Chapter 7: Conception and Development of the Embryo and Fetus Nursing School Test Banks

Chapter 7: Conception and Development of the Embryo and Fetus

MULTIPLE CHOICE

1. A faculty member explains the Human Genome Project to a class of nursing students. Which information about this project is correct?
A. It began in the 1980s to find the basic building blocks of human proteins.
B. The findings will be used to create better matches for animal-to-human transplants.
C. The goal is to identify exact DNA sequences and genes occurring in humans.
D. Information from the project is being used to find preventative measures for diseases.
ANS: C
The Human Genome Project began in 1990 with an overarching goal to identify the exact DNA sequences and genes that occur in humans. It is hoped that the findings will lead to new methods of diagnosing, treating, and perhaps preventing human disease and disorders.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. A nurse is interested in studying the functions and interactions of the genes in the human genome. What branch of science should this nurse pursue?
A. Biology
B. Genetics
C. Genomics
D. Inheritance
ANS: C
Genomics is the study of the functions and interactions of all the genes in the genome. Genetics is the study of single genes and their effects. Both are subsets of biology, which is the study of life and living matter. Inheritance is the way in which genetic material is passed on to subsequent generations.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

3. A nursing instructor is explaining genetic concepts to a class of students. Where in the cell does the instructor tell the students that each persons genes can be found?
A. Golgi body
B. Lysosome
C. Mitochondria
D. Nucleus
ANS: D
Most genes are located on chromosomes found in the nucleus of cells. Golgi bodies process cellular proteins. Lysosomes break down waste and cellular debris. Mitochondria are responsible for cellular energy production.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

4. A couple wishes to determine the chances of having a blue-eyed baby. Both parents have brown eyes, but have heterozygous gene pairs for eye color. Calculate the odds of their having a child with blue eyes.
A. 10%
B. 20%
C. 25%
D. 50%
ANS: C
Each parent has a heterozygous gene pair for brown eyes, which means that each parent has one blue gene and one brown gene. Using a Punnett square, one can calculate the odds of their having a blue-eyed baby to be 25%.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

5. A nurse reads in a patients chart that the patient has a condition caused by monosomy X. What can the nurse conclude about this patient?
A. Female with one missing X chromosome
B. Female with very feminine features
C. Male with one extra X chromosome
D. Male with very feminine features
ANS: A
A monosomy condition is one in which only one of the paired chromosomes is present. In this case, the patient would have one or more cells with one X chromosome and nothing else. Turners syndrome is the most common example of this defect; children born with this syndrome are female and exhibit juvenile external genitalia, underdeveloped ovaries, short stature, webbing of the neck, and possible intellectual deficits and cardiac disorders.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

6. A nurse has completed a family pedigree on a patient with a known autosomal dominant inheritance disorder. No one else in the family has been affected by this disorder. How does the nurse explain this finding to the patient?
A. Genetic variation occurred via a mutation.
B. Information about the family is incorrect.
C. The patient is not biologically related to the family.
D. The patients diagnosis must be incorrect.
ANS: A
Most autosomal dominant inheritance disorders are seen in families in which multiple members in different generations have been affected by the disorder. However, the variant allele may arise from a mutation, in which case the affected person will be the first known person in the family to be affected. The other options are incorrect.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

7. A nurse is counseling a couple whose child has been diagnosed with cystic fibrosis. They understand that this is an inherited disease, but dont know how the child got it, as neither of them is affected. What response by the nurse is best?
A. Are you certain that you (points to man) are the biological father?
B. Maybe each of you has a mild case that hasnt been diagnosed yet.
C. Something in your environment must have altered one of the genes.
D. This is a recessive disorder, meaning that each of you is just a carrier.
ANS: D
Cystic fibrosis is an example of an autosomal recessive inheritance problem. Both parents carry an altered gene for this condition (carriers), but both parents must pass this altered version on to their child in order for it to be expressed. Asking if the man is the father is accusatory and unhelpful. Each parent has the gene, but not the disease, so they dont have a mild form. An environmental factor can cause genetic mutations, but this is not the case in this type of inheritance.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

8. A couple wishes to know the chances of passing on an X-linked dominant heritable disorder to their four sons. The fathers family has the disorder. The sons appear healthy, but the couple wants to be prepared for possible future events related to the disease. What information does the nurse give them?
A. All of them will be affected.
B. Half of them will be affected.
C. None of your sons will be affected.
D. One of the four will be affected.
ANS: C
An X-linked dominant inheritance disorder is the result of an alteration in a gene located on an X chromosome. None of this couples sons can be affected because boys get a Y chromosome from the father, whereas all of a mans daughters will have it.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

