Chapter 05: Conception and Prenatal Development
Foundations of Maternal-Newborn & Women’s Health Nursing, 7th Edition
MULTIPLE CHOICE
1. An expectant father asks the nurse, “Which part of the mature
sperm contains the male chromosome?” What is the correct
response by the nurse?
a. X-bearing sperm
b. The tail of the sperm
c. The head of the sperm
d. The middle portion of the sperm
ANS: C
The head of the sperm contains the male chromosomes that
will join the chromosomes of the ovum. If an X-bearing
sperm fertilizes the ovum, the baby will be female. The tail
of the sperm helps propel the sperm toward the ovum. The
middle portion of the sperm supplies energy for the tail’s
whip-like action.
DIF: Cognitive Level: Application
OBJ: Nursing Process
Step: Implementation MSC: Patient Needs: Health Promotion and
Maintenance
2. One of the assessments performed in the birth room is checking the umbilical cord for blood
vessels. Which finding is considered to be within normal limits?
a. One artery and one vein
b. Two veins and one artery
c. Two arteries and one vein
d. Two arteries and two veins
ANS: C
The umbilical cord contains two arteries and one vein to transport blood between the fetus and
the placenta. Any option other than two arteries and one vein is considered abnormal and
requires further assessment. Two veins and one artery is abnormal and may indicate an
anomaly. Two arteries instead is a normal finding; this infant would require further
assessment for anomalies due to the finding of two veins.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
3. What is the purpose of the ovum’s zona pellucida?
a. Prevents multiple sperm from fertilizing the ovum
b. Stimulates the ovum to begin mitotic cell division
c. Allows the 46 chromosomes from each gamete to merge
d. Makes a pathway for more than one sperm to reach the ovum
ANS: A
Fertilization causes the zona pellucida to change its chemical composition so that multiple
sperm cannot fertilize the ovum. Mitotic cell division begins when the nuclei of the sperm and
ovum unite. Each gamete (sperm and ovum) has only 23 chromosomes; there will be 46
chromosomes when they merge. Once sperm has entered the ovum, the zona pellucida
changes to prevent other sperm from entering.
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DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
4. The nurse is explaining the process of cell division during the preembryonic period to a group
of nursing students. Which statement best describes the characteristics of the morula?
a. Fertilized ovum before mitosis begins
b. Double layer of cells that becomes the placenta
c. Flattened, disk-shaped layer of cells within a fluid-filled sphere
d. Solid ball composed of the first cells formed after fertilization
ANS: D
The morula is so named because it resembles a mulberry. It is a solid ball of 12 to 16 cells that
develops after fertilization. The fertilized ovum is called the zygote. The placenta is formed
from two layers of cells—the trophoblast, which is the other portion of the fertilized ovum,
and the decidua, which is the portion of the uterus where implantation occurs. The flattened,
disk-shaped layer of cells is the embryonic disk; it will develop into the body.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Implementation
MSC: Patient Needs: Health Promotion and Maintenance
5. The upper uterus is the best place for the fertilized ovum to implant due to which anatomical
adaptation?
a. Maternal blood flow is lower.
b. Placenta attaches most firmly.
c. Uterine endometrium is softer.
d. Developing baby is best nourished.
ANS: D
The uterine fundus is richly supplied with blood and has the thickest endometrium, both of
which promote optimum nourishment of the fetus. The blood supply is rich in the fundus,
which allows for optimal nourishment of the fetus. If the placenta attaches too deeply, it does
not easily detach. Softness is not a concern with implantation; attachment and nourishment are
the major concerns.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
6. Some of the embryo’s intestines remain within the umbilical cord during the embryonic
period because the
a. intestines need this time to grow until week 15.
b. nutrient content of the blood is higher in this location.
c. abdomen is too small to contain all the organs while they are developing.
d. umbilical cord is much larger at this time than it will be at the end of pregnancy.
