Deck 24: The Pregnant Patient

Question 1

Which hematological finding for a pregnant woman requires immediate referral for further evaluation?

A) increased white blood cell (WBC) and red blood cell (RBC) volume
B) increased fibrinogen and clotting factors VII through X
C) low platelets, hemolysis, and elevated liver enzymes
D) increased plasma volume and decreased hematocrit

Answer 1

low platelets, hemolysis, and elevated liver enzymes

Question 2

Thalassemia is more commonly found in infants with which ethnic backgrounds?

A) African American, Middle Eastern, Haitian
B) Ashkenazi Jews, Greek, Italian
C) Asian, Asian Indian, Mediterranean
D) Cajun, American Indian, French Canadian

Answer 2

Asian, Asian Indian, Mediterranean

Question 3

According to the recommendations of the American College of Obstetricians and Gynecologists,prenatal visits should be scheduled every 2 weeks from

A) 6 to 28 weeks' gestation.
B) 28 to 36 weeks' gestation.
C) 32 to 38 weeks' gestation.
D) 36 weeks' until delivery.

Answer 3

28 to 36 weeks' gestation.

Question 4

Increased levels of progesterone lead to which change in the lungs and thorax typically occurring during pregnancy?

A) expansion of the diaphragm by 2 cm
B) expansion of the circumference of the thorax by 5-7 cm
C) increase in tidal volume by 10%
D) increase in PaO₂ and PaCO₂ levels by 30%

Question 5

The incidences of small-for-gestational-age infants,preterm labor,spontaneous abortions,and lower Apgar scores are higher than normal among pregnant women who

A) exercise vigorously.
B) ingest alcohol.
C) smoke.
D) drink coffee.

Question 6

Which breast change(s)occurs in the first few weeks of pregnancy?

A) enlargement, tingling, and tenderness
B) nodular tissue upon palpation
C) proliferation of lactiferous ducts
D) secretion of colostrum

Question 7

Because of its possible teratogenic effect on the fetus,which medication is most likely to be changed during pregnancy?

A) acetaminophen
B) Coumadin
C) methyldopa
D) hydralazine

Question 8

Primary goals for the health examination of the pregnant patient include all of the following,EXCEPT

A) confirming the pregnancy and gestational age.
B) promoting recommended long-term lifestyle changes.
C) evaluating general health as a guide for any needed intervention.
D) providing education on maintaining and promoting the health of mother and fetus.

Question 9

Softening of the uterine isthmus occurring at 8 weeks' gestation is called

A) Chadwick's sign.
B) Goodell's sign.
C) Hegar's sign.
D) McDonald's sign.

Question 10

Normal changes during pregnancy that affect the heart and peripheral vasculature include

A) increase in cardiac output primarily resulting from an increase in plasma levels.
B) increase in heart rate by 30-35 beats per minute.
C) lower diastolic pressure in the third trimester.
D) supine hypertension.

Question 11

Which notation indicates that a woman has three living children?

A) G3 P2, T2 P0, A1 E0 LC2
B) G4 P3, T2 P1, A1 E0 LC2
C) G6 P4, T2 P2, A1 E1 LC3
D) G7 P4, T4 P0, A3 E0 LC4

Question 12

Physiological changes during pregnancy affecting the skin and hair include

A) disappearance of linea alba.
B) decreased sweat and sebaceous gland production.
C) increased pigmentation in nipples, areolae, external genitalia, and anal region.
D) increased scalp hair.

Question 13

Hypertensive disorders of pregnancy are typically noted during which period of a pregnancy?

A) after 20 weeks
B) labor and delivery
C) the first month
D) the first 20 weeks

Question 14

Which of the following are not commonly associated with changes related to pregnancy?

