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Maternal Child Exam 1 Questions with Answers
1.The nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should a. tell the couple they need to have an abortion within 2 to 3 weeks. b. explain that the fetus has a 50% chance of having the disorder. c. discuss options with the couple, including amniocentesis to determine whether the fetus is affected. d. refer the couple to a psychologist for emotional support.: ANS: C Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected. The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counselor is the best source for determining genetic probability ratios. The couple eventually may need emotional support, but the status of the pregnancy must be determined first 2.In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as a. anxiety and altered family relationships. b. denial of insurance benefits. c. high false-positive results associated with genetic testing. d. ethnic and socioeconomic disparity associated with genetic testing.: ANS: B Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Anxiety and altered family relationships, high false-positive results, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing 3.A man's wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as a. occurrence risk. b. recurrence risk.
2 / c. predictive testing. d. predisposition testing.: ANS: B
4 / a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a. "That must have been a coincidence; babies can't respond like that."
5 / b. "The fetus is demonstrating the aural reflex." c. "Babies respond to sound starting at about 24 weeks of gestation." d. "Let me know if it happens again; we need to report that to your midwife."- : ANS: C "Babies respond to sound starting at about 24 weeks of gestation" is an accurate statement. "That must have been a coincidence; babies can't respond like that" is inaccurate. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The statement, "Let me know if it happens again; we need to report that to your midwife" is not appropriate; it gives the impression that something is wrong. 7.The nurse caring for the laboring woman should know that meconium is produced by a. fetal intestines. b. fetal kidneys. c. amniotic fluid. d. the placenta.: ANS: A As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. 8.A woman asks the nurse, "What protects my baby's umbilical cord from being squashed while the baby's inside of me?" The nurse's best response is a. "Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby." b. "Your baby's umbilical floats around in blood anyway." c. "You don't need to worry about things like that." d. "The umbilical cord is a group of blood vessels that are very well protected by the placenta.": ANS: A "Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby" is the most appropriate response. "Your baby's umbilical floats around in blood anyway" is inaccurate. "You don't need to worry about things like that" is an
7 / 9.The is/are responsible for oxygen and carbon diox- ide transport to and from the maternal bloodstream. a. decidua basalis b. blastocyst c. germ layer d. chorionic villi: ANS: D Chorionic villi are finger-like projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula. Implantation occurs at this stage. The germ layer is a layer of the blastocyst. 10.A woman who is 8 months pregnant asks the nurse, "Does my baby have any antibodies to fight infection?" The most appropriate response by the nurse is a. "Your baby has all the immune globulins necessary: IgG, IgM, and IgA." b. "Your baby won't receive any antibodies until he/she is born and you breastfeed him." c. "Your baby does not have any antibodies to fight infection." d. "Your baby has IgG and IgM.": ANS: D During the third trimester, the only immune globulin that crosses the placenta, IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM by the end of the first trimester. IgA is not produced by the baby. By the third trimester, the fetus has IgG and IgM. Breastfeeding supplies the baby with IgA. "Your baby does not have any antibodies to fight infection" is an inaccurate statement. 11.Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), "How does my baby get air inside my uterus?" The correct response is a. "The baby's lungs work in utero to exchange oxygen and carbon dioxide." b. "The baby absorbs oxygen from your blood system." c. "The placenta provides oxygen to the baby and excretes carbon dioxide
8 / into your bloodstream." d. "The placenta delivers oxygen-rich blood through the umbilical artery to the
10 / abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.
11 / 14.As relates to the structure and function of the placenta, the maternity nurse should be aware that a. as the placenta widens, it gradually thins to allow easier passage of air and nutrients. b. as one of its early functions, the placenta acts as an endocrine gland. c. the placenta is able to keep out most potentially toxic substances such as cigarette smoke to which the mother is exposed. d. optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.: ANS: B The placenta produces four hormones necessary to maintain the pregnancy. The placenta widens until week 20 and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.
- With regard to the development of the respiratory system, maternity nurses should understand that a. the respiratory system does not begin developing until after the embryonic stage. b. the infant's lungs are considered mature when the lecithin/sphingomyelin [L/S] ratio is 1:1, at about 32 weeks. c. maternal hypertension can reduce maternal-placental blood flow, acceler- ating lung maturity. d. fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks.: ANS: C A reduction in placental blood flow stresses the fetus, increases blood levels of cor- ticosteroids, and accelerates lung maturity. Development of the respiratory system begins during the embryonic phase and continues into childhood. The infant's lungs are mature when the L/S ratio is 2:1, at about 35 weeks. Lung movements have been seen on ultrasound scans at 11 weeks 16.The nurse caring for a pregnant patient knows that her health teaching regarding fetal circulation has been effective when the patient reports that she has been sleeping a. in a side-lying position.
13 / d. on her abdomen.: ANS: A Optimal circulation is achieved when the woman is lying at rest on her side. De- creased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women find lying on her abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus. 17.A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is a. "You should have felt the baby move by now." b. "Within the next month, you should start to feel fluttering sensations." c. "The baby is moving; however, you can't feel it yet." d. "Some babies are quiet, and you don't feel them move.": ANS: B Maternal perception of fetal movement usually begins 16 to 20 weeks after concep- tion. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating that "you should have felt the baby move by now" is incorrect and may be alarming to the patient. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary. 18.A new mother asks the nurse about the "white substance" covering her infant. The nurse explains that the purpose of vernix caseosa is to a. protect the fetal skin from amniotic fluid. b. promote normal peripheral nervous system development. c. allow transport of oxygen and nutrients across the amnion. d. regulate fetal temperature: Ans: A Prolonged exposure to amniotic fluid during the fetal period could result in break- down of the skin without the protection of the vernix caseosa.
14 / Normal development of the peripheral nervous system is dependent on nutritional intake of the mother. The amnion is the inner membrane that surrounds the fetus. It is not involved
16 / alcohol, also may result in structural and functional abnormalities.
17 / 21.Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (Select all that apply.) a. human chorionic gonadotropin (hCG). b. insulin. c. estrogen. d. progesterone. e. testosterone.: ANS: A, C, D hCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman's uterus and breasts; cause growth of the ductal system in the breasts; and, as term approaches, play a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT, hCA, and numerous growth factors. Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures 22.A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a. 3-1-1-1- 3 b. 4-1-2-0- 4 c. 3-0-3-0- 3 d. 4-2-1-0-3: ANS: B The correct calculation of this woman's gravidity and parity is 4-1-2-0-4. The num- bers reflect the woman's gravidity and parity information. Using the GPTAL system, her information is calculated as: G: The first
19 / pregnancies in which she delivered preterm. A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L: This number signifies the number of children born who are currently living; the woman has four children. 23.A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have a. amenorrhea. b. positive pregnancy test. c. Chadwick's sign. d. Hegar's sign: ANS: A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are felt by the woman. A positive pregnancy test, the presence of Chadwick's sign, and the presence of Hegar's sign are all probable signs of pregnancy. 24.The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is a. a positive pregnancy test. b. fetal movement palpated by the nurse-midwife. c. Braxton Hicks contractions. d. quickening.: ANS: B Positive signs of pregnancy are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. A positive pregnancy test and Braxton Hicks contractions are probable signs of pregnancy. Quickening is a presumptive sign of pregnancy. 25.A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level? a. Not palpable above the symphysis at this time b. Slightly above the symphysis pubis c. At the level of the umbilicus d. Slightly above the umbilicus: ANS: B In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and
20 / 14th weeks of pregnan- cy. As the uterus grows, it may be palpated above the symphysis pubis sometime
