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1 Marks: 1 What is the endometrium called after implantation? Choose one answer.

a.Decidua basalis

b.Mesoderm c.Endoderm d.Decidua After implantation, the endometrium is called the decidua. The portion directly under the blastocyst, where the chorionic villi tap into the maternal blood vessels, is the decidua basalis. The ectoderm, mesoderm and endoderm refers to the primary germ layers of the embryonic disk. (Lowdermilk & Perry, 2007)

Correct Marks for this submission: 1/1. Question2 Marks: 1 Premature rupture of membranes is spontaneous rupture of the membranes prior to the onset of labor. Which of the following is a priority nursing diagnosis in the event that PROM occurs? Choose one answer.

a. Risk for ineffective individual coping

b. Risk for infection c. Impaired gas exchange in the fetus Maternal risk of infection increases as does the risk of abruption placentae. Fetalnewborn implications include risk of respiratory distress syndrome, fetal sepsis due to ascending pathogens, malpresentation, prolapse of the umbilical cord and increased perinatal morbidity and mortality. (London et. Al., 2007)

d. Acute pain Correct Marks for this submission: 1/1. Question3 Marks: 1 Who is at increased risk for gestational diabetes mellitus? Choose one answer.

a. Beth, 30-year old G1P0 mother, who had a previous history of GDM b. Charlene, 28-year old G1P1 mother, who is classified as Obese II

c. Anna, 35-year old G2P2 mother, who has a family history of diabetes d. All of the choices Gestational diabetes mellitus is defined as any degree of glucose intolerance that has its onset or is first diagnosed during pregnancy. Women who are markedly obese, have a prior history of GDM, have glycosuria or have a strong family of diabetes are at high risk. The woman may remain asymptomatic or may have a mild form of the disease. Diagnosis of GDM is very important because even mild diabetes causes increased risk for perinatal morbidity and mortality. (London et. Al., 2007)

Correct Marks for this submission: 1/1. Question4 Marks: 1 Which of the following statements about the yolk sac is true? Choose one answer. The yolk sac aids in transferring maternal nutrients and oxygen, which have diffused through the chorion, to the embryo. Blood vessels form to aid transport. The manufacture of blood cells and plasma or hematopoiesis occurs in the yolk sac during the second and third weeks. The folding in of the embryo during the fourth week results in incorporation of part of the yolk sac into the embryos body as the primitive digestive system. Primordial germ cells arise in the yolk sac and move into the embryo. The shrinking remains of the yolk sac degenerate and by the fifth or sixth week, the remnant has separated from the embryo. (Lowdermilk & Perry, 2007)

a. All of the choices

b. Part of the yolk sac becomes incorporated into the primitive digestive system of the embryo by the fourth week c.Hematopoiesis occurs in the yolk sac. d. The yolk sac aids in transferring maternal nutrients and oxygen to the embryo Correct Marks for this submission: 1/1. Question5 Marks: 1 Vitamins are organic substances needed for life and growth. These vitamins serve as vital coenzyme factors in many reactions such as cell respiration, glucose oxidation and energy metabolism:

Choose one answer.

a.Vitamin C The B vitamins include thiamine (B1), riboflavin (B2), niacin, folic acid, pantothenic acid, vitamin B6 and vitamin B12. These vitamins serve as vital coenzyme factors in many reactions such as cell respiration, glucose oxidation and energy metabolism. The quantities needed increase as caloric intake increases to meet the metabolic and growth needs of the pregnant woman. (London et. Al., 2007)

b. B vitamins

c.Vitamins A, D, E, K d. All of the choices Correct Marks for this submission: 1/1. Question6 Marks: 1 Fundal height may be used as an indicator of uterine size. How do you determine the fundal height? Choose one answer. a. Place a tape measure from the top of the symphysis pubis to the umbilical cord. b. Place a tape measure from the center of the abdomen to the umbilical cord. c. Place a tape measure from the umbilical cord to the symphysis pubis. d. Place a tape measure from the top of the symphysis pubis to the Fundal height in centimeters correlates well with weeks of gestation between 22 to 24 weeks and 34 weeks. A centimeter tape is used to measure the distance abdominally from the top of the symphysis pubis to top of the uterine fundus. the top of the uterine fundus. (London et. Al., 2007) Correct Marks for this submission: 1/1. Question7 Marks: 1 Which of the following statements is incorrect with regards to pregnant women diagnosed with hyperthyroidism? Choose one answer.

