Ladewig 8e TIF Ch10 PDF

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E
Chapter 10
Question 1
Type: MCSA
The pregnant patient has completed the prenatal questionnaire and asks the nurse why this form had to be
completed. The best response by the nurse is:
1. “Some people have things that have happened in the past that could impact their current pregnancy.”
2. “The doctor wants all of the pregnant patients to complete the form so that our records are complete.”
3. “We occasionally identify a health problem that puts the current pregnancy at higher risk.”
4. “This form is designed to predict who will develop problems with their pregnancy or delivery.”
Correct Answer: 3
Rationale 1: Although this is true, this statement is too vague to be the best response. It is best to explain
specifically that the impact on the current pregnancy might put the pregnancy at higher risk.
Rationale 2: The purpose of the form is to identify which patients have risk factors; the fact that records are
complete is less important than identifying at risk pregnancies.
Rationale 3: This is the reason for risk assessment during pregnancy, whether it is a patient-completed
questionnaire or a nurse assessment form.
Rationale 4: The form will identify those patients who have risk factors based on their medical history; prediction
implies seeing into the future without a basis for the concern.
Global Rationale:
Cognitive Level: Understanding

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO01 - Use information provided on a prenatal history to identify risk factors for the mother
and/or fetus.
Question 2
Type: MCSA
The pregnant patient's prenatal record indicates that she is a gravida 4 para 2022. The nurse understands that this
indicates the patient had four pregnancies and:
1. Has four living children.
Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Copyright 2014 by Pearson Education, Inc.
2. Delivered two infants preterm.
3. Is pro-abortion.
4. Delivered two term infants.
Correct Answer: 4
Rationale 1: In the four digit number, the fourth number indicates the number of living children, which is 2.
Rationale 2: In the four digit number, the second digit indicates the number of preterm births, so the patient has
had no preterm births.
Rationale 3: In the four digit number, the third digit indicates the number of abortions the patient has experienced.
Because abortion may be spontaneous or therapeutic, this number does not does not necessarily reflect a woman's
stance on surgical abortion.
Rationale 4: In the four digit number, the first digit indicates the number of term infants born, which is two.
Global Rationale:
Cognitive Level: Analyzing

Client Need Sub:
Learning Outcome: LO02 - Define common obstetric terminology found in the history of maternity patients.
Question 3
Type: MCSA
A multigravida gave birth to an 18-week fetus last week. She is in the clinic for follow-up and notices that her
chart states she has had one abortion. The patient is upset over the use of this word. How can the nurse best
explain this terminology to the patient?
1. “Abortion is the medical term for all pregnancies that end before 28 weeks.”
2. “Abortion is the word we use when someone has miscarried.”
3. “Abortion is how we label pregnancies that end in the second trimester.”
4. “Abortion is what we call all babies who are stillborn.”
Correct Answer: 1
Rationale 1: Abortions are fetal losses prior to the onset of the third trimester and include elective induced
(medical or surgical) abortions, ectopic pregnancies, and spontaneous abortions or miscarriages.
Rationale 4: Third-trimester losses are considered fetal death in utero, and the term abortion is not used.
Global Rationale:
Cognitive Level: Applying

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Question 4
Type: MCSA
Which of the following patients would be considered a multipara?
1. A patient at 34 weeks’ gestation who previously had one spontaneous abortion
2. A patient at 13 weeks’ gestation who previously delivered two term infants
3. A patient at 28 weeks’ gestation with no previous pregnancies
4. A patient at 32 weeks’ gestation who previously delivered one term infant
Correct Answer: 2
Rationale 1: A woman who has had no births at more than 20 weeks' gestation is considered a nullipara.
Rationale 2: A woman who has had two or more births at more than 20 weeks’ gestation is considered a
multipara.
Rationale 3: A woman who has had no births at more than 20 weeks' gestation is considered a nullipara.
Rationale 4: A woman who has had one birth at more than 20 weeks’ gestation, regardless of whether the infant
was born alive or dead, is considered a primipara.
Global Rationale:

Client Need Sub:
Question 5
Type: MCSA

The patient has delivered her first child at 39 weeks. The nurse would explain this to the patient as what type of
delivery?
1. Preterm
2. Post-term
3. Term
4. Near term
Correct Answer: 3
Rationale 1: Preterm deliveries are those that occur prior to 37 completed weeks’ gestation.
Rationale 2: Post-term applies to birth that occur after 42 weeks' gestation.
Rationale 3: Term births are those that occur from between gestation weeks 38 and 42.
Rationale 4: Near term is not terminology used to describe birth.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Question 6
Type: MCSA
The prenatal clinic nurse is designing a new prenatal intake information form for pregnant patients. Which
question is best to include on this form?
1. Where was the father of the baby born?
2. Do genetic diseases run in the family of the baby’s father?
3. What is the name of the baby’s father?
4. Are you married to the father of the baby?
Correct Answer: 2
Rationale 1: This is not important information for pregnancy.

