Chapter 11: Nursing Care related to assessment of a pregnant family

1. Prenatal care is essential for ensuring the overall health of newborns and their mothers. Which of the following
is/are not true regarding prenatal care?
a. It is a major strategy for helping to reduce complications of pregnancy such as the number of LBW babies born
each year.
b. It begins during a woman’s childhood. which starts from adequate intake of calcium and vit. D extending up to
early immunization.
c. It starts from adequate intake of calcium and vit. D extending up to early immunization.
d. It includes an overall healthy lifestyle about sexuality, womanhood, and childbearing.

2. Women who maintain a healthy lifestyle this way come to a first prenatal visit prepared to follow health promotion
strategies. Which of the ffng. is true regarding prenatal visit?
a. For many woman, it is the first visit they have been to a healthcare facility not counting their routinely visit since
childhood.
b. It is an appointment that focuses on sedentary lifestyle rather than health promotion and diagnosis of disease.
c. It is a time for additional health promotion, pregnancy education, and development of a positive pattern of healthy
behaviors for the family to use in the future.

3. Although most women probably have used a home pregnancy kit to find out if they are pregnant, the first prenatal
visit officially confirms this, so nursing diagnoses usually focus on the response of a woman and her family to that
information. Nursing diagnoses appropriate to prenatal care include:
A. Health-seeking behaviors related to guidelines for nutrition and activity during pregnancy
B. Deficient knowledge regarding exposure to teratogens during pregnancy
C. Health-seeking behaviors related to strong cultural desire to have a healthy child
D. Risk for injury to fetus related to lifestyle choices
E. All of the above

4. The overall purposes of prenatal care are to (select all that apply):
a) Establish a baseline of past health
b) Determine the gestational age of the fetus
c) Monitor fetal development and maternal well-being
d) Identify women at risk for mortality
e) Minimize the risk of possible complications by anticipating and preventing problems after they occur
f) Provide education about pregnancy, lactation, and newborn care

5. Before planning a pregnancy, which of the following action should she take?
a. Schedule specific appointment with her primary care provider to obtain accurate reproductive life planning
information, receive reassurance about fertility, and identify any problems that may need correction to help ensure
fertility.
b. Take prenatal vitamin to ensure the folic acid will be adequate throughout pregnancy.
c. All of the Above
d. None of the above

6. All of the following are actions that should be taken when a woman becomes pregnant, except:
a. Choose a primary healthcare provider to care for her throughout the pregnancy and birth
b. Woman should schedule a first prenatal visit as soon as she suspected that she is pregnant
c. Join seminars on woman during the early stages of pregnancy.
d. All of the above

7. One of the first things a woman who suspects she is pregnant must do is choose a primary healthcare provider to
guide her through her pregnancy. Many women ask, “What type of care provider should I choose?”
To investigate whether pregnancy care and outcomes differed when women chose a nurse-midwife rather than a
physician as their primary care provider, researchers examined 15 different trials involving 17,674 women researchers
interviewed a sample of 6,421 Canadian women, all 15 years of age or older, all who had given birth to a singleton
baby, and all who were living with their infant. Results of the study showed women whose primary prenatal care
provider was a nurse-midwife were more likely to be satisfied with their maternity care experience and information
provided on pregnancy and birth topics and have improved outcomes for both the birthing parent and the infant. They
were prescribed fewer ultrasounds and were more likely to attend prenatal classes. They were almost half as likely to
have labor induced and 7.33 times more likely to experience a medication-free birth, experienced fewer inductions,
forceps or vacuum deliveries, amniotomies, episiotomies, preterm births, and fewer overall fetal or neonatal deaths
before 24 weeks gestation. Women who chose midwifery led continuity care had higher rates of unmedicated
childbirth (Sandall, Soltanni, Gates, et al., 2016). Postpartally, they were more likely to initiate and maintain
breastfeeding at 3 and 6 months (O’Brien, Chalmers, Fell, et al., 2011).
Based on the previous study, if Sandra asks the nurse if she should choose a nurse- midwife as her primary care
provider, how would the nurse best answer her question?
a. “Of course. Nurses are always more ‘patient friendly’ than physicians.”
b. “Who you choose is such a personal choice; I shouldn’t give you any advice.”
c. “Nurse-midwives tend to use less medication with birth. Is that important to you?”
d. “Nurse-midwives don’t talk to women as much as doctors. Would you like that?”

