Maternity Nursing

The nurse is preparing to teach a prenatal class about fetal circulation. Which statements would be included in the teaching plan? Select all that apply.

•  “The ductus arteriosus allows blood to bypass the fetal lungs.”

• “One vein carries oxygenated blood from the placenta to the fetus.”

• “The normal fetal heartbeat range is 160 to 180 beats per minute in pregnancy.”

•  “Two arteries carry deoxygenated blood and waste products away from the fetus to the placenta.

•  “Two veins carry blood that is high in carbon dioxide and other waste products away from the fetus to the placenta.”

Answer explanation

The ductus arteriosus is a unique fetal circulation structure that allows blood to bypass the nonfunctioning fetal lungs. Oxygenated blood is transported to the fetus by one umbilical vein. The normal fetal heartbeat range is considered to be 110 to 160 beats per minute. Two arteries carry deoxygenated blood and waste products from the fetus, and one umbilical vein carries oxygenated blood and provides oxygen and nutrients to the fetus. Blood pumped by the embryo’s heart leaves the embryo through two umbilical arteries.

The nursing instructor teaches a group of students about fetal circulation and then asks a student to describe fetal circulation, specifically the ductus venosus. Which statement by the student indicates an understanding of the ductus venosus?

• 1. “It connects the pulmonary artery to the aorta.”

• 2. “It is an opening between the right and left atria.”

• 3. “It connects the umbilical vein to the inferior vena cava.”

• 4. “It connects the umbilical artery to the inferior vena cava.”

Answer explanation

The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.

A pregnant client tells the clinic nurse that they want to know the sex of the baby as soon as it can be determined. The nurse plans to inform the client that they will be able to find out the sex at 16 weeks’ gestation because of which factor?

• 1. The appearance of the fetal external genitalia

• 2. The beginning of differentiation in the fetal groin

• 3. The fetal testes are descended into the scrotal sac.

• 4. The internal differences in different genders become apparent.

Answer explanation

Between weeks 16 and 20, the external genitalia of the fetus have developed to such a degree that the sex of the fetus can be determined visually. Differentiation of the external genitalia occurs at the end of the ninth week. Testes begin to descend into the scrotal sac at the end of the 38th week. Internal differences in the genders occur at the end of the seventh week.

The nurse is performing an assessment on a client who is at 38 weeks’ gestation and notes that the fetal heart rate (FHR) is 174 beats per minute. On the basis of this finding, what is the priority nursing action?

• 1. Document the finding.

• 2. Notify the obstetrician (OB).

• 3. Check the mother’s heart rate.

•    4. Tell the client that the fetal heart rate is normal.

Answer explanation

The FHR depends on gestational age and ranges from 160 to 170 beats per minute in the first trimester but slows with fetal growth to 110 to 160 beats per minute. If the FHR is less than 110 beats per minute or more than 160 beats per minute with the uterus at rest, the fetus may be in distress. Because the FHR is increased from the reference range, the nurse would notify the OB. Options 3 and 4 are inappropriate actions based on the information in the question. Although the nurse documents the findings, based on the information in the question, the OB needs to be notified.

The nurse is conducting a prenatal class on the reproductive system. When a client in the class asks why the fertilized ovum stays in the fallopian tube for 3 days, what is the nurse’s best response?

• 1. “It promotes the fertilized ovum’s chances of survival.”

• 2. “It promotes the fertilized ovum’s exposure to estrogen and progesterone.”

• 3. “It promotes the fertilized ovum’s normal implantation in the top portion of the uterus.”

• 4. “It promotes the fertilized ovum’s exposure to luteinizing hormone and follicle-stimulating hormone.”

Answer explanation

The tubal isthmus remains contracted until 3 days after conception to allow the fertilized ovum to develop within the tube. This initial growth of the fertilized ovum promotes its normal implantation in the fundal portion of the uterine corpus. Estrogen is a hormone produced by the ovarian follicles, corpus luteum, adrenal cortex, and placenta during pregnancy. Progesterone is a hormone secreted by the corpus luteum of the ovary, adrenal glands, and placenta during pregnancy. Luteinizing hormone and follicle-stimulating hormone are excreted by the anterior pituitary gland. The survival of the fertilized ovum does not depend on it staying in the fallopian tube for 3 days.

The nursing instructor asks a nursing student to explain the characteristics of the amniotic fluid. The student responds correctly by explaining which as characteristics of amniotic fluid? Select all that apply.

• 1.Allows for fetal movement

•  2.Surrounds, cushions, and protects the fetus

• 3.Maintains the body temperature of the fetus

• 4.Can be used to measure fetal kidney function

• 5.Prevents large particles such as bacteria from passing to the fetus

Answer explanation

The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the birthing parent and the fetus.

A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse would determine whether this method of family planning would be most appropriate?

• 1. “Have you ever had surgery?”

• 2. “Do you plan to have any other children?”

• 3. “Do either of you have diabetes mellitus?”

• 4. “Do either of you have problems with high blood pressure?”

Answer explanation

Sterilization is a method of contraception for couples who have completed their families. It should be considered a permanent end to fertility, because reversal surgery is not always successful. The nurse would ask the couple about their plans for having children in the future. Options 1, 3, and 4 are unrelated to this procedure.

The nurse would plan to make which statement to a pregnant client found to have a gynecoid pelvis?

• 1. “Your type of pelvis has a narrow pubic arch.”

• 2. “Your type of pelvis is the most favorable for labor and birth.”

• 3. “Your type of pelvis is a wide pelvis, but it has a short diameter.”

• 4. “You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery.”

Answer explanation

A gynecoid pelvis is a normal pelvis and is the most favorable for successful labor and birth. An android pelvis would be unfavorable for labor because of the narrow pelvic planes. An anthropoid pelvis has an outlet that is adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat pelvis) has a wide transverse diameter, but the anteroposterior diameter is short, making the outlet inadequate.

Which purposes of placental functioning would the nurse plan to include in a prenatal class? Select all that apply.

• 1.It cushions and protects the baby.

•  2.It maintains the temperature of the baby.

•  3.It is the way the baby gets food and oxygen.

• 4.It prevents all antibodies and viruses from passing to the baby.

• 5.It provides an exchange of nutrients and waste products between the birthing parent and       developing fetus.

Answer explanation

The placenta provides an exchange of oxygen, nutrients, and waste products between the birthing parent and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. Nutrients, medications, antibodies, and viruses can pass through the placenta.

A 55-year-old client confides in the nurse about being concerned about sexual function. What is the nurse’s best response?

• 1. “How often do you have sexual relations?”

• 2. “Please share with me more about your concerns.”

• 3. “You are still young and have nothing to be concerned about.”

• 4. “You should not have a decline in testosterone until you are in your 80s.”

Answer explanation

The nurse needs to establish trust when discussing sexual relationships. The nurse would open the conversation with broad statements to determine the true nature of the client’s concerns. The frequency of intercourse is not a relevant first question to establish trust. Testosterone declines with the aging process.