Fetal Circulation Teaching Plan Options

242. The nursing student is preparing to teach a prenatal class about fetal circulation.
Which statement should be included

in the teaching plan?
1. One artery carries oxygenated blood from the placenta to the fetus.
2. Two arteries carry oxygenated blood from the placenta to the fetus.
3. Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta.
4. Two veins carry blood that is high in carbon dioxide and other waste products away from the fetus to the placenta.
243. A nursing student is assigned to care for a client in labor. The nursing instructor asks the student to describe fetal
circulation, specifically the
ductus venosus. Which statement is correct regarding the ductus venosus?
1. Connects the pulmonary artery to the aorta
2. Is an opening between the right and left atria
3. Connects the umbilical vein to the inferior vena cava
4. Connects the umbilical artery to the inferior vena cava
244. A pregnant client tells the clinic nurse that she wants to know the gender of her baby as soon as it can be determined.
The nurse understands that
the client should be able to find out the gender at 12 weeks gestation because of which factor?
1. The appearance of the fetal external genitalia
2. The beginning of differentiation in the fetal groin
3. The fetal testes are descended into the scrotal sac
4. The internal differences in males and females become apparent
245. The nurse is performing an assessment on a client who is at 38 weeks gestation and notes that the fetal heart rate is
174 beats/minute. On the
basis of this finding, what is the priority nursing action?
1. Document the finding.
2. Check the mothers heart rate.
3. Notify the health care provider (HCP).
4. Tell the client that the fetal heart rate is normal.
246. The nurse is conducting a prenatal class on the female reproductive system. When a client in the class asks why the
fertilized ovum stays in the
fallopian tube for 3 days, what is the nurses best response?
1. It promotes the fertilized ovums chances of survival.
2. It promotes the fertilized ovums exposure to estrogen and progesterone.
3. It promotes the fertilized ovums normal implantation in the top portion of the uterus.
4. It promotes the fertilized ovums exposure to luteinizing hormone and follicle-stimulating hormone.
247. The nursing instructor asks a nursing student to list the characteristics of the amniotic fluid. The student responds
correctly by listing which as
characteristics of amniotic fluid? Select all that apply.
1. Allows for fetal movement
2. Surrounds, cushions, and protects the fetus
3. Maintains the body temperature of the fetus
4. Can be used to measure fetal kidney function
5. Prevents large particles such as bacteria from passing to the fetus
6. Provides an exchange of nutrients and waste products between the mother and the fetus
248. A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse
would determine whether this
method of family planning would be most appropriate?
1. Has either of you ever had surgery?
2. Do you plan to have any other children?
3. Do either of you have diabetes mellitus?
4. Do either of you have problems with high blood pressure?
249. The nurse should include which statement to a pregnant client found to have a gynecoid pelvis?
1. Your type of pelvis has a narrow pubic arch.
2. Your type of pelvis is the most favorable for labor and birth.
3. Your type of pelvis is a wide pelvis, but has a short diameter.
4. You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery.
250. Which explanation should the nurse provide to the prenatal client about the purpose of the placenta?
1. It cushions and protects the baby.
2. It maintains the temperature of the baby.
3. It is the way the baby gets food and oxygen.
4. It prevents all antibodies and viruses from passing to the baby.
251. A 55-year-old male client confides in the nurse that he is concerned about his sexual function. What is the nurses
best response?
1. How often do you have sexual relations?
2. Please share with me more about your concerns.
3. You are still young and have nothing to be concerned about.
4. You should not have a decline in testosterone until you are in your 80s.
ANSWERS
242. 3
Rationale: Blood pumped by the embryos heart leaves the embryo through two umbilical arteries. When oxygenated, the blood is returned by one
umbilical vein. Arteries carry deoxygenated
blood and waste products from the fetus, and the umbilical vein carries oxygenated blood and provides oxygen and nutrients to the fetus.
Test-Taking Strategy: Focus on the subject, fetal circulation. Recall that three umbilical vessels are within the umbilical cord (two arteries and one vein)
and that the vein carries oxygenated blood
and the arteries carry deoxygenated blood.
Review: Fetal circulation
Level of Cognitive Ability: Understanding

Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: MaternityAntepartumPriority Concepts: Client Education; Perfusion
Reference: Lowdermilk et al (2012), pp. 382-383.
243. 3
Rationale: The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and
left atria. The ductus arteriosus joins the aorta
and the pulmonary artery.
Test-Taking Strategy: Focus on the subject, the description of the ductus venosus. Note the relationship of the word venosus in the question and vein in
the correct option.
Review: Fetal circulation
Content Area: MaternityIntrapartum
Priority Concepts: Clinical Judgment; Perfusion
References: Lowdermilk et al (2012), pp. 279-280; Perry et al (2010), p. 180.
244. 1
Rationale: By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the gender of the fetus can be
determined visually. Differentiation of the external
genitalia occurs at the end of the ninth week. Testes descend into the scrotal sac at the end of the thirty-eighth week. Internal differences in the male and
female occur at the end of the seventh
week.
Test-Taking Strategy: Focus on the subject, gender of the fetus. Remember that the gender of the fetus can be recognizable visually by the appearance
of the external genitalia by gestational
week 12.
Review: Fetal development
Client Needs: Health Promotion and Maintenance
Content Area: MaternityAntepartum
Priority Concepts: Clinical Judgment; Reproduction
Reference: Murray, McKinney (2010), p. 100.
245. 3
Rationale: The fetal heart rate (FHR) depends on gestational age and ranges from 160 to 170 beats/minute in the first trimester, but slows with fetal
growth to 110 to 160 beats/minute near or at
term. At or near term, if the FHR is less than 110 beats/minute or more than 160 beats/minute with the uterus at rest, the fetus may be in distress.