9. A nursing faculty member is explaining the process of fertilization to a class of students. One student asks the instructor to clarify the term secondary oocyte. What description is best?
A. An oocyte in the secondary position during transportation
B. An oocyte in which the first meiotic division has occurred
C. The second egg released by the ovary during ovulation
D. The second egg to reach its place in the fallopian tube
ANS: B
The secondary oocyte is one in which the first meiotic division has occurred. This is the egg that is expelled from the ovary during ovulation. The other statements are incorrect.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

10. The perinatal nurse understands that 4 days after fertilization, the morula now contains how many cells?
A. 2
B. 4
C. 8
D. 16
ANS: D
By 34 days after fertilization, there are approximately 16 cells in the zygote, which is now termed a morula.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

11. The nursing faculty member explains to a class that embryonic stem cells have a special feature. Which feature is the instructor describing?
A. Ability to develop into any type of human cell
B. Able to nourish the blastocyst as it develops
C. Gives rise to the embryo and placenta
D. Secretes a mixture of lipids and other liquids
ANS: A
Embryonic stem cells have the ability to differentiate into any one of the 200 kinds of human cells that will be present at birth. The uterus secretes a mix of lipids, mucopolysaccharides, and glycogen that nourishes the blastocyst. The embryo develops from the blastocyst, and the placenta develops from the trophoblast.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

12. A student asks the faculty member to explain the term nidation. Which explanation is best?
A. Blood vessel development
B. Degradation of the zona pellucida
C. Implantation of the fertilized ovum
D. Sperm washing
ANS: C
Nidation is the process whereby the fertilized ovum is implanted into the endometrium. This usually occurs by the 10th day.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

13. The experienced perinatal nurse explains hormone function to a new graduate. Which hormone does the nurse describe as being responsible for regulating glucose availability for the fetus?
A. Estrogen
B. Human chorionic gonadotropin
C. Human placental lactogen
D. Progesterone
ANS: C
Human placental lactogen is responsible for glucose availability for the fetus and promotes fetal growth by altering maternal protein, carbohydrate, and fat metabolism. Estrogen has multiple functions, but these do not include regulating glucose availability. Human chorionic gonadotropin maintains the corpus luteum until the placenta has developed enough to produce adequate progesterone. Among other functions, progesterone helps suppress maternal immunological responses to fetal antigens.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

14. The perinatal nurse understands that maternal antibodies pass through the placenta by which mechanism?
A. Active transport
B. Facilitated diffusion
C. Osmosis
D. Pinocytosis
ANS: D
Maternal antibodies pass through the placenta via pinocytosis, not by active transport, facilitated diffusion, or osmosis.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

15. A student has read that hematopoiesis occurring in the wall of the yolk sac declines after the eighth week of gestation and asks the instructor for clarification. What statement by the faculty member is most accurate?
A. All of the blood needed is transported across the placenta.
B. Bone marrow production of blood begins in week 8.
C. The fetal liver takes over that function then.
D. You must have misread that information.
ANS: C
Formation and development of red blood cells (hematopoiesis) occurs in the wall of the yolk sac beginning in the third week. The function gradually declines after the eighth gestational week when the fetal liver begins to take over this process.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

16. The nurse assessing a newborns umbilical cord stump would document which finding as normal anatomy?
A. One artery, one vein
B. One artery, two veins
C. Two veins, two arteries
D. One vein, two arteries
ANS: D
The vessels in the umbilical cord are comprised of two arteries and one vein.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Easy

PTS: 1

17. The perinatal nurse explains the function of Whartons jelly to a class of expectant parents. What description is most accurate?
A. Collection of blood from the maternal circulation
B. Gooey uterine substance that cushions the fetus
C. Precursor cells from which blood cells originate
D. Protects the umbilical cord from compression
ANS: D
Whartons jelly is a specialized type of connective tissue surrounding the vessels within the umbilical cord that protects the cord from compression.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

18. The perinatal nurse is explaining blood transport though fetal circulation to the new nurse. How does the perinatal nurse describe the foramen ovale?
A. Opening in the hearts septum between the right and left atria
B. Vascular channel between the pulmonary artery and the descending aorta
C. Vascular channel connecting the umbilical vein to the inferior vena cava
D. Vascular route connecting the heart to the extremities
ANS: A
The foramen ovale is an opening in the hearts septum between the right and left atria. The vascular channel between the pulmonary artery and descending aorta is the ductus arteriosus. The channel connecting the umbilical vein to the inferior vena cava is the ductus venosus. The closest thing to a route connecting the heart to the extremities would be the aorta, which then leads to peripheral and cerebral circulation.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

