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RICCI CHAPTER 11 EXAM 2024 WITH
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- During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse documents this finding as: A. Hegar sign. B. Goodell sign. C. Chadwick sign. D. Ortolani sign. - ANSWER ☑☑Answer: A Rationale: Hegar sign refers to the softening of the lower uterine segment or isthmus. Bluish coloration of the cervix is termed Chadwick sign. Goodell sign refers to the softening of the cervix. Ortolani sign is a maneuver done to identify developmental dysplasia of the hip in infants.
- The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. What will the mother likely experience at that time? A. dysuria B. dyspnea C. constipation D. urinary frequency - ANSWER ☑☑Answer: D
Rationale: Lightening refers to the descent of the fetal head into the pelvis and engagement. With this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection. Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to lightening.
- A gravida 2 para 1 client in the 10th week of her pregnancy says to the nurse, "I've never urinated as often as I have for the past three weeks." Which response would be most appropriate for the nurse to make? A. "Having to urinate so often is annoying. I suggest that you watch how much fluid you are drinking and limit it." B. "You shouldn't be urinating this frequently now; it usually stops by the time you're eight weeks pregnant. Is there anything else bothering you?" C. "By the time you are 12 weeks pregnant, this frequent urination should really decrease, but it is likely to return toward the end of your pregnancy." D. "Women having their second child generally don't have frequent urination. Are you experiencing any burning sensations?" - ANSWER ☑☑Answer: C
- A primiparous client is being seen in the clinic for her first prenatal visit. It is determined that she is 11 weeks pregnant. The nurse develops a teaching plan to educate the client about what she will most likely experience during this period. Which possible effect would the nurse include? A. ankle edema B. urinary frequency C. backache D. hemorrhoids - ANSWER ☑☑Answer: B Rationale: The client is in her first trimester and would most likely experience urinary frequency as the growing uterus presses on the bladder. Ankle edema, backache, and hemorrhoids would be more common during the later stages of pregnancy.
- The nurse is discussing the insulin needs of a primiparous client with diabetes who has been using insulin for the past few years. The nurse informs the client that her insulin needs will increase during pregnancy based on the nurse's understanding that the placenta produces: A. hCG, which increases maternal glucose levels. B. hPL, which deceases the effectiveness of insulin. C. estriol, which interferes with insulin crossing the placenta.
D. relaxin, which decreases the amount of insulin produced. - ANSWER ☑☑Answer: B Rationale: Human placental lactogen (hPL) acts as an antagonist to insulin, so the mother must produce more insulin to overcome this resistance. If the mother has diabetes, then her insulin need would most likely increase to meet this demand. Human chorionic gonadotropin (hCG) does not affect insulin and glucose level. Estrogen, not estriol, is believed to oppose insulin. In addition, insulin does not cross the placenta. Relaxin is not associated with insulin resistance.
- When teaching a pregnant client about the physiologic changes of pregnancy, the nurse reviews the effect of pregnancy on glucose metabolism. Which underlying reason for the effect would the nurse include? A. Pancreatic function is affected by pregnancy. B. Glucose is utilized more rapidly during a pregnancy. C. The pregnant woman increases her dietary intake. D. Glucose moves through the placenta to assist the fetus. - ANSWER ☑☑Answer: D Rationale: The growing fetus has large needs for glucose, amino acids, and lipids, placing demands on maternal glucose stores. During the first half of pregnancy, much of the maternal
experience abdominal discomfort, gas, and diarrhea if they ingest foods containing lactose. Fish and shellfish are an important part of a healthy diet because they contain high- quality proteins, are low in saturated fat, and contain omega-3 fatty acids.
- Which change in the musculoskeletal system would the nurse mention when teaching a group of pregnant women about the physiologic changes of pregnancy? A. ligament tightening B. decreased swayback C. increased lordosis D. joint contraction - ANSWER ☑☑Answer: C Rationale: With pregnancy, the woman's center of gravity shifts forward, requiring a realignment of the spinal curvatures. There is an increase in the normal lumbosacral curve (lordosis). Ligaments of the sacroiliac joints and pubis symphysis soften and stretch. Increased swayback and an upper spine extension to compensate for the enlarging abdomen occur. Joint relaxation and increased mobility occur due to the influence of the hormones relaxin and progesterone.
- Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which finding?
