Chapter 31: The Pregnant Woman
Jarvis: Physical Examination and Health Assessment, 8th Edition
MULTIPLE CHOICE
1. Which of these statements best describes the action of the hormone progesterone during
pregnancy?
a.
Progesterone produces the hormone human chorionic gonadotropin.
b.
Duct formation in the breast is stimulated by progesterone.
c.
Progesterone promotes sloughing of the endometrial wall.
d.
Progesterone maintains the endometrium around the fetus.
2. A female patient has nausea, breast tenderness, fatigue, and amenorrhea. Her last menstrual
period was 6 weeks ago. What signs of pregnancy is this patient experiencing?
a.
Positive
b.
Possible
c.
Probable
d.
Presumptive
3. A woman who is 8 weeks’ pregnant is visiting the clinic for a checkup. Her systolic blood
pressure is 30 mm Hg higher than her prepregnancy systolic blood pressure. How should the
nurse proceed?
a.
Consider this a normal finding.
b.
Expect the blood pressure to decrease as the estrogen levels increase throughout
the pregnancy.
c.
Consider this an abnormal finding because blood pressure is typically lower at this
point in the pregnancy.
d.
Recommend that the patient decreases her salt intake in an attempt to decrease her
peripheral vascular resistance.
4. A patient is being seen at the clinic for her 10-week prenatal visit. She asks when she will be
able to hear the baby’s heartbeat. How should the nurse reply?
a.
“The baby’s heartbeat is not usually heard until the second trimester.”
b.
“The baby’s heartbeat may be heard anywhere from the ninth to the twelfth week.”
c.
“It is often difficult to hear the heartbeat at this point, but we can try.”
d.
“It is normal to hear the heartbeat at 6 weeks. We may be able to hear it today.”
5. A patient who is in her first trimester of pregnancy tells the nurse that she is experiencing
significant nausea and vomiting and asks when it will improve. What is an appropriate
response by the nurse?
a.
“Did your mother have significant nausea and vomiting?”
b.
“Many women experience nausea and vomiting until the third trimester.”
c.
“Usually, by the beginning of the second trimester, the nausea and vomiting
improve.”
d.
“At approximately the time you begin to feel the baby move, the nausea and
vomiting will subside.”
6. During the examination of a woman in her second trimester of pregnancy, the nurse notices
the presence of a small amount of yellow drainage from the nipples. How does the nurse
interpret this finding?
a.
An indication that the woman’s milk is coming in.
b.
A sign of possible breast cancer in a pregnant woman.
c.
Most likely colostrum and considered a normal finding at this stage of the
pregnancy.
d.
Too early in the pregnancy for lactation to begin and refers the woman to a
specialist.
7. A woman in her second trimester of pregnancy complains of heartburn and indigestion. When
discussing this with the woman, the nurse considers which explanation for these problems?
a.
Tone and motility of the gastrointestinal tract increase during the second trimester.
b.
Sluggish emptying of the gallbladder, from the effects of progesterone, often
causes heartburn.
c.
Lower blood pressure at this time decreases blood flow to the stomach and
gastrointestinal tract.
d.
Enlarging uterus and altered esophageal sphincter tone predispose the woman to
have heartburn.
8. A patient who is 20 weeks’ pregnant tells the nurse that she feels more shortness of breath as
her pregnancy progresses. The nurse recognizes which statement to be true?
a.
High levels of estrogen cause shortness of breath.
b.
Feelings of shortness of breath are abnormal during pregnancy.
c.
Hormones of pregnancy cause an increased respiratory effort.
d.
The patient should get more exercise in an attempt to increase her respiratory
reserve.
9. The nurse auscultates a functional systolic murmur, grade ii/iv, on a woman in week 30 of her
pregnancy. The remainder of her physical assessment is within normal limits. How should the
nurse proceed?
a.
Consider this finding abnormal, and refer her for additional consultation.
b.
Ask the woman to run briefly in place and then assess for an increase in intensity
of the murmur.
c.
Know that this finding is normal and is a result of the increase in blood volume
during pregnancy.
d.
Ask the woman to restrict her activities and return to the clinic in 1 week for
re-evaluation.