19. A couple has been told that there is a problem with their pregnancy. They only remember the term ductus venosus. The nurse explains that there is a problem in the circulation between which two structures?
A. Pulmonary artery and descending aorta
B. Pulmonary vein and pulmonary artery
C. Right and left atria in the heart
D. Umbilical cord and inferior vena cava
ANS: D
The ductus venosus is a vascular channel connecting the umbilical vein to the inferior vena cava. The ductus arteriosus connects the pulmonary artery and descending aorta. The foramen ovale is an opening in the septum between the right and left atria of the heart.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

20. A student reviewing the anatomy and physiology of fetal circulation learns that fetal blood enters the aorta through which structure?
A. Ductus arteriosus
B. Ductus venosus
C. Foramen ovale
D. Portal circulation
ANS: A
Most blood enters the aorta through the ductus arteriosus, which is a channel between the pulmonary artery and the descending aorta. The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is an opening between the atria of the heart. Most blood bypasses the liver (portal circulation).

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

21. A student reviewing the anatomy and physiology of the fetal circulatory system learns that the highest concentration of oxygen in fetal blood is measured at what level?
A. 1020 mm Hg
B. 2025 mm Hg
C. 3035 mm Hg
D. 4050 mm Hg
ANS: C
The highest concentration of oxygen (PO2) in fetal circulation is found in the blood returning from the placenta via the umbilical vein and is measured at 3035 mm Hg.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

22. A student asks the faculty member to explain why the fetus has such a low PO2. What explanation by the faculty member is most accurate?
A. Blood from the mother is deoxygenated.
B. It keeps the ductus arteriosus open.
C. It maintains the maternal circulation.
D. It supports the foramen ovale.
ANS: B
The low fetal PO2 helps to maintain fetal (not maternal) circulation and keeps the ductus arteriosus open. It also helps keep the pulmonary vascular bed constricted. Blood from the mother is oxygenated. It does not support the foramen ovale.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

23. The nurse discussing fetal development describes the hormone responsible for suppressing the maternal immunological response to the fetus, thereby facilitating physiological acceptance of the pregnancy. Which hormone is the nurse describing?
A. Estrogen
B. Human chorionic gonadotropin
C. Human placental lactogen
D. Progesterone
ANS: D
Progesterone helps to suppress maternal immunological responses to fetal antigens, thereby preventing maternal rejection of the fetus. Estrogen enhances myometrial activity, promotes myometrial vasodilation, increases maternal respiratory center sensitivity to carbon dioxide, softens fibers in the cervical collagen tissue, increases the pituitary secretion of prolactin, increases serum-binding proteins and fibrinogen, decreases plasma proteins, and increases sensitivity of the uterus to progesterone in late pregnancy. Human placental lactogen regulates glucose availability for the fetus and promotes fetal growth by altering maternal protein, carbohydrate, and fat metabolism. Human chorionic gonadotropin maintains the corpus luteum during early pregnancy until the placenta has sufficiently developed to produce adequate amounts of progesterone.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

24. A clinic nurse explains to a pregnant woman that the amount of amniotic fluid present at 7 or 8 months gestation is approximately what volume?
A. 500 mL
B. 750 mL
C. 800 mL
D. 1,000 mL
ANS: C
Amniotic fluid first appears at about 3 weeks. There is approximately 30 mL of amniotic fluid present at 10 weeks of gestation, and this amount increases to approximately 800 mL at 24 weeks of gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

25. A pregnant woman is confused about the terms embryo and fetus. How does the nurse explain the difference?
A. The baby cant be called a fetus until the limbs and organs have formed.
B. The baby is an embryo until 8 weeks gestation; then it is called a fetus.
C. There really isnt any difference between the terms; they are interchangeable.
D. Your baby is a fetus until the kidneys are matured and he makes urine.
ANS: B
During the first 8 weeks of gestation, the baby is called an embryo. By the end of the eighth week, the embryo has developed enough to be called a fetus. The other statements are inaccurate.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

26. A nurse teaching a prenatal class instructs the participants that early organ system development occurs during which period of time?
A. Embryonic period
B. Fetal period
C. Pre-embryonic period
D. Post-embryonic period
ANS: A
The early development of the nervous system, cardiovascular system, and all major internal and external structures occurs during the embryonic period, which is the first 2 weeks beginning at fertilization.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

