Maternity Practice Test #1: Prenatal Care and Normal Pregnancy

Answer: C. March 17, 2027.

Rationale: Naegele's rule starts with the FIRST day of the last menstrual period, adds 7 days, subtracts 3 months and adds 1 year. June 10 plus 7 days is June 17; going back 3 months gives March 17; adding 1 year gives March 17, 2027 (C). This is the same as counting forward 280 days (40 weeks) from the last period. The rule assumes a regular cycle of about 28 days, so the provider may adjust the date using an early ultrasound. Option A is wrong because it subtracts 7 days instead of adding them. Option B is wrong because it leaves out the 7 days altogether. Option D is wrong because it adds 7 days but subtracts only 2 months.

Answer: A. Fetal heart tones heard with a Doppler device.

Rationale: Positive signs can only be caused by a fetus, so they confirm pregnancy. They include fetal heart tones heard by Doppler or seen on ultrasound, seeing the fetus on ultrasound, and fetal movement felt by the examiner (A). Option B is wrong because a urine test detects hCG, which is a probable sign; hCG can also be raised by other conditions, such as some tumors, or by certain medications. Option C is wrong because Hegar's sign is a probable sign: the examiner notices it, but it can have causes other than pregnancy. Option D is wrong because a missed period is a presumptive sign; the client notices it, and stress, weight loss, illness and many other conditions can also stop periods.

Answer: D. Turn the client onto her left side.

Rationale: Lying flat on the back late in pregnancy lets the heavy uterus press on the inferior vena cava. Less blood returns to the heart, so cardiac output and blood pressure fall, and blood flow to the placenta can drop too. Turning the client onto her side, usually the left, lifts the uterus off the vena cava and quickly improves her symptoms (D). A wedge under one hip can be used when she must stay on her back. After repositioning, the nurse rechecks her blood pressure and pulse and checks on the fetus as the facility directs. Option A is wrong because tilting her head down keeps her on her back, so the pressure on the vena cava continues, and the uterus pushes up on the diaphragm. Option B is wrong because she is still on her back, so the vena cava stays compressed. Option C is wrong because waiting leaves the cause in place while she has symptoms.

Answer: B. "The baby's spinal cord and brain form very early, often before you know you're pregnant. Taking folic acid before and during early pregnancy lowers the risk of neural tube defects."

Rationale: The neural tube, which becomes the brain and spinal cord, closes within about the first month after conception, often before a pregnancy is recognized. Enough folic acid before conception and in early pregnancy lowers the risk of neural tube defects such as spina bifida and anencephaly (B). That is why folic acid is recommended for anyone who could become pregnant, not only after a positive test. The dose depends on the client's history, so she takes the amount her provider recommends; clients with a prior affected pregnancy and some other risk factors are often prescribed a higher dose. Option A is wrong because, although folate is needed to make red blood cells, the main reason to start before pregnancy is to protect the developing neural tube. Option C is wrong because folic acid is not a treatment for nausea and vomiting of pregnancy. Option D is wrong because folic acid is advised for all clients who could become pregnant; a prior affected pregnancy changes the dose, not whether it is needed.

Answer: A. Report the measurement to the provider because it is smaller than expected for her gestational age.

Rationale: From about 20 to 36 weeks of gestation, the fundal height in centimeters (measured from the top of the symphysis pubis to the top of the fundus) roughly matches the number of weeks. At 28 weeks, a measurement of about 28 cm would be expected. A difference of more than about 2 cm is commonly reported for further evaluation, although facilities may use slightly different guidance. A measurement 6 cm smaller than dates (A) may point to fetal growth restriction, low amniotic fluid, or dating or measuring errors, so the provider usually orders an ultrasound. Option B is wrong because fundal height should roughly equal, not fall well below, the weeks of gestation. Option C is wrong because fundal height cannot tell the fetal position, and the nurse should not offer that explanation. Option D is wrong because drinking water will not correct the measurement; a full bladder can actually make the reading less accurate, which is why the client empties her bladder first.

