1210 EAQ 4 Antenatal
Which statement made by a client with hyperemesis gravidarum would confirm that the client requires further teaching?
'I'll start limiting carbohydrates' 'I'll Lie down for at least 2 hours after I eat' RATIONALE: The client should not decrease carbohydrate intake. During pregnancy the cardiac sphincter may relax, which allows food to come back up into esophagus when the client is supine. The client should not lie down for 2 hours after eating to provide time for digestion so that food is not regurgitated. Drinking protein shakes can help provide protein needed to decrease the chance of negative nitrogen balance. The individual protein shakes, though, should be evaluated for other additive ingredients that may not be recommended in pregnancy. The client should be encouraged to drink plenty of fluids to help prevent dehydration. Hyperemesis gravidarum can be aggravated by stress and fatigue. Rest periods may reduce the client's stress level and fatigue and promote relaxation.
An Rh-negative, 30-year old gravida 1 para 0 experiences a miscarriage at 10 weeks' gestation. Which action would the nurse anticipate regarding the administration of Rho(D) immune globulin?
Administration of one intramuscular microdose (50 mcg) of Rho(D) immune globulin RATIONALE: To prevent production of anti-Rho(D) antibodies in an Rh-negative woman who has been exposed to Rh-positive blood, a microdose of Rho(D) immune globulin (RhoGAM) must be administered intramuscularly because the pregnancy ended in the first trimester. Had the pregnancy ended at 13 weeks' gestation or later, a standard dose of Rho(D) immune globulin would be administered intramuscularly. Rho(D) immune globulin is not administered subcutaneously.
Which vaccine would the nurse identify as being safe to administer during pregnancy?
Inactive influenza RATIONALE: The inactive influenza and diphtheria, tetanus, pertussis (dTAP) immunizations can be safely administered during the first trimester of pregnancy, although dTAP is recommended at 27 to 36 weeks' gestation to provide immunity to the mother and infant. The inactivated influenza vaccine may be given because it is a killed virus vaccine and will not have teratogenic effects. Rubella (measles) and rubeola (German measles) vaccines are both live viruses that should never be administered during pregnancy because they can have teratogenic effects. Varicella (chicken pox) immunization is not given because it may cause birth defects in the fetus.
Which sign or symptom would the nurse instruct a client at 29 weeks' gestation to report immediately to the primary care provider?
Leakage of fluid from the vagina RATIONALE: Leakage may indicate rupture of the amniotic membranes; the client is at risk for an ascending infection from the vagina if birth does not occur within 24 hours or if early treatment is not instituted. Lower back pain is a common discomfort of pregnancy because the enlarged uterus causes a shift in the client's center of gravity. Leukorrhea is common during pregnancy because of increased vascularity of the cervix and increased mucus production. Preparatory (Braxton-Hicks) contractions occur at irregular intervals throughout pregnancy; they become stronger after the 28th week of gestation.
The nurse caring for a pregnant client at 28 weeks' gestation suspects intimate partner violence. Which assessment supports this suspicion?
The client has injuries to the breasts and abdomen The partner answers question that are asked of the woman The client has visited the clinic several times in the past month RATIONALE: During pregnancy, batterers may concentrate their anger at the pregnancy itself and focus their assaults on the breasts, buttocks, and abdomen. It is most common for the abuser to control the conversation by answering for the client. Women who are battered are at risk for stress illnesses such as gastrointestinal distress and chest pain. They are also more likely to suffer from frequent headaches and depression and therefore may have more than normal number of clinic visits. Control is a primary concern of the abuser, so it would be highly unlikely for him to leave the client alone with the care provider. The many questions a client may have regarding all aspects of her care are not related to the probability of intimate partner violence.
Which statement by a client who was normal weight before pregnancy indicates the need for further teaching regarding weight gain guidelines?
"I should gain 1 to 2 pounds per week through the entire pregnancy.' RATIONALE: Women should gain only about 2.2 to 4.4 pounds in the first trimester, and 1 pound per week in the second and third trimesters, for a total of 25 to 35 pounds throughout the pregnancy. Higher weight gain than normal, more than 6 to 7 pounds in 1 month, will warrant additional investigation because it can be a sign of preeclampsia. Weight loss and cutting calories are not appropriate during pregnancy due to the risk of malnutrition to both mother and baby.
