Question 1

A 20-year-old client comes to the clinic due to abdominal cramping. She informs the midwife that it is more than a month and a half past the date of her expected menstrual period. The client's human chorionic gonotropin level is 5,500 mIU/mL. Pregnancy is suspected. Which diagnostic test should the midwife order to obtain the most accurate diagnosis of pregnancy at this time?

Accepted Answer

The midwife orders a transvaginal ultrasound to verify the pregnancy. Transvaginal ultrasound or TVU is considered the most accurate means of verifying pregnancy during the early first trimester. Transabdominal ultrasound may be ordered when the hCG level is greater than 6,500 mIU/mL. Intrauterine gestation can only be visualized if the amount of hCG is above the this level. A TVU can detect pregnancy once the hCG level is between 1,000 and 1,500 mIU/mL. Serum progesterone is a useful addition for evaluating abnormal early pregnancies.

Question 2

A 25-year-old client at 10 weeks' gestation comes to the clinic for her first prenatal visit. It is the client's first pregnancy. The client is concerned about the chances of her child developing Down syndrome. The client's medical and family history is not remarkable. When the client asks about the risk factors associated with Down syndrome, which of the following statements by the midwife is the most accurate?

Accepted Answer

Females who have a history of three first trimester abortions not due to hormonal deficiencies or incompetent cervix are at risk of having babies with Down syndrome. The risk of the child developing Down syndrome increases with advancing maternal and paternal age. The risk increases when the mother is older than 35 years and the father is older than 55 years at the time of fertilization. A female who has a child with Down syndrome has an increased risk of having another child with the same diagnosis.

Question 3

A 20 - year - old client is pregnant for the first time. The client is a marathon runner and has been on a rigorous exercise and training program. The client asks the midwife if she could still exercise while pregnant. Which of the following statements by the midwife is the most appropriate for the client?

Accepted Answer

The client may still exercise as long as the intensity and type of exercises are modified and that non - weight - bearing exercises are incorporated into the exercise program. If a client is used to exercising before pregnancy, she may incorporate non - weight - bearing exercises, such as swimming or water aerobics, into the program. These exercises are non - impact activities and can decrease the risk of injuries. The client may return to her pre - pregnancy exercise program about six weeks after the delivery to give her body sufficient time for recovery.

Question 4

A 32 - year - old client at 28 weeks' gestation complains of backache, especially at night. The midwife teaches which of the following exercises to relieve the discomfort?

Accepted Answer

The midwife may teach pelvic rocking to relieve backache. Pelvic rocking also increases the flexibility of the lumbar spine, which helps prevent prolonged labor. This exercise can be done on hands and knees, lying down, standing or sitting. The client arches her back, lengthening or stretching her spine, for one minute, and then hollows her back. Tailor sitting stretches the perineal muscles without occluding the blood supply to the lower legs. Squatting stretches the perineal muscles; be sure to keep your feet flat on the floor when squatting. Kegel exercises may help strengthen the perineal muscles.

Question 5

A 32 - year - old G3P2 client at 34 weeks' gestation comes to the facility due to contractions, which started about two hours ago. The contractions occur every 5 minutes. Assessment findings include cervical dilatation at 3 cm and effacement at 50%. Amniotic fluid leakage is negative. The fetal heart rate is 155 beats per minute and is reactive. The client is administered with magnesium sulfate through the intravenous route and with oral ampicillin. The midwife administers which of the following medications as an additional pharmacological treatment?

Accepted Answer

The midwife administers betamethasone as an additional pharmacological treatment. The client is in premature labor, based on the assessment findings. Betamethasone is a corticosteroid that is mainly used to decrease the risk of respiratory distress syndrome by stimulating the production of surfactant. It is also used to prevent intracranial hemorrhaging. It is administered through intramuscular injections. The other options are incorrect. Ampicillin is administered to prevent group B streptococcal disease, so adding penicillin is not necessary. Tertbutaline, a tocolytic, is not necessary because magnesium sulfate, another tocolytic, has been initiated. Gentamicin is administered to treat chorioamnionitis.

Question 6

A triple screen test is ordered for a 37 - year - old client, who is at 16 weeks' gestation, to evaluate her risk of having a baby with a neural tube defect. The triple screen test measures all of the following substances except:

Accepted Answer

The triple screen test does not measure pregnancy - associated plasma protein. A triple screen test is a routine prenatal screening test that measures the levels of alpha - fetoprotein, human chorionic gonadotropin and estriol. These markers are used to provide some information about a client's risk of having a baby with certain birth defects or genetic abnormalities. This test is not diagnostic; it only screens clients who need to undergo further tests for evaluation.