a.Propylthiouracil is not excreted in breast milk, so mothers may still choose to breastfeed

Graves disease is the most common cause of hyperthyroidism in pregnant women. The primary treatment of hyperthyroidism during pregnancy is drug therapy; the medication of choice is propylthiouracil (PTU). Moderate and severe hyperthyroidism must be treated during pregnancy; untreated or inadequately treated women have an increased risk of preterm birth, stillborns, fetal goiter, and fetal hypothyroidism or hyperthyroidism. Women with hyperthyroidism are also at increased risk to develop severe preeclampsia. Radioactive iodine must not be used in the diagnosis or treatment of hyperthyroidism in pregnancy because it may compromise the fetal thyroid. Mothers choosing to breastfeed who are also taking hyperthyroid medication need to be instructed that small amounts are excreted in breast milk. (Lowdermilk & Perry, 2007)

b. The primary treatment of hyperthyroidism during pregnancy is drug therapy

c. Women with hyperthyroidism are at increased risk to develop severe preeclampsia d. Radioactive iodine must not be used in the diagnosis or treatment of hyperthyroidism in pregnancy Correct Marks for this submission: 1/1. Question8 Marks: 1 Labor that occurs between 20 and 37 completed weeks of pregnancy is called preterm labor. Tocolysis is the use of medications in an attempt to stop labor. All of the following are tocolytic drugs except: Choose one answer. Drugs currently used as tocolytics include beta adrenergic agonists (also called beta mimetics), magnesium sulfate, prostaglandin synthetase inhibitors, and calcium channel blockers. The beta mimetics (ritodrine and terbutaline sulfate) and magnesium sulfate are the most widely used tocolytics. Nifedipine, a calcium channel blocker, is becoming increasingly popular as a tocolytic because it is easily administered orally or sublingually and has few serious maternal side effects. Prostaglandin synthesis inhibitors such as indomethacin are being used for tocolysis in selected instances. Methyldopa is often used for long-term control of mild to moderate hypertension in pregnancy because it is safe and effective. (London et. Al., 2007)

a.Methyldopa

b.Indomethacin c. Ritodrine d. Nifedipine Correct Marks for this submission: 1/1.

Question9 Marks: 1 The following hormones are produced by the placenta except: Choose one answer.

a. Human chorionic gonadotropin (hCG)

b.Progesterone c. Oxytocin The placenta produces hormones vital to survival of the fetus. These include human chorionic gonadotropin (hCG), human placental lactogen (hPL), and two steroid hormones, estrogen and progesterone. (London, et. Al., 2007)

d. Human placental lactogen (hPL) Correct Marks for this submission: 1/1. Question10 Marks: 1 Which of the following is not considered as a maternal complication caused by gestational diabetes mellitus? Choose one answer. The development of congenital anomalies is a fetal-neonatal risk, not a maternal risk. Hydramnios, or an increase in the volume of amniotic fluid is thought to be a result of excessive fetal urination because of fetal hyperglycemia. Premature rupture of membranes and onset of labor may occasionally be a problem with hydramnios. Preeclampsiaeclampsia occurs more often in diabetic pregnancies, especially when vascular changes already exist. Hyperglycemia can lead to ketoacidosis as a result of the increase in ketone bodies released in the blood from the metabolism of fatty acids. Decreased gastric motility and the antiinsulin effects of hPL also predispose the woman to ketoacidosis. (London et. Al., 2007)

a. Congenital anomalies

b.Preeclampsia-eclampsia c.Ketoacidosis d. Hydramnios Correct Marks for this submission: 1/1. Question11 Marks: 1

Which of the following pairs illustrate a correct pairing of the immunoglobulin and its description? i. IgG lines mucous membranes and protects body surfaces ii. IgD assists in the differentiation of B lymphocytes iii. IgE causes symptoms of allergic reactions iv. IgA is the only immunoglobulin that crosses the placenta and is responsible for the secondary immune response v. IgM is responsible for the primary immune response Choose one answer.