Because the FHR is increased from the reference
range, the nurse should notify the HCP. Options 2 and 4 are inappropriate actions based on the information in the question. Although the nurse documents
the findings, based on the information in
the question, the HCP needs to be notified.
Test-Taking Strategy: Note the strategic word, priority. Also note the FHR and that the client is at 38 weeks of gestation. Remember that the normal
FHR at or near term is 110 to 160
beats/minute.
Review: Normal fetal heart rate
Level of Cognitive Ability: Applying
Integrated Process: Nursing ProcessImplementation
Reference: Murray, McKinney (2010), p. 125.
246. 3
Rationale: The tubal isthmus remains contracted until 3 days after conception to allow the fertilized ovum to develop within the tube. This initial growth
of the fertilized ovum promotes its normal
implantation in the fundal portion of the uterine corpus. Estrogen is a hormone produced by the ovarian follicles, corpus luteum, adrenal cortex, and
placenta during pregnancy. Progesterone is a
hormone secreted by the corpus luteum of the ovary, adrenal glands, and placenta during pregnancy. Luteinizing hormone and follicle-stimulating
hormone are excreted by the anterior pituitary
gland. The survival of the fertilized ovum does not depend on it staying in the fallopian tube for 3 days.
Test-Taking Strategy: Note the strategic word best and use knowledge of the anatomy and physiology of the female reproductive system.
Remember that fertilization occurs in the fallopian tube
and the fertilized ovum remains in the fallopian tube for about 3 days. This promotes its normal implantation.
Review: Anatomy and physiology of the reproductive system
Reference: Lowdermilk et al (2012), p. 273.
247. 1, 2, 3, 4
Rationale: The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the
fetus. In addition, the amniotic fluid contains
urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and
provides an exchange of nutrients and
waste products between the mother and the fetus.
Test-Taking Strategy: Focus on the subject of the question: the characteristics of amniotic fluid. Visualizing the location of the amniotic fluid will assist
in answering this question.
Review: Characteristics of the amniotic fluid
248. 2
Rationale: Sterilization is a method of contraception for couples who have completed their families. It should be considered a permanent end to fertility
because reversal surgery is not always
successful. The nurse would ask the couple about their plans for having children in the future. Options 1, 3, and 4 are unrelated to this procedure.
Test-Taking Strategy: Note the strategic words, most appropriate. Focus on the subject, sterilization procedure. Noting the relationship between the
word sterilization and the correct option will
direct you to this option.
Review: Effects of sterilization

Integrated Process: Nursing ProcessAssessment
Priority Concepts: Health Promotion; Reproduction
249. 2
Rationale: A gynecoid pelvis is a normal female pelvis and is the most favorable for successful labor and birth. An android pelvis (resembling a male
pelvis) would be unfavorable for labor because
of the narrow pelvic planes. An anthropoid pelvis has an outlet that is adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat
pelvis) has a wide transverse diameter, but
the anteroposterior diameter is short, making the outlet inadequate.
Test-Taking Strategy: Focus on the subject, female pelvis types. Recalling that the gynecoid pelvis is the normal female pelvis will direct you to the
correct option.
Review: Female pelvic types
Reference: Lowdermilk et al (2012), pp. 374, 376.
250. 3
Rationale: The placenta provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus. The amniotic fluid surrounds,
cushions, and protects the fetus and
maintains the body temperature of the fetus. Nutrients, drugs, antibodies, and viruses can pass through the placenta.
Test-Taking Strategy: Focus on the subject, the purpose of the placenta. Remember that the placenta provides oxygen and nutrients.
Review: Structure and function of the placenta and amniotic fluid
Client Needs: Health Promotion and MaintenanceIntegrated Process: Teaching and Learning
251. 2
Rationale: The nurse needs to establish trust when discussing sexual relationships with men. Open the conversation with broad statements to determine
the true nature of the clients concerns. The
frequency of intercourse is not a relevant first question to establish trust. Testosterone declines with the aging process.
Test-Taking Strategy: Note the strategic word best. Determine whether further assessment or validation is needed. In this case, more information is
needed to determine the nature of the clients
concerns. Keeping these concepts in mind and focusing on the subject will assist in directing you to the correct option.
Review: Sexual function in the male client
Content Area: Adult HealthReproductive
Priority Concepts: Reproduction; Sexuality
Reference: Ignatavicius, Workman (2013), pp. 1578-1579.
252. The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the
fundal height in centimeters
and expects which finding?
1. 22 cm
2. 30 cm
3. 36 cm
4. 40 cm
253. The nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the
client for probable signs of
pregnancy. Which are probable signs of pregnancy? Select all that apply.
1. Ballottement
2. Chadwicks sign
3. Uterine enlargement
4. Braxton Hicks contractions
5. Fetal heart rate detected by a nonelectronic device
6. Outline of fetus via radiography or ultrasonography
254. A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions.
The nurse determines that
she is experiencing Braxton Hicks contractions. On the basis of this finding, which nursing action is most appropriate?
1. Contact the health care provider.
2. Instruct the client to maintain bed rest for the remainder of the pregnancy.
3. Inform the client that these contractions are common and may occur throughout the pregnancy.
4. Call the maternity unit and inform them that the client will be admitted in a prelabor condition.
255. The nurse is providing instructions to a pregnant client with genital herpes about the measures that are needed to
protect the fetus. Which
instruction should the nurse provide to the client?