ANS: C
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The abdominal contents grow more rapidly than the abdominal cavity, so part of their
development takes place in the umbilical cord. By 10 weeks, the abdomen is large enough to
contain them. The intestines remain within the umbilical cord only until about week 10. Blood
supply is adequate in all areas; intestines stay in the umbilical cord for about 10 weeks
because they are growing faster than the abdomen. Intestines begin their development within
the umbilical cord, but only because the liver and kidneys occupy most of the abdominal
cavity, not because of the size of the umbilical cord.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
7. A patient who is 16 weeks pregnant with her first baby asks how long it will be before she
feels the baby move. Which is the nurse’s best answer?
a. “You should have felt the baby move by now.”
b. “The baby is moving, but you can’t feel it yet.”
c. “Some babies are quiet and you don’t feel them move.”
d. “Within the next month you should start to feel fluttering sensations.”
ANS: D
Maternal perception of fetal movement (quickening) usually begins between 17 and 20 weeks
after conception. Because this is her first pregnancy, movement is felt toward the later part of
the 17 to 20 weeks. “The baby is moving, but you can’t feel it yet” may be alarming to the
woman. “Some babies are quiet and you don’t feel them move” is a true statement; the fetus’
movements are not strong enough to be felt until 17 to 20 weeks; however, this statement does
not answer the woman’s concern. Fetal movement should be felt between 17 and 20 weeks; if
movement is not perceptible by the end of that time, further assessment will be necessary.
DIF: CognitiveLevel:ApplicN
atiUo nR S I N GOTBB
J : .C
N uOr sMing ProcessStep:Implementation
MSC: Patient Needs: Health Promotion and Maintenance
8. Which statement best describes the changes that occur during the fetal period of development?
a. Maturation of organ systems
b. Development of basic organ systems
c. Resistance of organs to damage from external agents
d. Development of placental oxygen–carbon dioxide exchange
ANS: A
During the fetal period, the body systems grow in size and mature in function to allow
independent existence after birth. Basic organ systems are developed during the embryonic
period. The organs are always at risk for damage from external sources; however, the older
the fetus, the more resistant will be the organs. The greatest risk is when the organs are
developing. The placental system is complete by week 12, but that is not the best description
of the fetal period.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
9. An expectant mother says to the nurse, “When my sister’s baby was born, it was covered in a
cheese-like coating. What is the purpose of this coating?” The correct response by the nurse is
to explain that the purpose of vernix caseosa is to
a. regulate fetal temperature.
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b. protect the fetal skin from amniotic fluid.
c. promote normal peripheral nervous system development.
d. allow the transport of oxygen and nutrients across the amnion.
ANS: B
Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the
skin without the protection of the vernix caseosa. The amniotic fluid aids in maintaining fetal
temperature. Normal peripheral nervous system development is dependent on the nutritional
intake of the mother. The amnion is the inner membrane that surrounds the fetus. It is not
involved in the oxygen and nutrient exchange.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Implementation
MSC: Patient Needs: Health Promotion and Maintenance
10. An expectant mother, diagnosed with oligohydramnios, asks the nurse what this condition
means for the baby. Which statement should the nurse provide for the patient?
a. Oligohydramnios can cause poor fetal lung development.
b. Oligohydramnios means that the fetus is excreting excessive urine.
c. Oligohydramnios could mean that the fetus has a gastrointestinal blockage.
d. Oligohydramnios is associated with fetal central nervous system abnormalities.
ANS: A
Because an abnormally small amount of amniotic fluid restricts normal lung development, the
fetus may have poor fetal lung development. Oligohydramnios may be caused by a decrease
in urine secretion. Excessive amniotic fluid production may occur when the gastrointestinal
tract prevents normal ingestion of amniotic fluid. Excessive amniotic fluid production may
occur when the fetus has a central nervous system abnormality.