a. i, iv and v

b. i, ii and iv c. ii, iv and v d. ii, iii and v During the third trimester, albumin and globulin are present in the fetus. The only immunoglobulin that crosses the placenta, IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM in response to blood group antigens, gram-negative enteric organisms, and some viruses. IgA lines mucous membranes and protects body surfaces. IgD is present on lymphocyte surface and assists in the differentiation of B lymphocytes. IgE causes symptoms of allergic reactions and assists in defense against parasitic infections. (Lowdermilk & Perry, 2007)

Correct Marks for this submission: 1/1. Question12 Marks: 1 Which of the following is the earliest biochemical marker for pregnancy? Choose one answer.

a. Estrogen Human chorionic gonadotropin is the earliest biochemical marker for pregnancy and pregnancy tests are based on the recognition of hCG or a beta subunit of hCG. Production of beta-hCG begins as early as the day of implantation and can be detected as early as 7 to 10 days after conception. The level of hCG increases until it peaks at about 60 to 70 days of gestation and then declines until about 80 days of pregnancy. (Lowdermilk & Perry, 2007)

b. Human chorionic gonadotropin

c. Human placental lactogen d. Oxytocin Correct Marks for this submission: 1/1. Question13

Marks: 1 Certain exercises help strengthen muscle tone in preparation for birth and promote more rapid restoration of muscle tone after birth. This type of exercise strengthens the pubococcygeus muscle and increases its elasticity. It is also known as perineal muscle tightening. Choose one answer.

a. Pelvic tilt

b. Inner thigh exercises c.Abdominal exercises d. Kegel exercises Perineal muscle tightening, also called Kegel exercises, strengthens the pubococcygeus muscle and increases its elasticity. The woman can feel the specific muscle group to be exercised by stopping urination midstream. Doing Kegel exercises while urinating is discouraged, however, because this practice has been associated with urinary stasis and urinary tract infection. (London et. Al., 2007)

Correct Marks for this submission: 1/1. Question14 Marks: 1 Changes in skin pigmentation commonly occur during pregnancy. Which of the following refers to reddish, wavy streaks that may appear on the abdomen, thighs, buttocks and breasts that result from reduced connective tissue strength due to elevated adrenal steroid levels? Choose one answer.

a. Spider nevi The linea nigra is a pigmented line in the middle of the abdomen which usually extends from the pubic area to the umbilicus or higher. Facial chloasma (melasma gravidarum)is a darkening of the skin over the forehead and around the eyes. Vascular spider nevi are small, bright red elevations of the skin radiating from a central body which may develop on the chest, neck, face, arms and legs. They may be caused by increased subcutaneous blood flow in response to elevated estrogen levels. (London et. Al., 2007)

b. Striae gravidarum

c. Melasma gravidarum d. Linea nigra Correct Marks for this submission: 1/1. Question15 Marks: 1

Changes in the endocrine system of a pregnant woman include the following except: Choose one answer. During pregnancy, gland activity and hormone production increase. Parathyroid hormone controls calcium and magnesium metabolism. Pregnancy induces a slight hyperparathyroidism, a reflection of increased fetal requirements for calcium and vitamin D. There is a moderate enlargement of the thyroid gland caused by hyperplasia of the glandular tissue and increased vascularity. The elevated levels of estrogen and progesterone suppress secretion of folliclestimulating hormone and luteinizing hormone by the anterior pituitary. Serum prolactin produced by the anterior pituitary begins to increase early in the first trimester and increases progressively to term. It is responsible for initial lactation. (Lowdermilk & Perry, 2007)

a. Serum prolactin is produced in the second trimester

b. There is a moderate enlargement of the thyroid gland c. The secretion of the follicle-stimulating hormone and the luteinizing hormone is suppressed d. Pregnancy induces a slight hyperparathyroidism Correct Marks for this submission: 1/1. Question16 Marks: 1 Which of the following correctly describes Goodell sign? Choose one answer.

a. Softening of the uterine isthmus b. White or slightly gray mucoid discharge with a faint musty odor

c. Softening of the cervical tip

A softening of the cervical tip called Goodell sign may be observed about the beginning of the sixth week in a normal, unscarred cervix. At approximately 6 weeks of gestation , softening and compressibility of the lower uterine segment (uterine isthmus) may occur and this is known as the Hegar sign. Uterine contractions felt through the abdominal wall soon after the fourth month of pregnancy are known as Braxton Hicks contractions. Leucorrhea is a white or slightly gray mucoid discharge with a faint musty odor and it occurs in response to cervical stimulation by estrogen and progesterone. (Lowdermilk & Perry, 2007)

d. Uterine contractions felt through the abdominal wall Correct Marks for this submission: 1/1.

