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Maternity Nursing An Introductory Text 11th Edition By Gloria Leifer -Test Bank
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Chapter 02: Reproductive Anatomy and Physiology
Test Bank
MULTIPLE CHOICE
- Reproductive structures that have erectile tissue include the:
| a. | Labia majora and the scrotum |
| b. | Penis and clitoris |
| c. | Vestibule and epididymis |
| d. | Vas deferens and vagina |
ANS: B
The penis in the male and the clitoris in the female are similar in that both have erectile tissue.
DIF: Cognitive Level: Knowledge REF: 17 | 23 OBJ: 3 | 9
TOP: External Genitalia KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The glands that secrete mucus to lubricate the vagina are _____ glands.
| a. | Bartholin’s |
| b. | Skene’s |
| c. | Cowper’s |
| d. | Montgomery’s |
ANS: A
Bartholin’s glands secrete the mucus that lubricates the vagina.
DIF: Cognitive Level: Knowledge REF: 19 OBJ: 3
TOP: Female External Genitalia KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Breast cells that secrete milk are called:
| a. | Myoepithelium |
| b. | Acini |
| c. | Lactiferous |
| d. | Alveoli |
ANS: B
Breast milk is secreted in the acini cells.
DIF: Cognitive Level: Knowledge REF: 22 OBJ: 5
TOP: Breasts KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- On her first prenatal visit, a patient expresses concern that she will not produce enough milk to breastfeed because her breasts are small. Which response is most appropriate?
| a. | “You might want to talk to your doctor about different formulas.” |
| b. | “Your breasts will enlarge during pregnancy.” |
| c. | “Breast enlargement surgery might be helpful.” |
| d. | “Breast size does not indicate how much milk you can produce.” |
ANS: D
Breast size is determined by the amount of fatty tissue in the breasts and is not related to milk production.
DIF: Cognitive Level: Application REF: 23 OBJ: 5
TOP: Breasts KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- The unique muscle fiber pattern of the uterine myometrium makes the uterus ideally suited for:
| a. | Menstruation |
| b. | Labor |
| c. | Hemostasis |
| d. | Fertilization |
ANS: B
The longitudinal, transverse, and oblique directions of the myometrium provide extreme strength to thin out, pull up, and dilate the cervix, as well as push out the fetus during labor.
DIF: Cognitive Level: Comprehension REF: 19 OBJ: 7
TOP: Female Internal Reproductive Organs KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- What is a function of the mucosal lining of the cervix?
| a. | Serves as a site for implantation of the fertilized ovum |
| b. | Protects against infection by acting as a bacteriostatic agent |
| c. | Contains muscle fibers that force the fetus from the uterus |
| d. | Provides an acid environment to shelter the sperm |
ANS: B
The mucosal lining of the cervix acts as a bacteriostatic agent. It also provides an alkaline environment, which is needed for sperm survival. The ovum is implanted in the endometrium, and muscle fibers are in the myometrium.
DIF: Cognitive Level: Knowledge REF: 20 OBJ: 4
TOP: Female Internal Reproductive Organs KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A patient at the prenatal clinic tells the nurse that she plans to continue daily douching to maintain vaginal cleanliness during her pregnancy. The nurse’s best response is:
| a. | “That is an excellent way to prevent an infection.” |
| b. | “Be sure to use an antimicrobial solution.” |
| c. | “You must be careful to maintain the alkalinity of your vagina.” |
| d. | “Frequent douching alters the normal acidic nature of the vagina, increasing the risk of infection.” |
ANS: D
A change in the normally acidic pH of the vagina, caused by excessive douching or use of vaginal sprays or deodorant tampons, alters its self-cleansing properties and increases the risk of infection.
DIF: Cognitive Level: Application REF: 19 OBJ: 4
TOP: Female Internal Reproductive Organs
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- To assess the adequacy of the pelvis for delivery, the examiner measures the:
| a. | Diagonal conjugate |
| b. | Midpelvis |
| c. | Ischial spines |
| d. | False pelvis |
ANS: A
The diagonal conjugate is commonly measured during a pelvic examination to determine whether the pelvic outlet is large enough for the fetus to pass through.