10. A woman who is 28 weeks’ pregnant has bilateral edema in her lower legs after working 8
hours a day as a cashier at a local grocery store. She is worried about her legs. What is the
nurse’s best response?
a.
“You will be at risk for development of varicose veins when your legs are
edematous.”
b.
“I would like to listen to your heart sounds. Edema can indicate a problem with
your heart.”
c.
“Edema is usually the result of too much salt and fluids in your diet. You may need
to cut down on salty foods.”
d.
“As your baby grows, it slows blood return from your legs, causing the swelling.
This often occurs with prolonged standing.”
11. When assessing a woman who is in her third trimester of pregnancy, the nurse looks for the
classic symptoms associated with preeclampsia. What symptoms is the nurse looking for that
would indicate preeclampsia?
a.
Edema, headaches, and seizures
b.
Decreased blood pressure and edema
c.
Elevated blood pressure and proteinuria
d.
Elevated liver enzymes and high platelet counts
12. The nurse should know that what is the best time to assess a woman’s blood pressure during
an initial prenatal examination?
a.
At the end of the examination when she will be the most relaxed
b.
At the beginning of the interview as a nonthreatening method of gaining rapport
c.
During the middle of the physical examination when she is the most comfortable
d.
Before beginning the pelvic examination because her blood pressure will be higher
after the pelvic examination
13. When examining the face of a woman who is 28 weeks’ pregnant, the nurse notices the
presence of a butterfly-shaped increase in pigmentation on the face. How should the nurse
document this finding?
a.
Striae
b.
Chloasma
c.
Linea nigra
d.
Mask of pregnancy
14. Which finding is considered normal and expected when the nurse is performing a physical
examination on a pregnant woman?
a.
Palpable, full thyroid
b.
Edema in one lower leg
c.
Pale mucous membranes of the mouth
d.
Significant diffuse enlargement of the thyroid
15. When auscultating the anterior thorax of a pregnant woman, the nurse notices the presence of
a murmur over the second, third, and fourth intercostal spaces. The murmur is continuous but
can be obliterated by pressure with the stethoscope or finger on the thorax just lateral to the
murmur. How does the nurse interpret these findings?
a.
Murmur of aortic stenosis
b.
Most likely a mammary souffle
c.
Associated with aortic insufficiency
d.
Indication of a patent ductus arteriosus
16. When the nurse is assessing the deep tendon reflexes (DTRs) on a woman who is 32 weeks’
pregnant, which of these would be considered a normal finding?
a.
Absent DTRs
b.
2+
c.
4+
d.
Brisk reflexes with clonus
17. When performing an examination of a woman who is 34 weeks’ pregnant, the nurse notices a
midline linear protrusion in the abdomen over the area of the rectus abdominis muscles as the
woman raises her head and shoulders off of the bed. Which response by the nurse is correct?
a.
The presence of diastasis recti should be documented.
b.
This condition should be discussed with the physician because it will most likely
need to be surgically repaired.
c.
The possibility that the woman has a hernia attributable to the increased pressure
within the abdomen from the pregnancy should be suspected.
d.
The woman should be told that she may have a difficult time with delivery because
of the weakness in her abdominal muscles.
18. The nurse is palpating the fundus of a pregnant woman. Which statement about palpation of
the fundus is true?
a.
The fundus should be hard and slightly tender to palpation during the first
trimester.
b.
Fetal movement may not be felt by the examiner until the end of the second
trimester.
c.
After 20 weeks’ gestation, the number of centimeters should approximate the
number of weeks’ gestation.
d.
Fundal height is usually less than the number of weeks’ gestation, unless an
abnormal condition such as excessive amniotic fluid is present.
19. The nurse is palpating the abdomen of a woman who is 35 weeks’ pregnant and notices that
the fetal head is facing downward toward the pelvis. What does this describe?
a.
Fetal lie
b.
Fetal variety
c.
Fetal attitude
d.
Fetal presentation
20. The nurse is palpating the uterus of a woman who is 8 weeks’ pregnant. Which finding would
be most consistent with a normal finding at this stage of pregnancy?
a.