1. Total abstinence from sexual intercourse is necessary during the entire pregnancy.
2. Sitz baths need to be taken every 4 hours while awake if vaginal lesions are present.
3. Daily administration of acyclovir (Zovirax) is necessary during the entire pregnancy.
4. A cesarean section will be necessary if vaginal lesions are present at the time of labor.
256. The nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The health care
provider has documented
the presence of Goodells sign. This finding is most closely associated with which characteristic?
1. A softening of the cervix
2. The presence of fetal movement
3. The presence of human chorionic gonadotropin in the urine
4. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus
257. A client arrives at the clinic for the first prenatal assessment. She tells the nurse that the first day of her last
menstrual period was October 19,
2014. Using Ngeles rule, which expected date of delivery should the nurse document in the clients chart?
1. July 12, 2014
2. July 26, 2015
3. August 12, 2015
4. August 26, 2015
258. The health care provider (HCP) is assessing the client for the presence of ballottement. To make this determination,
the HCP should take which
action?
1. Auscultate for fetal heart sounds.
2. Assess the cervix for compressibility.
3. Palpate the abdomen for fetal movement.
4. Initiate a gentle upward tap on the cervix.
259. A pregnant client asks the nurse in the clinic when she will be able to begin to feel the fetus move. The nurse
responds by telling the mother that
fetal movements will be noted between which weeks of gestation?
1. 6 and 8
2. 8 and 10
3. 10 and 12
4. 14 and 18
260. The nurse is performing an assessment of a primigravida who is being evaluated in a clinic during her second
trimester of pregnancy. Which
finding concerns the nurse and indicates the need for follow-up?
1. Quickening
2. Braxton Hicks contractions
3. Fetal heart rate of 180 beats/minute
4. Consistent increase in fundal height
261. The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a
healthy 5-year-old child who
was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise.
Using GTPAL, what should the
nurse document in the clients chart?
1. G = 3, T = 2, P = 0, A = 0, L = 1
2. G = 2, T = 1, P = 0, A = 0, L = 1
3. G = 1, T = 1, P = 1, A = 0, L = 1
4. G = 2, T = 0, P = 0, A = 0, L = 1
ANSWERS
252. 2
Rationale: During the second and third trimesters (weeks 18 to 30), fundal height in centimeters approximately equals the fetus age in weeks 2 cm. At
16 weeks, the fundus can be located
halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, the fundus is at the umbilicus. At 36 weeks, the fundus is at the xiphoid
process.
Test-Taking Strategy: Focus on the subject, the location of fundal height. Remember that during the second and third trimesters (weeks 18 to 30),
fundal height in centimeters approximately
262. The nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction
should the nurse provide?
1. Strict bed rest is required after the procedure.
2. Hospitalization is necessary for 24 hours after the procedure.
3. An informed consent needs to be signed before the procedure.
4. A fever is expected after the procedure because of the trauma to the abdomen.
263. A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin,
colorless vaginal drainage. The
nurse should make which statement to the client?
1. Come to the clinic immediately.
2. The vaginal discharge may be bothersome, but is a normal occurrence.
3. Report to the emergency department at the maternity center immediately.
4. Use tampons if the discharge is bothersome, but to be sure to change the tampons every 2 hours.
264. The nurse has performed a nonstress test on a pregnant client and is reviewing the fetal monitor strip. The nurse
interprets the test as reactive.
How should the nurse document this finding?
1. Normal
2. Abnormal
3. The need for further evaluation
4. That findings were difficult to interpret
265. A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings.
The health care provider
prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this
finding?
1. A normal test result
2. An abnormal test result
3. A high risk for fetal demise
4. The need for a cesarean delivery
266. A pregnant client tells the nurse that she has been craving unusual foods. The nurse gathers additional assessment
data and discovers that the
client has been ingesting daily amounts of white clay dirt from her backyard. Laboratory studies are performed and the
nurse determines that which
finding indicates a physiological consequence of the clients practice?
1. Hematocrit 38%
2. Glucose 86 mg/dL
3. Hemoglobin 9.1 g/dL
4. White blood cell count 12,400 cells/mm3
267. A pregnant client asks the nurse about the types of exercises that are allowable during pregnancy. The nurse should
tell that client that which
exercise is safest?
1. Swimming
2. Scuba diving
3. Low-impact gymnastics
4. Bicycling with the legs in the air
268. A health care provider has prescribed transvaginal ultrasonography for a client in the first trimester of pregnancy and
the client asks the nurse
about the procedure. How should the nurse respond to the client?
1. The procedure takes about 2 hours.
2. It will be necessary to drink 1 to 2 quarts of water before the examination.
3. The probe that will be inserted into the vagina will be covered with a disposable cover and coated with a gel.
4. Gel is spread over the abdomen, and a round disk transducer will be moved over the abdomen to obtain the picture.
269. The nurse has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which statement
by the client indicates a
need for further instructions?
1. I should wear panty hose.
2. I should wear support hose.
3. I should wear flat nonslip shoes that have good support.
4. I should wear knee-high hose, but I should not leave them on longer than 8 hours.
270. A pregnant client calls a clinic and tells the nurse that she is experiencing leg cramps that awaken her at night. What
should the nurse tell the
client to provide relief from the leg cramps?
1. Bend your foot toward your body while flexing the knee when the cramps occur.
2. Bend your foot toward your body while extending the knee when the cramps occur.
3. Point your foot away from your body while flexing the knee when the cramps occur.
4. Point your foot away from your body while extending the knee when the cramps occur.
271. A rubella titer result of a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is prescribed to be
administered before discharge.
The nurse provides which information to the client about the vaccine? Select all that apply.