A. linea nigra B. striae gravidarum (stretch marks) C. melasma (chloasma) D. vascular spiders - ANSWER ☑☑Answer: A Rationale: Linea nigra refers to the darkened line of pigmentation down the middle of the abdomen in pregnant women. Striae gravidarum refers to stretch marks, irregular reddish streaks on the abdomen, breasts, and buttocks. Melasma (chloasma) refers to the increased pigmentation on the face, also known as the "mask of pregnancy." Vascular spiders are small, spiderlike blood vessels that appear usually above the waist and on the neck, thorax, face, and arms.
- A nurse is assessing a pregnant woman on a routine checkup. When assessing the woman's gastrointestinal tract, what would the nurse expect to find? Select all that apply. A. hyperemic gums B. increased peristalsis C. reports of bloating D. heartburn E. nausea - ANSWER ☑☑Answer: A, C, D, E Rationale: Gastrointestinal system changes include hyperemic gums due to estrogen and increased proliferation of blood vessels and circulation to the mouth; slowed peristalsis; acid
D. Avoid using diuretics. E. Participate in physical activity. - ANSWER ☑☑Answer: B, D, E Rationale: To promote optimal nutrition, the nurse would recommend gradual and steady weight gain based on the client's prepregnant weight, eating three meals with one or two snacks daily, not restricting the use of salt unless instructed to do so by the health care provider, avoiding the use of diuretics, and participating in reasonable physical activity daily.
- Assessment of a pregnant woman reveals that she compulsively craves ice. The nurse documents this finding as: A. quickening. B. pica. C. ballottement. D. linea nigra. - ANSWER ☑☑Answer: B Rationale: Pica refers to the compulsive ingestion of nonfood substances such as ice. Quickening refers to the mother's sensation of fetal movement. Ballottement refers to the feeling of rebound from a floating fetus when an examiner pushes against the woman's cervix during a pelvic examination. Linea nigra refers to the pigmented line that develops in the middle of the woman's abdomen.
- A woman in her second trimester comes for a follow-up visit and says to the nurse, "I feel like I'm on an emotional roller-coaster." Which response by the nurse would be most appropriate? A. "How often has this been happening to you?" B. "Maybe you need some medication to level things out." C. "Mood swings are completely normal during pregnancy." D. "Have you been experiencing any thoughts of harming yourself?" - ANSWER ☑☑Answer: C Rationale: Emotional lability is characteristic throughout most pregnancies. One moment a woman can feel great joy, and within a short time she can feel shock and disbelief. Frequently, pregnant women will start to cry without any apparent cause. Some women feel as though they are riding an "emotional roller-coaster." These extremes in emotion can make it difficult for partners and family members to communicate with the pregnant woman without placing blame on themselves for their mood changes. Clear explanations about how common mood swings are during pregnancy are essential.
- While talking with a woman in her third trimester, the nurse understands that which behavior indicates that the woman is learning to give of oneself?
and fatigue. Abdominal enlargement and Braxton-Hicks contractions are probable signs of pregnancy. Fetal heart sounds are a positive sign of pregnancy.
- After teaching a refresher class to a group of prenatal clinic nurses about pregnancy, insulin, and glucose, the nurse determines that additional teaching is needed when the group identifies which hormone as being involved with opposing insulin? A. prolactin B. estrogen C. progesterone D. aldosterone - ANSWER ☑☑Answer: D Rationale: Prolactin, estrogen, and progesterone are all thought to oppose insulin. As a result, glucose is less likely to enter the mother's cells and is more likely to cross over the placenta to the fetus. Aldosterone does not oppose insulin.
- A pregnant woman comes to the clinic and tells the nurse that she has been having a whitish vaginal discharge. The nurse suspects vulvovaginal candidiasis based on which assessment finding? A. fever B. vaginal itching
C. urinary frequency D. incontinence - ANSWER ☑☑Answer: B Rationale: Vaginal secretions become more acidic, white, and thick during pregnancy. Most women experience an increase in a whitish vaginal discharge, called leukorrhea. This is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Fever would suggest a more serious infection. Urinary frequency occurs commonly in the first trimester, disappears during the second trimester, and reappears during the third trimester. Incontinence would not be associated with a vulvovaginal candidiasis. Incontinence would require additional evaluation.
- A woman is at 20 weeks' gestation. The nurse would expect to find the fundus at which area? A. just above the symphysis pubis B. midway between the pubis and umbilicus C. at the level of the umbilicus D. midway between the umbilicus and xiphoid process - ANSWER ☑☑Answer: C Rationale: The uterus, which starts as a pear-shaped organ, becomes ovoid as length increases
and feels a rebound from the floating fetus) usually occurs at about 16 weeks.