DIF: Cognitive Level: Knowledge REF: 21 OBJ: 4
TOP: Pelvis KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- The pelvic landmark(s) used to assess how far the baby’s head has descended through the birth canal is/are the:
| a. | Symphysis pubis |
| b. | Ischial spines |
| c. | Linea terminalis |
| d. | Ischial tuberosities |
ANS: B
The ischial spines that form the posterior border of the ischium represent the shortest diameter of the pelvic cavity. They are used as landmarks to determine the descent of the baby’s head.
DIF: Cognitive Level: Knowledge REF: 20 OBJ: 8
TOP: Pelvis KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- The gynecoid, or female-type, pelvis is best suited to childbirth because it has a:
| a. | Long anteroposterior outlet |
| b. | Round outlet and a fixed coccyx |
| c. | Heart-shaped outlet that readily expands |
| d. | Wide pubic arch and more movable coccyx |
ANS: D
The gynecoid pelvis has a wide pubic arch; more movable coccyx; and better proportioned inlet, cavity, and outlet than other pelvic shapes.
DIF: Cognitive Level: Knowledge REF: 21-22 OBJ: 8
TOP: Pelvis KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- What is the purpose of the rise of progesterone during the secretory phase of the menstrual cycle?
| a. | To prepare and maintain the endometrium for implantation of an ovum |
| b. | To regenerate the endometrium to begin the menstrual cycle |
| c. | To increase elasticity of cervical mucus |
| d. | To decrease blood flow to the endometrium before menstruation |
ANS: A
In the secretory phase, progesterone causes endometrial cells to become thickened, dilated, and tortuous in preparation for implantation.
DIF: Cognitive Level: Comprehension REF: 23 | Table 2-1
OBJ: 5 TOP: Endocrine System and Female Reproduction
KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- The phases of the ovarian cycle are the _____ phases.
| a. | Secretory and ischemic |
| b. | Follicular and luteal |
| c. | Proliferative and menstrual |
| d. | Luteal and secretory |
ANS: B
Only the follicular and luteal phases are in the ovarian cycle; the others are in the menstrual cycle.
DIF: Cognitive Level: Knowledge REF: 23 | Table 2-1
OBJ: 6 TOP: Endocrine System and Female Reproduction
KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- Which statement best describes the follicular phase of the ovarian cycle?
| a. | If the ovum is not fertilized, the corpus luteum degenerates. |
| b. | The corpus luteum increases estrogen and progesterone production. |
| c. | The graafian follicle ruptures, releasing the ovum from the ovarian surface. |
| d. | It extends from the fifteenth to the twenty-eighth day of the menstrual cycle. |
ANS: C
The development and release of the ovum is the focus of the follicular phase. The other events listed occur in the luteal cycle.
DIF: Cognitive Level: Comprehension REF: 23 | Table 2-1
OBJ: 6 TOP: Endocrine System and Female Reproduction
KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- The client asks the nurse when she is most likely to become pregnant. The most appropriate response is the _____ day of the menstrual cycle.
| a. | Third |
| b. | Seventh |
| c. | Tenth |
| d. | Fourteenth |
ANS: D
The development of an ovarian follicle occurs during the follicular phase of the menstrual cycle. In a typical menstrual cycle, ovulation occurs 14 days before the next cycle begins.
DIF: Cognitive Level: Application REF: 22 OBJ: 6
TOP: Endocrine System and Female Reproduction KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Hormones secreted by the anterior pituitary gland that influence ovarian activity are:
| a. | Prolactin and progesterone |
| b. | Estrogen and progesterone |
| c. | Follicle-stimulating hormone and luteinizing hormone |
| d. | Oxytocin and estrogen |
ANS: C
Follicle-stimulating and luteinizing hormones, which are secreted by the anterior pituitary, stimulate ovarian development and estrogen production.