27. A woman is starting on birth control, but tells the nurse she wants to become pregnant next year. What action by the nurse is most important?
A. Ask the woman to describe how her life will be different in the next year.
B. Educate the woman about the need for folic acid supplementation before conceiving.
C. Have the woman make a pre-pregnancy appointment for next year before she leaves.
D. Tell the woman that it is difficult to get pregnant right after stopping birth control.
ANS: B
Neural tube defects occur during the fourth week of pregnancy, which is often before women know they are pregnant. Any woman considering pregnancy should take folic acid supplements well in advance of trying to conceive. The other options are not helpful interventions.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

28. A newborn has rachischisis. What action by the nurse takes priority?
A. Contact the palliative care team for interventions.
B. Discourage the family from seeing the infant.
C. Obtain informed consent for immediate surgery.
D. Prepare to provide the baby total parenteral nutrition.
ANS: C
Rachischisis is spina bifida, a type of neural tube defect that often requires immediate surgery. The priority of the nurse is to obtain signatures on the informed consent form and place it on the chart. There is no need for palliative care or parenteral nutrition. The nurse would not discourage the family from seeing the baby.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

29. A woman in her 26th week of pregnancy is in preterm labor. What can the nurse conclude about this babys ability to survive?
A. Cannot survive, as all organ systems are too immature
B. Might survive, as lungs can breathe air with rhythmic breathing
C. Probably will not survive, as all organ systems have not formed
D. Will survive, because all body systems are completely mature
ANS: B
A baby born at this gestation can survive because the lungs are capable of breathing air, they produce surfactant, and the central nervous system can regulate body temperature and direct rhythmic breathing. Many obstacles remain for a baby born this early, and survival is not guaranteed. The other statements are inaccurate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

30. A baby is born with several congenital anomalies. The parents are distraught and begin questioning each other about what they did wrong during the pregnancy. What response by the nurse is best?
A. Chances are you did everything right; we may never know why this happened.
B. Usually these types of issues result from toxic environmental exposures.
C. You are lucky you did not have a miscarriage and instead have a wonderful baby.
D. You cant worry about that now; you have a baby who needs you.
ANS: A
Damage to a developing embryo/fetus can occur from genetic or environmental causes or a combination of both. However, in 50 to 60% of cases, the exact cause may never be known. The nurse should reassure the parents gently. It is incorrect to state that anomalies are usually caused by environmental factors. Telling the family they are lucky and they shouldnt worry is disrespectful and dismissive to the parents.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy

PTS: 1

31. A nurse is assessing a pregnant woman who says she drinks 5 to 7 alcoholic drinks per week. What action by the nurse is best?
A. Advise the woman to decrease her drinking to 3 to 4 drinks per week.
B. Explain that during pregnancy, alcohol in any amount can harm the fetus.
C. Teach her that for women, the safe alcohol limit is 1 drink in an hour.
D. Tell the woman to substitute caffeinated beverages for the alcohol.
ANS: B
Alcohol is one of the most potent teratogens known, and a safe level of alcohol during pregnancy has not been established. Therefore, the nurse should advise the woman to stop drinking alcohol altogether while she is pregnant. Caffeine is also considered a teratogen, so this is not a good substitute.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

32. A preterm infant is jittery and has an oxygen saturation of 88%. After stabilizing the newborn, what action by the nurse is most important?
A. Assess the mother for caffeine use during pregnancy.
B. Assess the mother for opioid use during pregnancy.
C. Call Child Protective Services (CPS) to take the child away.
D. Question the father about maternal drug abuse.
ANS: B
Maternal opioid use can lead to neonatal withdrawal syndrome, characterized by hyperirritability, gastrointestinal dysfunction, respiratory distress, and autonomic disturbances. After stabilizing the baby, the nurse should first assess the mother for opioid abuse during pregnancy. Caffeine use would not cause these effects. Calling CPS is premature at this point. Questioning the father is not the best way to determine if the mother has abused drugs.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

33. A neonate whose mother is a drug addict is listless and sweating. What action by the nurse takes priority?
A. Check the babys blood sugar.
B. Have the mother hold the baby to her skin.
C. Obtain an oxygen saturation.
D. Place the baby on a cardiac monitor.
ANS: A
Babies born of mothers who have used amphetamines during pregnancy may exhibit hypoglycemia, sweating, poor visual tracking, lethargy, and difficulty feeding. The nurse would conclude that the baby may be at risk for hypoglycemia because he or she has other manifestations of this syndrome and should check the blood sugar. If low, the blood glucose can be treated quickly. The other options may be valuable, but do not take priority over this assessment.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

