NR 509 EXAM – PREGNANCY- QUESTIONS, ANSWERS AND EXPLANATIONS Question 1 What is the standard instrument used to auscultate fetal heart tones? A.
... [Show More] Stethoscope B. Doppler C. Pre-natal monitor D. Ultrasound Explanation: The Doppler fetal rate monitor is the standard instrument used for this measurement, and can detect the fetal rate (FHR) as early as 10 weeks gestation. Question 2 During pregnancy, what sound may be auscultated at the second or third intercostal space at the sternal border due to increased blood flow through the vessels? A. Diastolic murmur B. Systolic murmur C. Venous hum D. Bruit Explanation: A venous hum, or continuous mammary souffle that occurs during pregnancy is due to increased blood flow through normal vessels. The mammary souffle is commonly heard during late pregnancy or lactation. It is heard loudest in the second or third intercostal space at the sternal border, and is typically both systolic and diastolic, though only the systolic component may be audible. Question 3 If regular uterine contractions occur prior to 37 weeks gestation, this could be: A. a normal finding. B. preterm labor. C. preeclampsia. D. supine hypotensive syndrome. Explanation: Before 37 weeks, regular uterine contractions with or without pain and bleeding are abnormal, suggesting preterm labor. Question 4 Weight gain should be monitored during pregnancy. For a pregnant woman whose BMI is 18.5 - 24.9, the total weight gain should be: A. 11-20 pounds. B. 15-25 pounds. C. 25-35 pounds D. 28-40 pounds. Explanation: Weight gain should be closely monitored during pregnancy, as both excessive and inadequate weight gain are associated with poor birth outcomes. The pregnant woman who has a BMI of <18.5, should gain 28 - 40 pounds; BMI 18.5-24.9 should gain 25 - 35 pounds; BMI 25-29.9 should gain 15 - 25 pounds; and the obese pregnant woman should gain 11 - 20 pounds. Question 5 During pregnancy, a palpable softening of the cervical isthmus is noted. This finding is: A. Hegar's sign. t B. Chadwick's sign. C. striae gravidarum. D. linea nigra. Explanation: Hegar’s sign is the palpable softening of the cervical isthmus, the portion of the uterus that narrows into the cervix. Increased vascularity throughout the pelvis during pregnancy gives the vagina a bluish color, known as Chadwick’s sign. As the skin over the abdomen stretches to accommodate the fetus, purplish striae gravidarum (“stretch marks”) may appear. Linea nigra is a brownish black pigmented vertical stripe along the midline skin of the abdomen. Question 6 As tension on the abdominal wall increases with advancing pregnancy, the rectus abdominis muscles may separate at the midline of the abdomen. This finding is termed: A. striae gravidarum. B. linea nigra. C. adnexae. D. diastasis recti. Explanation: As tension on the abdominal wall increases with advancing pregnancy, the rectus abdominis muscles may separate at the midline: this is diastasis recti. If diastasis is severe, especially in multiparous women, only a layer of skin, fascia, and peritoneum may cover the anterior uterine wall, and fetal parts may be palpable through this muscular gap. Question 7 Facial edema in a pregnant woman after 20 weeks gestation, could be: A. a normal finding. B. suggestive of preeclampsia. C. renal failure. D. heart failure. Explanation: Facial edema in a pregnant woman after 20 gestational weeks may reflect preeclampsia and should be investigated. Question 8 Weight gain should be monitored during pregnancy. For a pregnant woman whose BMI is < 18.5, the total weight gain should be: A. 11-20 pounds. B. 15-25 pounds. C. 25-35 pounds D. 28-40 pounds. Explanation: Weight gain should be closely monitored during pregnancy, as both excessive and inadequate weight gain are associated with poor birth outcomes. The pregnant woman who has a BMI of <18.5, should gain 28 - 40 pounds; BMI 18.5-24.9 should gain 25 - 35 pounds; BMI 25-29.9 should gain 15 - 25 pounds; and the obese pregnant woman should gain 11 - 20 pounds. Question 9 Murmurs audible during pregnancy may suggest: A. preeclampsia. B. hypertension. C. anemia. D. pulmonary embolus. Explanation: Murmurs audible during pregnancy may suggest anemia. However, benign systolic murmurs can be heard in pregnant women after the first trimester. Question 10 What is the importance of prenatal care? A. Determines gestational age B. Estimates expected date of delivery C. Optimizes health and minimizes risk for mother and fetus D. Obtain family history Explanation: Prenatal care focuses on optimizing health and minimizing risk for the mother and fetus. Goals of the initial prenatal visit are to confirm the pregnancy, assess the health of the mother and risks of complications, and counsel the mother about expectations for the pregnancy. Question 11 During pregnancy, which hormone promotes endometrial growth that supports the early embryo? A. Progesterone B. Human chorionic gonadotropin (HCG) C. Estrogen D. Human placental lactogen Explanation: Estrogen promotes endometrial growth that supports the early embryo. This hormone appears to stimulate prolactin output in the anterior lobe of the pituitary gland, which readies breast tissue for lactation. Estrogen also contributes to the hypercoagulable state that puts pregnant women at higher risk for thromboembolic events. Question 12 B/P readings greater than 140 mm HG systolic and greater than 90 mm HG diastolic prior to pregnancy, before 20 weeks gestation, or beyond 12 weeks postpartum is: A. gestational hypertension. B. preeclampsia. C. chronic hypertension. D. primary hypertension. Explanation: Chronic hypertension occurs when systolic BP (SBP) >140 mm Hg or diastolic BP (DBP) >90 mm Hg documented prior to pregnancy, before 20 weeks, or beyond 12 weeks postpartum. Gestational hypertension refers to elevated