Rationale 2: This question has the highest priority because it gets at the physiologic issue of inheritable genetic
diseases that might directly impact the baby.
Rationale 3: Although it is helpful for the nurse to know the name of the father’s baby to include him in the
prenatal care, this is psychosocial information and much less important than possible genetic diseases that the
baby might have inherited.
Rationale 4: Although the marital status of the patient might have cultural significance, this is psychosocial
information and much less important than possible genetic diseases that the baby might have inherited.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: LO03 - Identify factors related to the father’s health that are generally recorded on the
prenatal record in assessing risk factors for the mother and/or fetus.
Question 7
Type: MCSA
The nurse is assessing a primiparous patient. The patient indicates that her religion is Judaism. This information is
important for the nurse to assess because:
1. Religious and cultural background can impact what a patient eats during pregnancy.
2. It provides a baseline from which to ask questions about the patient’s religious and cultural background.
3. Knowing what the patient’s beliefs and behaviors regarding pregnancy are is important.
4. Patients sometimes encounter problems in their pregnancies based on what religion they practice.
Correct Answer: 2
Rationale 1: Although this is true, much more than diet is impacted by religious and cultural background; values,
beliefs, expectations for the birth, and acceptance or refusal of medical treatment are also influenced by religious
or cultural background.
Rationale 2: This is the best explanation because not all people interpret or live out their religious or cultural
backgrounds the same way. It is imperative to avoid stereotyping patients. Thus, the nurse should use the
information on the patient’s background as an educated starting point from which to base further questions about
how this specific patient enacts her religious or cultural background.
Rationale 3: Not all people interpret or live out their religious or cultural backgrounds the same way. It is
imperative to avoid stereotyping patients based on what their background is. The nurse must use the information
on the patient’s background as an educated starting point from which to base further questions about how this
specific patient enacts her religious or cultural background.

Rationale 4: How a patient enacts her religion occasionally will cause problems with pregnancy. But the most
important reason for asking a patient for her religious or cultural background is to have a starting point from
which to base further questions on the specifics of how this patient is impacted by or enacts her cultural or
religious background as a unique individual.
Global Rationale:

Client Need Sub:
Learning Outcome: LO04 - Evaluate those areas of the initial assessment that reflect the psychosocial and
cultural factors related to a woman’s pregnancy.
Question 8
Type: MCSA
The clinic nurse is assisting with an initial prenatal assessment. The following findings are present: spider nevi
present on lower legs; dark pink, edematous nasal mucosa; mild enlargement of the thyroid gland; mottled skin
and pallor on palms and nail beds; heart rate 88 with murmur present. What is the best action for the nurse to take
based on these findings?
1. Document the findings on the prenatal chart.
2. Have the physician see the patient today.
3. Instruct the patient to avoid direct sunlight.
4. Analyze previous thyroid hormone lab results.
Correct Answer: 2
Rationale 1: These abnormalities must be reported to the physician immediately.
Rationale 2: Mottling of the skin is indicative of poor oxygenation and a circulation problem. Skin and nail bed
pallor can indicate either hypoxia or anemia. These abnormalities must be reported to the physician immediately.
Rationale 3: Spider nevi are common in pregnancy due to the increased vascular volume and high estrogen levels.
Nasal passages can be inflamed during pregnancy from edema, caused by increased estrogen levels.
Rationale 4: The thyroid gland increases in size during pregnancy due to hyperplasia.
Global Rationale:

Client Need Sub:

Learning Outcome: LO05 - Predict the normal physiologic changes a nurse would expect to find when
performing a physical assessment of a pregnant woman.
Question 9
Type: MCSA
A 25-year-old primigravida is 20 weeks pregnant. At the clinic, her nurse begins a prenatal assessment and
obtains the following vital signs. Which finding would require the nurse to contact the physician?
1. Pulse 88/min
2. Respirations 30/min
3. Temperature 37.4°C (99.3°F)
4. Blood pressure 134/82
Correct Answer: 2
Rationale 1: A slight increase in pulse is an expected finding during pregnancy due to the increased oxygen
consumption to support fetal metabolism.
Rationale 2: Tachypnea is not a normal finding and requires medical care.
Rationale 3: Temperature is an expected finding during pregnancy due to the increased oxygen consumption to
support fetal metabolism.
Rationale 4: The blood pressure is within normal limits.
Global Rationale:

Client Need Sub:
Question 10
Type: MCSA
The nurse is seeing prenatal patients in the clinic. Which patient is exhibiting expected findings?
1. Primip at 12 weeks with fetal heart tones heard by Doppler fetoscope
2. Multip at 22 weeks who reports no fetal movement felt yet
3. Primip at 26 weeks with fundal height of 30 cm