34. A pregnant woman tells the perinatal nurse that she stopped abusing other drugs when she learned that she was pregnant but kept using marijuana because it is so harmless. What response by the nurse is best?
A. Agree with the patient that marijuana is less dangerous than other drugs.
B. Ask the patient what other drugs she used before discovering she was pregnant.
C. Inform the mother that the child may have withdrawal syndrome after birth.
D. Tell the mother that marijuana use can affect language and cognitive development.
ANS: D
Marijuana use is associated with carbon monoxide levels five times higher than those produced with cigarettes and can lead to intrauterine growth restriction and abnormal neonatal neurobehavior (hyperirritability, tremors, photosensitivity). Marijuana can also lead to cognitive and language abnormalities up to 48 months of age. The nurse should not agree that it is less dangerous than other drugs, but should also not tell the mother the child may have withdrawal syndrome, as that information is incorrect. Assessing the mother for a complete history of drug use is important, but is not directly related to the effects of marijuana, and is less important.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

35. A male baby is born with undescended testes. After caring for the newborn, what question by the nurse is most important?
A. Did your other children have this problem?
B. Do you have cats and litter boxes at home?
C. Have you been exposed to measles?
D. How old is the house in which you live?
ANS: D
One risk factor for undescended testes is intrauterine lead exposure. In this country, the most common source of lead is from lead-based paint in older homes (built prior to 1978), lead-contaminated house dust and soil, and vinyl products. The nurse should assess for sources of lead exposure. The other questions are not relevant.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

36. The prenatal clinic nurse is providing information to a pregnant woman who is at 15 weeks gestation. The patient asks when she should expect to feel fetal movement. Which of the following is the most appropriate answer by the nurse?
A. 15 to 18 weeks
B. 17 to 20 weeks
C. 18 to 21 weeks
D. 20 to 24 weeks
ANS: B
In gestational weeks 17 to 20, fetal growth continues, and maternal awareness of fetal movements (termed quickening) is often first noted.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

37. During preconception counseling, the nurse explains that the fetus is most vulnerable to the effects of teratogens during which time period?
A. 2 to 8 weeks
B. 4 to 12 weeks
C. 5 to 10 weeks
D. 6 to 15 weeks
ANS: A
The period of organogenesis lasts from approximately the second until the eighth week of gestation, during which time the embryo undergoes rapid growth and differentiation. During organogenesis, the embryo is extremely vulnerable to teratogens, such as medications, alcohol, tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections. Structural fetal defects are most likely to occur during this period because exposure to teratogens, either before or during a critical period of development of an organ, can cause a malformation.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

38. During prenatal classes for expectant parents, the perinatal nurse explains that fetal brain development is most critical during which gestational weeks?
A. 2 to 8
B. 3 to 16
C. 5 to 24
D. 6 to 14
ANS: B
The most critical time for brain development is between 3 and 16 weeks of gestation. However, the fetal brain continues to differentiate and grow rapidly until at least the first 2 years of life.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

39. The birthing center nurse caring for a 21-year-old laboring woman is given a report about the patients cocaine use throughout pregnancy. This history prompts the labor nurse to assess for which condition?
A. Abruptio placentae
B. Cephalopelvic disproportion
C. Hypotension
D. Placenta previa
ANS: A
Cocaine and crack use during pregnancy causes vasoconstriction of the uterine vessels and adversely affects blood flow to the fetus. Cocaine use in pregnancy is associated with spontaneous abortion, abruptio placentae, stillbirth, intrauterine growth restriction (IUGR), fetal distress, meconium staining, and preterm birth.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

40. The birthing center nurse is assisting with pain management for a laboring woman at 18 weeks gestation. The fetus is born and the weight is 450 gm. The nurse would document this birth as which of the following?
A. Abortion
B. Fetal loss
C. Neonatal death
D. Stillbirth
ANS: A
The loss of a fetus before 20 to 22 weeks of gestation is referred to as an abortion because the fetus is considered too immature to survive outside the uterus. Fetal loss and neonatal death are not medical terms. Stillbirth is the intrauterine death of a fetus old enough to survive outside the womb.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

41. A 26-year-old woman has come for preconception counseling and asks about caring for her cat, because she has heard that she should not touch the cat during pregnancy. Which of the following is the nurses best response?
A. If someone else changes the litter box you should be okay.
B. It is more important to avoid eating raw vegetables now.
C. That is correct; in fact, you should give the cat away.
D. You probably already have had toxoplasmosis from the cat.
ANS: A
Toxoplasmosis is usually acquired by consuming raw or poorly cooked meat that has been contaminated with Toxoplasma gondii. Toxoplasmosis may also be acquired through close contact with feces from an infected animal (usually cats) or soil that has been contaminated with T. gondii. The nurse should advise the woman to avoid poorly or undercooked meat and changing the cats litter box. The other statements are inaccurate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