DIF: Cognitive Level: Knowledge REF: 23 | Table 2-1
OBJ: 6 TOP: Endocrine System and Female Reproduction
KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- The client is very anxious before his prostatectomy. He asks the nurse how his semen will be affected with the removal of the prostate gland. The nurse explains that the function of prostate fluid is to:
| a. | Nourish and protect the spermatozoa. |
| b. | Provide lubrication during sexual intercourse. |
| c. | Transport spermatozoa from the seminiferous tubules to the epididymis. |
| d. | Enhance sperm motility by neutralizing the acidity of the vas deferens and the vagina. |
ANS: D
The acidity of the vas deferens and the vagina interferes with sperm motility. Because prostate fluid is alkaline, it alters the pH of the vas deferens and the vagina to create an environment that enhances sperm motility and life span.
DIF: Cognitive Level: Application REF: 26 OBJ: 9
TOP: Internal Male Structures KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The effects of testosterone include:
| a. | Increased production of white blood cells |
| b. | Development of male secondary sex characteristics |
| c. | Lengthening and thinning of muscles and growth of bones |
| d. | Stimulation of androgen production by Leydig’s cells |
ANS: B
Testosterone promotes the development of male reproductive organs and secondary sex characteristics. It causes bones and muscles to become longer and thicker (not thinner). Luteinizing hormone causes Leydig’s cells in the testes to release androgens, including testosterone.
DIF: Cognitive Level: Knowledge REF: 26 OBJ: 10
TOP: Endocrine System and Male Reproduction KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A young man tells the clinic nurse that he has been told that, if he wants a family, he should wear boxer shorts, not briefs. What would be the nurse’s best response?
| a. | “That is just an old wives’ tale!” |
| b. | “The type of undershorts that you wear makes no difference to male fertility.” |
| c. | “Tight briefs are the best underwear for you to wear.” |
| d. | “Excessive warmth of the scrotum can decrease sperm production, so continuous use of tight underwear may not be appropriate.” |
ANS: D
Normal spermatogenesis requires a slightly lower than normal body temperature. Excessive warmth decreases sperm production.
DIF: Cognitive Level: Knowledge REF: 23-24 OBJ: 9
TOP: Male Reproductive System KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- The patient asks how long she remains fertile after ovulation. The best response is the ovum remains fertile:
| a. | For approximately 24 hours |
| b. | For approximately 1 week |
| c. | For approximately 4 hours |
| d. | Until menstruation begins |
ANS: A
The ovum remains fertile for about 24 hours after ovulation.
DIF: Cognitive Level: Application REF: 22 OBJ: 6
TOP: Endocrine System and Female Reproduction KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The nurse is providing discharge instructions to a pregnant woman at risk for preterm labor. Which statement by the patient indicates the teaching was effective?
| a. | “I will avoid eating spicy foods.” |
| b. | “I will avoid taking a warm bath.” |
| c. | “I will avoid sexual intercourse.” |
| d. | “I will avoid wearing tight-fitting clothing.” |
ANS: C
Sexual abstention is advised for women at risk for miscarriage or preterm labor because of the uterine-stimulating effects of the hormone oxytocin that is released during orgasm.
DIF: Cognitive Level: Application REF: 27 OBJ: 5
TOP: Physiology of the Female Sex Act KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiologic Integrity
- The patient asks the nurse which pelvic shape is best suited for childbirth. The best response would be:
| a. | Gynecoid |
| b. | Android |
| c. | Platypelloid |
| d. | Anthropoid |
ANS: A
The gynecoid (or round) pelvis has better proportions, with a wide pubic arch and more movable coccyx, which makes it most suitable for childbirth. The android pelvis has a heart-shaped outlet, the anthropoid pelvis has a long anteroposterior outlet, and the platypelloid pelvis has a wide transverse outlet that is not favorable for vaginal delivery.
