1.	The clinic nurse talks with Jayne, a 30-year-old woman at 34 weeks gestation who complains of having difficulty sleeping.  Jayne has noticed that getting back to sleep after she has been up at night is difficult.  The nurse's best response is:
A)	“This is abnormal; it is important that you describe this problem to the doctor.”
B)	“This is normal and many women have this same problem during pregnancy; try napping for several hours each morning and afternoon.”
C)	“This is abnormal; tell the doctor about this problem because diagnostic testing may be necessary.”
D)	“This is normal in pregnancy, particularly during the third trimester when you also feel fetal movement at night; try napping once a day.”

2.	Sandra, a 26-year-old woman at 29 weeks gestation, experienced epigastric pain following the consumption of a large meal of fried fish and onion rings.  The pain resolved a few hours later.  The most likely diagnosis for this symptom is:
A)	Cholelithiasis
B)	Influenza
C)	Urinary tract infection
D)	Intrahepatic choleliathiasis

3.	The clinic nurse reviews the complete blood count results for Tamara, a 30-year-old woman who is now 33 weeks gestation.  Tamara's hemoglobin value is 11.2 g/dL and her hematocrit is 38%.   The clinic nurse interprets these findings as:
A)	Normal adult values
B)	Normal pregnancy values for the third trimester
C)	Increased adult values
D)	Increased values for 33 weeks gestation

4.	The clinic nurse is aware that the pregnant woman's blood volume increases by:
A)	20 – 25%
B)	30 – 35%
C)	40 – 45%
D)	50 – 55%

5.	Trudy, an 18-year-old woman at 23 weeks gestation, tells the nurse that she has fainted two times.  The nurse teaches Trudy about the warning signs that often precede syncope so that Trudy can sit or lie down to prevent personal injury.  Warning signs include: 
Select all answers that apply:
A)	Sweating
B)	Nausea
C)	Chills
D)	Yawning

6.	The clinic nurse encourages paternal attachment during pregnancy by including the father in: Select all answers that apply:
A)	Prenatal visits
B)	Ultrasound appointments
C)	Prenatal class information
D)	History taking and obtaining prenatal screening information

7.	The perinatal nurse teaches the student nurse about the physiological changes in pregnancy that most often contribute to the increased incidence of urinary tract infections.  These changes include: 
Select all answers that apply:
A)	Relaxation of the smooth muscle of the urinary sphincter
B)	Relaxation of the smooth muscle of the bladder
C)	Inadequate emptying of the bladder
D)	Increased incidence of bacteriuria

8.	The clinic nurse discusses normal bladder function in pregnancy with Noreen, a 22-year-old pregnant woman who is now in her 29th gestational week.  The nurse explains that at this time in pregnancy, it is normal to experience: 
Select all answers that apply:
A)	Urinary frequency
B)	Urinary urgency
C)	Nocturia
D)	Bacteriuria

9.	Karen, a 32-year-old woman now at 32 weeks gestation, is complaining of right-sided sharp abdominal pain.  Karen is examined by the clinic nurse and given information about abdominal discomfort in pregnancy.  Karen is also instructed to seek immediate attention if she: 
Select all answers that apply:
A)	Has heartburn
B)	Has chills or a fever
C)	Feels decreased fetal movements
D)	Has increased abdominal pain

10.	Katie, an 18-year-old woman at 28 weeks gestation, describes blurred vision to the clinic nurse.  The clinic nurse is aware that this common visual complaint during pregnancy is most likely caused by: 
Select all answers that apply:
A)	Corneal thickening
B)	Corneal thinning
C)	Increased intraocular pressure
D)	Decreased intraocular pressure

11.	The clinic nurse talks with Suzy, a pregnant woman at 9 weeks gestation who has just learned of her pregnancy.  Suzy's nausea and vomiting are most likely caused by: 
Select all answers that apply:
A)	Increased levels of estrogen
B)	Increased levels of progesterone
C)	An altered carbohydrate metabolism
D)	Increased levels of human chorionic gonadotropin

12.	The clinic nurse encourages all pregnant women to increase their water intake to at least 8–10 glasses per day in order to: 
Select all answers that apply:
A)	Decrease the risk of constipation
B)	Decrease the risk of bile stasis
C)	Decrease their feelings of fatigue
D)	Decrease the risk of urinary tract infections