42. A couple has undergone prenatal testing and their fetus has an identified congenital anomaly. What action by the nurse is best?
A. I know how you feel; my daughter has a cleft lip.
B. Im sure you will come to love your baby anyway.
C. It is normal for both of you to be afraid, sad, or angry.
D. You are lucky you found out now and can prepare.
ANS: C
The nurse plays an important role in situations such as this by providing support and education. The nurse should use empathetic and therapeutic communication and be sure to include the father. The other statements are not examples of therapeutic communication and sound dismissive.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy

PTS: 1

43. A baby is born with trisomy 18. What action by the nurse is most appropriate?
A. Allow the family members to express their grief and anger.
B. Call the hospital chaplain to counsel the parents.
C. Make a referral to a home health agency for home visits.
D. Prepare the parents for the babys imminent death.
ANS: A
Trisomy 18 (Edward syndrome) is a rare genetic disorder with a poor prognosis; approximately 70% of infants die within the first 3 months of life. The nurse should allow the family to grieve. The parents may or may not welcome a visit from a religious person and the nurse should ask them before calling a chaplain. A home health-care agency may or may not be needed; further assessment is needed. The baby may not die immediately, so preparing the parents for an imminent death is unwarranted.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Caring
Difficulty: Easy

PTS: 1

44. An obstetrical nurse is taking a medication history from a pregnant woman. One of the womans medications is classified as category D. What action by the nurse is best?
A. Advise her to stop the medication right away.
B. Encourage her to find herbal substitutions.
C. Have her call her primary care provider immediately.
D. Tell her to cut the medication dose in half until she gives birth.
ANS: C
A category D medication is one with well-documented risks to the fetus. In some situations, this may be acceptable if the medication is prescribed for a life-threatening situation or for a disease for which safer drugs cannot be used or do not exist. The nurse should help the woman contact her primary care provider during the OB visit to discuss the continued used of the medication. The nurse should not advise the woman to just stop the medication; she needs to discuss this with the primary care provider, but that needs to be accomplished quickly. The nurse should not encourage substituting herbal preparations or cutting the medication dose in half.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

45. A parent wonders why his baby needs all the blood samples to test for different diseases. What response by the nurse is best?
A. Many serious disorders can be found before they cause damage or death.
B. This is a hospital policy; if you want to opt out you need to sign a waiver.
C. We see a lot of these diseases in our community so we screen for them.
D. Your baby doesnt need the blood tests if you dont want them.
ANS: A
Newborn screening was the first population-based screening program to test for genetic conditions. Many diseases that cause an increased risk for infection, liver damage, mental retardation, or even death can often be identified through these tests. The hospital may require an opt-out waiver, but this is not the best initial answer. Some of the diseases are uncommon but potentially devastating, so the screening is not done for diseases only seen in one community. Parents can opt out of some or all tests, depending on the state in which they live, but the nurse should first educate the parent about why the tests are so important.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

46. A woman is admitted with rubella. What action by the nurse manager is best?
A. Place the woman on droplet precautions.
B. Put the woman in contact isolation.
C. Tell the nurses to use good hand-washing techniques.
D. Use standard precautions only.
ANS: A
Rubella (German measles) is spread through respiratory droplets. The patient should be put on droplet precautions. Nurses should use good hand-washing techniques for all patient contacts.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

47. A newborn nursery nurse is arranging genetic screening for several newborns. The nurse should educate the parents of which baby about screening for Tay-Sachs disease?
A. African American baby
B. Asian baby
C. Caucasian baby
D. Jewish baby
ANS: D
Tay-Sachs disease is the most common genetic disease among people of Jewish ancestry. The nurse should educate the parents with Jewish ancestry about screening for this disease.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

48. A pediatric nurse is reviewing the chart of a new school-age patient. The chart notes the child is on a phenylalanine-free diet. What does the nurse conclude about this patient?
A. Has Canavan disease
B. Has familial dysautonomia
C. Has phenylketonuria (PKU)
D. Has Tay-Sachs disease
ANS: C
Children with PKU are born without an enzyme to metabolize the amino acid phenylalanine. If not treated with a life-long phenylalanine-free diet, the child can have severe mental and physical retardation. The other diseases do not require this diet.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