1. Breast-feeding needs to be stopped for 3 months.
2. Pregnancy needs to be avoided for 1 to 3 months.
3. The vaccine is administered by the subcutaneous route.
4. Exposure to immunosuppressed individuals needs to be avoided.
5. A hypersensitivity reaction can occur if the client has an allergy to eggs.
6. The area of the injection needs to be covered with a sterile gauze for 1 week.
272. The nurse in a health care clinic is instructing a pregnant client how to perform kick counts. Which statement by the
client indicates a need for
further instructions?
1. I will record the number of movements or kicks.
2. I need to lie flat on my back to perform the procedure.
3. If I count fewer than 10 kicks in a 2-hour period I should count the kicks again over the next 2 hours.
4. I should place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the
kicks.
273. The nurse is providing instructions regarding treatment of hemorrhoids to a client who is in the second trimester of
pregnancy. Which statement by
the client indicates a need for further instruction?
1. Ithe client indicates a need for further instruction?
1. I should avoid straining during bowel movements.
2. I can gently replace the hemorrhoids into the rectum.
3. I can apply ice packs to the hemorrhoids to reduce the swelling.
4. I should apply heat packs to the hemorrhoids to help the hemorrhoids shrink.
274. The nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in
reducing breast tenderness. Which
instruction should the nurse provide?
1. Avoid wearing a bra.
2. Wash the breasts with warm water and keep them dry.
3. Wear tight-fitting blouses or dresses to provide support.
4. Wash the nipples and areolar area daily with soap, and massage the breasts with lotion.
275. The nurse is describing cardiovascular system changes that occur during pregnancy to a client and understands that
which finding would be
normal for a client in the second trimester?
1. Increase in pulse rate
2. Increase in blood pressure
3. Frequent bowel elimination
4. Decrease in red blood cell production
276. The clinic nurse is providing instructions to a pregnant client regarding measures that assist in alleviating heartburn.
Which statement by the client
indicates an understanding of the instructions?
1. I should avoid between-meal snacks.
2. I should lie down for an hour after eating.
3. I should use spices for cooking rather than using salt.
4. I should avoid eating foods that produce gas and fatty foods.
ANSWERS
262. 3
Rationale: Because amniocentesis is an invasive procedure, informed consent needs to be obtained before the procedure. After the procedure, the client
is instructed to rest, but may resume light
activity after the cramping subsides. The client is instructed to keep the puncture site clean and to report any complications, such as chills, fever,
bleeding, leakage of fluid at the needle insertion
site, decreased fetal movement, uterine contractions, or cramping. Amniocentesis is an outpatient procedure and may be done in a health care providers
private office or in a special prenatal
testing unit. Hospitalization is not necessary after the procedure.
Test-Taking Strategy: Focus on the subject, nursing implications related to amniocentesis. Recalling that this procedure is invasive will direct you to the
correct option.
Review: Amniocentesis
Priority Concepts: Client Education; Reproduction
263. 2
Rationale: Leukorrhea begins during the first trimester. Many clients notice a thin, colorless or yellow vaginal discharge throughout pregnancy. Some
clients become distressed about this
condition, but it does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, the
client may use panty liners, but she should
not wear tampons because of the risk of infection. If the client uses panty liners, she should change them frequently.
Test-Taking Strategy: Eliminate options 1 and 3 first because they are comparable or alike, indicating that the client requires medical attention. From
the remaining options, recalling that this
manifestation is a normal physiological occurrence or that tampons should be avoided will assist in directing you to the correct option.
Review: Normal assessment findings in pregnancy
Integrated Process: Nursing ProcessImplementation
References: Lowdermilk et al (2012), pp. 295, 355; Perry et al (2010), p. 216.
264. 1
Rationale: A reactive nonstress test is a normal result. To be considered reactive, the baseline fetal heart rate must be within normal range (120 to 160
beats/minute) with good long-term variability.
In addition, two or more fetal heart rate accelerations of at least 15 beats/minute must occur, each with a duration of at least 15 seconds, in a 20-minute
interval.
Test-Taking Strategy: Eliminate options 2, 3, and 4 because they are comparable or alike, indicating that an alteration from normal is present.
Review: Interpretation of a nonstress test
Level of Cognitive Ability: Analyzing
Integrated Process: Nursing ProcessAnalysis
Priority Concepts: Communication; Perfusion

Reference: McKinney et al (2013), p. 309.
265. 1
Rationale: Contraction stress test results may be interpreted as negative (normal), positive (abnormal), or equivocal. A negative test result indicates that
no late decelerations occurred in the fetal
heart rate, although the fetus was stressed by three contractions of at least 40 seconds duration in a 10-minute period. Options 2, 3, and 4 are incorrect
interpretations.
Test-Taking Strategy: Note that options 2, 3, and 4 are comparable or alike in that they indicate an abnormal test result finding.
Review: The interpretation of the results of a contraction stress test
Priority Concepts: Communication; Perfusion
266. 3
Rationale: Pica practices often lead to iron deficiency anemia, resulting in a decreased hemoglobin level. The laboratory values in options 1, 2, and 4 are
normal for the pregnant client.
Test-Taking Strategy: Focus on the subject, recalling that pica results in anemia. This will assist in eliminating options 2 and 4. From the remaining
options, recall the normal laboratory values in a
pregnant client to assist in directing you to the correct option.
Review: Physiological effects of pica and related laboratory values
Priority Concepts: Gas Exchange; Nutrition
267. 1
Rationale: Nonweight-bearing exercises are preferable to weight-bearing exercises during pregnancy. Exercises to avoid are shoulder standing and
bicycling with the legs in the air because theknee-chest position should be avoided. Competitive or high-risk sports such as scuba diving, water skiing,
downhill skiing, horseback riding, basketball, volleyball, and gymnastics should be
avoided. Nonweight-bearing exercises such as swimming are allowable.