Question17 Marks: 1 The following statements regarding the fetal gastrointestinal system are correct except: Choose one answer. a. Esophageal atresia is a malformation in the development of the foregut.

b. The hindgut develops into the distal half of the colon, the rectum and parts of the anal canal, the urinary bladder and the urethra. c. The midgut becomes the distal half of the duodenum, the jejunum and ileum, the cecum and appendix and the proximal half of the colon. d. The gastrointestinal system matures by 26 weeks. The foregut produces the pharynx, part of the lower respiratory tract, the esophagus, the stomach, the first half of the duodenum, the liver, the pancreas and the gallbladder. These structures evolve during the fifth and sixth weeks. Malformations that occur in these areas include esophageal atresia, hypertrophic pyloric stenosis, duodenal stenosis or atresia and biliary atresia. The midgut becomes the distal half of the duodenum, the jejunum and ileum, the cecum and appendix and the proximal half of the colon. Meckels diverticulum is the most common malformation of the midgut. The hindgut develops into the distal half of the colon, the rectum and parts of the anal canal, the urinary bladder and the urethra. Anorectal malformations are the most common abnormalities of the digestive system. The gastrointestinal system is mature by 36 weeks. (Lowdermilk & Perry, 2007)

Correct Marks for this submission: 1/1. Question18 Marks: 1 Heartburn is the regurgitation of acidic gastric contents into the esophagus. Which of the following is inappropriate when teaching a pregnant mother about heartburn relief? Choose one answer.

a. Antacids containing magnesium can cause constipation b. Sodium bicarbonate should be avoided because it may lead to electrolyte imbalance Liquid forms of low-sodium antacids are often most effective in providing relief from heartburn. The nurse should advise women that antacids containing aluminum may cause constipation, and antacids containing magnesium can cause diarrhea. The nurse should also inform the client that she should avoid sodium bicarbonate (baking soda) because they may lead to electrolyte imbalance. (London et. Al., 2007)

c. Antacids that contain aluminum may cause diarrhea

d. None of the choices. Correct Marks for this submission: 1/1. Question19 Marks: 1 Many respiratory changes occur to meet the increased oxygen requirements of a pregnant woman. Which of the following changes occur in the respiratory system of a pregnant woman? Choose one answer.

a. All of the choices

b. Breathing changes from thoracic to abdominal c. The anteroposterior diameter decreases d.Progesterone decreases airway resistance The anteroposterior diameter increases and the chest circumference expands by as much as 6cm. Breathing changes from abdominal to thoracic as pregnancy progresses , and descent of the diaphragm on inspiration becomes less possible. Progesterone decreases airway resistance, permitting a 15% to 20% increase in oxygen consumption, as well as increases in carbon dioxide production and in the respiratory functional reserve. (London et. Al., 2007)

Correct Marks for this submission: 1/1. Question20 Marks: 1 Which of the following illustrates the ideal weight gain pattern during pregnancy? Choose one answer. a. 3.5lb to 5lb during the first trimester, 1lb per week during the second and third trimesters Maternal weight gain is an important factor in fetal growth and infant birth weight. For a normal weight woman, the ideal pattern of weight gain during pregnancy is a gain of 3.5lb to 5lb (1.6kg to 2.3kg) during the first trimester, followed by a gain of about 1lb (0.5kg) per week during the second and third trimesters. (London et. Al., 2007)

b. 1lb per week during the first trimester and 3.5lb to 5lb in total during the second and third trimesters c. 1lb during the first trimester, 3lbs per week during the second and third trimesters d. 3.5lb to 5lb during the first trimester and 3lbs in total during the second and

third trimesters Correct Marks for this submission: 1/1. Question21 Marks: 1 Which of the following statements about maternal and fetal nutrition is incorrect? Choose one answer.

a. The need for sodium increases during pregnancy b. There is no increase in the daily recommended intake of calcium during pregnancy and lactation, in comparison with the recommendation for the nonpregnant woman c. Zinc deficiency is associated with malformations of the gastrointestinal system in infants Fat-soluble vitamins A, D, E and K are stored in the body tissues. With chronic overdoses, these vitamins can reach toxic levels. Because of the high potential for toxicity, pregnant women are advised to take fat-soluble vitamin supplements only as prescribed. During pregnancy, the need for sodium increases slightly, primarily because the body water is expanding. Sodium is essential for maintaining body water balance. There is no increase in the DRI of calcium during pregnancy and lactation, in comparison with the recommendation for the nonpregnant woman. The DRI appears to provide sufficient calcium for fetal bone and tooth development to proceed while maternal bone mass is maintained. Zinc deficiency is associated with malformations of the central nervous system in infants. (Lowdermilk & Perry, 2007)

d. Chronic overdoses of the fat-soluble vitamins can lead to toxicity and are therefore supplemented only as prescribed Correct Marks for this submission: 1/1. Question22 Marks: 1 Preeclampsia is the most common hypertensive disorder in pregnancy. Which of the following are important assessment parameters for a client with preeclampsia? i. Vaginal bleeding and uterine rigidity ii. Level of consciousness iii. Fetal heart rate iv. Deep tendon reflexes Choose one answer.

a. i, ii and iii

b. ii, iii and iv

c. i and iii only d. i, ii, iii and iv Vaginal bleeding and uterine rigidity may indicate placental separation. Observe the womans level of consciousness: alertness, mood changes and any signs of impending convulsion. Check the fetal heart rate with the blood pressure, or monitor continuously with the electronic fetal monitor. Assess the woman for evidence of hyperreflexia in the brachial, wrist, patellar or or Achilles tendons. (London et. Al., 2007)

Correct Marks for this submission: 1/1. Question23 Marks: 1 Which of the following statements regarding herpes simplex virus infection of the newborn is true? Choose one answer.

a. After 2 to 12 days, the infant develops jaundice and seizures

b. The infant develops vesicular skin lesions c. All of the choices Transmission of herpes simplex infection almost always occurs after the membranes rupture and the virus ascends or during birth through an infected birth canal. The infected infant is asymptomatic at birth but develops symptoms of fever (or hypothermia), jaundice, seizures and poor feeding after an incubation period of 2 to 12 days. Approximately half of infected infants develop the characteristic vesicular skin lesions. Infants who show signs of neonatal herpes should be evaluated promptly and treated with intravenous acyclovir. (London et. Al., 2007)

d. The infected infant is asymptomatic at birth Correct Marks for this submission: 1/1. Question24 Marks: 1 Ectopic pregnancy is the implantation of the fertilized ovum in a site other than the endometrial lining of the uterus. Which of the following indicate the possibility of an ectopic pregnancy in a woman? Choose one answer.

a. Nausea As the pregnancy progresses, the chorionic villi grow into the tube wall or implantation site and establish a blood supply. When the embryo outgrows this space, the tube ruptures and there is bleeding into the abdominal cavity. Physical examination usually reveals adnexal tenderness or pain on the area over each ovary and fallopian tube. An adnexal mass is palpable about half the

b. Adnexal tenderness

time. Bleeding tends to be slow and chronic, and the abdomen gradually becomes rigid and very tender. With bleeding into the abdominal cavity, pelvic examination is very painful, and a mass of blood may be palpated in the lower abdomen. (London et. Al., 2007)

c. Breast tenderness d.Amenorrhea Correct Marks for this submission: 1/1. Question25 Marks: 1 The following are probable signs of pregnancy except: Choose one answer.

a. Hegar sign Three commonly used signs and symptoms of pregnancy are presumptive (those felt by the woman: amenorrhea, fatigue, nausea and vomiting, breast changes); probable (those changes observed by an examiner: (Hegar sign, ballottement, pregnancy tests); and positive (those signs that are attributable only to the presence of the fetus: hearing fetal heart tones, visualization of the fetus, and palpating fetal movements). (Lowdermilk & Perry, 2007)

b.Amenorrhea

c.Pregnancy test d.Ballottement Correct Marks for this submission: 1/1. Question26 Marks: 1 All of the following are implications of iron deficiency anemia on a pregnant woman except: Choose one answer.

