Study Questions
Chapter 23: Pregnant Patient
- Physiologic changes that may be normal in pregnancy include (choose two):
(a)chloasma, or mask of pregnancy.
(b)thinning of the skin.
(c)increase in scalp hair.
(d)changes in vision and smell.
Answer: a, d
Rationale: Skin tends to thicken and hair tends to thin during pregnancy.
- During pregnancy, women generally find this position most comfortable for sleeping:
(a)lying on their backs.
(b)lying on their right sides.
(c)lying on their left sides.
(d)on their backs, propped up with three pillows.
Answer: c
Rationale: A left side-lying position helps to take pressure off the inferior vena cava and prevent supine hypotension.
- As part of prenatal care, pregnant women should be warned about a change in their center of balance. They should exercise caution when doing all of the following except:
(a)walking, especially over uneven surfaces.
(b)ascending and descending stairs.
(c)participating in activities which require a sense of balance.
(d)driving.
Answer: d
Rationale: Driving should not pose a problem with a change in the center of balance.
- Common hematologic changes during pregnancy include (choose two):
(a)decreased white blood cell count.
(b)increased red blood cell volume.
(c)increased plasma volume.
(d)decreased number and size of platelets.
Answer: b, c
Rationale: The white blood cell count increases, as does the size of platelets. The plasma volume increases more than the red cell volume, which leads to the physiological anemia of pregnancy.
- Your patient is in her eighth month of pregnancy, and you have been concerned about her since you first met her six months ago. This is her first visit without the baby’s father present. During previous visits, he did most of the talking for her, and his hovering has seemed more defiant than solicitous. Today, she is quiet, as usual, but seems to want to say something. You ask her about her preparations for the baby, and she replies, “My husband will get what we need.”You ask if someone, like her mother, will come to help her when the baby is born, and she answers that her husband “doesn’t like to have anyone in the house.”You give her your card and tell her to call you if she has any questions or problems, and she says, “My husband doesn’t let me use the phone.”Further conversation might include:
(a)assuring her that her husband can take care of all her needs.
(b)gently pointing out that women, especially new mothers, benefit from extra help and conversation with other mothers.
(c)asking if she has friends and family and how they feel about her situation.
(d)reminding her that if she ever feelsuncomfortable with her situation, there are agencies that can help her.
Answer: a
Rationale: This woman is being virtually held captive by her husband, and this is a form of abuse. She must make her own decisions, but the nurse can offer her support and options.
- The following medications should probably be switched to an alternative during pregnancy (choose two):
(a)hydralazine
(b)coumadin
(c)oral diabetic agents
(d)methyldopa
Answer: b, c
Rationale: Coumadin should be switched to heparin, and oral diabetic agents should be changed to insulin. Any pregnant woman should consult her health care provider before taking any medication.
- This immunization is not contraindicated during pregnancy:
(a)tetanus
(b)rubella
(c)hepatitis B
(d)varicella
Answer: c
Rationale: Rubella and varicella immunizations should be given three months prior to conception. Other immunizations should be given only if absolutely necessary and after a discussion of benefits and risks. The patient should be thoroughly informed before giving consent.
- Pregnant women should wear seat belts in cars in this manner:
(a)Only the shoulder harness should be used.
(b)Only the lap belt should be used.
(c)Both sections should be used, with the lap belt over the largest part of the abdomen.
(d)Both sections should be used, with the lap belt under the abdomen.
Answer: d
Rationale: Both sections should be used to secure both the upper and lower body. The lap belt should be worn below the abdomen to prevent harm to the fetus.
- Your 35-year-old 7-month pregnant patient has a blood pressure of 150/92 when she arrives for her appointment. She says that she is in a rush, because she has to complete a project at work today. You note slight ankle edema. The retinal exam is within normal limits, her lungs are clear, and she has no discomfort or neurological findings. She has gained 3 lbs. in the last month. You recheck her blood pressure, and it is 126/79. She has no history of hypertension. She most likely has experienced:
(a)preeclampsia.
(b)eclampsia.
(c)chronic hypertension.
(d)transient hypertension.
Answer: d
Rationale: Both chronic hypertension and pregnancy-induced hypertension produce retinal changes. Preeclampsia and eclampsia lead to rapid weight gain, more prolonged high blood pressure, and other symptoms.
- The following laboratory tests are performed early during a pregnancy. Which one should be repeated at 26–28 weeks and again at 36 weeks?
(a)blood type
(b)Rh factor
(c)rubella titer
(d)complete blood count
Answer: d
Rationale: Blood type and Rh factor do not change. If a patient is not immune to rubella, she should be cautioned to avoid possible exposure during the first trimester.
- Women should be screened for cystic fibrosis, ideally prior to pregnancy. Which ethnic group has the highest rate of carriers?
(a)Caucasians (non-Hispanic)
(b)Hispanic
(c)AfricanAmericans
(d)Asian Americans
Answer: a
Rationale: Non-Hispanic Caucasians have the highest rate for carrying this gene.
- Your patient’s last menstrual period was 7 weeks ago. Her home pregnancy test was positive. She says that a short while ago she experienced a severe right lower quadrant pain and passed out briefly. Despite a history of hypertension, her blood pressure is 90/60. You suspect that she is experiencing:
(a)appendicitis.
(b)severe gastrointestinal distress.
(c)ruptured ectopic pregnancy.
(d)placenta previa.
Answer: c
Rationale: She may well have a ruptured ectopic pregnancy. This is a medical emergency.
- Your patient is 38 weeks pregnant. You are listening to the fetal heart rate, which has previously been about 140 bpm. Today, it is 60 bpm. This indicates:
(a)a normal rate.
(b)an abnormal bradycardia.
(c)a molar pregnancy.
(d)an abnormal tachycardia.
Answer: b
Rationale: A rate below 110 bpm is bradycardia, which is abnormal. This may be a sign of fetal distress, heart block, or drug use. A consultation with a perinatologist is advised.
- Your patient has suffered a miscarriage at 3 months. She comes to your office with her husband. She is cradling something in a piece of cloth in her hands and is crying. Appropriate interventions would include:
(a)offering condolences on their loss.
(b)examining the tissue that she is carrying, and asking if she passed anything else.
(c)checking her physical condition and referring her for further care if it seems that she is bleeding excessively or has not passed all the products of conception.
(d)telling them about support groups and other counseling options.
(e)all of the above
Answer: e
Rationale: Rationale: They are obviously grieving and need emotional, as well as physical care.
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