NURSINGTB.COM
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Implementation
MSC: Patient Needs: Health Promotion and Maintenance
11. The nurse is conducting a staff in-service on multifetal pregnancy. Which statement regarding
dizygotic twin development should the nurse include in the teaching session?
a. Dizygotic twins arise from two fertilized ova and are the same sex.
b. Dizygotic twins arise from a single fertilized ovum and are always of the same sex.
c. Dizygotic twins arise from two fertilized ova and may be the same sex or different
sexes.
d. Dizygotic twins arise from a single fertilized ovum and may be the same sex or
different sexes.
ANS: C
Dizygotic twins arise from two ova that are fertilized by different sperm. They may be the
same or different gender, and they may not have similar physical traits. Monozygotic twins
are always the same sex. A single fertilized ovum that produces twins is called monozygotic.
Dizygotic twins are from two fertilized ova and may or may not be the same sex.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Implementation
MSC: Patient Needs: Health Promotion and Maintenance
12. An infant is diagnosed with fetal anemia. Which information would support this clinical
diagnosis?
a. Presence of excess maternal hormones
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b. Maternal blood type O-negative, Rh-negative, and infant blood type O-negative,
Rh-negative
c. Passive immunity
d. Rh-negative mother and Rh-positive baby
ANS: C
Passive immunity provides temporary protection to the baby based on the transfer of maternal
antibodies. Maternal hormones would not lead to a clinical diagnosis of fetal anemia. These
blood types and Rh factors are the same; therefore, no antibodies will be created. In this
situation, an Rh-negative mother and Rh-positive baby will result in stimulation of antibodies
that will stimulate a reaction leading to hemolysis.
DIF: Cognitive Level: Analysis
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Physiologic Integrity/Reduction of Risk Potential
13. The nurse is explaining the function of the placenta to a pregnant patient. Which statement
indicates to the nurse that further clarification is necessary?
a. “My baby gets oxygen from the placenta.”
b. “The placenta functions to help excrete waste products.”
c. “The nourishment that I take in passes through the placenta.”
d. “The placenta helps maintain a stable temperature for my baby.”
ANS: D
Amniotic fluid and not the placenta helps with thermoregulation. The remaining statements
are correct regarding placental function.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Evaluation
MSC: Patient Needs: Health PrN
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TaBin.teCnaOnM
14. The nurse is assessing a newborn immediately after birth. After assigning the first Apgar score
of 9, the nurse notes two vessels in the umbilical cord. What is the nurse’s next action?
a. Assess for other abnormalities of the infant.
b. Note the assessment finding in the infant’s chart.
c. Notify the health care provider of the assessment finding.
d. Call for the neonatal resuscitation team to attend the infant immediately.
ANS: A
The normal finding in the umbilical cord is two arteries and one vein. Two vessels may
indicate other fetal anomalies. Notation of the finding is the appropriate next step when the
finding is expected. The health care provider will need to be notified; however, the infant is
the nurse’s primary concern and must be assessed for abnormalities first. The initial Apgar
score is 9, indicating no signs of distress or need of resuscitation.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
15. A pregnant patient asks the nurse how her baby gets oxygen to breathe. What is the nurse’s
best response?
a. “Oxygen-rich blood is delivered through the umbilical vein to the baby.”
b. “Take lots of deep breaths because the baby gets all of its oxygen from you.”
c. “You don’t need to be concerned about your baby getting enough oxygen.”
d. “The baby’s lungs are not mature enough to actually breathe, so don’t worry.”
