Pregnant women should limit water intake during exercise.

a. b. c. d.

ANS: C

In general, moderate exercise several times a week, from the 8th week through delivery, is advised during pregnancy. DIF: Cognitive Level: Comprehension REF: p. 67 OBJ: 9 | 13 TOP: Exercise During Pregnancy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. An ultrasound confirms that a 16-year-old girl is pregnant. How does the need for prenatal

care and counseling for adolescents differ from other age populations? a. A pregnant adolescent is experiencing two major life transitions at the same time. b. Adolescents who get pregnant are more likely to have other chronic health

problems. c. Adolescents are at greater risk for multifetal pregnancies. d. At this age, a pregnant adolescent will accept the nurse’s advice.

ANS: A

The pregnant adolescent must cope with two of life’s most stress-laden transitions simultaneously: adolescence and parenthood. DIF: TOP: KEY: MSC:

Cognitive Level: Comprehension REF: p. 66 Psychological Adaptations to Pregnancy Nursing Process Step: Planning NCLEX: Psychosocial Integrity: Coping and Adaptation

OBJ: 12

20. At what age is a woman who becomes pregnant for the first time described as an “elderly

primip”? After 25 years old After 28 years old After 30 years old After 35 years old

a. b. c. d.

ANS: D

A woman over the age of 35 who becomes pregnant for the first time is described as an “elderly primip.” DIF: Cognitive Level: Knowledge REF: p. 74 OBJ: 12 TOP: Elderly Primip KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Physical Adaptation 21. The nurse explains that the softening of the cervix and vagina is a probable sign of pregnancy.

What is the appropriate term for this sign? Chadwick’s Hegar’s McDonald’s Goodell’s

a. b. c. d.

ANS: D

Goodell’s sign is one of the probable signs of pregnancy and describes a softened cervix and vagina. DIF: Cognitive Level: Knowledge REF: p. 53 OBJ: 1 | 6 | 7 TOP: Goodell’s Sign KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physical Adaptation 22. When obtaining a prenatal history on a pregnant patient the nurse notes a family history of

sickle cell disease. Given this information, what lab test can the nurse anticipate the physician will order? a. Endovaginal ultrasound b. Pap test c. Complete blood count d. Hemoglobin electrophoresis ANS: D

Hemoglobin electrophoresis identifies the presence of sickle cell trait or disease (in women of African or Mediterranean descent). It is ordered in the first trimester, if indicated. DIF: OBJ: KEY: MSC:

Cognitive Level: Comprehension REF: p. 50|Table 4.1 3 TOP: Prenatal laboratory tests Nursing Process Step: Implementation NCLEX: Health Promotion and Maintenance: Prenatal Care

23. A pregnant woman is attending her second prenatal visit. Prenatal lab work indicates she is

not immune to the rubella virus. What is the most appropriate nursing intervention? Provide the rubella vaccine as ordered by the physician immediately. Inform the woman she should receive the vaccine in the hospital after delivery. Hold all immunizations until 1 month postpartum. Encourage the patient to decide whether or not to get the rubella vaccine prenatally.

a. b. c. d.

ANS: B

The rubella vaccine is contraindicated during pregnancy. A woman should be instructed to avoid pregnancy for at least 1 month following rubella immunization. It is not necessary to hold all immunizations until 1 month postpartum. DIF: Cognitive Level: Application REF: p. 76 OBJ: 4 TOP: Immunizations KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prenatal Care 24. A woman who is 37 weeks pregnant reports feeling dizzy when lying on her back. What does

the nurse explain as the most likely cause of this symptom? Supine hypotension syndrome Gestational diabetes Pregnancy-induced hypertension Malnutrition

a. b. c. d.

ANS: A

Supine hypotension syndrome, also called aortocaval compression or vena cava syndrome, may occur if the woman lies on her back. Symptoms of supine hypotension syndrome include faintness, lightheadedness, dizziness, and agitation. DIF: Cognitive Level: Comprehension REF: p. 57 OBJ: 7 TOP: Physiological Changes KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prenatal Care MULTIPLE RESPONSE 1. A woman who is 36 weeks pregnant tells the nurse she plans to take a 12-hour flight to

Hawaii. What would the nurse recommend that the patient do during the flight? (Select all that apply.) a. Wear tight-fitting clothing to promote venous return. b. Eat a large meal before boarding the flight. c. Request a seat with greater leg room.

d. Drink at least 4 ounces of water every hour. e. Get up and walk around the plane frequently. ANS: C, D, E

Because of the increase in clotting potential, the pregnant patient is prone to a thromboembolism. Adequate hydration, frequent position changes, and movement decrease the risk. DIF: Cognitive Level: Application REF: p. 69 OBJ: 10 TOP: Flight Precautions KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 2. The nurse cautions the patient that, because of hormonal changes in late pregnancy, the pelvic

joints relax. What does this result in? (Select all that apply.) Waddling gait Joint instability Urinary frequency Back pain Aching in cervical spine

a. b. c. d. e.

ANS: A, B

A waddling gait and joint instability are the only signs that relate to joint changes. The other discomforts are related to the enlarging uterus with its attendant weight. DIF: Cognitive Level: Comprehension REF: p. 59 OBJ: 7 TOP: Joint Changes KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. The nurse assesses the progress from the announcement stage of fatherhood to the acceptance

stage when the patient reports which actions by the father? (Select all that apply.) Goes fishing every afternoon. Has revised his financial plan. Spends leisure time with his friends. Traded his sports car for a sedan. Helped select a crib.

a. b. c. d. e.

ANS: B, D, E

Active planning for an infant is an indication of the acceptance stage. Concentration on a hobby and spending time away from home are indicators of nonacceptance. DIF: Cognitive Level: Comprehension REF: pp. 73-74 OBJ: 11 TOP: Stages of Fatherhood KEY: Nursing Process Step: Data Collection MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 4. What nursing interventions are appropriate for the prenatal patient in terms of prenatal care?

(Select all that apply.) Offer nutritional counseling. Reinforce responsibility of parenthood. Reduce risk factors. Improve health practices.

a. b. c. d.

e. Make financial arrangements for delivery. ANS: A, B, C, D

Nutritional counseling, reinforcing and discussing the responsibility of parenthood, reducing risk factors for the pregnant woman and the fetus, and improving health practices are all goals of prenatal care. DIF: Cognitive Level: Comprehension REF: pp. 48-49 OBJ: 2 | 3 TOP: Goals of Prenatal Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 5. The nurse recognizes which behavior characteristic(s) of women in their first trimester of

pregnancy? (Select all that apply.) Showing off her sonogram photos Ambiv...