Maternity Nursing 8th ed By Lowdermilk, Perry, Cashion -Test Bank

Maternity Nursing 8th ed By Lowdermilk, Perry, Cashion -Test Bank

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 06: Anatomy and Physiology of Pregnancy

Test Bank

MULTIPLE CHOICE

1. 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 child 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

Feedback
A The numbers do not accurately reflect the woman’s gravidity and parity information. Using the GTPAL system, her information would be calculated as:
G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.
T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.
P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two 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 that currently are living; the woman has four children.
B This is the correct calculation of this woman’s gravidity and parity.
C The numbers do not accurately reflect the woman’s gravidity and parity information. Using the GTPAL system, her information would be calculated as:
G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.
T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.
P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two 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 that currently are living; the woman has four children.
D The numbers do not accurately reflect the woman’s gravidity and parity information. Using the GTPAL system, her information would be calculated as:
G: This, the first number, reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time.
T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term.
P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two 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 that currently are living; the woman has four children.

DIF: Cognitive Level: Comprehension REF: 169, 170
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

2. A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?
a. 2-0-0-1-1
b. 2-1-0-1-0
c. 3-1-0-1-0
d. 3-0-1-1-0

ANS: C

Feedback
A Using the GTPAL system explained in question 1, this patient’s gravidity and parity information would be calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time).
T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).
P: Number of pregnancies that resulted in a preterm birth (none).
A: Abortions or miscarriages before the period of viability (she has had one).
L: Number of children born who are currently living (she has no living children).
B Using the GTPAL system explained in question 1, this patient’s gravidity and parity information would be calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time).
T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).
P: Number of pregnancies that resulted in a preterm birth (none).
A: Abortions or miscarriages before the period of viability (she has had one).
L: Number of children born who are currently living (she has no living children).
C This is the correct calculation of this woman’s gravidity and parity.
D Using the GTPAL system explained in question 1, this patient’s gravidity and parity information would be calculated as follows:
G: Total number of times the woman has been pregnant (she is pregnant for the third time).
T: Number of pregnancies carried to term (she has had only one pregnancy that resulted in a fetus at term).
P: Number of pregnancies that resulted in a preterm birth (none).
A: Abortions or miscarriages before the period of viability (she has had one).
L: Number of children born who are currently living (she has no living children).

DIF: Cognitive Level: Comprehension REF: 169, 170
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

3. Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)?
a. Radioimmunoassay
b. Radioreceptor assay
c. Latex agglutination test
d. Enzyme-linked immunosorbent assay (ELISA)

ANS: D

Feedback
A The radioimmunoassay test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results.
B The radioreceptor assay test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results.
C The latex agglutination test is used to detect hCG at varying times in the early gestational period; however, it is not a feature of the OTC pregnancy test. OTC pregnancy tests use ELISA technology for its one-step, accurate results.
D ELISA technology is used in OTC pregnancy tests.

DIF: Cognitive Level: Knowledge REF: 171
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

4. 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

Feedback
A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman.
B A positive pregnancy test would be a probable sign of pregnancy.
C The presence of Chadwick’s sign would be a probable sign of pregnancy.
D The presence of Hegar’s sign would be a probable sign of pregnancy.

DIF: Cognitive Level: Comprehension REF: 172
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

5. 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

Feedback
A A positive pregnancy test would be a probable sign of pregnancy.
B Positive signs of pregnancy are those that are attributed to the presence of a fetus such as hearing the fetal heartbeat or palpating fetal movement.
C Braxton Hicks contractions would be a probable sign of pregnancy.
D Quickening would be a presumptive sign of pregnancy.

DIF: Cognitive Level: Comprehension REF: 172
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

6. 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

Feedback
A As the uterus grows, it may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy.
B In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the twelfth and fourteenth weeks of pregnancy.
C The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.
D The uterus rises gradually to the level of the umbilicus at 22 to 24 weeks of gestation.

DIF: Cognitive Level: Comprehension REF: 173
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

7. Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester?
a. Less audible heart sounds (S1, S2)
b. Increased pulse rate
c. Increased blood pressure
d. Decreased red blood cell (RBC) production

ANS: B

Feedback
A Splitting of S1 and S2 is more audible.
B Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term.
C In the first trimester, blood pressure usually remains the same as at the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg.
D Production of RBCs accelerates during pregnancy.

DIF: Cognitive Level: Comprehension REF: 177
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

8. The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change?
a. Her center of gravity will shift backward.
b. She will have increased lordosis.
c. She will have increased abdominal muscle tone.
d. She will notice decreased mobility of her pelvic joints.

ANS: B

Feedback
A The center of gravity shifts forward.
B An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain her balance.
C She will have decreased muscle tone.
D She will notice increased mobility of her pelvic joints.

DIF: Cognitive Level: Comprehension REF: 185
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

9. A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:
a. This is a normal respiratory change in pregnancy caused by elevated levels of estrogen.
b. This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign.
c. The woman is a victim of domestic violence and is being hit in the face by her partner.
d. The woman has been using cocaine intranasally.