Test-Taking Strategy: Focus on the subject, safe exercise to engage in during pregnancy. Identify the activities or exercises that could cause an injury to
the fetus. This should direct you to the
correct option.
Review: Appropriate exercise activities for the pregnant client
268. 3
Rationale: Transvaginal ultrasonography allows clear visibility of the uterus, gestational sac, embryo, and deep pelvic structures, such as the ovaries and
fallopian tubes. The client is placed in a
lithotomy position and a transvaginal probe, encased in a disposable cover and coated with a gel that provides lubrication and promotes conductivity, is
inserted into the vagina. The client may feel
more comfortable if she is allowed to insert the probe. The procedure takes about 10 to 15 minutes. Options 2 and 4 identify components of abdominal
ultrasound.
Test-Taking Strategy: Focus on the subject, the procedure for a transvaginal ultrasonography. Also, note the relationship of the name of the test and
the description in the correct option.
Review: Transvaginal ultrasonography
Reference: Lowdermilk et al (2012), pp. 200, 640-641.
269. 4
Rationale: Varicose veins often develop in the lower extremities during pregnancy. Any constrictive clothing, such as knee-high hose, impedes venous
return from the lower legs and places the
client at risk for developing varicosities. The client should be encouraged to wear support hose or panty hose. Flat nonslip shoes with proper support are
important to assist the pregnant woman to
maintain proper posture and balance and to minimize falls.
Test-Taking Strategy: Note the strategic words need for further instructions. These words indicate a negative event query and ask you to select an
option that is an incorrect statement. Focus on
the subject of the question as it relates to preventing varicose veins. Recall that anything that constricts the lower vessels and impedes venous return
from the lower legs would place the client at
risk for varicosities.
Review: Measures to prevent varicose veins
Level of Cognitive Ability: Evaluating
270. 2
Rationale: Leg cramps occur when the pregnant client stretches her leg and plantar flexes her foot. Dorsiflexion of the foot while extending the knee
stretches the affected muscle, prevents the
muscle from contracting, and stops the cramping. Options 1, 3, and 4 are not measures that provide relief from leg cramps.
Test-Taking Strategy: Focus on the subject of the question, to provide relief from the leg cramps. Visualize each of the descriptions in the options to
assist in directing you to the correct option.
Review: Measures in alleviating muscle cramps
Reference: McKinney et al (2013), pp. 253-254.
271. 2, 3, 4, 5
Rationale: Rubella vaccine is administered to women who have not had rubella or women who are not serologically immune. The vaccine may be
administered in the immediate postpartum period
to prevent the possibility of contracting rubella in future pregnancies. The live attenuated rubella virus is not communicable in breast milk; breast-feeding
does not need to be stopped. The client is
counseled not to become pregnant for 1 to 3 months after immunization as specified by the health care provider because of a possible risk to a fetus from
the live virus vaccine; the client must be
using effective birth control at the time of the immunization. The client should avoid contact with immunosuppressed individuals because of their low
immunity toward live viruses and because the
virus is shed in the urine and other body fluids. The vaccine is administered by the subcutaneous route. A hypersensitivity reaction can occur if the client
has an allergy to eggs because the vaccine
is made from duck eggs. There is no useful or necessary reason for covering the area of the injection with a sterile gauze.
Test-Taking Strategy: Focus on the subject, client instructions regarding the rubella vaccine. Recalling that the rubella vaccine is a live virus vaccine
will assist in selecting options 2 and 5. Next,
recalling the route of administration and the contraindications associated with its use will assist in selecting options 3 and 4.
Review: Client instructions regarding the rubella vaccine
Content Area: MaternityPostpartum
272. 2
Rationale: The client should sit or lie quietly on her side to perform kick counts. Lying flat on the back is not necessary to perform this procedure, can
cause discomfort, and presents a risk of vena
cava (supine hypotensive) syndrome. The client is instructed to place her hands on the largest part of the abdomen and concentrate on the fetal
movements. The client records the number of
movements felt during a specified time period. The client needs to notify her health care provider if she feels fewer than 10 kicks over two, 2-hour
intervals or as instructed by her HCP.
Test-Taking Strategy: Note the strategic words need for further instructions. These words indicate a negative event query and ask you to select an
option that is an incorrect statement. If you are
unfamiliar with this procedure, recalling that the risk of vena cava (supine hypotensive) syndrome exists when the client lies on her back will direct you to
the correct option.
Review: Procedure for kick counts
Priority Concepts: Client Education; Perfusion
273. 4
Rationale: Measures that provide relief from hemorrhoids include avoiding constipation and straining during bowel movements; applying ice packs to
reduce the hemorrhoidal swelling; gently
replacing the hemorrhoids into the rectum; using stool softeners, ointments, or sprays as prescribed; and assuming certain positions to relieve pressure on
the hemorrhoids. Heat packs increase
the blood flow to the area and worsen the discomfort from hemorrhoids.
Test-Taking Strategy: Note the strategic words need for further instruction. These words indicate a negative event query and ask you to select an
option that is an incorrect statement. Recalling
the principles regarding heat and cold will assist in directing you to the correct option.
Review: Treatment measures for hemorrhoids
Priority Concepts: Client Education; Elimination
References: McKinney et al (2013), pp. 253-254; Potter et al (2013), pp. 1092, 1111.
274. 2
Rationale: The pregnant client should be instructed to wash the breasts with warm water and keep them dry. The client should be instructed to avoid
using soap on the nipples and areolar area to
prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses cause
discomfort. The client is instructed to wear
soft-textured clothing to decrease nipple tenderness and to use breast pads inside the bra to prevent leakage through the clothing if colostrum is a
problem.