49. A student has read that fetal development progresses in a cephalocaudal fashion and asks the faculty member for clarification. What explanation by the faculty member is best?
A. From feet to head
B. From head to feet
C. Inward to outward
D. Outward to inward
ANS: B
Cephalocaudal development proceeds from head to feet.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

50. A nursing student asks the faculty member to define lanugo. Which description is best?
A. Fine, downy hair on the fetus
B. Immune complexes in the amniotic fluid
C. Initial scalp hair on the fetus
D. Outer layer of pale, wrinkled skin
ANS: A
Lanugo is the fine, downy hair seen on fetuses.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

MULTIPLE RESPONSE

1. The perinatal nurse explains to a childbirth class that which of the following are the primary functions of the placenta? (Select all that apply.)
A. Creates blood vessels in the fetus
B. Protects the fetus from pathogens
C. Provides hormones that maintain the pregnancy
D. Removes waste products from the fetus
E. Transfers nutrients to the fetus
ANS: B, C, D, E
The placenta serves several functions, including providing nutrition and oxygen to the fetus, carrying waste products away from the fetus, providing hormones that help to maintain the pregnancy, and protecting the fetus from pathogens. The placenta does not create blood vessels in the fetus.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

2. The perinatal nurse explains to a student the different mechanisms by which substances are transported across the placenta. Which mechanisms are included? (Select all that apply.)
A. Active diffusion
B. Bulk flow
C. Endocytosis
D. Osmosis
E. Pinocytosis
ANS: A, B, C, E
Several mechanisms exist to transport substances across the placenta. These include passive or simple diffusion, facilitated diffusion, active diffusion, pinocytosis, endocytosis, bulk flow, accidental capillary breaks, and independent movement.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

3. The nursing instructor is explaining mechanisms of substance transport across the placenta. Which substances require facilitated diffusion? (Select all that apply.)
A. Carbon dioxide
B. Fatty acids
C. Globulins
D. Glucose
E. Oxygen
ANS: D, E
Glucose and oxygen require facilitated diffusion to cross the placenta. Carbon dioxide and fatty acids move by simple diffusion. Globulins move via pinocytosis and endocytosis.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

4. The nursing instructor is explaining the function of the placenta in hormone production. Which hormones does the instructor include in this discussion? (Select all that apply.)
A. Estrogens
B. Human chorionic gonadotropin
C. Human placental lactogen
D. Luteinizing hormone
E. Progesterone
ANS: A, B, C, E
The placenta produces four main hormones: estrogens, human chorionic gonadotropin, human placental lactogen, and progesterone. Luteinizing hormone is produced in the anterior pituitary gland.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

5. During prenatal class, the nurse teaches expectant couples about the importance of the amniotic fluid and its functions. What functions does the nurse describe? (Select all that apply.)
A. Cushions the fetus from mechanical injury
B. Facilitates symmetrical growth of fetal limbs
C. Helps regulate fetal body temperature
D. Provides nourishment to the fetus
E. Prevents the amnion from adhering to the fetus
ANS: A, B, C, E
Amniotic fluid allows for symmetrical fetal growth, cushions the fetus from mechanical injury, and aids in fetal musculoskeletal development. Amniotic fluid prevents adherence of the amnion to the fetus and is essential for normal fetal lung development and temperature regulation. Amniotic fluid does not provide nourishment to the fetus.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

6. The nurse explaining fetal growth and development to a class of expectant parents describes events that occur during weeks 9 to 12 as which of the following? (Select all that apply.)
A. External genitalia are distinguishable.
B. Hair appears on the eyebrows and head.
C. Intestines become visible in the abdomen.
D. Ossification centers appear in the skeleton.
E. Rapid eye movements occur and fingernails form.
ANS: A, C, D
During gestational weeks 9 to12 several events occur: distinguishable external genitalia appear, ossification centers in the skeleton appear, and the intestines leave the umbilical cord to become an abdominal organ. Hair growth occurs during weeks 17 to 20. The baby develops rapid eye movements and fingernails during weeks 21 to 25.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