ANS: A

Feedback
A Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract. This may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis.
B Cardiovascular changes in pregnancy may cause edema in lower extremities.
C This determination cannot be made on the basis of the sparse facts provided. If the woman had been hit in the face, she most likely would have additional physical findings.
D This determination cannot be made on the basis of the sparse facts provided.

DIF: Cognitive Level: Application REF: 181
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

10. The nurse caring for the pregnant patient must understand that the hormone essential for maintaining pregnancy is:
a. Estrogen.
b. Human chorionic gonadotropin (hCG).
c. Oxytocin.
d. Progesterone.

ANS: D

Feedback
A Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy.
B hCG levels rise at implantation but decline after 60 to 70 days.
C Oxytocin stimulates uterine contractions.
D Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles. This reduces uterine activity and prevents miscarriage.

DIF: Cognitive Level: Comprehension REF: 187
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

11. The nurse providing care to the pregnant woman should know that all are normal gastrointestinal changes in pregnancy except:
a. Ptyalism.
b. Pyrosis.
c. Pica.
d. Decreased peristalsis.

ANS: C

Feedback
A Ptyalism (excessive salivation) is a normal finding.
B Pyrosis (heartburn) is a normal finding.
C Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated.
D Decreased peristalsis is a normal finding.

DIF: Cognitive Level: Analysis REF: 186
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

12. Appendicitis may be difficult to diagnose in pregnancy because the appendix is:
a. Displaced upward and laterally, high and to the right.
b. Displaced upward and laterally, high and to the left.
c. Deep at McBurney point.
d. Displaced downward and laterally, low and to the right.

ANS: A

Feedback
A The appendix is displaced high and to the right.
B The appendix is displaced high and to the right.
C The appendix is displaced beyond McBurney point.
D The appendix is displaced high and to the right.

DIF: Cognitive Level: Comprehension REF: 187
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

13. Which time-based description of a stage of development in pregnancy is accurate?
a. Viability—22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight greater than 500 g)
b. Term—pregnancy from the beginning of week 38 of gestation to the end of week 42
c. Preterm—pregnancy from 20 to 28 weeks
d. Postdate—pregnancy that extends beyond 38 weeks

ANS: B

Feedback
A Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since LMP.
B Term is 38 to 42 weeks of gestation.
C Preterm is 20 to 37 weeks of gestation.
D Postdate or postterm is a pregnancy that extends beyond 42 weeks or what is considered the limit of full term.

DIF: Cognitive Level: Knowledge REF: 170
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

14. Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and therefore the basis for many tests. A maternity nurse should be aware that:
a. hCG can be detected as early as 2½ weeks after conception.
b. The hCG level increases gradually and uniformly throughout pregnancy.
c. Much lower than normal increases in the level of hCG may indicate a postdate pregnancy.
d. A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

ANS: D

Feedback
A hCG can be detected as early as 7 to 10 days after conception.
B The hCG level fluctuates during pregnancy: peaking, declining, stabilizing, and increasing again.
C Abnormally slow increases may indicate impending miscarriage.
D Higher levels also could be a sign of multiple gestation.

DIF: Cognitive Level: Knowledge REF: 171
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

15. To reassure and educate pregnant patients about changes in the uterus, nurses should be aware that:
a. Lightening occurs near the end of the second trimester as the uterus rises into a different position.
b. The woman’s increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening.
c. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise.
d. The uterine souffle is the movement of the fetus.

ANS: B

Feedback
A Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends.
B The softening of the lower uterine segment is called Hegar’s sign.
C Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop.
D The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

DIF: Cognitive Level: Comprehension REF: 173
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

16. When the nurse is providing education to the pregnant patient regarding changes in the cervix, vagina, and the position of the fetus, it is important to be aware that:
a. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are much easier to evaluate.
b. Quickening is a technique of palpating the fetus to engage it in passive movement.
c. The deepening color of the vaginal mucosa and cervix (Chadwick’s sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor.
d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

ANS: D

Feedback
A These cervical changes make evaluation of abnormal Pap tests more difficult.
B Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus.
C Chadwick’s sign appears from the sixth to eighth weeks.
D Increased sensitivity and an increased interest in sex sometimes go together. This frequently occurs during the second trimester.

DIF: Cognitive Level: Comprehension REF: 176
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

17. The mucous plug that forms in the endocervical canal is called:
a. The operculum.
b. Leucorrhea.
c. The funic souffle.
d. Ballottement.

ANS: A

Feedback
A The operculum protects against bacterial invasion.
B Leucorrhea is the mucus that forms the endocervical plug (the operculum).
C The funic souffle is the sound of blood flowing through the umbilical vessels.
D Ballottement is a technique for palpating the fetus.

DIF: Cognitive Level: Knowledge REF: 176
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment