NR-327 Maternal-Child Nursing - Set 1 - Part 2

Correct Answer: Explain that these symptoms are a recognized response

Couvade syndrome describes a partner who develops physical symptoms mirroring the pregnancy. It is common, unconscious and harmless, and it often marks deep involvement, so normalizing it is the right response. Option a is incorrect because pulling away would undo the very involvement these symptoms reflect. Partners who attend visits and share the experience adapt better and support the client more effectively. Option b is incorrect because an extensive workup is unnecessary for a familiar, benign pattern and may frighten a partner who is coping well. A brief history is enough to rule out other causes. Option d is incorrect because nothing about mirrored nausea or backache suggests disease, and framing it that way creates alarm where none belongs. The pattern resolves on its own after the birth.

Correct Answer: Placental lactogen, which antagonizes maternal insulin

Human placental lactogen rises as the placenta grows and blocks maternal insulin so glucose stays available for the fetus. That resistance is why screening happens in the second trimester. Option a is incorrect because chorionic gonadotropin peaks near the end of the first trimester and then falls away. Its work is sustaining early progesterone, not shifting how maternal tissues respond to insulin. Option b is incorrect because progesterone slackens smooth muscle, which explains heartburn, constipation, and urinary stasis. Slowed motility does not raise circulating glucose or blunt the action of insulin at the cell. Option c is incorrect because estrogen drives uterine enlargement, breast duct growth, and mucous membrane vascularity. None of those effects involve carbohydrate handling, so an abnormal screening result points elsewhere.

Correct Answer: Softening of the lower uterine segment

Softening and compressibility of the isthmus is Hegar sign, which the examiner elicits directly. Objective examination findings like this one sit in the probable group, since a tumor could also soften tissue. Option b is incorrect because tiredness has a long list of causes, including anemia, thyroid disease and depression. Nothing about it can be measured by the examiner, so it never rises above presumptive. Option c is incorrect because sore, heavier breasts are something the client feels, and the same sensation arrives before many menstrual periods or with oral contraceptives. Subjective complaints stay in the presumptive group. Option d is incorrect because pigment change in the areolae follows melanocyte stimulation that hormonal contraception can also produce. The client notices the change herself, which keeps this finding presumptive.

Correct Answer: Major organs are being formed during those weeks

Organogenesis runs through the embryonic period, so an insult arriving while a structure is being laid down can delete or deform it permanently. That window carries the highest risk of major malformation. Option a is incorrect because the fastest weight gain belongs to the third trimester, when the fetus lays down fat and muscle. Rapid growth late in pregnancy produces restriction, not missing or deformed organs. Option b is incorrect because maternal drug clearance actually speeds up as renal blood flow rises in pregnancy. Danger here comes from what the embryo is doing, not from how long the drug lingers. Option d is incorrect because the placenta never filters lipid soluble agents such as this one, at any gestational age. Its barrier is selective and incomplete from the first villi onward.

Correct Answer: "Seeing the baby on the ultrasound will prove it."

Seeing the fetus on ultrasound is one of the three positive signs, along with fetal heart tones heard through a device and fetal movement felt by the examiner. Nothing else confirms a pregnancy. Option a is incorrect because nausea in early pregnancy tracks rising human chorionic gonadotropin, yet gastroenteritis, food poisoning and medication produce identical symptoms. A sensation the client alone reports remains presumptive. Option c is incorrect because the hormone measured by that test also rises with molar pregnancy and with hormone-secreting tumors. A positive result therefore ranks as probable, one step below proof. Option d is incorrect because Chadwick sign reflects venous congestion in the pelvis, something an ovarian mass can imitate. An examiner observes it, so it belongs with the probable findings.

Correct Answer: A forward shift in her center of gravity

The enlarging uterus moves the center of gravity forward, and the client answers with an exaggerated lumbar curve and a wider stance. Backache, a waddling gait and poorer balance follow. Option a is incorrect because the lumbar spine curves more deeply instead of shortening. That exaggerated curve, called lordosis, strains the paraspinal muscles and produces the ache she describes. Option b is incorrect because muscle strength is preserved in an uncomplicated pregnancy, and many clients stay active until birth. Posture changed because the load moved forward, not because the legs weakened. Option c is incorrect because relaxin widens the pelvis rather than narrowing it, loosening the symphysis pubis and sacroiliac joints for birth. A smaller pelvis would not explain the altered gait.

Correct Answer: She has not formed antibodies against fetal cells

Typing identifies the client who lacks the D antigen, and a negative screen shows her immune system has not yet reacted to fetal red cells. That combination is what makes prevention possible. Option a is incorrect because fetal anemia follows sensitization, and this client shows no antibodies at all. Being Rh negative alone harms nothing; the danger begins only after maternal antibody forms. Option c is incorrect because an Rh negative person can certainly receive matched blood. Typing in pregnancy exists to protect the fetus from red cell destruction, not to rule the client out of transfusion. Option d is incorrect because a positive screen, not a negative one, would mark her as already sensitized. Prior exposure would show up as circulating antibody, and prevention would no longer be an option.

Correct Answer: "I will assume the baby is asleep if I feel nothing all day."

Sleep cycles last minutes to an hour, not a whole day. A full day without movement demands evaluation, and treating silence as normal sleep is the misunderstanding most likely to delay care. Option a is incorrect because side lying after eating is the recommended position and timing for counting. Blood sugar rises and uteroplacental flow improves, so movements are easiest to feel then. Option b is incorrect because that threshold is precisely what the teaching specifies. Fewer than ten movements within a two hour window is the trigger for calling, so she has repeated it accurately. Option d is incorrect because a consistent daily hour makes a change in the baby's pattern easier to notice. Choosing a regular time strengthens the practice instead of revealing any gap in her learning.

Correct Answer: Defects of the neural tube such as spina bifida

Folic acid taken before conception and in early pregnancy lowers the risk of neural tube defects, because the neural tube closes near the end of the first month, often before pregnancy is recognized. Option b is incorrect because orofacial clefting arises from failed fusion of the facial processes, a problem folic acid has not been shown to prevent reliably. Prenatal vitamins are not marketed for that purpose. Option c is incorrect because clubfoot usually reflects mechanical positioning or an underlying neuromuscular condition rather than a vitamin deficit. No supplement corrects the foot position, and treatment after birth relies on serial casting. Option d is incorrect because cardiac malformations develop during the same weeks yet trace to genetic and multifactorial causes, not to placental blood flow. Folate supplementation targets closure of the spine and skull instead.

Correct Answer: Prolactin is blocked by placental progesterone until birth

Prolactin climbs steadily through pregnancy but placental progesterone keeps it from producing milk. Once the placenta is delivered, progesterone falls sharply and prolactin is free to start full lactation. Option a is incorrect because the ducts are open, which is exactly why colostrum appears at the nipple. What holds back true milk is the hormonal brake supplied by the placenta. Option b is incorrect because suckling does trigger oxytocin and the let-down reflex, yet that reflex only moves milk that already exists. The block on making milk is hormonal, not mechanical. Option c is incorrect because colostrum forms during the second trimester in many clients and can often be expressed then. Estrogen supports ductal growth instead of preventing this early secretion.

Correct Answer: Placental hormones increasingly oppose the action of insulin

Human placental lactogen, cortisol, progesterone and estrogen all antagonize insulin, and their levels climb with placental mass. Maternal cells resist insulin so glucose stays in the blood and crosses to the fetus. Option a is incorrect because the pancreas keeps working and usually raises output to meet the extra demand. Gestational diabetes appears only when that increase cannot keep pace with the resistance. Option c is incorrect because glucose crosses the placenta toward the fetus, following a gradient from higher maternal levels. Nothing sends sugar back the other way to raise her readings. Option d is incorrect because filtration rises in pregnancy, which is why sugar often spills into the urine. More glucose is lost through the kidney, so renal handling cannot explain higher blood levels.

Correct Answer: Estrogen, which increases mucous membrane vascularity

Estrogen swells and engorges mucous membranes throughout the body, so the nasal passages block and the gums bleed easily. The same hormone raises clotting factors and increases the vaginal discharge. Option a is incorrect because relaxin works on collagen in the pelvic joints and cervix, loosening ligaments and producing the waddling walk. It leaves the vascular supply of mucous membranes untouched. Option b is incorrect because smooth muscle relaxation shows up as heartburn, sluggish bowels, and dilated ureters. A bleeding gum line comes from engorged capillaries, which is a vascular change rather than a muscular one. Option d is incorrect because placental lactogen drives lipolysis and insulin resistance so the fetus receives glucose. Metabolic shifts of that kind do not engorge capillaries in the nose or mouth.

Correct Answer: Nesting, an expected sign of readiness for birth

A burst of cleaning and organizing near term is nesting, a normal part of preparing for parenthood. It signals readiness and often appears in the last weeks before labor begins. Option b is incorrect because a client who rejects a pregnancy avoids preparation rather than throwing herself into it. Washing infant clothes points toward acceptance and toward making room for the baby. Option c is incorrect because worry about labor and about the newborn's health is expected this late, and purposeful household work is not evidence of a disorder. Referral would be premature here. Option d is incorrect because preterm labor announces itself through regular contractions, low backache, pelvic pressure and changed discharge. Energetic housework carries no such warning and precedes term birth in many clients.