DIF: Cognitive Level: Comprehension REF: 22 | Figure 2-6
OBJ: 8 TOP: Pelvic Types KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- What is the name of the hoodlike covering of the clitoris and glans penis?
| a. | Vestibule |
| b. | Fundus |
| c. | Fourchette |
| d. | Prepuce |
ANS: D
The hoodlike covering of the clitoris and glans penis is the prepuce.
DIF: Cognitive Level: Knowledge REF: 17 | 23 | Figure 2-1
OBJ: 3 | 9 TOP: Female Reproductive System | Male Reproductive System
KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- The almond-shaped area of the female genitalia enclosed by the labia minora that contains openings to the urethra, Skene’s glands, vagina, and Bartholin’s glands is known as the:
| a. | Vestibule |
| b. | Fourchette |
| c. | Mons pubis |
| d. | Symphysis pubis |
ANS: A
The almond-shaped area of the female genitalia enclosed by the labia minora that contains openings to the urethra, Skene’s glands, vagina, and Bartholin’s glands is the vestibule.
DIF: Cognitive Level: Knowledge REF: 17 OBJ: 3
TOP: Female Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- What is the thin, flat tissue formed by the joining of the labia minora, underneath the vagina at the midline?
| a. | Fourchette |
| b. | Rugae |
| c. | Mons pubis |
| d. | Prepuce |
ANS: A
The thin, flat tissue formed by the joining of the labia minora, underneath the vagina at the midline is the fourchette.
DIF: Cognitive Level: Knowledge REF: 17 | Figure 2-1
OBJ: 3 TOP: Female Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The fibromuscular, collapsible tubular structure that extends from the vulva to the uterus, lying between the bladder and rectum is called the:
| a. | Scrotum |
| b. | Vagina |
| c. | Mons pubis |
| d. | Labia majora |
ANS: B
The fibromuscular, collapsible tubular structure that extends from the vulva to the uterus, lying between the bladder and rectum is called the vagina.
DIF: Cognitive Level: Comprehension REF: 18 OBJ: 4
TOP: Female Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- What is the term for the dome-shaped top of the uterus?
| a. | Cervix |
| b. | Fundus |
| c. | Myometrium |
| d. | Fallopian tube |
ANS: B
The dome-shaped top of the uterus is called the fundus.
DIF: Cognitive Level: Knowledge REF: 19 OBJ: 4
TOP: Female Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Which statement about the scrotum is correct?
| a. | It consists of skin, muscle, and fascia. |
| b. | It lies within the abdominal cavity. |
| c. | It surrounds the male urethra. |
| d. | It is the male organ of copulation. |
ANS: A
The scrotum is a wrinkled, pigmented pouch of skin, muscle, and fascia that lies beneath the penis and outside of the abdominal cavity.
DIF: Cognitive Level: Comprehension REF: 23 | 25 | Figure 2-9
OBJ: 9 TOP: Male Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The oval glands located within the scrotal sac are known as the:
| a. | Vas deferens |
| b. | Prostate glands |
| c. | Testes |
| d. | Bartholin’s glands |
ANS: C
The oval glands located within the scrotal sac are called the testes.
DIF: Cognitive Level: Knowledge REF: 23-24 | Figure 2-9
OBJ: 9 TOP: Male Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The patient asks what the purpose of the vas deferens is. The correct response would be that:
| a. | The vas deferens is a continuation of the epididymis and carries sperm from each testis to the urethra. |
| b. | There has been no documented purpose for the vas deferens. |
| c. | The vas deferens carries urine from the bladder to the urethral opening. |
| d. | The vas deferens carries testosterone to the bloodstream. |
ANS: A
The vas deferens is a continuation of the epididymis and carries sperm from each testis to the urethra.
DIF: Cognitive Level: Comprehension REF: 26 OBJ: 9
TOP: Male Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The chestnut-sized structure surrounding the male urethra, just below the urinary bladder, is known as the:
| a. | Prostate gland |
| b. | Testis |
| c. | Seminal vesicle |
| d. | Glans penis |
ANS: A
The chestnut-sized structure surrounding the male urethra, just below the urinary bladder, is known as the prostate gland.