8. Which of the following is true regarding First prenatal visit?

a. Women should schedule a first prenatal visit as soon as they suspect they are pregnant.
b. Return appointments are usually scheduled every 4 weeks through the 28th week of pregnancy, every 2 weeks
through the 36th week, and then every week until birth.
c. An important focus of all prenatal visits, in addition to education about pregnancy and helping a woman achieve a
healthy pregnancy lifestyle, is to assure women that they have no signs of communicable diseases.
d. To screen for danger signs that might reveal a complication is beginning.
e. True answers includes only option A, B, and D.

9. The major causes of serious illness or death during pregnancy for women today are:
a. Hypertension
b. Hemorrhage
c. Embolism
d. Morbid obesity and anesthesia-related complication
e. All of the above

10. Sandra Czerinski feels healthy, so she asks the nurse why she needs to bother coming for prenatal care. What
benefit should the nurse cite when responding to Sandra’s statement?
A. Gynecologic
a. Discovering any allergies History
can reduce the risk ofB.preterm
Day History
labor. C. Hx of family
illness
b. It allows for the collection of accurate epidemiologic and demographic data.
D. Demographic Data E. Family Profile F. Chief Concern
c. It provides time for education about pregnancy and birth.
H. History of past illness I. Obstetric History
d. It provides important time to interact with a prenatal group.

11. Because obtaining an initial health history can be time-consuming, a woman may be asked to complete some
necessary forms before arrival. Appropriate interviewing techniques, however, are important to obtain a thorough and
meaningful health history. Which of the following should be taken into consideration when taking initial review:
a. Established rapport thru a face to face interviewing
b. Caution a woman that a first visit may be lengthy because of all the things that need to be accomplished.
c. Interviewing is best accomplished in a private, quiet setting.
d. Be certain to ask how a patient wants you to address her taking into account gender identification
e. All of the above

12. True/False: As a whole, interviewing is most effective if it is a one-to-one interaction because a woman may be
unwilling to mention certain concerns when her family is present for fear of worrying them.

13. True/False: If childbearing is to be a family affair, however, it is not as important to determine a partner’s degree
of acceptance of the pregnancy and how well prepared he or she is of assuming a new parenting role. Including the
fetus’s siblings in a prenatal visit also provides them an opportunity to be involved.

14. True/False: If a woman wishes, a partner can accompany her during the physical examination. After confirmation
of pregnancy, include the partner in healthcare information or suggestions.

For 15-22. Choose your answer on the Box

________15. This is If a woman wishes, a partner can accompany her during the physical examination. After
confirmation of pregnancy, include the partner in healthcare information or suggestions.
_______16. It is the reason the woman has come to healthcare setting. This also includes documenting date of her
LMP, signs of early pregnancy, danger signs of pregnancy, etc.
_______17. This includes identifying her support person, marital status, educational level, size and structure of house,
family composition, and lifestyle.
______18. Questioning this is very pivotal because a past condition can become active during or immediately
following pregnancy. This will serve as a basis for the immunization that she can get during delivery.
______19. Identifying any illnesses that occur frequently in a woman’s relatives can help identify potential problems a
woman or her infant could experience during pregnancy or after birth.
_______20. Information about a woman’s current nutrition, elimination, sleep, recreation, and interpersonal
interactions can be elicited best by asking a woman to describe what her typical day is like. This includes nutrition,
exercise, hobbies, violence, and vices

_______21. This includes menstrual hx, perineal and breast examination, past surgery, reproductive planning, sexual
history, and stress inconsistence.
_______22. For each previous pregnancy, document the newborn’s sex and the place and date of birth.

23. Do not assume the current pregnancy is a woman’s first pregnancy simply because she is very young or says she
has only recently been married. She may have had an adolescent pregnancy or this could be a second marriage. For
each previous pregnancy, document the newborn’s sex and the place and date of birth. Review the pregnancy briefly
by asking:
a. • How did the pregnancy go, overall? Did she have any complications, such as
b. • What was the infant’s birth weight and sex? Did the infant cry right away? What was the infant’s Apgar score?
c. • What was the infant’s birth weight and sex? Did the infant cry right away? What was the infant’s Apgar score?
d. All of the above

24. The nurse is reviewing Sandra’s electronic health record. While doing so, the nurse asks Sandra to clarify and
confirm her surgical history. Why is it important to ask Sandra about past surgery during a pregnancy health history?
a. Previous use of general anesthetics is a risk factor for preterm labor.
b. Adhesions from surgery could potentially limit uterine growth.
c. Previous experience with surgery means that she will likely be comfortable in a hospital setting.
d. Abdominal incisions are associated with potential uterine rupture.