Answer: C. "I'll lie down for a nap right after lunch so my food can settle."

Rationale: In pregnancy, progesterone relaxes the lower esophageal sphincter and slows stomach emptying, and the growing uterus pushes up on the stomach. Together these make reflux of stomach acid more likely. Lying down right after eating lets acid flow back into the esophagus, so the client should stay upright for a while after meals (C). Option A is correct teaching because smaller, more frequent meals put less pressure on the stomach. Option B is correct teaching because fatty, fried and spicy foods commonly trigger heartburn. Option D is correct teaching because raising the head of the bed uses gravity to keep acid in the stomach at night. The client should check with her provider before using any antacid, because some products are not recommended in pregnancy.

Answer: B. "Heat deli meats and hot dogs until they are steaming hot before you eat them."

Rationale: Listeria is a bacterium that can grow even at refrigerator temperatures. Pregnant clients are much more likely than other adults to get listeriosis, and the infection can cause miscarriage, stillbirth, preterm birth or serious infection in the newborn. Heating deli meats, cold cuts and hot dogs until steaming hot kills the bacteria (B). Option A is wrong because raw (unpasteurized) milk, and soft cheeses made from it, are common sources of Listeria; pregnant clients should choose pasteurized products. Option C is wrong because refrigerated smoked seafood can carry Listeria; it is safe only when cooked, for example in a hot dish, or when it is a shelf-stable canned product. Option D is wrong because leftovers should be eaten within a few days and reheated until steaming hot; 2 weeks is far too long.

Answer: D. "Take the iron with a source of vitamin C, such as orange juice."

Rationale: Vitamin C helps the body absorb iron, so taking iron with orange juice or another vitamin C source improves absorption (D). Iron is best absorbed on an empty stomach, but if it upsets the stomach, the provider may advise taking it with a small amount of food. Option A is wrong because the calcium in milk and dairy products reduces iron absorption; they should be taken at a different time. Option B is wrong because coffee and tea contain compounds that bind iron and reduce how much is absorbed. Option C is wrong because dark green or black stools are an expected effect of oral iron and are not a reason to stop it. The nurse also teaches ways to prevent constipation, a common side effect, such as fluids, fiber and activity as allowed, and to report black, sticky stools with dizziness or abdominal pain, which can mean bleeding.

Answer: A. Resting heart rate about 10 to 15 beats/min higher than her rate before pregnancy.

Rationale: During pregnancy, blood volume rises a great deal and cardiac output increases. To help move this extra volume, the resting heart rate commonly rises by about 10 to 15 beats/min or a little more (A). Blood pressure usually stays the same or dips slightly in the second trimester, then returns toward the client's baseline. Option B is wrong because a blood pressure of 150/96 mm Hg is high; new hypertension after 20 weeks can signal gestational hypertension or preeclampsia and is reported to the provider. Option C is wrong because 2+ protein on a dipstick is not expected and, with high blood pressure, raises concern for preeclampsia; the provider may order further urine testing. Option D is wrong because painless bright red bleeding in the second half of pregnancy suggests placenta previa and needs prompt evaluation; the nurse avoids vaginal exams until the placenta's location is known.

Answer: C. Measles, mumps and rubella (MMR) vaccine.

Rationale: MMR is a live virus vaccine. Live vaccines, including MMR and varicella, are not given during pregnancy because of the theoretical risk to the fetus (C). A client who is not immune to rubella is usually vaccinated after the birth, before she leaves the hospital, and is taught to avoid becoming pregnant for the time period her provider advises. Option A is wrong because the inactivated (shot) influenza vaccine is recommended during pregnancy to protect the client and, through her antibodies, the newborn. Option B is wrong because Tdap is recommended during each pregnancy, commonly in the third trimester, so antibodies pass to the baby and help protect against whooping cough in the first months of life. Option D is wrong because Rho(D) immune globulin is commonly given around 28 weeks to an Rh-negative client who is not sensitized (negative antibody screen) to help prevent her from making antibodies against Rh-positive fetal blood cells; it is not a vaccine and is safe in pregnancy.