DIF: Cognitive Level: Knowledge REF: 26 OBJ: 9
TOP: Male Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The male organ of copulation and part of the urinary system is known as the:
| a. | Testes |
| b. | Scrotum |
| c. | Prostate gland |
| d. | Glans penis |
ANS: D
The male organ of copulation and part of the urinary system is known as the glans penis.
DIF: Cognitive Level: Knowledge REF: 23 | 25 | Figure 2-9
OBJ: 9 TOP: Male Reproductive System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
Leifer: Maternity Nursing: An Introductory Text, 11th Edition
Chapter 04: Physiologic and Psychological Changes During Pregnancy
Test Bank
MULTIPLE CHOICE
- A woman who is pregnant for the third time is referred to as a:
| a. | Nullipara |
| b. | Primigravida |
| c. | Multigravida |
| d. | Grand multipara |
ANS: C
Gravida refers to the number of pregnancies, and the prefix multi indicates more than one. Therefore, anyone who has had more than one pregnancy is a multigravida.
DIF: Cognitive Level: Knowledge REF: 43 OBJ: 1
TOP: Terminology KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A woman who is 8 weeks pregnant has a daughter age 5 and a son age 2. Previously, she had a spontaneous abortion at 12 weeks’ gestation. Therefore, she is gravida _____, para _____.
| a. | 3; 1 |
| b. | 3; 2 |
| c. | 4; 1 |
| d. | 4; 2 |
ANS: D
She is in her fourth pregnancy, which means she is a gravida 4. Because she has delivered two children after 20 weeks’ gestation, she is a para 2.
DIF: Cognitive Level: Comprehension REF: 43-44 OBJ: 1
TOP: Previous Obstetric History KEY: Nursing Process Step: Assessment
MSC: NCLEX: N/A
- A woman’s last normal menstrual period began July 4. Using Nägele’s rule, what would be her estimated date of delivery?
| a. | April 1 |
| b. | April 11 |
| c. | May 11 |
| d. | May 29 |
ANS: B
Using Nägele’s rule, add 7 days to the first day of the last menstrual period (LMP) to obtain the day (4 + 7 = 11). To determine the month, subtract 3 from the month of the LMP. (July is the seventh month, so 7 – 3 = 4 [April].) Therefore, the estimated due date is April 11.
DIF: Cognitive Level: Knowledge REF: 44 OBJ: 2
TOP: Determining Date of Birth KEY: Nursing Process Step: Assessment
MSC: NCLEX: N/A
- A woman comes to the physician’s office because she has missed a menstrual period. She suspects she is pregnant because she has been nauseated in the morning and feels unusually tired. These are _____ signs of pregnancy.
| a. | Presumptive |
| b. | Probable |
| c. | Positive |
| d. | Potential |
ANS: A
These signs and symptoms are common in the early stage of pregnancy. However, they only suggest pregnancy. They do not provide definitive evidence of pregnancy because they could be attributed to other causes.
DIF: Cognitive Level: Comprehension REF: 44-45 | Table 4-1
OBJ: 3 TOP: Signs of Pregnancy
KEY: Nursing Process Step: Assessment MSC: NCLEX: N/A
- Which are classified as probable signs of pregnancy?
| a. | Linea nigra, abdominal enlargement, palpation of fetal outline |
| b. | Abdominal enlargement, urinary frequency, quickening |
| c. | Uterine enlargement, Hegar’s sign, positive pregnancy test |
| d. | Quickening, Goodell’s sign, striae gravidarum |
ANS: C
Enlargement of the uterus, Hegar’s sign, and a positive pregnancy test are called probable signs of pregnancy because they indicate a woman is probably pregnant.