A) glycosuria and proteinuria
B) elevated blood urea nitrogen (BUN) and creatinine
C) urinary frequency and nocturia
D) urinary tract infection

Question 15

At 16 weeks in a pregnancy,the fundus of the uterus is palpated approximately

A) at the umbilicus.
B) just above the symphysis pubis.
C) midway between the symphysis pubis and the umbilicus.
D) midway between the umbilicus and xiphoid process.

Question 16

Throughout pregnancy,vaginal secretions are typically

A) thin, clear, and watery.
B) thick, white, and milky.
C) thick with white mucoid clumps.
D) thin, with occasional dark red or rust-colored discharge.

Question 17

Because of the relaxation of the esophageal sphincter and subsequent reflux,pregnant women commonly complain of

A) constipation.
B) heartburn.
C) increased flatulence.
D) nausea and vomiting.

Question 18

Cocaine use during pregnancy can lead to an addicted newborn and is associated with a higher incidence of

A) fetal anomalies and hemorrhage.
B) low infant birth weight and stillbirth.
C) microcephaly and cardiovascular defects.
D) abruptio placentae and preterm delivery.

Question 19

Which notation indicates that a woman has had four previous live births and that two were preterm?

A) G4 P3, T3 P0, A1 E0 LC3
B) G5 P4, T2 P2, A0 E1 LC4
C) G6 P4, T3 P0, A2 E0 LC3
D) G6 P2, T2 P0, A4 E0 LC1

Question 20

A pregnant woman must be questioned closely about all of the following,EXCEPT

A) first-trimester exposure to rubella.
B) recent immunization with rubella or varicella.
C) existing HIV, syphilis, or hepatitis B infections.
D) all childhood immunizations.

Question 21

During pregnancy,hypertension at any time is abnormal.Hypertension is defined as

A) 120/80
B) 130/90
C) 140/90
D) 150/100

Question 22

You are examining a woman in the clinic.Which of the following are probable signs that the woman is pregnant? Select all that apply.

A) Amenorrhea
B) Fatigue
C) Uterine changes
D) HCG in blood or urine
E) Braxton Hicks contractions
F) Breast tenderness and enlargement

Question 23

During which phase of Leopold's maneuver would you determine the long axis of the fetus in relationship to the long axis of your patient?

A) first maneuver
B) second maneuver
C) third maneuver
D) fourth maneuver

Question 24

Striae gravidarum (changes of the connective tissue)are often found on which body parts? Select all that apply.

A) Arms
B) Breasts
C) Abdomen
D) Upper thighs
E) Calves of the legs
F) Face

Question 25

Your patient complains of midline epigastric pain that has worsened during the sixth month of her pregnancy.It is most likely related to

A) cholecystitis.
B) gastric ulcer.
C) heartburn.
D) hepatitis.

Question 26

The plasma level increase that occurs during pregnancy functions to do which of the following? Select all that apply.

A) Increases renal filtration
B) Dissipates fetal heat production
C) Increases the transport of oxygen
D) Increases heart rate during activity
E) Produces swelling in the hands and feet
F) Protects the mother from hemorrhage at delivery

Question 27

A patient asks you about sexual relations during pregnancy.The most accurate answer you can give her is

A) you may be more comfortable on your back in the later stages of the pregnancy.
B) you may experience increased sexual arousal during the first trimester.
C) it is not known that it will harm your baby or yourself if you have sexual intercourse throughout your pregnancy.
D) to be safe, it is best to avoid sexual relations during pregnancy.

Question 28

Which of the following could indicate a compromised fetus?

A) decrease in fetal movement during the ninth month
B) fluttering movements at 20 weeks
C) no fetal movement by 12 weeks
D) a fetal heart rate of 155

Question 29

Your patient reports severe nausea and vomiting,which started during the second month of her pregnancy,and a weight loss of 10 pounds over the past month.She most likely is experiencing

A) food allergies.
B) morning sickness.
C) hyperemesis gravidarum.
D) toxemia.