Correct Answer: Binding-in to the baby as a person

Quickening turns an abstract pregnancy into a separate person, and the client responds by naming, imagining and talking to the baby. Rubin called this binding-in, and it accelerates through the second trimester. Option a is incorrect because accepting the pregnancy belongs to the first trimester, when the client is absorbed in her own body and says only that she is pregnant. Fantasy about a specific baby comes later. Option b is incorrect because seeking safe passage shows in keeping appointments, eating carefully and worrying about the birth itself. Imagining the baby's face reflects attachment rather than concern for safety. Option c is incorrect because arranging the nursery and stocking supplies is nesting, a third trimester activity tied to preparing for parenthood. Nothing in this stem describes work on the house.

Correct Answer: Problems such as preeclampsia appear late in pregnancy

The last weeks carry the highest risk of rising blood pressure, slowed fetal growth and early labor, and all three are caught by checks that repeat often. Close spacing buys time to act. Option a is incorrect because the interval comes from clinical guidelines about risk, not from a payer requirement. Framing care as paperwork gives the client no reason to value the appointments she is being asked to keep. Option b is incorrect because attendance has no effect on how long labor lasts. Prenatal visits detect problems early; they do not alter the mechanics of the labor that follows weeks later. Option d is incorrect because fundal height, fetal heart rate and presentation are all still assessed weekly until birth. Growth surveillance intensifies at this stage rather than stopping, particularly if the measurements have been drifting.

Correct Answer: Both are recorded under the abortion entry

The abortion entry gathers every pregnancy lost before twenty weeks, whether it ended on its own or was ended deliberately. Both events also raise gravidity, since each was a pregnancy she carried. Option a is incorrect because preterm covers births from twenty weeks to the end of the thirty-sixth week, a range neither of these losses reached. Placing them there would overstate how far each pregnancy went. Option b is incorrect because an elective termination counts exactly like a spontaneous loss in this system. Leaving it out would understate her gravidity and hide history the provider needs when assessing risk. Option c is incorrect because early losses are precisely what the fourth letter exists to capture. Ignoring them erases a pattern of recurrent loss that would otherwise prompt evaluation before or during this pregnancy.

Correct Answer: Human chorionic gonadotropin from the trophoblast

The trophoblast secretes chorionic gonadotropin almost from implantation, which is what every pregnancy test measures. That same hormone rescues the corpus luteum so progesterone continues until the placenta takes over. Option a is incorrect because placental lactogen antagonizes insulin to spare glucose for the fetus and climbs with placental mass. No pregnancy test measures it, and it does nothing for the corpus luteum. Option c is incorrect because estriol synthesis depends on a working fetal adrenal gland and liver, which makes it a marker of fetal wellbeing later on. Early urine tests do not look for it. Option d is incorrect because relaxin softens the cervix and loosens pelvic joints, producing the waddling gait of later pregnancy. Its actions are mechanical and have nothing to do with a urine assay.

Correct Answer: Swordfish, king mackerel, and tilefish

Methylmercury concentrates in large predatory fish, and swordfish, king mackerel, and tilefish carry the highest loads. The metal crosses the placenta and injures the developing brain, so these species are removed entirely. Option b is incorrect because these are the low mercury choices actively encouraged, and canned light tuna sits well below albacore. Clients are urged to eat several ounces of such fish each week. Option c is incorrect because white fleshed species low on the food chain accumulate little mercury. Removing them would strip protein and omega three fats from the diet without reducing any real exposure. Option d is incorrect because shellfish and small bottom feeders of this kind appear on the recommended list rather than the restricted one. Their short lifespan keeps tissue mercury too low to matter.

Correct Answer: Quickening as fetal movement becomes perceptible

Quickening is the first maternal perception of fetal movement, felt near sixteen weeks by a woman who has been pregnant before and closer to twenty weeks in a first pregnancy. Option a is incorrect because lightening happens near term, when the presenting part drops into the pelvis and breathing eases. A client in the middle of the second trimester is far too early for it. Option c is incorrect because ballottement is something an examiner elicits by tapping the cervix and feeling the fetus float back. The client herself cannot produce or report that rebound. Option d is incorrect because engagement describes the widest diameter of the presenting part passing the pelvic inlet, an event assessed by the examiner during late pregnancy or labor rather than felt as flutters.

Correct Answer: Pain that is steady and comes with fever

Round ligament pain is fleeting, one sided, and provoked by movement. Pain that persists or arrives with fever, bleeding, or a rhythmic pattern points toward infection, appendicitis, or preterm labor and needs evaluation. Option a is incorrect because flexing the knees toward the abdomen is one of the taught relief measures, so improvement with that position supports the benign explanation rather than undermining it. Option b is incorrect because brevity is a defining feature of this ligament stretch. A stab that ends within seconds fits the pattern exactly, and it is duration that separates benign from worrisome. Option c is incorrect because coughing and sudden turning are classic triggers, since both jerk the stretched ligament. Naming a trigger describes the usual presentation and gives the nurse no reason to look further.