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ANS: A
Oxygen-rich blood travels from the mother’s circulatory system to the placenta and from the
placenta to the umbilical vein (veins carry blood to the heart). From the vein, most of the
oxygenated blood travels to the fetal liver or the inferior vena cava. Taking deep breaths can
temporarily increase oxygenation but can also lead to increased carbon dioxide retention and
dizziness. The patient is asking a normal fetal developmental question often asked by
pregnant women. Fetal lungs reach maturity by 37 weeks of gestation, but fetal breathing
movements are common. Oxygen transport across lung tissue occurs with the first breath.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Implementation
MSC: Patient Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
1. Which physical characteristics decrease as the fetus nears term? (Select all that apply.)
a. Vernix caseosa
b. Lanugo
c. Port wine stain
d. Brown fat
e. Eyebrows or head hair
ANS: A, B
Both vernix caseosa and lanugo decrease as the fetus reaches term. Port wine stain is a
birthmark and, if present, will be exhibited at or shortly after birth. Brown fat in the fetus will
be maintained in order to maintain core temperature. Eyebrows and head hair increase as the
fetus nears term.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance: Techniques of Physical Assessment
2. Along with gas exchange and nutrient transfer, the placenta produces many hormones
necessary for normal pregnancy, including which of the following? (Select all that apply.)
a. Insulin
b. Estrogen
c. Progesterone
d. Testosterone
e. Human chorionic gonadotropin (hCG)
ANS: B, C, E
HCG causes the corpus luteum to persist and produce the necessary estrogens and
progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the woman’s uterus
and breasts and growth of the ductal system in the breasts and, as term approaches, plays a
role in the initiation of labor. Progesterone causes the endometrium to change, providing early
nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal
reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones
produced by the placenta include hCT, hCA, and a number of growth factors. Insulin and
testosterone are not secreted by the placenta.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
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3. The nurse is planning a prenatal class on fetal development. Which characteristics of prenatal
development should the nurse include for a fetus of 24 weeks, based on fertilization age?
(Select all that apply.)
a. Ear cartilage firm
b. Skin wrinkled and red
c. Testes descending toward the inguinal rings
d. Surfactant production nears mature levels
e. Fetal movement becoming progressively more noticeable
ANS: B, C, E
A fetus of 24 weeks, based on fertilization age, will have wrinkled and red skin, testes
descending toward inguinal rings, and the fetal movement becoming progressively more
noticeable. Surfactant production nearing the mature levels does not occur until 32 weeks and
ear cartilage is not firm until 38 weeks.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Planning
MSC: Patient Needs: Health Promotion and Maintenance
4. The nurse is explaining fetal circulation to a group of nursing students. Which information
should be included in the teaching session? (Select all that apply.)
a. After birth the ductus venosus remains open, but the other shunts close.
b. The foramen ovale shunts blood from the right atrium to the left atrium.
c. The ductus venosus shunts blood from the liver to the inferior vena cava.
d. The ductus arteriosus shunts blood from the right ventricle to the left ventricle.
ANS: B, C
The foramen ovale shunts ox Ny g eURnS
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the lungs. The ductus venosus shunts oxygenated blood from the liver to the inferior vena
cava. All shunts close after birth. The ductus arteriosus shunts blood from the right ventricle
to the aorta.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Implementation
MSC: Patient Needs: Health Promotion and Maintenance
5. A nurse is conducting prenatal education classes for a group of expectant parents. Which
information should the nurse include in her discussion of the purpose of amniotic fluid?
(Select all that apply.)
a. Cushions the fetus
b. Protects the skin of the fetus
c. Provides nourishment for the fetus
d. Allows for buoyancy for fetal movement
e. Maintains a stable temperature for the fetus
ANS: A, D, E
The amniotic fluid provides cushioning for the fetus against impacts to the maternal abdomen.
It provides a stable temperature and allows room and buoyancy for fetal movement. Vernix
caseosa, the cheeselike coating on the fetus, provides skin protection. The placenta provides
nourishment for the fetus.
DIF:
Cognitive Level: Application
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OBJ: Nursing Process Step: Implementation
Chapter 06: Maternal Adaptations to Pregnancy
Foundations of Maternal-Newborn & Women’s Health Nursing, 7th Edition
MULTIPLE CHOICE
1. During vital sign assessment of a pregnant patient in her third trimester, the patient complains of
feeling faint, dizzy, and agitated. Which nursing intervention is most appropriate?
a. Have the patient stand up and retake her blood pressure.
b. Have the patient sit down and hold her arm in a dependent position.
c. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.
d. Have the patient lie supine for 5 minutes and recheck her blood pressure on both
arms.