Question 30

To perform Leopold's maneuver on a patient in order to determine the fetal presentation,you would first palpate her

A) abdomen with the left hand only.
B) abdomen with first one hand and then the other.
C) symphysis pubis.
D) uterine fundus.

Question 31

Erythematous plaques that develop into vesicular lesions and may later become pustular are known as

A) chloasma or melasma.
B) herpes lesions.
C) papular dermatitis.
D) prurigo.

Question 32

To assess the breast for discharge and protraction of the nipple,you would place

A) the fingertips of both hands on each side of the breast and press gently.
B) one hand under the breast for support and gently press with the fingers of your other hand from the outer edge of the areola toward the nipple.
C) your thumb and forefinger on the areola and press inward.
D) your thumb and forefinger on the nipple and gently squeeze.

Question 33

A patient reports increased frequency in voiding and the feeling that she is not completely emptying her bladder.Your examination reveals costovertebral angle tenderness.These findings most likely indicate

A) cystitis.
B) increased pressure from the developing fetus.
C) urinary tract infection.
D) dehydration.

Question 34

A patient who has no history of a seizure disorder,has had two episodes of seizures,which in the pregnant patient are most commonly due to

A) brain tumor.
B) cerebrovascular accident.
C) eclampsia.
D) epilepsy.

Question 35

To measure the height of the uterine fundus with a tape measure,the nurse would place the 0 cm mark at the

A) level of the iliac crests.
B) symphysis pubis.
C) top of the fundus.
D) umbilicus.

Question 36

After careful examination,you are unable to determine the outline of your patient's fetus.This result may be associated with

A) the need for cesarean section.
B) polyhydramnios or maternal obesity.
C) severe fetal malformations.
D) uterine tumor or hydatidiform mole.

Question 37

Which change in the retina most likely indicates a hypertensive disorder of pregnancy?

A) arterial constriction
B) exudates
C) hemorrhage
D) vascular tortuosity

Question 38

Your patient is 6 weeks pregnant and complains of abdominal pain.Her pelvic examination reveals a right adnexal mass with increased tenderness upon cervical motion.She may be experiencing

A) abruptio placenta.
B) ectopic pregnancy.
C) infection of the ovary.
D) pain related to pregnancy-induced hypertension.

Question 39

Your patient is 9 months pregnant and is anxious to deliver her baby.Using the Doppler,you best hear the fetal heart tones above her umbilicus and note that the rate is 150.These findings may indicate

A) a breech presentation.
B) fetal distress.
C) immaturity of the fetal nervous system.
D) possible heart block.

Question 40

A glucose screen should be performed during the initial prenatal examination of women

A) who are underweight.
B) without a family history of diabetes mellitus.
C) who are under 20 years of age or younger.
D) who have delivered a prior macrosomic baby.

Question 41

A decrease in fundal height resulting from the descent of the fetus into the pelvis is known as ____________________ or ____________________.

Question 42

Widening of the symphysis pubis produces an unsteady gait known as the __________________________.

Question 43

Melasma,or chloasma,is better known as the _____________________.

Question 44

Braxton Hicks contractions can begin in the ____________________ trimester.

Question 45

When teaching a pregnant woman techniques for maintaining a center of balance,you would include a discussion of which of the following factors which might cause imbalance? Select all that apply.

A) Driving a car
B) Changing in position
C) Ascending stairs
D) Descending stairs
E) Moving over uneven surfaces
F) Participating in activities such as riding a bicycle

Question 46

Which of the following are Grade: B Recommendations from the U.S.Preventive Services Task Force? Select all that apply.

A) Screen all pregnant women for HIV.
B) Screen for hepatitis B virus in pregnant women at the first prenatal visit.
C) Screen for iron deficiency anemia in asymptomatic pregnant women.
D) Intervene during pregnancy and after birth to promote breast feeding.
E) Screen for chlamydial infection for all pregnant women aged 24 and younger and older pregnant women who are at risk.
F) Screen for asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks gestation or at the first visit.