Maternal Child Health NUR 2513 Exam 1 Study Guide
(Answers with rationales)
Q1. While the vital signs of a pregnant client in her third trimester are being assessed, the client
complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?
a. Have the stand up and retake her blood pressure.
b. Have client the client sit down and hold her arm in a dependent position.
c. Have the client turn to her left side and recheck her blood pressure in 5 minutes.
d. Have the client lie supine for 5 minutes and recheck her blood pressure on both arms.
Blood pressure is affected by positions during pregnancy. The supine position may cause
occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral
recumbent position alleviates pressure on the blood vessels and quickly corrects supine
hypotension. Pressures are significantly higher when the patient is standing. This would cause an
increase in systolic and diastolic pressures. The arm should be supported at the same level of the
heart. The supine position may cause occlusion of the vena cava and descending aorta, creating
hypotension.
Q2
A pregnant client has come to the emergency department with complaints of nasal congestion
and epistaxis. Which is the correct interpretation of these symptoms by the health care provider?
a. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone.
b. These conditions are abnormal. Refer the client to an ear, nose, and throat specialist.
c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are
within normal limits.
d. Estrogen causes increased blood supply to the mucous membranes and can result in
congestion and nosebleeds.
As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema
and hyperemia, which causes these conditions, seen commonly during pregnancy. Progesterone
is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone
levels increase during pregnancy. The client should be reassured that these symptoms are within
normal limits. No referral is needed at this time. Relaxation of the smooth muscles in the
respiratory tract is affected by progesterone.
,Q3
Which suggestion is appropriate for the pregnant client who is experiencing heartburn?
a. Drink plenty of fluids at bedtime.
b. Eat only three meals a day so the stomach is empty between meals.
c. Drink coffee or orange juice immediately on arising in the morning.
d. Use Tums or Alkamints to obtain relief, as directed by the health care provider.
Antacids high in calcium (e.g., Tums, Alkamints) can provide temporary relief. Fluids
overstretch the stomach and may precipitate reflux when lying down. Instruct the woman to eat
five or six small meals per day rather than three full meals. Coffee and orange juice stimulate
acid formation in the stomach.
Q4
While providing education to a primiparous client regarding the normal changes of pregnancy,
what is important for the nurse to explain about Braxton Hicks contractions?
a. These contractions may indicate preterm labor.
b. These are contractions that never cause any discomfort.
c. Braxton Hicks contractions only start during the third trimester.
d. These occur throughout pregnancy, but you may not feel them until the third trimester.
Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks
contractions. During the first two trimesters, the contractions are infrequent and usually not felt
by the woman until the third trimester. Braxton Hicks contractions do not indicate preterm labor.
Braxton Hicks contractions can cause some discomfort, especially in the third trimester. Braxton
Hicks contractions occur throughout the whole pregnancy.
Q5
What is the reason for vascular volume increasing by 40% to 60% during pregnancy?
a. Prevents maternal and fetal dehydration
b. Eliminates metabolic wastes of the mother
c. Provides adequate perfusion of the placenta
d. Compensates for decreased renal plasma flow
The primary function of increased vascular volume is to transport oxygen and nutrients to the
fetus via the placenta. Preventing maternal and fetal dehydration is not the primary reason for the
,increase in volume. Assisting with pulling metabolic wastes from the fetus for maternal excretion
is one purpose of the increased vascular volume. Renal plasma flow increases during pregnancy.
Q6
Physiologic anemia often occurs during pregnancy because of:
a. inadequate intake of iron.
b. the fetus establishing iron stores.
c. dilution of hemoglobin concentration.
d. decreased production of erythrocytes.
When blood volume expansion is more pronounced and occurs earlier than the increase in red
blood cells, the woman will have physiologic anemia, which is the result of dilution of
hemoglobin concentration rather than inadequate hemoglobin. Inadequate intake of iron may
lead to true anemia. If the woman does not take an adequate amount of iron, true anemia may
occur when the fetus pulls stored iron from the maternal system. There is increased production of
erythrocytes during pregnancy.
Q7 A client is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had
oneother pregnancy that terminated at 8 weeks. Which are her gravida and para?
a. 3, 2
b. 4, 3
c. 4, 2
d. 3, 3
She has had four pregnancies, including the current one (gravida 4). She had two pregnancies
that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as
an abortion. Because she is currently pregnant, she is classified as a gravida 4. Gravida 4 is
correct, but she is para 2; the pregnancy that was terminated at 8 weeks is classified as an
abortion. Because she is currently pregnant, she would be classified as a gravida 4, not 3.
Q8
A client’s last menstrual period was June 10. What is her estimated date of birth (EDD)?
a. April 7
b. March 17
c. March 27
d. April 17
, To determine the EDD, the nurse uses the first day of the last menstrual period (June 10),
subtracts 3 months (March 10), and adds 7 days (March 17). April 7 would be subtracting 2
months instead of 3 months and then subtracting 3 days instead of adding 7 days. March is the
correct month, but instead of adding 7 days, 17 days were added. April 17 is subtracting 2
months instead of 3.
Q9
Why should a woman in her first trimester of pregnancy expect to visit her health care provider
every 4 weeks?
a. Problems can be eliminated.
b. She develops trust in the health care team.
c. Her questions about labor can be answered.
d. The conditions of the expectant mother and fetus can be monitored.
This routine allows for monitoring maternal health and fetal growth and ensures that problems
will be identified early. All problems cannot be eliminated because of prenatal visits, but they
can be identified. Developing a trusting relationship should be established during these visits, but
that is not the primary reason. Most women do not have questions concerning labor until the last
trimester of the pregnancy.
Q10
A client in her first trimester complains of nausea and vomiting. She asks, “Why does this
happen?” What is the nurse’s best response?
a. “It is due to an increase in gastric motility.”
b. “It may be due to changes in hormones.”
c. “It is related to an increase in glucose levels.”
d. “It is caused by a decrease in gastric secretions.”
Nausea and vomiting are believed to be caused by increased levels of hormones, decreased
gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels
decrease in the first trimester. Gastric secretions decrease, but this is not the main cause of
nausea and vomiting.
