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1. A pregnant client uses a computer continuously during her working hours. This has implications for her plan of care during pregnancy. What should a nurse recommend?

• “Try to walk around every few hours during the workday.”
• “Ask for time in the morning and afternoon to elevate your legs.”
• “Tell your boss that you cannot work beyond the second trimester.”
• “Ask for time in the morning and afternoon to get something to eat.”

2. During a physical in the prenatal clinic the client’s vaginal mucosa is observed to have a purplish discoloration. What sign should the nurse document in the client’s clinical record?

• Hegar
• Goodell
• Chadwick
• Braxton Hicks

3. A client tells the nurse that the first day of her last menstrual period was July 22, 2010. What is the estimated date of birth?

• May 7, 2011
• April 29 2011
• April 22, 2011
• March 6, 2011

4. When involved in prenatal teaching, a nurse should inform clients that there is an increase in vaginal secretions during pregnancy called leukorrhea. What causes this increase?

• Metabolic rate
• Production of estrogen
• Secretion from the Bartholin glands
• Supply of sodium chloride to the vaginal cell

5. What information concerning the childbearing process should the nurse teach a client during the first trimester of pregnancy?

• Labor and birth
• Signs and symptoms of complications
• Role transition into parenthood and its acceptance
• Physical and emotional changes resulting from pregnancy

6. During a client’s first visit to the prenatal clinic, a nurse discusses a pregnancy diet. The client states that her mother told her she should restrict her salt intake. What is the nurse’s best response?

• “Your mother is correct. You should use less salt to prevent swelling.”
• “Because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet.”
• “Salt is an essential nutrient that is naturally reduced by the body’s estrogen. There is no reason to restrict salt in your diet.”
• “We no longer recommend that salt intake be as restricted as much as in the past. However, you shouldn’t add salt to your food.”

7. Which food selected by a client with osteoporosis indicates that the nurse’s dietary instruction was effective?

• Red meat
• Soft drinks
• Turnip greens
• Enriched grains

8. Why is it important for a nurse in the prenatal clinic to provide nutritional counseling to all newly pregnant women?

• Most weight gain is caused by fluid retention.
• Different cultural groups favor different essential nutrients.
• Dietary allowances should not increase throughout pregnancy.
• Pregnant women must adhere to a specific pregnancy dietary regimen.

9. A client at her first prenatal clinic visit is at 6 weeks’ gestation. She asks how long she may continue to work and when she should plan to quit. How should the nurse respond?

• “What activities does your job entail?”
• “How do you feel about continuing to work?”
• “Most women work throughout their pregnancy.”
• “Usually women quit work at the start of their third trimester.”

10. At what time during prenatal development should the nurse expect the greatest fetal weight gain?

• Third trimester
• Second trimester
• First eight weeks
• Implantation period

11. A pregnant woman reports nausea and vomiting during the first trimester of pregnancy. An increase in which hormone should the nurse explain is the precipitating cause of the nausea and vomiting?

• Estrogen
• Progesterone
• Luteinizing hormone
• Chorionic gonadotropin

12. A 36-year-old multigravida who is at 14 weeks’ gestation 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:

• kidney defects
• cardiac anomalies
• neural tube defects
• urinary tract anomalies.

13. What recommendation should a nurse give to clients who have fluid retention during pregnancy?

• Decrease fluid intake
• Maintain a low-sodium diet
• Elevate the lower extremities
• Ask the health care provider for a diuretic.

14. A primigravida in her 10th week of gestation is concerned because she has read that nutrition during pregnancy is important for the growth and development of the fetus. She wants to know something about the foods she should eat. What should be the nurse’s initial response?

• Instruct her to continue eating her regular diet.
• Ask her what she has eaten over the last three days.
• Give her a list of foods to help her plan her meals more efficiently.
• Emphasize to her the importance of limiting highly seasoned foods.

15. A client at 7 weeks’ gestation tells a nurse in the prenatal clinic that she is sick every morning with nausea and vomit ing and adds that she does not think she can tolerate it throughout her pregnancy. The nurse assures her that this is a common occurrence in early pregnancy and will probably disappear by the end of the:

• fifth month.
• third month.
• fourth month.
• second month.

16. A client is scheduled for a nonstress test in the 37th week of gestation. A nurse explains the procedure. Which statement demonstrates that the client understands the teaching?

• “An IV will be needed to inject the medication.”
• “My baby may get very restless after this procedure.”
• “I hope this test does not cause my labor to begin early.”
• “If the heart reacts well, my baby should do okay when I give birth.”

17. A client at 35 weeks’ gestation asks a nurse why her breathing has become more difficult. How should the nurse respond?

• “Your lower rib cage is more restricted.”
• “Your diaphragm has been displaced upward.”
• “There is an increase in the size of your lungs.”
• “There is an increase in the height of your rib cage.”

18. What should a nurse include in nutritional planning for a newly pregnant woman of average height weighing 145 pounds?