- A nurse is monitoring a client's hCG levels because she has had a previous ectopic pregnancy and one spontaneous abortion. Which finding would the nurse interpret as indicating that the pregnancy is progressing appropriately? A. doubling of the level every 2 to 3 days B. plateauing of the level at 7 days C. gradually increasing levels every month D. abruptly declining levels after 60 days - ANSWER ☑☑Answer: A Rationale: Human chorionic gonadotropin (hCG) is a glycoprotein and the earliest biochemical marker for pregnancy. Many pregnancy tests are based on the recognition of hCG or a beta subunit of hCG. hCG levels in normal pregnancy usually double every 48 to 72 hours until they peak approximately 60 to 70 days after fertilization. At this point, they decrease to a plateau at 100 to 130 days of pregnancy.
- A nurse is providing nutritional counseling to a pregnant woman and gives her suggestions about consuming foods that are high in folic acid. As part of the plan of care, the client is to keep a food diary that the client and nurse will review at the next visit. When reviewing the client's
diary, which meals would indicate to the nurse that the client is increasing her intake of folic acid? Select all that apply. A. chicken breast with baked potato and broccoli B. cheeseburger with spinach and baked beans C. pork chop with mashed potatoes and green beans D. strawberry walnut salad with romaine lettuce E. fried chicken sandwich with mayonnaise and avocado - ANSWER ☑☑Answer: A, B, D Rationale: Good food sources of folic acid include dark green vegetables, such as broccoli, romaine lettuce, and spinach; baked beans; black-eyed peas; citrus fruits; peanuts; and liver. So the meals containing chicken breast with baked potato and broccoli, cheeseburger with spinach and baked beans, and the strawberry walnut salad with romaine lettuce demonstrate an intake of foods high in folic acid.
- A pregnant woman asks the nurse, "I've heard that I should avoid eating certain types of fish. So what fish can I eat?" Which type of fish would the nurse recommend? Select all that apply. A. shark B. tilefish C. shrimp D. salmon
blood pressure decreases 5 to 10 mm Hg and thereafter returns to first-trimester levels. This decrease in blood pressure begins at about 7 weeks' gestation and persists until 32 weeks' gestation, when it begins to rise to prepregnancy levels. The client's blood pressure suggests a normal finding related to peripheral vasodilation from progesterone. Any significant rise in blood pressure during pregnancy should be investigated to rule out gestational hypertension. Gestational hypertension is a clinical diagnosis defined by the new onset of hypertension (systolic of 140 mm Hg or higher and/or diastolic of 90 mm Hg or higher) after 20 weeks' gestation. A lower blood pressure does not suggest anemia. Orthostatic hypotension occurs when the blood pressure drops more than 20 mm Hg systolic or 10 mm Hg diastolic with a change in position, such as going from a lying to a standing position.
- At a routine visit, a pregnant woman nearing the end of her second trimester tells the nurse, "It is so strange. I lie down to go to sleep and then I have to get up to go to the bathroom. This always happens when I am trying to sleep." Which response by the nurse would be appropriate? A. "You might be developing a urinary tract infection. Let's get a urine sample." B. "Your kidneys increase their activity when you lie down causing you to urinate."
C. "Lying on your side instead of lying on your back will help stop this problem." D. "Maybe you are drinking too much fluid before you go to bed." - ANSWER ☑☑Answer: B Rationale: The activity of the kidneys normally increases when a person lies down and decreases upon standing. This difference is amplified during pregnancy, which is one reason a pregnant woman feels the need to urinate frequently while trying to sleep. Late in the pregnancy (third trimester), the increase in kidney activity is even greater when the woman lies on her side rather than her back. Lying on either side relieves the pressure that the enlarged uterus puts on the vena cava carrying blood from the legs. Subsequently, venous return to the heart increases, leading to increased cardiac output. Increased cardiac output results in increased renal perfusion and glomerular filtration. The woman has not voiced any reports suggesting a urinary tract infection. Fluid intake may be contributing to the woman's urination concern, but it is important for the woman to drink adequate amounts of fluid.
- A nurse is teaching a pregnant woman about ways to prevent the development of the foodborne illness listeriosis. The nurse determines that the teaching was successful when the woman identifies the need to avoid which food(s)? Select all that apply. A. Soft cheeses