Test-Taking Strategy: Focusing on the subject of the questionreducing breast tendernessand visualizing each of the measures identified in the
options will direct you to the correct option.
Also, noting the word warm and the word dry in the correct option will direct you to this option.
Review: Treatment measures for breast tenderness
Level of Cognitive Ability: ApplyingClient Needs: Health Promotion and Maintenance
275. 1
Rationale: Between 14 and 20 weeks gestation, the pulse rate increases about 10 to 15 beats/minute, which then persists to term. Options 2, 3, and 4
are incorrect. During pregnancy, the blood
pressure usually is the same as the prepregnancy level, but then gradually decreases up to about 20 weeks of gestation. During the second trimester,
systolic and diastolic pressures decrease by
about 5 to 10 mm Hg. Constipation may occur as a result of decreased gastrointestinal motility or pressure of the uterus. During pregnancy, there is an
accelerated production of red blood cells.
Test-Taking Strategy: Focus on the subject of the question, the findings that would be considered normal for a client in her second trimester. Think
about the physiological occurrences during
pregnancy and remember that between 14 and 20 weeks gestation, the pulse increases about 10 to 15 beats/minute.
Review: Normal physiological changes in the second trimester of pregnancy
276. 4
Rationale: Lying down is likely to lead to reflux of stomach contents, especially immediately after a meal. The client should be instructed to avoid spices,
along with salt, because spices trigger
heartburn. Salt produces edema. The client should be encouraged to eat between-meal snacks and should be instructed that to control heartburn, eating
smaller, more frequent portions is
preferred over eating three large meals. The client also should limit or avoid gas-producing and fatty foods.
Test-Taking Strategy: Focus on the subject and note the words indicates an understanding of the instructions. Recalling that the client needs to limit or
avoid gas-producing and fatty foods will
assist in directing you to the correct option.
Review: Measures to alleviate heartburn in the pregnant client
Integrated Process: Nursing ProcessEvaluation
Priority Concepts: Client Education; Nutrition
References: Lowdermilk et al (2012), p. 354; Peckenpaugh (2010), pp. 427-428.
277. The nurse is providing instructions to a pregnant client with human immunodeficiency virus (HIV) infection regarding
care to the newborn after
delivery. The client asks the nurse about the feeding options that are available. Which response should the nurse make to
the client?
1. You will need to bottle-feed your newborn.
2. You will need to feed your newborn by nasogastric tube feeding.
3. You will be able to breast-feed for 6 months and then will need to switch to bottle-feeding.
4. You will be able to breast-feed for 9 months and then will need to switch to bottle-feeding.
278. The home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia. Which assessment finding
indicates a worsening of the
preeclampsia and the need to notify the health care provider?
1. Urinary output has increased.
2. Dependent edema has resolved.
3. Blood pressure reading is at the prenatal baseline.
4. The client complains of a headache and blurred vision.
279. A stillborn baby was delivered in the birthing suite a few hours ago. After the delivery, the family remained together,
holding and touching the
baby. Which statement by the nurse would further assist the family in their initial period of grief?
1. What can I do for you?
2. Now you have an angel in heaven.
3. Dont worry, there is nothing you could have done to prevent this from happening.
4. We will see to it that you have an early discharge so that you dont have to be reminded of this experience.
280. The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes
mellitus. Which statement made by
the client indicates a need for further teaching?
1. I should stay on the diabetic diet.
2. I should perform glucose monitoring at home.
3. I should avoid exercise because of the negative effects on insulin production.
4. I should be aware of any infections and report signs of infection immediately to my health care provider.
281. The nurse is performing an assessment on a pregnant client with a diagnosis of severe preeclampsia. The nurse
reviews the assessment findings
and determines that which finding is most closely associated with a complication of this diagnosis?
1. Enlargement of the breasts
2. Complaints of feeling hot when the room is cool
3. Periods of fetal movement followed by quiet periods
4. Evidence of bleeding, such as in the gums, petechiae, and purpura
282. The nurse in a maternity unit is reviewing the clients records. Which client would the nurse identify as being at the
most risk for developing
disseminated intravascular coagulation?
1. A primigravida with mild preeclampsia
2. A primigravida who delivered a 10-lb infant 3 hours ago
3. A gravida II who has just been diagnosed with dead fetus syndrome
4. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood
283. The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At
each home care visit, the
nurse assesses the client for which classic signs of preeclampsia? Select all that apply.
1. Proteinuria
2. Hypertension
3. Low-grade fever
4. Generalized edema
5. Increased pulse rate
6. Increased respiratory rate
284. The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing
insulin needs during
pregnancy. The nurse determines that further teaching is needed if the client makes which statement?
1. I will need to increase my insulin dosage during the first 3 months of pregnancy.
2. My insulin dose will likely need to be increased during the second and third trimesters.
3. Episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy.
4. My insulin needs should return to normal within 7 to 10 days after birth if I am bottle- feeding.
285. A pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss, and fatigue. After
assessment of the client,
tuberculosis is suspected. A sputum culture is obtained and identifies Mycobacterium tuberculosis. Which instruction should
the nurse include in the
clients teaching plan?
1. Therapeutic abortion is required.
2. She will have to stay at home until treatment is completed.
3. Medication will not be started until after delivery of the fetus.
4. Isoniazid plus rifampin (Rifadin) will be required for 9 months.
286. The nurse is providing instructions to a maternity client with a history of cardiac disease regarding appropriate dietary
measures. Which
statement, if made by the client, indicates an understanding of the information provided by the nurse?