DIF: Cognitive Level: Comprehension REF: 44-45 | Table 4-1
OBJ: 3 TOP: Signs of Pregnancy
KEY: Nursing Process Step: Assessment MSC: NCLEX: N/A
- A patient can be told that she is definitely pregnant when she has:
| a. | Positive pregnancy results |
| b. | Uterine enlargement |
| c. | Fetal heart sounds |
| d. | Amenorrhea |
ANS: C
Pregnancy is definitely confirmed when positive signs are present. Positive signs of pregnancy include fetal heart sounds, fetal movements palpated by the examiner, and fetal outline visualized by ultrasound.
DIF: Cognitive Level: Knowledge REF: 44-45 | Table 4-1
OBJ: 3 TOP: Signs of Pregnancy
KEY: Nursing Process Step: Assessment MSC: NCLEX: N/A
- A woman calls the clinic to report that she had a positive home pregnancy test and asks how reliable these are. The nurse’s most appropriate response is:
| a. | “The tests are 100% accurate.” |
| b. | “Accuracy is very high if the test instructions are followed exactly.” |
| c. | “The home kits test for hCG, which is not present until the third month of pregnancy.” |
| d. | “Because they are highly inaccurate, these kits should not be relied on to diagnose pregnancy.” |
ANS: B
If done properly, these tests are about 97% accurate. Human chorionic gonadotropin (hCG) is present in the blood and urine around the end of the first week after conception.
DIF: Cognitive Level: Application REF: 44-45 OBJ: 3
TOP: Signs of Pregnancy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- The laboratory test used to confirm pregnancy measures:
| a. | Estrogen |
| b. | Progesterone |
| c. | Human chorionic gonadotropin (hCG) |
| d. | Follicle-stimulating hormone |
ANS: C
The hormone hCG is produced by the chorionic villi of the placenta. It is present in the pregnant woman’s blood and urine as early as 1 week after ovulation.
DIF: Cognitive Level: Knowledge REF: 45 OBJ: 4
TOP: Signs of Pregnancy KEY: Nursing Process Step: Assessment
MSC: NCLEX: N/A
- The mother’s first recognition of fetal movements is referred to as:
| a. | Lightening |
| b. | Quickening |
| c. | Ballottement |
| d. | Engagement |
ANS: B
The pregnant woman usually senses the fetal movements between 18 and 20 weeks’ gestation. The first time this occurs is referred to as quickening.
DIF: Cognitive Level: Knowledge REF: 44-45 | Table 4-1
OBJ: N/A TOP: Signs of Pregnancy KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Which change is related to increased progesterone levels?
| a. | Increased smooth muscle tone |
| b. | Braxton-Hicks contractions |
| c. | Deepening of the voice |
| d. | Sodium retention |
ANS: C
Progesterone causes enlargement of the vocal cords, which deepens the voice. It also decreases smooth muscle tone to prevent abortion, and stimulates sodium secretion.
DIF: Cognitive Level: Comprehension REF: 52 OBJ: 4
TOP: Changes in Respiratory System (Epistaxis) KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Which of the following is the cause of lordosis in pregnancy?
| a. | Tilting the thorax back relieves discomfort caused by muscle strain. |
| b. | Softening of the pelvic joints decreases the support of the spinal column. |
| c. | Loss of muscle tone makes the woman unable to maintain good posture. |
| d. | As the uterus enlarges, the center of gravity shifts, causing the woman to lean back. |
ANS: D
As the uterus enlarges and becomes heavier, the mother’s center of gravity shifts forward. Progressive curvature of the spine enables her to maintain balance.
DIF: Cognitive Level: Comprehension REF: 53 OBJ: 9
TOP: Changes in Integumentary and Skeletal Systems KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Which finding in a pregnant patient would require further assessment by the nurse?
| a. | Heart rate of 90 |
| b. | Blood volume increase by 35% |
| c. | Blood pressure of 150/92 |
| d. | White blood cell count of 16,000/mm3 |
ANS: C
An increased blood pressure in pregnancy requires further assessment. Increased heart rate, blood volume, and white blood cells are normal during physiologic changes during pregnancy.
