1. A 20-year-old woman who is G1 PO comes to the prenatal clinic for her initial exam.

She is 10
weeks pregnant. She asks why the baby needs amniotic fluid. The nurse would explain that amniotic
fluid:
A. Keeps the fetus's skin moist
B. Provides a cushion for trauma and facilitates movement
C. Contains the blood vessels that oxygenate the fetus
D. Provides an acidic medium for the fetus to swallow
RATIONALE (A) Vernix keeps the skin moist, not the fluid. (B) The amniotic fluid has five
functions: provides a cushion to prevent trauma,
al- lows fetal
ease of movement,
maintains a uniform fetal tempera- ture, provides fluid for swallowing, and protects the fetal head
during labor. (C) Amniotic fluid does not contain blood vessels. (D) Amniotic fluid is an alkaline, not
an acid.

2. The nurse discusses with a client a prenatal test to screen for spinal anomalies done between 16
and 20 weeks' gestation, which is called the:
A. Enzyme-linked immunosorbent (ELISA)
assay
B. VDRL
C. BHCG
D. Fetoprotein (AFP)
RATIONALE (A) ELISA is used for HIV screening. (B) VDRL is used for syphilis screening. (C)
BHCG is used to determine pregnancy, especially ectopic pregnancy. (D)
Elevated levels of AFP in amniotic fluid or maternal serum have been found to reflect open neural
tube defects.

3. A female client wants to know how she can be positively sure she is pregnant. The nurse answers:
A. Breast tenderness with pigment changes
B. Enlargement of the abdomen
C. FHR by Doppler at 10-12 weeks
D. Amenorrhea
RATIONALE (A) Breast tenderness can be due to hormonal changes other than pregnancy.
(B) Enlargement can be related to gas, weight gain, and abdominal conditions other than pregnancy.
(C) The posi- tive signs pregnancy include THR by Doppler at 10-12 weeks and by fetoscope at 18-
20 weeks; fetal movement perceived by trained examiner; fetal ECG; ultrasound visualization of fetal
parts.
(D) Amenorrhea is influenced by endocrine, metabolic, psychological changes and systemic disease.

4. In taking a client's history at her first visit to the prenatal clinic, the nurse would determine the
following in- formation:
A. The first day of the last normal menstrual period
B. The partner's physiological symptoms of pregnancy
C. The number of pregnancies the client's mother had
D. The energy level of the client
RATIONALE (A) The LMP is useful in calculating the EDC. Mothers need to know this information
to master the tasks of pregnancy. (B) A partner's physiological symptoms are not part of the medical
record.
(C) The parity of the client's mother is not important; however, the number of multiple gestations can
be influential in treatment. (D) Most pregnant women are tired in the first trimester; this is not crucial
information.

5. In screening for factors that place the pregnancy at risk, the nurse would assess a client at her first
prenatal visit for:
A. Emotional lability
B. Nausea and vomiting
C. Changes in bowel habits
D. Vaginal bleeding and cramping
RATIONALE (A) Emotional lability may last through the pregnancy, but it generally is not
pathological. (B) Unless nausea and vomiting cause severe dehydration and electrolyte imbalance,
the pregnancy is not at risk. (C) Bowel changes are affected by the progesterone levels of pregnancy;
constipation is expected. (D) Danger signs of pregnancy include bleeding from the vagina, sudden
gush of clear fluid from the vagina; fever and chills, severe headaches with blurred vision; abdominal
pain; generalized swelling of the face and limbs; and absence of fetal movement.

6. A client has missed two menstrual periods and has a positive pregnancy test and exam.
After counseling, she decides to have an elective abortion. The nurse should explain that the
procedure used for termination in early pregnancy is:
A. PG suppository
B. Saline infusion
C. Dilation and suction
D. Laminaria
RATIONALE (A) PG suppositories are used for second-trimester fetal demise. (B) Saline infusion is
unsafe and should no longer be used. (C) The method of choice for first-trimester elective abortion is
suc- tion curettage because it is safe and can be done at minimal expense. (D) Laminaria is used to
soften and efface a cervix prior to induction of labor

7. The nurse instructs a client in signs of post abortion complications requiring her return to the
physician. Which statement by the client indicates she needs additional teaching?
A. "I should take Tylenol if I have abdominal pain and tenderness."
B. "I may have feelings of sadness after the
abortion.
C. "My vaginal bleeding should be scant for 2 weeks."
D. I should call the physician if my temperature is 98.6 F (37 C)
RATIONALE (A) Abdominal tenderness and pain can be signs of uterine infection and should be
reported to a physician. (B) Sadness after abortion is normal, even if the termination is elective. (C)
Bleeding after termination can last up to a month. (D) Fever is indicated by a temperature of 101F
(38.3C) in women post abortion.

8. A 40-year-old primigravida is scheduled for an amniocentesis at 16 weeks'

gestation. The
nurse explains that the purpose of the procedure is to
A. Evaluate the sex of the fetus
B. Perform genetic studies
C. Assess L/S ratio
D. Monitor the bilirubin level
RATIONALE (A) Fetal sex cannot be determined until after 20 weeks. (B) Amniocentesis performed
at this point in pregnancy would be for genetic purposes. The woman's age places her at risk for a
Down syndrome baby. (C) L/S ratio is used to determine the lung maturity of the fetus during the
third trimester. (D) Bilirubin levels are drawn from the fluid to monitor fetuses compromised by
isoimmunization.

9. Following an amniocentesis, a client will be monitored 1 hour by the nurse for:

A. Temperature elevation
B. Bladder spasms
C. Spontaneous rupture of the membranes
D. Increased fetal activity
RATIONALE (A) Temperature elevation related to the procedure would not occur for at least 24
hours. (B) Bladder spasms are uncommon. (C) Rupture of the membranes is a potential complication
of amniocentesis. (D) FHR patterns are monitored, not fetal activity.

10. A client who is G2 Pl arrives for her 28-week appointment. She is complaining of hemorrhoids
and constipation.
A nursing
recommendation would include:
A. Decrease daily exercise.
B. Take laxatives at bedtime.
C. Take prenatal vitamins every other day.
D. Increase daily water and fiber intake.
RATIONALE (A) Increased daily activity is recommended. (B) Stool softeners are used in
pregnancy after all other measures have failed.
(C) Prenatal vitamins do not cause constipation and should be taken daily. (D) Increased fluid intake,
adequate roughage or bulk in diet, regular bowel habits, and adequate daily exercise can often
maintain good bowel function in women who have not had a previous problem.