4. Multip at 12 weeks reports bright red vaginal bleeding.
Correct Answer: 1
Rationale 1: This is an expected finding because fetal heart tones should be heard by 12 weeks using an
ultrasonic Doppler fetoscope.
Rationale 2: This is an abnormal finding. Fetal movement should be felt by 20 weeks.
Rationale 3: This is an abnormal finding. Beginning in the second trimester, the fundal height should correlate
with weeks of gestation; thus, at 26 weeks’ gestation, the fundal height should be about 26 cm.
Rationale 4: This is an abnormal finding. Bright red bleeding during pregnancy is never expected.
Global Rationale:

Client Need Sub:
Question 11
Type: MCSA
The nurse receives a phone call from a patient who thinks she is pregnant. The patient reports that she has regular
menses that occur every 28 days and last 5 days. The first day of her last menses was April 10. What is the
patient’s estimated date of delivery (EDD)?
1. November 13
2. January 17
3. January 10
4. December 3
Correct Answer: 2
Rationale 1: Naegele’s rule is to add 7 days to the last menstrual period and subtract 3 months. The LMP is April
10; therefore, January 17 is the EDD.

Global Rationale:
Cognitive Level: Applying

Client Need Sub:
Learning Outcome: LO06 - Calculate the estimated date of birth using the common methods.
Question 12
Type: MCSA
The nurse explains to a pregnant woman that her antepartum assessment will include assessment of clinical
pelvimetry. Which patient response reflects understanding of the reason for this test?
1. “It will help understand how big a baby I can have.”
2. “It will be used to find out whether my baby has a chromosomal abnormality."
3. “It will help tell whether my pelvis is big enough to deliver my baby vaginally."
4. “It will be used to screen for gestational diabetes.”
Correct Answer: 3
Rationale 1: Clinical pelvimetry is performed to estimate the adequacy of pelvic size for the purpose of vaginal
delivery; delivery of larger infants may be accommodated via Cesarean section.
Rationale 2: Clinical pelvimetry involves estimating the adequacy of pelvic size for facilitating vaginal birth.
Rationale 3: Clinical pelvimetry is performed to estimate the ease or difficulty associated with vaginal delivery of
an infant.
Rationale 4: Screening for maternal gestational diabetes requires some form of glucose screening.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO07 - Describe the essential measurements that can be determined by clinical pelvimetry.
Question 13
Type: MCSA

The nurse is assisting a physician during a prenatal examination. The physician seeks to estimate the adequacy of
the patient’s pelvis for birth. The nurse understands that the physician will need to perform which measurement
vaginally?
1. True conjugate
2. Diagonal conjugate
3. Transverse outlet diameter
4. Obstetrical conjugate
Correct Answer: 2
Rationale 1: The true conjugate is a measurement of the pelvic inlet and cannot be directly measured.
Rationale 2: The diagonal conjugate is measured from the lower edge of the symphysis to the sacral promontory.
Rationale 3: The transverse outlet diameter is measured externally.
Rationale 4: The obstetrical is a measurement of the pelvic inlet and cannot be directly measured.
Global Rationale:

Client Need Sub:
Learning Outcome: LO07 - Describe the essential measurements that can be determined by clinical pelvimetry.
Question 14
Type: MCSA
The nurse is working with a prenatal patient. Which statement indicates that additional teaching is necessary?
1. “I will have Rh testing, even though this is my first pregnancy.”
2. My vagina will be cultured at 36 weeks for group B strep.”
3. “Because I am married, I won’t have the STI screening.”
4. “My blood will be checked for hemoglobin level.”
Correct Answer: 3
Rationale 1: This is a true statement. All patients are screened for blood type, Rh factor, and Rh antibodies,
regardless of how many previous pregnancies (if any) they have had.

Rationale 2: This is a true statement. Women are tested for group B strep to prevent neonatal infection.
Rationale 3: All women should be screened for syphilis, gonorrhea, and hepatitis B.
Rationale 4: This is a true statement. All women will have their hemoglobin assessed.
Global Rationale:

Client Need Sub:
Learning Outcome: LO08 - Describe the major screening tests used during the prenatal period in the assessment
of the prenatal patient.
Question 15
Type: MCSA
Which phone call should the prenatal clinic nurse return first?
1. Primip at 32 weeks, reports headache and blurred vision
2. Multip at 18 weeks, reports no fetal movement this pregnancy
3. Primip at 16 weeks, reports increased urinary frequency
4. Multip at 40 weeks, reports sudden gush of fluid and contractions
Correct Answer: 1
Rationale 1: Headache and blurred vision are signs of pre-eclampsia, which is potentially life-threatening for both
mother and fetus. This patient has top priority.
Rationale 2: Fetal movement should be felt by 19–20 weeks. Multips sometimes feel fetal movement prior to 19
weeks, but the lack of fetal movement prior to 20 weeks is considered normal. This patient is a lower priority.
Rationale 3: Increased urinary frequency is common during pregnancy as the increased size of the uterus puts
pressure on the urinary bladder. Urinary frequency is expected. If the patient were reporting dysuria or hematuria,
a UTI would be suspected, but this patient is only reporting increased urinary frequency. This patient is a lower
priority.
Rationale 4: A term patient who is experiencing contractions and a sudden gush of fluid is in labor. Although
laboring patients should be in contact with their provider for advice on when to go to the hospital, labor at term is
an expected finding. This patient is a lower priority.
Global Rationale:

Client Need Sub:
Learning Outcome: LO09 - Assess the prenatal patient for the danger signs of pregnancy.
Question 16
Type: MCSA
The nurse is completing an assessment for a prenatal visit. Which statement indicates that further teaching is
necessary?
1. “Because I’m in my third trimester, I should return to the clinic in a month.”
2. “Now that I’ve felt fetal movement, I should feel movement regularly.”
3. “Before I take any over-the-counter medications, I should contact my doctor.”
4. “Alcohol is possibly harmful to my baby, even at the end of my pregnancy.”
Correct Answer: 1
Rationale 1: This statement is incorrect because prenatal visits during the third trimester are every two weeks
from 26 to 36 weeks, and every week from 36 weeks to delivery.
Rationale 2: This is a true statement. Once fetal movement is perceived, it should be felt regularly. Initially, this
might not be every day, but in the third trimester, fetal movement should be noticeable several times per day.
Rationale 3: This is a true statement. Regardless of the gestational age, over-the-counter medications can have
deleterious effects on mom or baby; thus, it is important for a pregnant woman to consult her provider prior to
taking any over-the-counter medications throughout the pregnancy.
Rationale 4: This is a true statement. Alcohol should be avoided throughout pregnancy and lactation.
Global Rationale:

Client Need Sub:
Learning Outcome: LO10 - Relate the components of the subsequent prenatal history and assessment to the
progress of pregnancy and the nursing care of the prenatal patient.


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Ladewig, Contemporary Maternal-Newborn Nursing, 8/E

Cognitive Level: Understanding

1. Has four living children.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

4. Delivered two term infants.

Cognitive Level: Analyzing

2. “Abortion is the word we use when someone has miscarried.”

3. “Abortion is how we label pregnancies that end in the second trimester.”

4. “Abortion is what we call all babies who are stillborn.”

Cognitive Level: Applying

Which of the following patients would be considered a multipara?

1. A patient at 34 weeks’ gestation who previously had one spontaneous abortion

2. A patient at 13 weeks’ gestation who previously delivered two term infants

3. A patient at 28 weeks’ gestation with no previous pregnancies

4. A patient at 32 weeks’ gestation who previously delivered one term infant

Cognitive Level: Analyzing

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Rationale 2: Post-term applies to birth that occur after 42 weeks' gestation.

Rationale 4: Near term is not terminology used to describe birth.

Cognitive Level: Understanding

1. Where was the father of the baby born?

2. Do genetic diseases run in the family of the baby’s father?

3. What is the name of the baby’s father?

4. Are you married to the father of the baby?

Rationale 1: This is not important information for pregnancy.

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Understanding

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Understanding

1. Document the findings on the prenatal chart.

2. Have the physician see the patient today.

3. Instruct the patient to avoid direct sunlight.

4. Analyze previous thyroid hormone lab results.

Rationale 1: These abnormalities must be reported to the physician immediately.

Cognitive Level: Analyzing

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

3. Temperature 37.4°C (99.3°F)

4. Blood pressure 134/82

Rationale 2: Tachypnea is not a normal finding and requires medical care.

Rationale 4: The blood pressure is within normal limits.

Cognitive Level: Analyzing

1. Primip at 12 weeks with fetal heart tones heard by Doppler fetoscope

2. Multip at 22 weeks who reports no fetal movement felt yet

3. Primip at 26 weeks with fundal height of 30 cm

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Rationale 2: This is an abnormal finding. Fetal movement should be felt by 20 weeks.

Cognitive Level: Analyzing

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Applying

1. “It will help understand how big a baby I can have.”

4. “It will be used to screen for gestational diabetes.”

Cognitive Level: Understanding

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

3. Transverse outlet diameter

Rationale 3: The transverse outlet diameter is measured externally.

Cognitive Level: Understanding

1. “I will have Rh testing, even though this is my first pregnancy.”

2. My vagina will be cultured at 36 weeks for group B strep.”

3. “Because I am married, I won’t have the STI screening.”

4. “My blood will be checked for hemoglobin level.”

Ladewig, Contemporary Maternal-Newborn Nursing, 8/E Test Bank

Cognitive Level: Understanding

1. Primip at 32 weeks, reports headache and blurred vision