DIF: Cognitive Level: Analysis REF: 50-51 | Table 4-4
OBJ: 5 TOP: Changes in Cardiovascular System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A patient in her third trimester of pregnancy complains of dizziness and faintness when she lies on her back. Which statement by the nurse is most appropriate?
| a. | “Don’t worry, you don’t have long to go until delivery.” |
| b. | “To improve the symptoms, lie on your left side instead of your back.” |
| c. | “The symptoms are due to an increase in cardiac output when you lie down.” |
| d. | “You will sleep more comfortably in a recliner.” |
ANS: B
Supine hypotensive syndrome is a drop in cardiac output that may occur in the third trimester as a result of pressure on the inferior vena cava by the enlarged uterus. Cardiac output is best when lying on the left side.
DIF: Cognitive Level: Application REF: 50-52 | Table 4-4 | Figure 4-3
OBJ: 6 TOP: Changes in Cardiovascular System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A pregnant woman diagnosed with anemia says, “I don’t see how I could be anemic. I have been very careful to take iron tablets and to eat a balanced diet.” The nurse’s most appropriate response is:
| a. | “Have you had any bleeding that might have caused this?” |
| b. | “It is normal to be anemic during pregnancy, so don’t worry about it.” |
| c. | “During pregnancy, the fluid portion of your blood increases, which dilutes your red blood cells.” |
| d. | “You need additional red blood cells to supply your baby’s oxygen needs. Too many of your blood cells are going to your baby.” |
ANS: C
Both plasma and red blood cells (RBCs) increase during pregnancy, but the increase in plasma exceeds the increase in RBCs. This essentially dilutes the RBCs so that the patient’s hemoglobin and hematocrit fall. The patient’s hemoglobin and hematocrit should be measured routinely. A hemoglobin below 11 g/dL or a hematocrit below 35% merits evaluation for anemia.
DIF: Cognitive Level: Application REF: 50-52 | Tables 4-4 and 4-5
OBJ: 5 TOP: Changes in Cardiovascular System
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- Changes in the gastrointestinal system during pregnancy include:
| a. | Increased saliva production |
| b. | Increased peristalsis |
| c. | Decreased resistance of maternal tissue to insulin |
| d. | Constriction of the cardiac sphincter of the stomach |
ANS: A
During pregnancy, increased estrogen causes ptyalism (increased saliva production); peristalsis decreases due to increased progesterone; insulin resistance develops; and the cardiac sphincter relaxes, which permits reflux of gastric contents and heartburn.
DIF: Cognitive Level: Comprehension REF: 52 OBJ: 4
TOP: Changes in Gastrointestinal System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- One cause of frequent urination during pregnancy is:
| a. | More rapid flow of urine to the bladder |
| b. | Pressure of the gravid uterus on the bladder |
| c. | Stasis of urine in the ureters |
| d. | Decreased renal blood flow |
ANS: B
During early pregnancy, the growing uterus puts pressure on the bladder, causing frequent urination. In late pregnancy, the uterus with the growing fetus settles into the pelvic cavity, again putting pressure on the bladder. Urine flows to the bladder more slowly (not more rapidly). Stasis of urine in the ureters occurs but would not cause frequency. Renal blood flow increases, rather than decreases.
DIF: Cognitive Level: Comprehension REF: 52-53 OBJ: 7
TOP: Changes in Renal System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Melanocyte-stimulating hormone (MSH) is responsible for which of the following signs of pregnancy?
| a. | Nausea and vomiting |
| b. | Feelings of warmth |
| c. | Linea nigra |
| d. | Breast enlargement |
ANS: C
MSH and estrogen cause increased skin pigmentation such as linea nigra and chloasma.
DIF: Cognitive Level: Comprehension REF: 53-54 OBJ: 8
TOP: Changes in Integumentary and Skeletal Systems KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A woman in her second trimester of pregnancy smiles and pats her abdomen when she feels the baby move. She expresses a wish for a beautiful little girl and often talks about the baby in positive terms. These behaviors illustrate which developmental task of pregnancy?
| a. | Pregnancy validation |
| b. | Fetal embodiment |
| c. | Fetal distinction |
| d. | Role transition |
ANS: C
When the mother achieves the task of fetal distinction, she begins to think of the fetus as distinct and separate from herself. Typically, she daydreams and talks about the baby, envisioning a perfect, beautiful baby.