• A decrease of 100 calories per day
• A decrease of 200 calories per day
• A decrease of 300 calories per day
• A decrease of 500 calories per day

19. A pregnant woman who is at term is admitted to the birthing unit in active labor. She is excited about the anticipated birth because she has three sons and the amniocentesis indicated that she will have a girl. Which factor in the clients history alerts the nurse that the newborn will be at risk for a complication?

• Her membranes ruptured two hours ago.
• Her first child was diagnosed with hemophilia.
• She used NSAIDs for frequent sinus headaches.
• She had a placenta previa in a previous pregnancy.

20. A couple who recently emigrated from Israel tells a nurse in the prenatal clinic that they are concerned about a genetic disease that is prevalent among Jewish people. Which genetic blood test should the nurse recommend to determine the possibility of their child inheriting the disease?

• Cystic fibrosis
• Phenylketonuria
• Turner syndrome
• Tay-Sachs disease

21. A nurse is teaching a client how to self-administer a medicated douche. In which direction should the nurse instruct the client to direct the douche nozzle?

• To the left
• To the right
• Toward the sacrum
• Toward the umbilicus

22. A nurse is teaching a childbirth class to a group of pregnant women. One of the women asks the nurse at what point during the pregnancy does the embryo become a fetus. How should the nurse respond?

• During the eighth week of the pregnancy
• At the end of the second week of pregnancy
• When the fertilized ovum becomes implanted
• When the products of conception are visualized on the sonogram

23. What does a nurse explain to a pregnant client about the cause of her physiologic anemia?

• Erythropoiesis decreases.
• Plasma volume increases.
• Utilization of iron decreases.
• Detoxification by the liver increases.

24. A nurse is caring for a client during an ultrasonogram. What parameters does the nurse expect to be used when determining pregnancy dates?

• Occipital frontal diameter at term
• Crown to rump measurement until 11 weeks
• Biparietal diameter of 12 cm or more at term
• Diagonal conjugate is between 26 and 37 weeks

25. A pregnant client is being prepared for a pelvic examination. She states that she is always tired and feels sick to her stomach, especially in the morning. What is the nurse’s best response?

• “Tell me about how you feel the rest of the day.”
• “Let’s discuss ways to resolve these common problems.”
• “Perhaps you should ask your health care provider about it.”
• “There is no need to worry about these expected problems.”

26. A client who is 28 weeks into her second pregnancy is expe­riencing increasing edema in the lower extremities. The nurse advises rest with the legs elevated and provides dietary instructions. What else should the nurse suggest?

• A preferred diet will include favorite foods
• A nutritionist should be involved in planning a diet
• The foods selected do not need to have a low salt content.
• The client should be referred to the health care provider at the prenatal clinic.

27. A health care provider prescribes teriparatide (Forteo), a parathyroid hormone (PTH) agonist, for a client with osteoporosis. What should the nurse consider before administering this medication?

• It requires an increased intake of vitamin A.
• It prevents existing bone from being destroyed.
• Sunscreen should be used to prevent vitamin D absorption.
• Osteoblastic activity is stimulated more than osteoclastic activity.

28. A thin older adult client is diagnosed with osteoporosis. What should the nurse include in the discharge plan for this client?

• Encouragement of gradual weight gain
• Monitoring for decreased urine calcium
• Instructions relative to diet and exercise
• Safety factors when using opioids and nonsteroidal antiinflammatory drugs

29. A nurse is assessing a pregnant client during the third trimester. What clinical finding is an expected response to the pregnancy?

• Tachycardia
• Dyspnea at rest
• Progressive dependent edema
• Shortness of breath on exertion

30. What change does a nurse expect in a client’s hematologic system during the second trimester of pregnancy?

• An increase in hematocrit
• An increase in blood volume
• A decrease in sedimentation rate
• A decrease in white blood cells

31. At her first prenatal visit, a client says to the nurse, “I guess I’ll be having an internal examination today.” What is the nurse’s best response?

• “Yes, an internal exam is done at the mother’s first visit.”
• “Are you fearful of having an internal examination done?”
• “Have you ever had an internal examination done before?”
• “Yes, a slightly uncomfortable internal exam must be done.”

32. A nurse is assessing a client for the potential for developing osteoporosis. Which factor in the client’s history increases the risk for this disorder?

• Estrogen therapy
• Hypoparathyroidism
• Prolonged immobility
• Excessive calcium intake

33. A client at 10 weeks’ gestation calls the clinic and tells a nurse that she has morning sickness and cannot control it. What should the nurse suggest to promote relief?

• “Eat dry crackers before arising.”
• “Increase fat intake before bedtime.”
• “Drink high-carbohydrate fluids with meals.”
• "Have two small meals a day with a snack at noon.”

34. When encouraging a client to cough and deep breathe after a bilateral mastectomy, the client says, “Leave me alone! Don’t you know I’m in pain?” What is the nurse’s most therapeutic response?