25. A pregnant woman has the following past history: a boy born at 39 weeks gestation, alive and well; a girl born at
40 weeks gestation, alive and well; and a girl born at 33 weeks gestation, alive and well. How would the nurse
summarize her gravida and para status?
GPTPALM- ______________

26. In ending an interview, what should be the best way?

a. Say thank you and that’s all
b. Cut the interview with a purpose
c. Ask if there is anything not being covered that the woman wants to discuss and give here chance to ask question
d. Leave the house

27. ________ should be taken before examination or physical examination,

Answer:

28. True/False: an empty bladder makes the pelvic examination more comfortable and, by reducing bladder size,
allows for easier identification of pelvic organs.

29. Rearrange the steps in obtaining a clean-catch urine specimen

1. Ask the woman to wash her hand
2. Ask the woman to sit on the commode and separate her labia with nondominant hand. She should then cleanse her
perineum, washing from front to back, using a cotton ball or wipe for only one stroke and then discarding it
3. Caution the woman to avoid touching inside of container
4. To finish, she should cap the specimen container, wash her hands, and bring the specimen to you.
5. The woman should begin urinating, allowing the first urine to flow into the toilet. Next, she should hold the
container under the urine stream until approximately 10–20 ml has been obtained.
6. She then needs to open the commercial clean-catch urine specimen kit and moisten the cotton balls with the
antiseptic solution or open the prepared antiseptic wipes.

A. 1-6-2-3-5-4
B.1-2-3-5-4-6
C. 1-2-3-4-5-6
D. 1-5-6-2-3-4

30. True/False: A physical examination at a first prenatal visit typically includes inspection of major body systems,
with emphasis on the changes that occur with pregnancy or that could signal a developing complication.

31. A sudden increase in blood pressure and a sudden weight gain are both danger signs that __________________
may be occurring.
Answer:
32. A sudden increase in pulse or respirations could suggest _________.
Answer:

33. Which is true about the fundal height and fetal heart sound of a fetus?
a. At about 14 to 16 weeks of pregnancy, the uterus becomes palpable as a firm globular sphere showing over the
symphysis pubis. It grows to reach the umbilicus at 20 to 22 weeks and the xiphoid process of the sternum at 36
weeks.
b. In primiparas, it then often returns to about 4 cm below the xiphoid process because of “lightening” for the rest of
pregnancy.
c. Auscultate for fetal heart sounds (a rate of 110 to 160 beats/min is normal) by Doppler if the pregnancy is past 12
weeks (the lower limit at which they can usually be heard).
d. Palpate for fetal outline and position after the 20th week as a further estimation of fetal size and growth.

34. Sandra reports that the palms of her hands are always itchy, and the nurse notices scratches on them when you
perform a physical examination. The nurse’s plan of care should specify that this problem is most likely due to what
factor in women who are pregnant?
a. Anxiety or fear about the pregnancy
b. A potential Rh incompatibility
c. Peripheral edema related to changes in fluid and electrolyte levels
d. A common reaction to increasing estrogen levels

35. A pelvic examination reveals information on the health of both a woman’s internal and external reproductive
organs. The following equipment is required (tick all that apply):
• A speculum (a metal or plastic instrument with movable flat blades; Fig. 11.4)
• A spatula and/or broom for cervical sampling
• Clean examining gloves
• Lubricant
• A glass slide or liquid collection device for a Pap smear
• A culture tube
• Two or three sterile cotton-tipped applicators or cytobrushes for obtaining cervical cultures
• A dim examining light
• Immovable stool at correct sitting height

36. In examining pelvic examination, what is true?

a. Pelvic examinations have the reputation of being painful and causing a loss of modesty.
b. After the woman empties her bladder, have her lie in a lithotomy position (on her back with her thighs flexed and
her feet resting in the examining table stirrups
c. Allow a woman the opportunity to talk with the person performing the examination while sitting up, before being
placed in a lithotomy position, because this can enhance her sense of self-esteem and control.
d. All of the above
Identification
37. a woman who is not now or never has been pregnant.
Answer:
38. A ______________ viral infection appears as clustered, pinpoint vesicles on an erythematous (reddened) base on
the vulva that feel painful when touched or irritated.
Answer:
39. A _________ is taken from the endocervix at a first prenatal visit to be certain a precancerous or cancerous
condition of the uterine cervix, vulva, or vagina is not present.
Answer:
40. The most commonly used classification system in Pap smear
Answer:
41. It is a trichomonas that is usually removed during vaginal inspection.
Answer:
42. Following the speculum examination, a ________ (two-handed) examination is performed to assess the position,
contour, consistency, and tenderness of pelvic organs.
Answer:
43. Sandra has not had a pelvic examination since she was in high school. Consequently, the nurse-midwife has asked
the nurse to help make her more at ease during her first prenatal pelvic examination. What action should the nurse
take?
a. Have her take a deep breath and hold it as long as she can during the examination.
b. Tell her to bear down slightly as the speculum is inserted.
c. Encourage her to moan in a low-pitched tone because this will push down the diaphragm.
d. Teach her to breathe slowly and evenly while being examined.