1. I should increase my sodium intake during pregnancy.
2. I should lower my blood volume by limiting my fluids.
3. I should maintain a low-calorie diet to prevent any weight gain.
4. I should drink adequate fluids and increase my intake of high-fiber foods.

287. The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which
assessment finding indicates
to the nurse that the client is at risk for contracting human immunodeficiency virus (HIV)?
1. A client who has a history of intravenous drug use
2. A client who has a significant other who is heterosexual
3. A client who has a history of sexually transmitted infections
4. A client who has had one sexual partner for the past 10 years
288. The nurse in a maternity unit is providing emotional support to a client and her husband who are preparing to be
discharged from the hospital after
the birth of a dead fetus. Which statement made by the client indicates a component of the normal grieving process?
1. We want to attend a support group.
2. We never want to try to have a baby again.
3. We are going to try to adopt a child immediately.
4. We are okay, and we are going to try to have another baby immediately.
289. The nurse evaluates the ability of a hepatitis Bpositive mother to provide safe bottle-feeding to her newborn during
postpartum hospitalization.
Which maternal action best exemplifies the mothers knowledge of potential disease transmission to the newborn?
1. The mother requests that the window be closed before feeding.
2. The mother holds the newborn properly during feeding and burping.
3. The mother tests the temperature of the formula before initiating feeding.
4. The mother washes and dries her hands before and after self-care of the perineum and asks for a pair of gloves before
feeding.
290. A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing
vaginal bleeding. A threatened
abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the
client indicates a need for
further instruction?
1. I will watch for the evidence of the passage of tissue.
2. I will maintain strict bed rest throughout the remainder of the pregnancy.
3. I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad.
4. I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding.
ANSWERS
277. 1
Rationale: Perinatal transmission of human immunodeficiency virus (HIV) can occur during the antepartum period, during labor and birth, or in the
postpartum period if the mother is breast-feeding.
Clients who have HIV are advised not to breast-feed. There is no physiological reason why the newborn needs to be fed by nasogastric tube.
Test-Taking Strategy: Use knowledge regarding the transmission of HIV. Eliminate options 3 and 4 first because these options are comparable or alike
in that they both address breast-feeding.
From the remaining options, select the correct option, knowing that it is unnecessary to feed the newborn by nasogastric tube.
Review: Feeding options for a newborn with a mother who has human immunodeficiency virus (HIV)
Client Needs: Safe and Effective Care Environment
Priority Concepts: Client Education; Infection
278. 4
Rationale: If the client complains of a headache and blurred vision, the HCP should be notified because these are signs of worsening preeclampsia.
Options 1, 2, and 3 are normal signs.
Test-Taking Strategy: Note the word worsening in the question. Eliminate options 1, 2, and 3 because these options are comparable or alike and
indicate normal findings.
Review: Signs of worsening preeclampsia
Reference: Swearingen (2012), p. 647.
279. 1
Rationale: When a loss or death occurs, the nurse should ensure that parents have been honestly told about the situation by their health care provider or
others on the health care team. It is
important for the nurse to be with the parents at this time and to use therapeutic communication techniques. The nurse must also consider cultural and
religious practices and beliefs. The correct
option provides a supportive, giving, and caring response. Options 2, 3, and 4 are blocks to communication and devalue the parents feelings.
Test-Taking Strategy: Use knowledge of therapeutic communication techniques to answer the question. The correct option is the only option that
reflects use of therapeutic communication
techniques.
Review: Grief associated with perinatal death
Client Needs: Psychosocial Integrity
Integrated Process: Caring
Priority Concepts: Communication; Coping
References: Lowdermilk et al (2012), pp. 931-932, 936; Potter et al (2013), pp. 320-322.
280. 3
Rationale: Exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifications are the
mainstay of treatment, and the client is
placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose
monitoring at home, it is performed at the clinic or
HCPs office. Signs of infection need to be reported to the HCP.
Test-Taking Strategy: Note the strategic words need for further teaching. These words indicate a negative event query and the need to select an
incorrect client statement. Noting these strategic
words and the closed-ended word avoid in the correct option will assist in answering the question.
Review: Teaching points for gestational diabetes
Priority Concepts: Client Education; Glucose Regulation
281. 4
Rationale: Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity.
Bleeding is an early sign of DIC and should be
reported to the health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy.
Test-Taking Strategy: Note the strategic word most. Focus on the subject, a complication of severe preeclampsia. Eliminate options 1, 2, and 3
because they are comparable or alike and are
normal occurrences in the last trimester of pregnancy.
Review: Assessment findings in disseminated intravascular coagulation (DIC)
Priority Concepts: Clinical Judgment; Clotting
282. 3
Rationale: In a pregnant client, disseminated intravascular coagulation (DIC) is a condition in which the clotting cascade is activated, resulting in the
formation of clots in the microcirculation. Dead
fetus syndrome is considered a risk factor for DIC. Severe preeclampsia is considered a risk factor for DIC; a mild case is not. Delivering a large newborn is
not considered a risk factor for DIC.
Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage.
Test-Taking Strategy: Note the strategic word most. Focus on the subject, the client at most risk for DIC. Think about the pathophysiology associated
with DIC and recall that dead fetus syndrome
is a risk factor. This will direct you to the correct option.
Review: Risk factors for disseminated vascular coagulationLevel of Cognitive Ability: Analyzing
Content Area: MaternityIntrapartum
Priority Concepts: Clinical Judgment; Clotting
283. 1, 2, 4
Rationale: The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. A low-grade fever, increased pulse rate, or
increased respiratory rate is not associated
with preeclampsia.
