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The nurse midwife tells a client that the baby is growing and that ballottement was evident during the vaginal examination. How should the nurse explain what the nurse midwife means by ballottement?
- A. The nurse midwife saw that the mucous plug was intact.
- B. The nurse midwife felt the baby rebound after being pushed.
- C. The nurse midwife palpated the fetal parts through the uterine wall.
- D. The nurse midwife assessed that the baby is head down.
Correct Answer: B
Rationale: Ballottement is the rebound of the fetus when it is pushed during a vaginal examination, indicating fetal movement and growth.
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What is the purpose of amniocentesis for a patient hospitalized at 34 weeks of gestation with pregnancy-induced hypertension?
- A. Determine if a metabolic disorder exists.
- B. Identify the sex of the fetus.
- C. Identify abnormal fetal cells.
- D. Determine fetal lung maturity.
Correct Answer: D
Rationale: At 34 weeks, amniocentesis is primarily used to assess fetal lung maturity, which is critical if early delivery is being considered.
A nurse is advising a pregnant woman about the danger signs of pregnancy. The nurse should teach the mother that she should notify the physician immediately if she experiences which of the following signs/symptoms? Select all that apply.
- A. Convulsions.
- B. Double vision.
- C. Epigastric pain.
- D. Persistent vomiting.
Correct Answer: D
Rationale: These symptoms may indicate severe complications such as preeclampsia, eclampsia, or hyperemesis gravidarum, requiring immediate medical attention. Polyuria is generally not a danger sign.
A pregnant patient at 30 weeks gestation reports back pain. What should the nurse recommend?
- A. Perform light stretching exercises and maintain good posture.
- B. Lie flat on your back to alleviate discomfort.
- C. Take over-the-counter pain medications as needed.
- D. Instruct the patient to rest in bed for the remainder of the pregnancy.
Correct Answer: A
Rationale: The correct answer is A because performing light stretching exercises and maintaining good posture can help alleviate back pain in pregnancy. Stretching helps to relieve muscle tension and improve flexibility, while good posture reduces strain on the back.
Choice B is incorrect because lying flat on the back can decrease blood flow to the uterus and may lead to dizziness and decreased oxygen supply to the fetus.
Choice C is incorrect because not all over-the-counter pain medications are safe during pregnancy. It is important for pregnant women to consult their healthcare provider before taking any medication.
Choice D is incorrect because prolonged bed rest can actually worsen back pain and may lead to other complications such as blood clots and muscle weakness. Staying active within limits is recommended during pregnancy.
What fetal change occurs when the fundal height reaches the xiphoid process?
- A. Surfactant forms in lungs
- B. Eyes begin to open and close
- C. Respiratory movements begin
- D. Spinal column is complete
Correct Answer: A
Rationale: Surfactant production begins in the lungs around this stage of pregnancy, preparing them for postnatal breathing.
Which of the following is the most accurate description of fetal station during labor?
- A. The distance from the cervix to the fetal head
- B. The level of the presenting part in relation to the ischial spines
- C. The degree of fetal flexion during contractions
- D. The amount of cervical dilation during labor
Correct Answer: B
Rationale: The correct answer is B: The level of the presenting part in relation to the ischial spines. Fetal station refers to the position of the baby's head in the mother's pelvis during labor. It is measured in centimeters above or below the ischial spines. This measurement helps determine the progress of labor and the descent of the baby through the birth canal. Choices A, C, and D do not accurately describe fetal station and are therefore incorrect. Choice A refers to the cervical length, choice C refers to fetal position, and choice D refers to cervical dilation, which are not related to fetal station.