13.	The perinatal nurse examines the thyroid gland as part of the physical examination of Savannah, a pregnant woman who is now at 16 weeks gestation.  The perinatal nurse informs Savannah that during pregnancy: 
Select all answers that apply:
A)	Increased size of the thyroid gland is normal
B)	Increased function of the thyroid gland is normal
C)	Decreased function of the thyroid gland is normal
D)	The thyroid gland will return to its normal size and function during the postpartal period

14.	The clinic nurse describes the respiratory system changes common to pregnancy to the new nurse.  These changes include: 
Select all answers that apply:
A)	An increased tidal volume
B)	A decreased airway resistance
C)	An increased chest circumference
D)	An increased airway resistance

15.	The clinic nurse teaches the new nurse about pregnancy-induced blood clotting changes.  The nurse explains that a pregnant woman is at risk for venous thrombosis due to: 
Select all answers that apply:
A)	Increased fibrinogen volume
B)	Increased blood factor V
C)	Increased blood factor X
D)	Venous stasis

16.	The clinic nurse describes possible interventions for the pregnant woman who is experiencing pain and numbness in her wrists.  The nurse suggests: 
Select all answers that apply:
A)	Elevating the arms and wrists at night
B)	Reassessment during the postpartum period
C)	The use of “cock splints” to prevent wrist flexion
D)	Massaging the hands and wrists with alcohol

	Use the following to answer questions 17-22:

The prenatal nurse knows that physiological alterations in various body systems during pregnancy may occur. Match the following alterations with their definitions:

Epulis gravidarum
Pyrosis
Ptyalism
Epistaxis
Pruritis gravidarum
Lumbar lordosis

17.	Lesions at the gum line that bleed easily

18.	Anterior convexity of the lumbar spine

19.	Increased saliva production

20.	Reflux of the stomach contents into the esophagus

21.	Severe itching due to stasis of bile in the liver

22.	Nose bleeds

23.	The clinic nurse speaks with the student nurse prior to the physical examination of a pregnant woman who is 32 weeks gestation.  The clinic nurse explains that the heart sounds heard in pregnancy are usually S1 and S3 with a possible murmur related to increased cardiac output.
A)	True
B)	False

24.	Cecilia, a pregnant woman at 30 weeks gestation, has her vital signs assessed during a routine prenatal visit.  Cecilia's blood pressure has remained at 110/70 for the last few visits and her pulse rate has increased from 70 to 80 beats per minute.  These findings would be considered normal at this time in pregnancy.
A)	True
B)	False

25.	The clinic nurse explains to the new nurse that during pregnancy, the maternal metabolism is altered to support the pregnancy by the hormones ___________ and ________ , which are produced by the anterior ______ gland.

26.	During the prenatal class, the perinatal nurse describes factors that may initiate the process of labor.  One of these factors is the production of _______, which are found in the uterine _______ and are released from the _______at term as it softens and dilates.

27.	The perinatal nurse describes common complaints of pregnancy to the prenatal class attendees.  Nasal _______, medically termed “_______ of pregnancy”, is caused by increased levels of estrogen and progesterone.

28.	The clinic nurse talks with Becky, a 16-year-old woman who is now 28 weeks gestation.  Today's visit is only the second prenatal appointment that Becky has kept. The nurse wonders if Becky's failure to come for routine prenatal checks is, in part, related to an adolescent's orientation to the ________, rather than to the _________.

29.	According to Rubin, the mother-to-be needs to accept the pregnancy and incorporate it into her own reality and _______________.  This process is known as “______________”.

Answer Key

1.	D
2.	A
3.	B
4.	C
5.	A, B, D
6.	A, B, C
7.	A, B, C
8.	A, B, C
9.	B, C, D
10.	A, D
11.	C, D
12.	A, B, C, D
13.	A, B, D
14.	A, B, C
15.	A, C, D
16.	A, B, C
17.	Epulis gravidarum
18.	Lumbar lordosis
19.	Ptyalism
20.	Pyrosis
21.	Pruritis gravidarum
22.	Epistaxis
23.	A
24.	A
25A.	thyrotropin
25B.	adrenotropin
25C.	pituitary
26A.	prostaglandins
26B.	decidua; lining
26C.	cervix
27A.	stuffiness
27B.	rhinitis
28A.	present
28B.	future
29A.	self-concept
29B.	binding in