The uterus seems slightly enlarged and softened.
b.
It reaches the pelvic brim and is approximately the size of a grapefruit.
c.
The uterus rises above the pelvic brim and is approximately the size of a
cantaloupe.
d.
The uterus is about the size of an avocado, approximately 8 cm across the fundus.
21. Which best describes the average length of pregnancy?
a.
38 weeks
b.
9 lunar months
c.
280 days from the last day of the last menstrual period
d.
280 days from the first day of the last menstrual period
22. A patient’s pregnancy test is positive, and she wants to know when the baby is due. The first
day of her last menstrual period was June 14, and that period ended June 20. Using the Nägele
rule, what is her expected date of delivery?
a.
March 7
b.
March 14
c.
March 21
d.
March 27
23. During the assessment of a woman in her 22nd week of pregnancy, the nurse is unable to hear
fetal heart tones with the fetoscope. How should the nurse proceed?
a.
Wait 10 minutes, and try again.
b.
Use ultrasound to verify cardiac activity.
c.
Ask the woman if she has felt the baby move today.
d.
Immediately notify the physician, then wait 10 minutes and try again.
24. A patient who is 24 weeks’ pregnant asks about wearing a seatbelt while driving. Which
response by the nurse is correct?
a.
“Seatbelts should not be worn during pregnancy.”
b.
“Place the lap belt below the uterus and use the shoulder strap at the same time.”
c.
“Place the lap belt below the uterus but omit the shoulder strap during pregnancy.”
d.
“Place the lap belt at your waist above the uterus and use the shoulder strap at the
same time.”
25. During a health history interview, a 38-year-old woman shares that she is thinking about
having another baby. The nurse knows which statement to be true regarding pregnancy after
35 years of age?
a.
Fertility does not start to decline until age 40 years.
b.
Occurrence of Down syndrome is significantly more frequent after the age of 35
years.
c.
Genetic counseling and prenatal screening are not routine until after age 40 years.
d.
Women older than 35 years who are pregnant have the same rate of
pregnancy-related complications as those who are younger than 35 years.
26. A 25-year-old woman is in the clinic for her first prenatal visit. The nurse will prepare to
obtain which laboratory screening test at this time?
a.
Urine toxicology
b.
Alpha-fetoprotein
c.
Complete blood cell count
d.
Carrier screening for cystic fibrosis
27. A woman at 25 weeks’ gestation comes to the clinic for her prenatal visit. The nurse notices
that her face and lower extremities are swollen, and her blood pressure is 154/94 mm Hg. The
woman states that she has had headaches and blurry vision but thinks it is just because she is
tired. What should the nurse suspect?
a.
Eclampsia
b.
Preeclampsia
c.
Preterm labor
d.
Diabetes type 1
28. During auscultation of fetal heart tones (FHTs), the nurse determines that the heart rate is 136
beats per minute. How should the nurse proceed?
a.
Document the results, which are within normal range.
b.
Have the patient change positions and count the FHTs again.
c.
Immediately notify the physician for possible fetal distress.
d.
Take the maternal pulse to verify these findings as the uterine souffle.
29. During a woman’s 34th week of pregnancy, she is told that she has preeclampsia. The nurse
knows which statement concerning preeclampsia is true?
a.
Preeclampsia has little effect on the fetus.
b.
Edema is one of the main indications of preeclampsia.
c.
Eclampsia only occurs before delivery of the baby.
d.
Untreated preeclampsia may contribute to restriction of fetal growth.
MULTIPLE RESPONSE
1. During a group prenatal teaching session, the nurse teaches Kegel exercises. Which
statements would be appropriate for this teaching session? (Select all that apply.)
a.
“Kegel exercises should be performed twice a day.”
b.
“Kegel exercises should be performed 50 to 100 times a day.”
c.
“Kegel exercises help keep your uterus strong during the pregnancy.”
d.
“To perform Kegel exercises, rapidly perform alternating squeeze-release exercises
up to the count of eight.”
e.
“To perform Kegel exercises, slowly squeeze to a peak at the count of eight, and
then slowly release to a count of eight.”