Which assessment finding best represents a positive sign of pregnancy?
- A. Palpable fetal outline
- B. Blotchy tan facial skin
- C. Positive pregnancy test
- D. Fetal heartbeat
Correct Answer: D
Rationale: A fetal heartbeat, detected by Doppler or ultrasound, is a positive sign of pregnancy, as it directly confirms the presence of a living fetus.
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The nurse uses which tool to measure fundal height?
- A. Tape measure
- B. Doppler device
- C. Ultrasound machine
- D. Blood pressure cuff
Correct Answer: A
Rationale: A tape measure is used to measure fundal height, assessing uterine growth and fetal development.
The nurse responds that, for clients with uncomplicated pregnancies, it is usually best to plan monthly visits for the first 28 weeks and then more frequent visits following which schedule?
- A. Weekly for the remainder of the pregnancy
- B. Every 2 weeks for the remainder of the pregnancy
- C. Every 2 weeks up to 36 weeks, then weekly for the last month
- D. Weekly up to 36 weeks, then twice weekly for the last month
Correct Answer: C
Rationale: Standard prenatal care involves monthly visits until 28 weeks, biweekly until 36 weeks, and weekly thereafter for uncomplicated pregnancies.
The client who is actively bleeding due to a spontaneous abortion asks the nurse why this is happening. The nurse advises the client that the majority of first-trimester losses are related to which problem?
- A. Cervical incompetence
- B. Chronic maternal disease
- C. Poor implantation
- D. Chromosomal abnormalities
Correct Answer: D
Rationale: Chromosomal abnormalities account for the majority of first-trimester spontaneous abortions. Cervical incompetence can result in spontaneous abortion but does not account for the majority. Chronic maternal disease can result in spontaneous abortion but does not account for the majority. Poor implantation can result in spontaneous abortion but does not account for the majority.
Which instruction should the nurse provide about newborn feeding?
- A. Feed on a strict schedule
- B. Breastfeed or formula-feed on demand
- C. Avoid feeding at night
- D. Offer water between feedings
Correct Answer: B
Rationale: Feeding on demand supports the newborn's nutritional needs and promotes bonding and growth.
Which condition increases the risk of congenital anomalies in the fetus?
- A. Maternal diabetes
- B. Mild anemia
- C. Normal weight gain
- D. Regular exercise
Correct Answer: A
Rationale: Maternal diabetes, if poorly controlled, increases the risk of congenital anomalies due to elevated blood glucose levels.