DIF: Cognitive Level: Comprehension REF: 56 OBJ: 12
TOP: Developmental Tasks KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A woman who is 36 weeks pregnant tells the clinic nurse that she is considering taking ibuprofen for her back pain and muscle cramps. The nurse’s best response is:
| a. | “That is a good choice for pain relief.” |
| b. | “Taking that mediation could cause your baby to experience distress because of premature changes in its cardiovascular system.” |
| c. | “Instead of using ibuprofen, you should take aspirin for the pain.” |
| d. | “Any of the over-the-counter pain relievers would be fine.” |
ANS: B
Use of ibuprofen during the third trimester can cause early closure of the ductus arteriosus. All women of childbearing age should be counseled about the risk of ingesting any drug during pregnancy and lactation.
DIF: Cognitive Level: Application REF: 54 OBJ: 10
TOP: Effect of Pregnancy and Lactation on Medication Ingestion
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- Which hormone stimulates uterine contractions and the milk ejection reflex in breastfeeding?
| a. | Progesterone |
| b. | Estrogen |
| c. | Oxytocin |
| d. | Testosterone |
ANS: C
Oxytocin, a posterior pituitary hormone, contracts the uterus before and after delivery and causes milk ejection during breastfeeding.
DIF: Cognitive Level: Knowledge REF: 49-50 | Table 4-3
OBJ: 4 TOP: Changes in Endocrine System KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A patient tells the nurse that she is worried because her partner does not seem interested in the pregnancy. Which response by the nurse would be the most appropriate?
| a. | “Your partner probably did not want a child.” |
| b. | “Your partner will go through stages of adjustment to fatherhood.” |
| c. | “It would be a good idea for you to see a counselor as soon as possible.” |
| d. | “If he doesn’t show more interest by the second trimester, he won’t be able to bond with the baby.” |
ANS: B
Although the major focus of pregnancy is the mother and baby, the partner also travels through stages of adjustment to fatherhood. Cultural values influence the role of the father, so the nurse should not assume that a father is not interested if he takes a less active role during the pregnancy and birth process.
DIF: Cognitive Level: Application REF: 56 OBJ: 12-13
TOP: Responses to Pregnancy: Impact on the Father KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
MULTIPLE RESPONSE
- The nurse is interviewing a woman in the clinic who thinks she might be pregnant. Which are presumptive signs of pregnancy? (Select all that apply.)
| a. | Amenorrhea |
| b. | Goodell’s sign |
| c. | Uterine enlargement |
| d. | Fatigue |
| e. | Breast tenderness |
| f. | Fetal heart sounds heard |
ANS: A, D, E
Amenorrhea, fatigue, and breast tenderness are presumptive signs of pregnancy. Goodell’s sign and uterine enlargement are probable signs, and auscultation of fetal heart sounds is a positive sign of pregnancy.
DIF: Cognitive Level: Comprehension REF: 44-45 | Table 4-1
OBJ: 3 TOP: Signs of Pregnancy
KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance
COMPLETION
- A pregnant woman has three living children, one single and one twin birth, one preterm birth, and no abortions. According to GTPALM, the nurse would record her pregnancy history as __________.
ANS:
4-2-1-0-3-1
GTPALM is a systematic, quick way to identify not only the number of pregnancies a woman has had, but also the outcomes of each one. It stands for G (gravida), T (number of term pregnancies), P (number of preterm deliveries), A (number of abortions), L (number of live births), and M (number of multiple births).
DIF: Cognitive Level: Comprehension REF: 43-44 | Box 4-1
OBJ: 1 TOP: Previous Obstetric History
KEY: Nursing Process Step: Assessment MSC: NCLEX: N/A
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