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VERSION 1
Antepartum (12 Questions)
Q1: A nurse is assessing a pregnant client at 28 weeks gestation. The client reports
feeling dizzy and lightheaded when lying flat on her back. Which physiologic change of
pregnancy is responsible for this symptom?
A. Increased progesterone causing smooth muscle relaxation
B. Compression of the vena cava by the gravid uterus
C. Increased blood volume causing hemodilution
D. Elevated hCG levels affecting blood pressure regulation
B. Compression of the vena cava by the gravid uterus. [CORRECT]
Correct Answer: B
Rationale: Supine hypotensive syndrome occurs when the gravid uterus compresses the
inferior vena cava and aorta, reducing venous return and cardiac output. This typically
occurs after 20 weeks gestation when the uterus rises out of the pelvis. The correct
intervention is to position the client on her left side to relieve compression. Option A is
incorrect because while progesterone does cause smooth muscle relaxation, it doesn't
cause positional hypotension. Option C is incorrect because increased blood volume
actually improves perfusion. Option D is incorrect because hCG peaks in the first
trimester and doesn't cause third-trimester hypotension.
,Q2: Using Nagele's rule, what is the estimated date of delivery (EDD) for a client whose
last menstrual period (LMP) began on March 10, 2026?
A. December 3, 2026
B. December 10, 2026
C. December 17, 2026
D. January 17, 2027
C. December 17, 2026. [CORRECT]
Correct Answer: C
Rationale: Nagele's rule calculates EDD by subtracting 3 months from the first day of the
LMP, adding 7 days, and adding 1 year. March 10 - 3 months = December 10; December
10 + 7 days = December 17; 2026 + 1 year = 2027 (but since we only advanced 7 days
within December, the year remains 2026). March 10, 2026 → December 17, 2026.
Option A subtracts 7 days instead of adding. Option B forgot to add the 7 days. Option D
incorrectly added the year before calculating the month adjustment.
Q3: A nurse is teaching a pregnant client about recommended weight gain during
pregnancy. The client has a pre-pregnancy BMI of 22 kg/m². How many pounds should
the nurse recommend this client gain during pregnancy?
A. 11-20 lbs
B. 15-25 lbs
C. 25-35 lbs
D. 28-40 lbs
C. 25-35 lbs. [CORRECT]
Correct Answer: C
,Rationale: The Institute of Medicine (IOM) guidelines recommend weight gain based on
pre-pregnancy BMI: Underweight (BMI <18.5): 28-40 lbs; Normal weight (BMI 18.5-24.9):
25-35 lbs; Overweight (BMI 25-29.9): 15-25 lbs; Obese (BMI ≥30): 11-20 lbs. This client
has a normal BMI of 22, so 25-35 lbs is appropriate. Option A is for obese clients.
Option B is for overweight clients. Option D is for underweight clients.
Q4: A nurse is caring for a client at 16 weeks gestation who asks when she should
expect to feel the baby move. Which response by the nurse is most accurate?
A. "You should already be feeling movement by now"
B. "Most women feel movement between 16 and 20 weeks"
C. "Fetal movement isn't felt until after 24 weeks"
D. "Quickening typically occurs after 28 weeks"
B. "Most women feel movement between 16 and 20 weeks". [CORRECT]
Correct Answer: B
Rationale: Quickening (maternal perception of fetal movement) typically occurs
between 16-20 weeks gestation for nulliparous women and may be felt slightly earlier
(14-18 weeks) for multiparous women. Before 16 weeks, the fetus is too small and
movements too weak to be perceived. Option A is incorrect because 16 weeks is the
earliest expected time, not the standard. Options C and D are incorrect as they
significantly overestimate when quickening occurs.
Q5: A nurse is reviewing laboratory results for a pregnant client at her first prenatal visit.
Which finding requires immediate follow-up?
A. Blood type A positive
B. Rubella immunity positive
C. Hemoglobin 10.5 g/dL
, D. HIV screening negative
C. Hemoglobin 10.5 g/dL. [CORRECT]
Correct Answer: C
Rationale: Hemoglobin of 10.5 g/dL indicates anemia (normal in pregnancy is ≥11
g/dL). This requires iron supplementation and nutritional counseling. While physiologic
anemia occurs in pregnancy due to hemodilution, values below 11 g/dL require
intervention. Option A is a normal blood type with positive Rh status (no concern).
Option B is protective. Option D is a normal negative screening result.
Q6: A pregnant client at 8 weeks gestation asks the nurse about recommended folic
acid supplementation. Which response by the nurse is most appropriate?
A. "You need at least 400 mcg daily throughout pregnancy"
B. "600 mcg daily is recommended to prevent neural tube defects"
C. "800 mcg is needed only in the first trimester"
D. "Folic acid is no longer recommended with modern diets"
B. "600 mcg daily is recommended to prevent neural tube defects". [CORRECT]
Correct Answer: B
Rationale: The recommended dietary allowance for folic acid during pregnancy is 600
mcg/day, increased from 400 mcg in non-pregnant women. This prevents neural tube
defects (spina bifida, anencephaly) which develop in the first 3-4 weeks after
conception. Option A provides the non-pregnant recommendation. Option C is incorrect
because folic acid is needed throughout pregnancy, not just the first trimester. Option D
is dangerously incorrect.