• “I know it hurts to cough, but try to use the incentive spirometer.”
• “We’ll start this tomorrow; I will give you something for your pain.”
• “I understand that you are in pain; rest now, and I’ll come back later.”
• “Your pain is to be expected, but you must attempt to expand your lungs.”

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

• acute hemolytic anemia.
• respiratory distress syndrome.
• protein metabolism deficiency.
• physiologic hyperbilirubinemia.

36. A nurse is writing a teaching plan about osteoporosis. The nurse should include in language that most clients would understand that osteoporosis is best described as:

• avascular necrosis.
• pathologic fractures.
• hyperplasia of osteoblasts.
• decrease in bone substance.

37. The nurse reviews the blood test results of a client who is at 24 weeks’ gestation. Which finding should be reported to the health care provider?

• Platelets: 230,000 mm3
• Hemoglobin: 10.8 g/dL
• Fasting blood glucose: 90 mg/dL
• White blood cell count: 10,000 mm3

38. A pregnant client is making her first antepartum visit. She has a 2-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, what does the nurse document about the client’s obstetric history?

• G4 T3 P2 A1 L4
• G5 T2 P2 A1 L4
• G5 T2 P1 A1 L4
• G4 T3 P1 A1 L4

39. A client at 8 weeks’ gestation reports having to urinate more often. The nurse explains that urinary frequency often occurs because bladder capacity during pregnancy is diminished by:

• atony of the detrusor muscle.
• compression by the enlarging uterus.
• compromise of the autonomic reflexes.
• narrowing of the ureteral entrance at the trigone.

40. What is the best advice a nurse can give to a pregnant woman in her first trimester?

• “Cut down on drugs, alcohol, and cigarettes.”
• “Avoid drugs, and refrain from smoking and ingesting alcohol.”
• “Avoid smoking, limit alcohol consumption, and do nottake aspirin.”
• “Take only prescription drugs, especially in the second and third trimesters.”

41. During a routine visit to the prenatal clinic, a client listens to the fetal heartbeat for the first time. The client, com­menting on how rapid it is, appears frightened and asks whether this is normal. The nurse should respond, “The heart rate is:

• usually rapid and is in the expected range.”
• sually rapid and twice the mother’s pulse rate.”
• rapid, but I’d be more concerned if it were slow.”
• rapid, but it accommodates the fetus’s nutritional needs.”

42. A client is concerned about gaining weight during preg nancy. What should the nurse explain is the cause of the largest amount of weight gain during pregnancy?

• Fetal growth
• Fluid retention
• Metabolic alterations
• Increased blood volume

43. A nurse is caring for a client who contracted a trichomonal infection. Which oral drug should the nurse anticipate the health care provider most likely will prescribe?

• Penicillin G
• Gentian violet
• Nystatin (Mycostatin)
• Metronidazole (Flagyl)

44. A female client who has been sexually active for 5 years is diagnosed with gonorrhea. The client is upset and asks the nurse, “What can I do to prevent getting another infection in the future?” The nurse provides health teaching. Which client statement indicates that the teaching was effective?

• “I will douche after each time I have sex.”
• “Having sex is a thing of the past for me.”
• “My partner must use a condom all the time.”
• “I will use a spermicidal cream from now on.”

45. What should a nurse suggest to a pregnant client that might help overcome first-trimester morning sickness?

• “Eat protein before bedtime.”
• “Take an antacid before breakfast.”
• “Drink water until the nausea subsides.”
• “Request a prescription for an antiemetic.”

46. A nurse at the prenatal clinic examines a client and determines that her uterus has risen out of the pelvis and is now an abdominal organ. At what week of gestation does this occur?

• 8th week of pregnancy
• 10th week of pregnancy
• 12th week of pregnancy
• 18th week of pregnancy

47. The plan of care for a client with osteoporosis includes active and passive exercises, calcium supplements, and daily vitamins. How does a nurse determine that the desired effect of therapy is attained?

• Mobility increases.
• Fewer muscle spasms occur.
• There is a more regular heartbeat.
• There are fewer bruises than before therapy.

48. A nurse teaches a pregnant woman to avoid lying on her back during labor. What information about the result of lying in the supine position is the basis for the nurse’s teaching?

• Labor may take longer.
• Placental perfusion is decreased.
• Movement of the coccyx is obstructed.
• Transient episodes of hypertension may occur.

49. At her first visit to the prenatal clinic, a client tells the nurse she is ambivalent about continuing the pregnancy. Why does the nurse conclude that the client is experiencing a crisis?

• Mood changes occur during pregnancy.
• Pregnancy is a period of change and adjustment to change.
• Hormonal and physiologic changes occur during pregnancy.
• Pregnancy changes the future parents’ relationship with each other.

50. A nurse is teaching a primigravida about how she can iden tify the onset of labor. What clinical indicator of labor would necessitate the client to call her health care provider?

• Bloody show and back pressure occur.
• Contractions become regular or get stronger.
• Membranes rupture or contractions are 5 to 8 minutes apart.
• Contractions are 10 to 12 minutes apart and last about 30 seconds.