NURSING 102 Antepartum Quiz with Answers
1. Question
A nursing instructor is conducting a lecture and is reviewing the functions of the female
... [Show More] reproductive system. She asks the student nurse to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). The student nurse accurately responds by stating that:
• A. FSH and LH are released from the anterior pituitary gland.
• B. FSH and LH are secreted by the corpus luteum of the ovary
• C. FSH and LH are secreted by the adrenal glands
• D. FSH and LH stimulate the formation of milk during pregnancy.
Correct
Correct Answer: A. FSH and LH are released from the anterior pituitary gland.
FSH and LH, when stimulated by the gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, the growth of the Graafian follicle, and production of progesterone.
• Option B: The primary hormone produced from the corpus luteum is progesterone, but it also produces inhibin A and estradiol. In the absence of fertilization, the corpus luteum will regress over time.
• Option C: Development of the ovarian follicle is largely under FSH control, and the secretion of estrogen from this follicle is dependent on FSH and LH. The granulosa cells of the ovary secrete inhibin, which plays a role in cellular differentiation.
• Option D: In women, LH stimulates estrogen and progesterone production from the ovary. A surge of LH in the mid menstrual cycle is responsible for ovulation, and continued LH secretion subsequently stimulates the corpus luteum to produce progesterone.
2. Question
A nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse accurately tells the client that fetal circulation consists of:
• A. Two umbilical veins and one umbilical artery.
• B. Two umbilical arteries and one umbilical vein.
• C. Arteries carrying oxygenated blood to the fetus.
• D. Veins carrying deoxygenated blood to the fetus.
Correct
Correct Answer: B. Two umbilical arteries and one umbilical vein. Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries. Once oxygenated, the blood then is returned by one umbilical vein. Arteries carry deoxygenated blood and waste products from the fetus, and veins carry oxygenated blood and provide oxygen and nutrients to the fetus.
• Option A: The fetal circulation system is distinctly different from adult circulation. This intricate system allows the fetus to receive oxygenated blood and nutrients from the placenta. It comprises the blood vessels in the placenta and the umbilical cord, which contains two umbilical arteries and one umbilical vein.
• Option C: Oxygenated blood from the mother in the placenta flows through the umbilical vein and into the inferior vena cava (IVC), bypassing the liver via the ductus venosus. From the IVC, oxygenated blood travels to the right atrium of the heart. There is greater pressure in the right atrium compared to the left atrium in fetal circulation; therefore most of the blood is shunted from the right atrium to the left atrium through an opening called the foramen ovale. Once in the left atrium, blood travels through the left ventricle into the aorta and the systemic circulation.
• Option D: The deoxygenated blood travels back to the placenta via the umbilical arteries to be oxygenated by the mother. Additionally, some oxygenated blood in the right atrium can also enter the right ventricle and then the pulmonary artery. Because there is high resistance to blood flow in the lungs, the blood is shunted from the pulmonary artery into the aorta via the ductus arteriosus, hence bypassing the lungs. Blood then enters the systemic circulation, and the deoxygenated blood is recycled back to the mother via the umbilical arteries.
3. Question
During a prenatal visit at 38 weeks, a nurse assesses the fetal heart rate. The nurse determines that the fetal heart rate is normal if which of the following is noted?
• A. 80 BPM
• B. 100 BPM
• C. 150 BPM
• D. 180 BPM
Correct
Correct Answer: C. 150 BPM.
The fetal heart rate depends on gestational age and ranges from 160-170 BPM in the first trimester but slows with fetal growth to 120-160 BPM near or at term. At or near term, if the fetal heart rate is less than 120 or more than 160 BPM with the uterus at rest, the fetus may be in distress.
• Option A: Data from a recently published study in a different context (Serra et al., 2009) is compatible with the findings of our exploratory analysis with a lower limit of 115 or 120 bpm for the gestational ages. Data for the 97th and 99th percentiles are not shown in this study. But shifting the lower limit to 120 will increase the number of false alarms whereas a lower limit of 115 will inevitably increase the risk to misinterpret maternal heart rates as fetal heart rate.
• Option B: A lower limit of 120 bpm leads only near term to more false alarms since normal FHR decreases further, and is more appropriate, to avoid misinterpretation of maternal heartbeat as FHR.
• Option D: The upper limit of 160 bpm raised concerns in the FIGO meeting in 1985, as Saling described abnormal findings in 24% of scalp blood analyses if the baseline was higher than 160 bpm. It could be shown that the current FIGO guidelines based on computerized analyses of the CTG show a high sensitivity to detect fetal acidosis in case of a suspect or pathological classification of the baseline level.
4. Question
A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele’s rule, the nurse determines the estimated date of confinement as:
• A. July 26, 2013
• B. June 12, 2014
• C. June 26, 2014
• D. July 12, 2014
Correct
Correct Answer: C. June 26, 2014.
Accurate use of Naegele’s rule requires that the woman has a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract three months, and then add one year to that date.
• Option A: An average pregnancy lasts 280 days from the first day of the last menstrual period (LMP) or 266 days after conception. Historically, an accurate LMP is the best estimator to determine the due date.