7. A perinatal nurse is assessing a woman who is approximately 10 weeks pregnant. The woman smells like cigarette smoke. What actions by the nurse are best? (Select all that apply.)
A. Advise her to stop smoking now so that the baby can be of normal weight.
B. Ask the woman if either she or her partner smokes.
C. Determine how many cigarettes she smokes a day.
D. Describe the behavior problems her child may develop.
E. Explain that nicotine deprives the fetus of oxygen.
ANS: A, B, E
If the nurse smells cigarette smoke, assessing the woman for smoking or exposure to second-hand smoke is appropriate. Exposure to nicotine causes vasoconstriction and deprives the fetus of essential oxygen and nutrients needed for growth and development. Consequences include low birth weight and small-for-gestational-age babies. If the woman stops smoking during the first trimester, the baby will have a similar birth weight to babies whose mothers did not smoke. The absolute number of cigarettes per day is not as important as determining if she does smoke and advising her to quit now. Childhood behavior problems are often attributed to cocaine use during pregnancy.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Difficult

PTS: 1

8. A nurse is assessing a woman for TORCH infections. What diseases are included in this acronym? (Select all that apply.)
A. Cytomegalovirus
B. Hepatitis B
C. Roseola
D. Toxoplasmosis
E. Varicella zoster
ANS: A, B, D, E
TORCH stands for toxoplasmosis, other infections, rubella, cytomegalovirus, and herpes simplex virus. Other infections include varicella zoster virus, human immunodeficiency virus, hepatitis B virus, human parvovirus B19, and syphilis. Roseola is not included.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

OTHER

1. Match each term with its definition or description.

a. Autosome 1. _____ Large female chromosome
b. X chromosome 2. _____ Gene pair in which the gene pairs are different
c. Y chromosome 3. _____ Genetic makeup of an individual
d. Homozygous 4. _____ Observable expression of a persons genotype
e. Heterozygous 5. _____ Non-sex chromosome common to both males and females
f. Genotype 6. _____ Smaller male chromosome
g. Genome 7. _____ Gene pair in which both genes are identical
h. Phenotype 8. _____ Complete set of genes present in a person
ANS:
1b, 2e, 3f, 4h, 5a, 6c, 7d, 8g
An autosome is a non-sex chromosome common to both males and females. The X chromosome is the larger female chromosome, whereas the Y chromosome is the smaller male chromosome. Homozygous gene pairs have identical genes, whereas heterozygous gene pairs have differing genes. A genotype is the genetic makeup of an individual. The genome is the complete set of genes present in each person. The phenotype is the observable genetic differences expressing a persons genotype, such as hair and eye color.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. Match each TORCH disease with its possible effects on the newborn or characteristics. Diseases may be used more than once or not at all.

a. Toxoplasmosis 1. _____ Without intervention, maternal transmission to the fetus is about 25%
b. Rubella 2. _____ The most common viral infection in the fetus
c. Cytomegalovirus 3. _____ Bullae, microcephaly, hydrencephaly, and encephalitis can occur
d. Herpes simplex virus 4. _____ No known risks if infection occurs after 20 weeks gestation
e. Human immunodeficiency virus (HIV) 5. _____ Late manifestations include keratitis, snuffles, deafness, and bowing of the shins
f. Varicella zoster virus 6. _____ Symptoms in the mother seem to be flu-like
g. Syphilis 7. _____ Maternal infection in the first trimester can lead to spontaneous abortion
8._____Maternal infection during the first trimester leads to a 20% chance of fetal infection
ANS:
1e, 2c, 3d, 4f, 5g, 6a, 7c, 8b

Toxoplasmosis has symptoms often referred to as flu-like. Maternal infection with rubella in the first trimester leads to a 20% chance of the fetus being infected. Cytomegalovirus is the most common viral infection in the fetus, and spontaneous abortion may result from maternal CMV infection in the first trimester. Herpes simplex infection leads to manifestations such as bullae, microcephaly, hydrencepahly, and encephalitis. Without medical intervention, vertical (maternal-to-child) transmission of HIV is about 25%. Varicella zoster virus carries no known risk to the fetus after 20 weeks gestation. Late syphilis symptoms include keratitis, snuffles, deafness, and bowing of the shins.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

3. Trace a drop of blood through the fetal circulation using the structures provided.

_____ Aorta
_____ Ductus arteriosus
_____ Ductus venosus
_____ Foramen ovale
_____ Head and extremities
_____ Left ventricle
_____ Right atrium
_____ Superior vena cava

ANS:
5, 8, 1, 3, 6, 4, 2, 7

Blood travels through the fetus in a unique pattern. Most blood enters the inferior vena cava through the ductus venosus, empties into the right atrium, and passes through the foramen ovale into the left atrium. It then travels to the left ventricle, into the aorta, and out into the rest of the systemic circulation. Blood returns to the heart from the head through the superior vena cava, goes through the right side of the heart before entering the pulmonary artery, or bypasses the lungs and enters the aorta through the ductus arteriosus.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

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