ANS: C
Blood pressure is affected by positioning 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.
DIF: Cognitive Level: Analysis
OBJ: Nursing Process Step: Implementation
MSC: Patient Needs: Physiologic Integrity
2. A pregnant woman has come to the emergency department with complaints of nasal
Nh isRSt hIeNcGo rTrBe.
congestion and epistaxis. W h i cU
c t inteOrpretation 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 patient 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.
ANS: D
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 patient 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.
DIF: Cognitive Level: Analysis
OBJ: Nursing Process Step: Planning
MSC: Patient Needs: Physiologic Integrity
3. While providing education to a primiparous patient regarding the normal changes of
pregnancy, what is an important information for the nurse to share regarding Braxton Hicks
contractions?
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a.
b.
c.
d.
These contractions may indicate preterm labor.
These are contractions that never cause any discomfort.
Braxton Hicks contractions only start during the third trimester.
These occur throughout pregnancy, but you may not feel them until the third
trimester.
ANS: D
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.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Implementation
MSC: Patient Needs: Health Promotion and Maintenance
4. What is the physiologic 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
ANS: C
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 thNe i nR
Uc r eSIa sNe dGTv a Bs c.uOlCa r vMolume. Renal plasma flow increases
during pregnancy.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Physiologic Integrity
5. Physiologic anemia often occurs during pregnancy due to
a. inadequate intake of iron.
b. the fetus establishing iron stores.
c. dilution of hemoglobin concentration.
d. decreased production of erythrocytes.
ANS: C
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.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Physiologic Integrity
6. Which finding is a positive sign of pregnancy?
a. Amenorrhea
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b. Breast changes
c. Fetal movement felt by the woman
d. Visualization of fetus by ultrasound
ANS: D
The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the
fetus by ultrasound, and fetal movement felt by the examiner. Amenorrhea is a presumptive
sign of pregnancy. Breast changes are a presumptive sign of pregnancy. Fetal movement is a
presumptive sign of pregnancy.
DIF: Cognitive Level: Understanding
OBJ: Nursing Process Step: Assessment
MSC: Patient Needs: Health Promotion and Maintenance
7. A patient in her first trimester complains of nausea and vomiting. The patient asks, “Why is
this happening?” 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.”
ANS: B
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.
DIF: Cognitive Level: Application
OBJ: Nursing Process Step: Implementation
MSC: PatientNeeds:PhysiologNicUI Rn t S
e gIr itNy GTB.COM
8. The patient has just learned that she is pregnant and overhears the gynecologist saying that she
has a positive Chadwick’s sign. When the patient asks the nurse what this means, how would
the nurse respond?
a. “Chadwick’s sign signifies an increased risk of blood clots in pregnant women
because of a congestion of blood.”
b. “That sign means the cervix has softened as the result of tissue changes that
naturally occur with pregnancy.”
c. “This means that a mucus plug has formed in the cervical canal to help protect you
from uterine infection.”
d. “This sign occurs normally in pregnancy, when estrogen causes increased blood
flow in the area of the cervix.”
ANS: D
Increasing levels of estrogen cause hyperemia (congestion with blood) of the cervix, resulting
in the characteristic bluish purple color that extends to include the vagina and labia. This
discoloration, referred to as Chadwick’s sign, is one of the earliest signs of pregnancy.
Although Chadwick’s sign occurs with hyperemia (congestion with blood), the sign does not
signify an increased risk of blood clots. The softening of the cervix is called Goodell’s sign,
not Chadwick’s sign. Although the formation of a mucus plug protects from infection, it is not
called Chadwick’s sign.
DIF:
Cognitive Level: Application
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OBJ: Nursing Process Step: Assessment