a. Easy fatigability

b. Increased susceptibility to infection

c. Increased risk for pre-eclampsia and eclampsia d. None of the choices Iron deficiency anemia is generally defined as a decrease in the oxygencarrying capacity of the blood. Pregnant women with iron deficiency anemia tires easily, is more susceptible to infection, had increased chance of preeclampsia, eclampsia and postpartal hemorrhage, and cannot tolerate even minimal blood loss during birth. Healing of episiotomy or incision may be delayed. Fetal implications include risk of low birth weight, prematurity, stillbirth, and neonatal death increases. Fetus may be hypoxic during labor due to impaired uteroplacental oxygenation. (London et. Al., 2007)

Correct Marks for this submission: 1/1. Question27 Marks: 1 The following changes can be observed in the vagina during pregnancy except: Choose one answer.

a. There is a thickening of the vaginal mucosa

b. The connective tissue in the vagina loosens c. The secretions in the vagina become basic Estrogen causes a thickening of the vaginal mucosa, a loosening of the connective tissue and an increase in vaginal secretions. These secretions are thick, white and acidic (pH 3.5 to 6.0). The acid pH helps prevent bacterial infection but favors the growth of yeast organisms. Thus, the pregnant woman is more susceptible to monilial infection that usual. (London et. Al., 2007)

d. There is an increase in vaginal secretions Correct Marks for this submission: 1/1. Question28 Marks: 1 A fetus may be exposed to HIV through which of the following mechanisms? i. Maternal circulation as early as the first trimester of pregnancy ii. During labor and birth by inoculation or ingestion of maternal blood iii. Through breast milk Choose one answer.

a. ii and iii only

b. ii only c. i and ii only d. i, ii and iii Pregnancy is not encouraged in HIV-positive women. Exposure may occur to the fetus through the maternal circulation as early as the first trimester of pregnancy, to the infant during labor and birth by inoculation or ingestion of maternal blood and other infected fluids, or to the infant through breast milk. (Lowdermilk & Perry, 2007)

Correct Marks for this submission: 1/1. Question29 Marks: 1 Leg cramps are painful muscle spasms in the gastrocnemius muscles. Which of the following is an inappropriate intervention for pregnant women experiencing leg cramps? Choose one answer. a. With the woman lying on her back, another person presses the womans knee down to straighten her leg while pushing her foot toward her leg

b. Massage and apply a warm compress on the legs c. Alternate squatting and standing up Extension of the foot can cause leg cramps. The exact cause of leg cramps is unknown but pressure of the enlarged uterus on pelvic nerves or blood vessels leading to the legs may be a contributing factor, especially during the third trimester. Stretching provides immediate relief of the muscle spasm. With the woman lying on her back, another person presses the womans knee down to straighten her leg while pushing her foot toward her leg. The woman may also stand and put her foot flat on the floor. Massage and warm packs can alleviate the discomfort of leg cramps. A diet that includes daily portions of both calcium and phosphorus may help prevent leg cramps. (London et. Al., 2007)

d. The woman stands and puts her foot flat on the floor Correct Marks for this submission: 1/1. Question30 Marks: 1 The following are functions of the amniotic fluid except: Choose one answer.

a. It acts as a cushion to protect against mechanical injury.

b. It permits symmetrical growth and development of the embryofetus. c. It acts as a wedge during labor. d. It adheres to the embryo-fetus to restrict movement. The primary functions of the amniotic fluid are to act as a cushion to protect against mechanical injury, help control the embryos temperature, permit symmetrical growth and development of the embryo-fetus, act as an extension of fetal extracellular space, prevent adherence of the amnion to the embryo-fetus to allow freedom of movement so that the embryo-fetus can change position, thus aiding in musculoskeletal development, allow the umbilical cord to be relatively free of compression, act as a wedge during labor and provide fluid for analysis to determine fetal health and maturity. (London, et. Al. 2007)

Correct Marks for this submission: 1/1. Question31 Marks: 1 Which of the following statements about the umbilical cord is true? Choose one answer. a. There is one large vein and one large artery in the umbilical cord.