44. Which is true regarding the structures present in pelvis (select all that apply):
a. Each innominate bone is divided into three parts: ilium, ischium, and pubis. The ilium forms the upper and lateral
portion. The flaring superior border forms the prominence of the hip (the crest of the ilium). The ischium is the
inferior portion.
b. The sacrum is the upper posterior portion of the pelvic ring. There is a marked anterior projection of this bone at the
point where it touches the lower lumbar vertebrae (the sacral prominence), which is used as a landmark when securing
pelvic measurements.
c. The coccyx, just below the sacrum, is composed of five very small bones fused together. Although the bone itself is
stiff, there is a degree of movement possible in the joint between the sacrum and the coccyx (the sacrococcygeal
joint). This movement is important during labor because it permits the coccyx to be pressed backward, allowing more
room for the fetal head to pass through the bony pelvic ring at birth.

45. ____________ is the entrance to a true pelvis. It is at the level of the linea terminalis or is marked by the sacral
prominence in the back, the ilium on the sides, and the superior aspect of the symphysis pubis in the front.
Answer:

46. The _________ is the inferior portion of the pelvis, or that portion bounded in the back by the coccyx, on the sides
by the ischial tuberosities, and in the front by the inferior aspect of the symphysis pubis.
Answer:

47. The ____________ is the space between the inlet and the outlet. This space is not a straight but a curved passage;
the purpose of its curve is to slow and control the speed of birth.
Answer:

48. A (n) ___________ pelvis has a well-rounded inlet and wide pubic arch. (female)
Answer:

49. In a(n) ________ pelvis, the transverse diameter is narrow and anteroposterior diameter of the inlet is larger. (ape-
like)
Answer:
50. A (n) __________ pelvis has smoothy curved oval-shaped inlet with a shallow anteroposterior diameter.
(flattened)
Answer:
51. In a(n) ________ pelvis, the pubic arch forms an acute angle, extremely narrowing the lower dimensions of the
pelvis. (male)
Answer:

52. The ____________ is the measurement between the anterior surface of the sacral prominence and the posterior
surface of the symphysis pubis. The average measurement is 10.5 to 11 cm.
Answer:
53. The _____________ diameter is the distance between the ischial tuberosities, or the transverse diameter of the
outlet (the narrowest diameter at that level, or the one most apt to cause a misfit). It is made at the medial and
lowermost aspect of the ischial tuberosities at the level of the anus.
Answer:

54. Urine is tested for the ffng:

a. Proteinuria
b. glycosuria
c. nitrites
d. pyuria
e. all of the following

55. In ultrasonography, the following are true:

a. If the date of the last menstrual period is unknown, a woman will be scheduled for a sonogram to confirm the
pregnancy length and document healthy fetal growth at 7 to 11 weeks of pregnancy.
b. An ultrasound may also be done, ideally between 13 and 15 weeks of pregnancy, as a part of a first trimester
screening to assess for increased risk of Down syndrome
c. A sonogram can be scheduled between 20 and 24 weeks gestation to verify healthy fetal structures and gender.
d. Be certain women know that a sonogram done under 10 weeks will show only the presence of a gestation sac, not a
moving, kicking fetus, so their expectations of what they will see are not disappointing

56. It is important for her to report a danger sign immediately, though, so it can be dealt with before something
harmful does occur. A pregnant woman should report the following signs or symptoms immediately (check all that
apply):
a. Vaginal bleeding
b. Persistent vomiting
c. Chills and fever or pain on urination
d. Sudden escape of clear fluid from the vagina.

57. The nurse is reviewing danger signs of pregnancy with Sandra. In the interests of safety, which of the following
would the nurse tell her to report if it should occur?
a. Her uterus becomes palpable over the symphysis pubis before 12 weeks.
b. Blue veins appear and can be readily observed on both of her breasts.
c. She gains more than 3 lb a week beginning at 20 weeks.
d. She tends to lose her balance when she wears high-heeled shoes.