blood pressure detected after 20 weeks gestation in the absence of proteinuria. Pre-eclampsia occurs in a woman who was previously normotensive but now has new onset hypertension with either proteinuria or end-organ damage. Primary hypertension, formerly known as essential hypertension, is a disorder which is associated with elevated blood pressure and an unidentifiable cause. Question 13 Pregnant women should avoid unpasteurized dairy products, such as soft cheese, raw eggs, and delicatessen meats because of the risk of: A. ingesting large amounts of mercury. B. ingestion large amounts of vitamin A. C. contracting toxoplasmosis. D. contracting botulism. Explanation: Pregnant patients should avoid unpasteurized dairy products, soft cheeses, raw eggs, and delicatessen meats due to the risk of Listeria, Salmonella, and toxoplasmosis. Question 14 When performing a pelvic exam on a pregnant woman, a larger speculum may be needed because of: A. increased vascularity of the vagina. B. vaginal wall relaxation. C. increased vascularity of the cervical structures. D. swelling in the vaginal cavity. Explanation: Because of vaginal wall relaxation, a larger than usual speculum may be needed. Question 15 During pregnancy, which hormone is produced by the placenta and supports progesterone synthesis in the corpus luteum? A. Progesterone B. Human chorionic gonadotropin (HCG) C. Estrogen D. Human placental lactogen Explanation: Human chorionic gonadotropin (HCG) is produced by the placenta and supports progesterone synthesis in the corpus luteum, effectively preventing the early embryo from being lost to menstruation. Question 16 When performing the first Leopold maneuver on a pregnant woman, if the fetal buttocks and head are easily palpated at the fundus, the fetus is said to be in: A. vertical lie. B. transverse lie. C. face presentation. D. vertex presentation. Explanation: The top of the uterus (fundus) is palpated to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or buttocks (Breech) of the fetus is in the fundus, then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie. If the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back, then the head is extended and the fetus is in face presentation. Question 17 During the vaginal examination of a pregnant woman in her first trimester, an adnexal mass with tenderness is palpated. This finding could be consistent with: A. multiple gestation. B. a fibroid tumor. C. an ectopic pregnancy. D. a false pregnancy. Explanation: Adnexal tenderness or masses identified early in gestation require ultrasound evaluation to rule out ectopic pregnancy. An enlarged uterus may indicate multiple gestation or a fibroid tumor. Question 18 Normal changes in the breast and nipples during pregnancy include all of the following except: A. a marked venous pattern on the breast. B. darkened nipples. C. mastitis. D. darkened areola. Explanation: Normal changes include a marked venous pattern, darkened nipples and areolae, and prominent Montgomery’s glands. Mastitis is inflammation of the breast tissue and can be seen during or after pregnancy but it is not a normal change during pregnancy. Question 19 During pregnancy, a patient's fundal height measured 26 centimeters. This would suggest that the gestational age was: A. 13 weeks. B. 26 weeks. C. 30 weeks. D. 36 weeks. Explanation: Uterine fundal height measured in centimeters correlates with gestational age between 18 and 34 weeks. Fundal height is measured in centimeters from symphysis pubis to top of uterus. This is know as McDonald's rule. Question 20 When should an oral glucose tolerance test be performed during pregnancy? A. Initially, when the pregnancy is confirmed B. 8 weeks C. 24 weeks D. 30 weeks Explanation: The oral glucose tolerance test is used to screen pregnant women for gestational diabetes between 24 and 28 weeks of pregnancy. It may also be used when the disease is suspected, even though fasting blood glucose level is normal. Question 21 Inflamed and overgrown gingiva during pregnancy is: A. a common finding during pregnancy. B. suggestive of anemia. C. suggestive of periodontal disease. D. indicative of poor nutrition. Explanation: Gingival inflammation and swelling is common during pregnancy because of hormonal shifts that occur. Consequently, meticulous oral hygiene is important in pregnant women. Question 22 When performing the third Leopold maneuver on a pregnant woman, the fetal head is the presenting part. This finding is referred to as the: A. vertical lie. B. transverse lie. C. face presentation. D. vertex presentation. Explanation: When performing the third Leopold maneuver on a pregnant woman, the fetal head is the presenting part. This finding is referred to as the vertex or cephalic presentation. Additionally, if the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back , then the head is extended and the fetus is in face presentation. The top of the uterus (fundus) is palpated to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or buttocks (Breech) of the fetus is in the fundus, then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie. Question 23 Inaudible fetal heart tones (FHT) may indicate: A. extra amniotic fluid. B. severe fetal morbidity. C. earlier gestation than expected. D. intrauterine growth restriction. Explanation: Lack of audible fetal heart tones (FHT) may indicate earlier gestation than expected, fetal demise, false pregnancy, or observer error; inability to locate the FHT should always be investigated with ultrasound. Question 24 Which one of the following symptoms would be seen in a 39 week gestational age patient who was suspected of having HELLP syndrome? A. Decreased liver enzymes, low platelet count, and nausea B. Vomiting, flu - like symptoms, and platelet count < 100,000 C. Flu - like sy [Show Less]