b. The umbilical cord has both sensory and motor innervation. c. All of the choices. d.Whartons jelly surrounds the blood vessels in the umbilical cord. A specialized connective tissue, known as Whartons jelly surrounds the blood vessels in the umbilical cord. This tissue, plus the high blood volume pulsating through the vessels prevents compression of the umbilical cord in utero. The body stalk, which contains attaches the embryo to the yolk sac, contains blood vessels that extend into the chorionic villi. As the body stalk elongates to become the umbilical cord, the vessels in the cord decrease to one large vein and two smaller arteries. About 1% of umbilical cords have only two vessels, an artery and a vein; this condition may be associated with congenital malformations. The umbilical cord has no sensory or motor innervation. (London, et. Al., 2007)

Correct Marks for this submission: 1/1. Question32 Marks: 1 Which of the following statements about fertilization and conception is correct? Choose one answer.

a. All of the choices.

b.Fertilization is defined as the union of a single egg and sperm. c.Conception takes place in the ampulla of the uterine tube. d.Conception marks the beginning of a pregnancy Conception is defined as the union of a single egg and sperm and it marks the beginning of a pregnancy. Conception occurs not as an isolated event but as a part of a sequential process. This sequential process includes gamete formation, ovulation, union of the gametes and implantation in the uterus. Fertilization takes place in the ampulla (the outer third) of the uterine tube within 24 hours of ovulation. (Lowdermilk & Perry, 2007)

Correct Marks for this submission: 1/1. Question33 Marks: 1 Which of the following statements is not true regarding the fetal circulatory system? Choose one answer. a. The cardiovascular system is the first organ system to function in the developing human b. Oxygenated blood that is distributed to the fetus comes from the placenta c. The heart develops into a four-chambered organ by the fourth and fifth week of development d. The fetal lungs are able to perform respiratory gas exchange The cardiovascular system is the first organ system to function in the developing human. The maternal-placental-embryonic circulation is in place by day 17, when the embryonic heart starts beating. In the intervillous spaces, maternal blood supplies oxygen and nutrients to the embryonic capillaries in the villi. The fetal lungs do not function for respiratory gas exchange, so a special circulatory pathway, the ductus arteriosus, bypasses the lungs. Oxygen-rich blood from the placenta flows rapidly through the umbilical vein into the fetal abdomen. The heart develops into a four-chambered organ by the fourth and fifth week. (Lowdermilk & Perry, 2007)

Correct Marks for this submission: 1/1. Question34 Marks: 1

The effects of rubella on the fetus and newborn are great because rubella causes a chronic infection that begins in the first trimester of pregnancy and may persist for months after birth. The following are fetal-neonatal risks involved when the pregnant mother develops rubella except: Choose one answer.

a. Congenital cataracts

b. Patent ductus arteriosus c. Mental retardation d.Hydrocephalus The period of greatest risk for the effects of rubella on the fetus is the first trimester. The most common clinical signs of congenital infection include congenital cataracts, sensorineural deafness and congenital heart defects, particularly patent ductus arteriosus. Other abnormalities, such as mental retardation or cerebral palsy, may become evident in infancy. (London et. Al., 2007)

Correct Marks for this submission: 1/1. Question35 Marks: 1 The following cardiovascular changes may be seen in pregnancy except: Choose one answer. a. The blood volume starts to increase at about the tenth to twelfth week.

b. There is slight cardiac hypertrophy c. Diastolic blood pressure increases in the first trimester Systolic blood pressure usually remains the same as the prepregnancy level but may decrease slightly as pregnancy advances. Diastolic blood pressure begins to decrease in the first trimester , continues to drop until 24-32 weeks, then gradually increases and returns to prepregnancy levels by term. The blood volume starts to increase at about the tenth to twelfth week, peaks at about the thirty-second to thirty-fourth week and then decreases slightly at the fortieth week. Cardiac output is elevated largely as a result of the increased stroke volume and heart rate. Slight cardiac hypertrophy is probably secondary to the increased blood volume and cardiac output that occurs. (Lowdermilk & Perry, 2007)

d. The cardiac output is elevated Correct Marks for this submission: 1/1. Question36

Marks: 1 Which of the following are normal occurrences in the fetal reproductive system? i. Sex differentiation begins in the seventh week ii. At birth, the ovaries contain the females lifetime supply of ova iii. Mammary engorgement and secretion of witchs milk upon birth occurs in female newborns only iv. Pseudomenstruation Choose one answer.