Question 7

A 23 - year - old client at 8 weeks' gestation is pregnant for the first time. The client asks the midwife for the recommended safe limit of alcohol per day during early pregnancy. Which of the following statements by the midwife is the most appropriate?

Accepted Answer

The most appropriate response is to inform the client that the safe limit of alcohol intake during early pregnancy is not known. Consumption of alcohol during pregnancy has been closely associated with birth intrauterine growth retardation, facial anomalies and dysfunctions involving the central nervous system. Option A is non - therapeutic and does not address the client's concerns. Option B is inaccurate and does not address the client's concerns. Option C is more appropriate for clients who are not pregnant.

Question 8

A midwife is teaching a group of nursing students about the stages of fetal development. Which of the following terms refers to the stage from fertilization to implantation?

Accepted Answer

Zygote is the term used to denote fetal growth from the time of fertilization to implantation. Embryo is used to denote fetal growth from implantation to between five and eight weeks. An ovum is an egg in the ovary of the female that has not been fertilized by a spermatozoon. Fetus is the term used to describe fetal growth from five to eight weeks' gestation until term.

Question 9

A midwife is teaching a group of student midwives about fetal circulation. Which of the following statements made by one of the students indicates that further teaching is necessary?

Accepted Answer

The oxygenated blood coming from the placenta enters the fetus through the umbilical vein. Oxygenated blood is transported to the fetal heart through the umbilical vein, whereas deoxygenated blood is transported away from the heart through the umbilical arteries. The other options are accurate.

Question 10

A 21 - year - old client comes to the prenatal clinic after a home pregnancy test indicated a positive result. The client informs the midwife that her last menstrual period was on October 28, 2010. Using Nagele's rule, the client's expected date of birth is on:

Accepted Answer

The client's expected date of birth using Nagele's rule is August 4, 2011. Nagele's rule is the standard method used to predict the length of pregnancy. To calculate the estimated date of delivery (EDD or EDC, for estimated date of confinement), add one year to the date of the last menstrual period (LMP), count back 3 months and add 7 days.

Question 11

A 20 - year - old G1P0 client comes to the prenatal clinic for her first prenatal visit on October 8, 2010. The client informs the midwife that her last menstrual period was on July 18, 2010. Based on Nagele's rule, which of the following data entries for the client is most accurate?

Accepted Answer

The client's expected date of birth is on April 25, 2011, the estimated date of conception is on August 1, 2010, and the estimated fetal age is 9 weeks and 5 days on October 8, 2010. Nagele's rule is the standard method for calculating the expected date of birth. It is obtained by adding a year to the date of the last menstrual period, counting back 3 months, and adding seven days. The estimated date of conception usually occurs 2 weeks after the LMP. The estimated fetal age is the amount time between the estimated date of conception and the date of the prenatal visit. Gestational age from the amount of time between the LMP and the prenatal visit.

Question 12

A midwife is assessing a client who is at 25 weeks' gestation. The midwife measures the client's fundal height from the symphysis pubis to the fundus to estimate fetal growth. A measurement of 30 cm is obtained. The midwife should consider all of the following conditions except:

Accepted Answer

Anencephaly is not likely to be considered by the midwife. The Using McDonald's rule, you can estimate the fetal growth by measuring the distance from the fundus to the symphysis pubis. A normal measurement is usually equal to the week of gestation between the 20th and 31st week of gestation. A measurement of 30 cm suggests that the fundal height is much greater than the standard, suggesting a multiple pregnancy, a large - for - gestational - age infant or hydatidiform mole. Anencephaly is considered if the fundal height is less than the standard.

Question 13

A midwife is estimating the fetal growth for each of four pregnant clients using McDonald's rule. Which of the following clients requires referral and further evaluation?

Accepted Answer

The client at 36 weeks' gestation with the fundus between the umbilicus and xiphoid process requires additional tests. The fundus is expected to reach the xiphoid process at 36 weeks. Between the 20th and 31st weeks of gestation, the fundal height in centimeters is usually equal to the week of gestation. The fundus is expected to reach the umbilicus at 20 weeks' gestation, and over the symphysis pubis at 12 weeks' gestation.

