1. During a prenatal visit, the nurse checks the fetal heart rate (FHR) of a client in the third trimester of pregnancy. The nurse
determines that the FHRis normal if which of the following heart rates is noted
ANSW
1. 80 beats per minute
2. 100 beats per minute
3. 150 beats per minute
4. 180 beats per minute: 3.
normal (first trimester): 160-170 beats per minute(gradually slows down)
low (at term): 110-120 beats per minutehigh (at term): 160 beats per
minute
2. A nursing student is asked to describe the size of the uterus in a nonpreg- nant client. Which of the following responses, if made by the
student, indicates an understanding of the anatomy of this structure
ANSW
1. "The uterus weighs about 2 ounces."
2. "The uterus weighs about 2.2 pounds"
3. "The uterus has a capacity of about 50 milliliters."
4. "The uterus is round in shape and weighs approximately 1000 grams.: 1. before conception, the uterus is small pear shaped organ
that is contained entirelyin the pelvic cavity. It weighs approximately 60 g (2 oz), and it has a capacity of about10 ml (1/3 oz). At the end of
pregnancy, the uterus weighs approximately 1000g (2.2lb), and it has a capacity that is sufficient for the fetus, the placenta, and the amniotic
fluid.
3. A nursing instructor asks a nursing student to list the functions of the amniotic fluid. The student responds correctly by stating that
which of thefollowing are functions of amniotic fluid
ANSW Select all that apply
ANSW
1. Allows for fetal movement
2. Is a measure of kidney function
3. Surrounds, cushions, and protects the fetus
4. Maintains the body temperature of the fetus
5. Prevents large particles such as bacteria from passing to the fetus
6. Provides an exchange of nutrients and waste products between the motherand the fetus: 1, 2, 3, 4
- function of amnionic fluid:
- surrounds, cushions, and protects the fetus
- allows the fetus to move freely
, pregnancy questions
- maintains the body temperature of the fetus
- helps to measure kidney function (the amount of fluid is based on the amount ofthe urination of the fetus)
- placenta prevents large particles such as bacteria from passing to the fetus
- provides an exchange of nutrients and waste products between the mother and thefetus.
4. A nurse is collecting data from a client who suspects that she is pregnant.The nurse is checking the client for probable signs of
pregnancy. Select all probable signs of pregnancy.
1. Ballottement
2. Chadwick's sign
3. Uterine enlargement
4. Braxton Hicks contractions
5. Outline of fetus via radiography or ultrasound
6. Fetal heart rate detected by a non-electronic device.: 1, 2, 3, 4
probable signs: uterine enlargement, Hegar's sign (softening and thinking of the lower uterine segment that occurs at about week 6),
Goodell's sign (the softening of the cervix that occurs at the beginning of the second month of pregnancy), Chadwick's sign (the violet
coloration of the mucous membranes of the cervix, vagina and vulva that occurs at about week 4), ballottement (the rebounding of the
fetus against the examiner's fingers on palpation), Braxton Hicks contractions, anda positive pregnancy test that measures for human
chorionic gonadotropin.
5. A nursing instructor asks a nursing student to describe the process of quickening. which of the following statements, made by the
student, indicatesan understanding of this term
ANSW
1. "It is the thinning of the lower uterine segment."
2. "It is the fetal movement that is felt by he mother."
3. "It is the irregular, painless contractions that occur throughout pregnancy."
4. "It is the soft blowing sound that can be heard when the uterus is auscul-tated.": 2.
quickening i the fetal movement that tis felt by the mother.
6. A pregnant client is seen in the health care clinic for a regular prenatal visit.The client tells the nurse that she is experiencing irregular
contractions. Thenurse determines that the client is experiencing Braxton Hicks contractions.Based on this finding, which nursing
action is appropriate
ANSW
1. Contact the physician
, pregnancy questions
2. Instruct the client to maintain bedrest for the remainder of the pregnancy
3. Tell the client that these are common and that they may occur throughoutthe pregnancy.
4. Call the maternity unit, and inform them that the client will be admitted in aprelabor condition.: 3.
Braxton Hicks contractions are irregular, painless contractions that may occur inter-mittently throughout pregnancy.
8. A nurse is collecting data from a pregnant client who is at 28 weeks' gestation. The nurse measures the fundal height in
centimeters and expectsthe finding s to be which of the following
ANSW
1. 22 cm
2. 28 cm
3. 36 cm
4. 40 cm: 2.
At around week 18 to week 30, fundal height is the age of the fetus in weeks plusor minus 2cm.
9. A primipara is being evaluated in the clinic during her second trimester ofpregnancy.Which of the following would indicate an
abnormal physical findingthat necessitates further testing
ANSW
1. Quickening
2. Braxton Hicks contractions
3. Consistent increase in fundal height
4. Fetal heart rate of 180 beats per minute: 4.
The fetal heart rate depends on the gestational age. It is slows with fetal growth toapproximately 120 to 160 beats per minute.
10. A nurse is reviewing the record of a client who has just been told that her pregnancy test is positive. The nurse notes that the physician
has documentedthe presence of goodell's sign. The nurse determines that this sign is indica-tive of:
1. A softening of the cervix
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