• Option B: Naegele’s rule, derived from a German obstetrician, subtracts 3 months and adds 7 days to calculate the estimated due date (EDD). It is prudent for the obstetrician to get a detailed menstrual history, including duration, flow, previous menstrual periods, and hormonal contraceptives. These factors are used to determine the length of her cycles and ovulation period.
• Option D: There are several fallacies with Naegele’s rule. First, a woman may not accurately recall the first day of her menstrual cycle. Second, this method assumes a woman’s cycle is exactly 28 days, with ovulation occurring at day 14, however, it does not consider menstrual cycles with shorter or longer durations. Third, there are small variations in the duration between fertilization and blastocyst implantation. Last, this method cannot differentiate between menstrual bleeding and early pregnancy bleeding.
5. Question
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child that was delivered at 37 weeks and tells the nurse that she doesn’t have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as:
• A. G = 3, T = 2, P = 0, A = 0, L =1
• B. G = 2, T = 0, P = 1, A = 0, L =1
• C. G = 1, T = 1. P = 1, A = 0, L = 1
• D. G = 2, T = 0, P = 0, A = 0, L = 1
A nurse is performing an assessment of a primipara who is being evaluated
in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing?
• A. Consistent increase in fundal height
• B. Fetal heart rate of 180 BPM
• C. Braxton Hicks contractions
• D. Quickening
orrect
Correct Answer: B. Fetal heart rate of 180 BPM.
The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160-170 BPM in the first trimester and slows with fetal growth, near and at term, the fetal heart rate ranges from 120-160 BPM. The other options are expected.
• Option A: A fundal height measurement is typically done to determine if a baby is small for its gestational age. The measurement is generally defined as the distance in centimeters from the pubic bone to the top of the uterus. The expectation is that after week 24 of pregnancy the fundal height for a normally growing baby will match the number of weeks of pregnancy — plus or minus 2 centimeters.
• Option C: Braxton Hicks contractions are sporadic contractions and relaxation of the uterine muscle. Sometimes, they are referred to as prodromal or “false labor” pains. It is believed they start around 6 weeks gestation but usually are not felt until the second or third trimester of the pregnancy.
• Option D: Quickening often occurs between the 16th to the 22nd week of pregnancy. This is called a presumptive sign of pregnancy as the other movements of the woman’s body can mimic early fetal movements such as flatus, peristalsis, and abdominal muscle contractions. A multiparous woman will usually first notice these fluttering movements of the fetus at an earlier gestation than a primiparous woman.
7. Question
A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell’s sign. The nurse determines this sign indicates:
• A. A softening of the cervix.
• B. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus.
• C. The presence of hCG in the urine.
• D. The presence of fetal movement.
Correct
Correct Answer: A. A softening of the cervix.
In the early weeks of pregnancy, the cervix becomes softer as a result of increased vascularity and hyperplasia, which causes the Goodell’s sign.
• Option B: Uterine souffle or placental souffle is a soft, blowing sound heard using a stethoscope, usually in the second trimester of pregnancy (13–28 weeks). This sound is heard most clearly in the lower part of the uterus and is synchronous with the pulse of the mother.
• Option C: hCG levels can usually be detected in the urine about 10 days after conception. If the woman takes a urine pregnancy test fewer than 10 days after conception, the at-home tests might give a “false negative” response. This means it will show that she is not pregnant when she actually is.
• Option D: Adequate oxygenation of the fetal tissues is central to fetal wellbeing. The importance of fetal movements as a marker of health has been demonstrated in sheep models, with fetal behavior being reflective of fetal brain function.
8. Question
A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term?
• A. “It is the irregular, painless contractions that occur throughout pregnancy.”
• B. “It is the soft blowing sound that can be heard when the uterus is auscultated.”
• C. “It is the fetal movement that is felt by the mother.”
• D. “It is the thinning of the lower uterine segment.”
Correct
Correct Answer: C. “It is the fetal movement that is felt by the mother.”
Quickening is fetal movement and may occur as early as the 16th and 18th week of gestation, and the mother first notices subtle fetal movements that gradually increase in intensity. A thinning of the lower uterine segment occurs about the 6th week of pregnancy and is called Hegar’s sign.
• Option A: Braxton Hicks contractions are irregular, painless contractions that may occur throughout the pregnancy.
• Option B: Uterine souffle or placental souffle is a soft, blowing sound heard using a stethoscope, usually in the second trimester of pregnancy (13–28 weeks). This sound is heard most clearly in the lower part of the uterus and is synchronous with the pulse of the mother.
• Option D: The lower uterine segment, therefore, is defined as the portion of the uterine musculature which must undergo circumferential dilatation during labor, its extent being dependent upon the size of the presenting part and its level in the uterine cavity. The available evidence suggests that brachystasis, with retraction, occurs in this segment just as it does in the upper, and that thinning in the first stage of labor is due not to passive elongation, but rather to active shortening of the cup-shaped lower pole with dilatation as it is pulled up about the presenting part.
9. Question
A nurse-midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement?
• A. Auscultating for fetal heart sounds.
• B. Palpating the abdomen for fetal movement.
• C. Assessing the cervix for thinning.
• D. Initiating a gentle upward tap on the cervix.
10. Question
A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Which of the following signs indicates a probable sign of pregnancy? Select all that apply.
• A. Uterine enlargement
• B. Fetal heart rate detected by nonelectric device
• C. Outline of the [Show Less]