Test-Taking Strategy: Focus on the subject, the classic signs of preeclampsia. Thinking about the pathophysiology associated with preeclampsia will
direct you to the correct options. Remember
that the three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria.
Review: Signs of preeclampsia
References: Lowdermilk et al (2012), pp. 660, 662; Swearingen (2012), p. 647.
284. 1
Rationale: Insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral
sensitivity to insulin. The statements in
options 2, 3, and 4 are accurate and signify that the client understands control of her diabetes during pregnancy.
Test-Taking Strategy: Note the strategic words further teaching is needed. These words indicate a negative event query and the need to select an
incorrect client statement. Eliminate options 2,
3, and 4 because they are comparable or alike and are accurate statements. Remember that insulin needs decrease in the first trimester of pregnancy.
Review: Insulin needs of the pregnant client with diabetes mellitus
Priority Concepts: Client Education; Glucose Regulation
285. 4
Rationale: More than one medication may be used to prevent the growth of resistant organisms in a pregnant client with tuberculosis. Treatment must
continue for a prolonged period. The preferred
treatment for the pregnant client is isoniazid plus rifampin daily for 9 months. Ethambutol is added initially if medication resistance is suspected.
Pyridoxine (vitamin B6) often is administered with
isoniazid to prevent fetal neurotoxicity. The client does not need to stay at home during treatment, and therapeutic abortion is not required.
Test-Taking Strategy: Focus on the subject, therapeutic management for a client with tuberculosis. Recalling the pathophysiology associated with
tuberculosis and its treatment will assist in
eliminating options 1, 2, and 3.
Review: Treatment measures for the pregnant client with tuberculosis
Priority Concepts: Client Education; Infection
286. 4
Rationale: The Valsalva maneuver should be avoided in clients with cardiac disease because it can cause blood to rush to the heart and overload the
cardiac system. Constipation can cause the
client to use the Valsalva maneuver. High-fiber foods are important. A low-calorie diet is not recommended during pregnancy and could be harmful to the
fetus. Diets low in fluid can cause a
decrease in blood volume, which could deprive the fetus of nutrients, so adequate fluid intake and high-fiber foods are important. Sodium should be
restricted as prescribed by the health care
provider because excess sodium would cause an overload to the circulating blood volume and contribute to cardiac complications.
Test-Taking Strategy: Focus on the subject, the pregnant client with heart disease. Think about the physiology of the cardiac system, maternal and
fetal needs, and the factors that increase the
workload on the heart. This will direct you to the correct option.
Review: Nursing measures for the pregnant client with heart disease
287. 1
Rationale: Human immunodeficiency virus (HIV) is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood,
and passage from an infected woman to her
fetus. Clients who fall into the high-risk category for HIV infection include individuals with persistent and recurrent sexually transmitted infections,
individuals who have a history of multiple sexual
partners, and individuals who have used intravenous drugs. A client with a heterosexual partner, particularly a client who has had only one sexual partner
in 10 years, does not have a high risk for
contracting HIV.
Test-Taking Strategy: Focus on the subject, risk factors for HIV. Recalling that exchange of blood and body fluids places the client at high risk for HIV
infection will direct you to the correct option.
Review: Risk factors associated with human immunodeficiency virus (HIV)
Priority Concepts: Infection; Sexuality
288. 1
Rationale: A support group can help the parents work through their pain by nonjudgmental sharing of feelings. The correct option identifies a statement
that would indicate positive, normal grieving.
Although the other options may indicate reactions of the client and significant other, they are not specifically a part of the normal grieving process.
Test-Taking Strategy: Read all the options carefully before selecting an answer and focus on the subject of the question, the normal grieving process.
Note that options 2, 3, and 4 are
comparable or alike in that they relate to childbearing.
Review: Normal grieving process
Client Needs: Psychosocial Integrity
Integrated Process: Caring
Priority Concepts: Coping; Family Dynamics
289. 4
Rationale: Hepatitis B virus is highly contagious and is transmitted by direct contact with blood and body fluids of infected persons. The rationale for
identifying childbearing clients with this disease
is to provide adequate protection of the fetus and the newborn, to minimize transmission to other individuals, and to reduce maternal complications. The
correct option provides the best evaluation
of maternal understanding of disease transmission. Option 1 will not affect disease transmission. Options 2 and 3 are appropriate feeding techniques for
bottle-feeding, but do not minimize disease
transmission for hepatitis B.
Test-Taking Strategy: Note the strategic word best. Focus on the subject of the question, disease transmission to the newborn. This focus will direct
you to the correct option.
Review: Measures to prevent transmission of hepatitis
Priority Concepts: Client Education; Reproduction; Infection
290. 2
Rationale: Strict bed rest throughout the remainder of the pregnancy is not required for a threatened abortion. The client is advised to curtail sexual
activities until bleeding has ceased and for 2weeks after the last evidence of bleeding or as recommended by the health care provider. The client is
instructed to count the number of perineal pads used daily and to note the quantity and color
of blood on the pad. The client also should watch for the evidence of the passage of tissue.
Test-Taking Strategy: Note the strategic words need for further instruction in the question. These words indicate a negative event query and the
need to select an incorrect client statement.
Noting the word strict in the correct option will assist in directing you to this option.
Review: Therapeutic management for threatened abortion

Fetal Circulation Teaching Plan Options

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242. The nursing student is preparing to teach a prenatal class about fetal circulation.

Which statement should be included

Level of Cognitive Ability: Understanding

Review: Effects of sterilization

Priority Concepts: Communication; Perfusion

4. I should drink adequate fluids and increase my intake of high-fiber foods.

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