Question 14

A midwife instructs a client at 20 weeks' gestation to observe and record the number of fetal movements on a daily basis to assess the well - being of her baby. The midwife teaches the client how to count and record fetal movements through the Cardiff method. All of the following instructions are appropriate except:

Accepted Answer

Feeling and counting for fetal movements for one hour at three different times a day describes the Sandovsky method. The other options accurately describe the Cardiff method, which is also known as the Count - to - Ten method. No research has actually proven which method works better. Instead of focusing on the method used, the midwife should give more emphasis on being aware of the consistency of the fetal movement patterns.

Question 15

A client at 30 weeks' gestation comes to the facility due to decreased fetal movements. After taking the client's history, the client is instructed to focus on fetal activity for an hour. After an hour, the client reports fewer than three fetal movements. Which of the following is the next action of the midwife?

Accepted Answer

The next action of the midwifeis to perform a non - stress test. If the NST is non - reactive, the client should be referred to a physician for further evaluation. Reinforcing fetal movement counting is indicated if the client fails to count three or more fetal movements in an hour.

Question 16

A 28 - year - old client at 29 weeks' gestation comes to clinic due to decreased fetal movements. The midwife instructs the client to focus on the fetal activity for an hour. After the specified time period, the client reports two fetal movements. The midwife orders a non - stress test. The NST records an increase in fetal heart rate by 15 beats per minute, lasting for 15 minutes, after each fetal movement. This finding is recorded thrice in a period of 20 minutes. Based on the NST result, the next action of the midwife is to:

Accepted Answer

The next action of the midwife is to reinforce fetal movement counting. The NST is reactive because more than two accelerations were recorded in a period of 20 minutes. Acceleration is the increase of the fetal heart rate by 15 beats per minute, lasting for 15 minutes, after each fetal movement. A reactive NST indicates fetal well - being. A contraction stress test, an order for serial fetal assessment and referral to a physician are not indicated because the NST is reactive.

Question 17

A client at 30 weeks' gestation is ordered a contraction stress test after a non - stress test gave a non - reactive result. The midwife reviews the result of the contraction stress. Which of the following findings indicates a positive result? What is the meaning of a positive result?

Accepted Answer

If the fetal heart rate significantly decreases toward the end of each contraction and continuously after, and if this observation occurs in about 50% or more of the contractions, a positive contraction stress test is indicated. Option A describes the procedure, rather than the results, of a contraction stress test. Option B describes acceleration, which is observed during the non - stress test. Absence of fetal heart decelerations with fetal contractions (option D) is a normal finding. A positive result indicates a need for further evaluation, whereas a negative result indicates fetal well - being.

Question 18

A client at 15 weeks' gestation may be scheduled for the following tests except:

Accepted Answer

A client at 15 weeks' gestation is should not be scheduled for chorionic villi sampling. Chorionic villi sampling is a biopsy of the chorionic villi for chromosomal analysis that is usually done between 10 to 12 weeks of pregnancy. Amniocentesis is performed between 14 and 16 weeks' gestation. Serum alpha - fetoprotein may be scheduled between 11 and 15 weeks' gestation. A Doppler ultrasound may be ordered all throughout the pregnancy.

Question 19

A G1P0 client at 10 weeks' gestation comes to the clinic for her prenatal visit. The client has a BMI of 32. The client asks the midwife how much weight she should gain by the end of her pregnancy. The most appropriate statement by the midwife is:

Accepted Answer

The client may gain no more than 20 pounds during the pregnancy. Based on the assessment, the client is obese, meaning her BMI is equal or greater than 30. Pregnant clients who are obese should gain between 11 and 20 pounds before delivery. The optimal weight gain for clients in the normal weight and slightly overweight categories is between 24 and 25 pounds. Clients should not be on restrictive food diets during pregnancy. Dieting when pregnant can be dangerous to both mother and child. Some pregnant clients with obesity lose weight during the pregnancy because of vomiting and decreased appetite, not because of dieting.

Question 20

A midwife is assessing a 43 - year - old client at 23 weeks' gestation. Which of the following findings alerts the midwife of a possible case of pre - eclampsia?

Accepted Answer

A possible case of pre - eclampsia is considered if the client's most recent blood pressure increases to 130/100 mm Hg from a pre - pregnancy blood pressure of 100/80 mm Hg. If the client's systolic blood pressure increases 30 mm Hg, or if the diastolic pressure increases 15 mm Hg above the pre - pregnancy level, pre - eclampsia is more likely. A weight gain of one pound per week during the second trimester does not indicate a possible pre - eclampsia. Pre - eclampsia is more likely if the client gains more than two pounds during the second trimester. Absence of proteinuria and edema indicate good maternal health.

Quiz 5: Prenatal