a. i and iii only

b. i, ii and iii only c. i, ii and iv only Sex differentiation begins in the seventh week. Distinguishing characteristics appear around the ninth week and are fully differentiated by the twelfth week. At birth the ovaries contain the females lifetime supply of ova. The fetal endometrium responds to maternal hormones, and withdrawal bleeding or vaginal discharge (pseudomenstruation) may occur at birth when these hormones are lost. The high level of maternal estrogen also stimulates mammary engorgement and secretion of fluid (witchs milk) in newborn infants of both sexes. (Lowdermilk & Perry, 2007)

d. ii and iii only Correct Marks for this submission: 1/1. Question37 Marks: 1 Which of the following terms is correctly defined? Choose one answer. a. Gravidity refers to the number of pregnancies in which the fetus or fetuses have reached viability when they are born b. Primigravida refers to a woman who has completed one pregnancy with a fetus or fetuses who have reached the stage of fetal viability c. Nulligravida refers to a woman who is pregnant for the first time d. Viability refers to the capacity to live outside the uterus; about 22 to 24 weeks Viability refers to the capacity to live outside the uterus; about 22 to 24 weeks since LMP or fetal weight greater than 500g. Gravidity refers to pregnancy. Parity refers to the number of since LMP or fetal weight greater than 500g pregnancies in which the fetus or fetuses have reached viability when they are born. A nullipara is a woman who has never been pregnant. A primigravida refers to a woman who is pregnant for the first time. A primipara refers to a woman who has completed one pregnancy with a fetus or fetuses who have reached the stage of fetal viability. (Lowdermilk & Perry, 2007) Correct

Marks for this submission: 1/1. Question38 Marks: 1 All of the following are actions of progesterone on pregnancy except: Choose one answer. a. Together with estrogen, it causes fats to deposit in subcutaneous tissues over the maternal abdomen, back and upper thighs Progesterone is essential for maintaining pregnancy by relaxing smooth muscles, resulting in decreased uterine contractility and prevention of miscarriage. Progesterone and estrogen cause fat to deposit in subcutaneous tissues over the maternal abdomen, back and upper thighs. This fat serves as an energy reserve for both pregnancy and lactation. The enlargement of the genitals, uterus and breasts is caused by estrogen and this occurs through the increase in vascularity, thereby causing vasodilation. (Lowdermilk & Perry, 2007)

b. It promotes the enlargement of the genitals, uterus and breasts

c. None of the choices d. It relaxes smooth muscles Correct Marks for this submission: 1/1. Question39 Marks: 1 Which of the following discomforts is normally experienced by a pregnant woman on her first trimester: Choose one answer.

a.Heartburn

b. Supine hypotension c. Nausea and vomiting Nausea and vomiting occur during the first trimester and this may result from hormonal changes. Heartburns and supine hypotension occur during the second trimester. Heartburns are present because progesterone slows GI tract motility and digestion, reverses peristalsis, relaxes cardiac sphincter and delays emptying time of stomach. The stomach is also displaced upward as it is compressed by the enlarging uterus. Supine hypotension is induced by the pressure of the gravid uterus on the ascending vena cava when the woman is supine and this reduces uteroplacental and renal perfusion. (Lowdermilk & Perry, 2007)

d. Ankle edema

Correct Marks for this submission: 1/1. Question40 Marks: 1 The Estimated Date of Birth (EDB) is calculated using Nageles Rule. Which of the following correctly describes Nageles Rule? Choose one answer.

a. Subtract 7 calendar months from the LMP, add 3 days and 1 year b. Determine the first day of LMP, subtract 3 calendar months, add 7 days and 1 year Nageles Rule is as follows: after determining the first day of LMP, subtract 3 calendar months, add 7 days and 1 year; or alternatively, add 7 days to the LMP and count forward 9 calendar months. Nageles rule assumes that the woman has a 28-day menstrual cycle and that pregnancy occurred on the fourteenth day. Most women give birth during the period extending from 7 days before to 7 days after the EDB. (Lowdermilk & Perry, 2007)

c. Add 7 days to the LMP and count forward 8 calendar months d. Add 11 days to the LMP and count forward 9 calendar months

SOURCE: CARL BALITA ONLINE REVIEW