Which question would help the nurse determine the pregnant client's estimated date of delivery?
"Are your menstrual periods regular?" RATIONALE: Determining an accurate estimated date of delivery requires synthesizing data from the client. Asking if the menstrual periods are regular allows the nurse to know if Naegeles rule can be appropriately used to determine the estimated delivery date for this client. If her menstrual periods are regular and occur roughly every 28 days, Naegele's rule would be used. If, however, her menses are irregular, use of this method for determining the estimated deliver date would not be accurate. Knowing whether she did a home pregnancy test, or her age at menarche do not help determine the estimated delivery date. The use of condoms before pregnancy does not affect the method of determining the estimated delivery date.
When a client is being interviewed on her first prenatal visit she states that she has a 4-year-old son who was born at 41 weeks' gestation and a 3-year-old daughter who was born at 35 weeks' gestation. The client lost one pregnancy at 9 weeks and another at 18 weeks. Using the GTPAL system, how would you record this information?
G5 T1 P1 A2 L2 RATIONALE: The client is gravida (G) 5: the current pregnancy, the 41-week pregnancy, the 35-week pregnancy, the 9-week pregnancy, and the 18-week pregnancy. She has had 1 term (T) pregnancy (1 that lasts 40 weeks plus or minus 2 weeks): the 41-week pregnancy. The 35-week pregnancy is considered preterm (P). Pregnancies that end before 20 weeks are considered abortions, so the losses at 9 and 18 weeks would be scored as A2. The other options do not consider the present pregnancy or the correct definitions of term and preterm and do not include abortions.
Which changes would the nurse include in the childbirth class focusing on the maternal psychological alterations that occur near the end of pregnancy?
Nesting needs increase Anxiety about childbirth increases Gastrointestinal motility decreases RATIONALE: Nesting needs increase as pregnancy reaches term; it is a psychological preparation for motherhood. As pregnancy nears term, maternal thoughts turn to the problems that may occur during labor and birth. Because the enlarged uterus is pressing on the organs of the gastrointestinal tract, digestive and elimination problems may increase. Food cravings start early in the pregnancy and do not commonly intensify as the pregnancy nears term; there is a need for being nurtured in preparation for providing it to the newborn.
Which statement would the nurse include in a teaching session for pregnant clients regarding fetal growth and development?
"Development occurs in a head-to-toe and central-to-peripheral pattern." "Pregnancy includes the preembryonic, embryonic, and fetal stages of development." "During pregnancy the embryo grows from a single cell to a complex physiologic being." RATIONALE: Information the nurse would include in a teaching session regarding fetal growth and development during pregnancy includes that development occurs in a head-to-toe (cephalocaudal) an central-to-peripheral (proximal-distal) pattern; the 3 stages of pregnancy include preembryonic, embryonic, and fetal stages of development; and the embryo grows from a single cell to a complex physiologic being. Although all major organs do develop during pregnancy, not all function before birth. The embryonic, not the fetal, stage of development is most vulnerable to teratogenic influences.
Which intervention would the nurse recommend to a client in her 37th week of gestation who calls the clinic and reports, 'My ankles are so swollen'?
Elevating her legs more frequently during the day RATIONALE: Dependent edema in the ankles is a common occurrence during the latter part of pregnancy. It results from an increased pressure of the uterus on the pelvic veins. Elevating the legs encourages venous return. Limiting fluid intake can be harmful; increasing circulating blood volume during pregnancy must be maintained. Salt is necessary to retain fluid for the increased circulating blood volume during pregnancy. Diuretics are not used during pregnancy; they may decrease the circulating blood volume.
Why is a multiple-gestation pregnancy considered a high risk?
Perinatal mortality is two to three times more likely in multiple than in single births. RATIONALE: Perinatal morbidity and mortality rates are higher with multiple-gestation pregnancies, because the greater metabolic demands and the possibility of malpositioning of one or more fetuses increase the risk of complications. Although postpartum hemorrhage does occur more frequently after multiple births, it is not an expected occurrence. Adjustment to a multiple gestation and birth is individual; the time needed for adjustment does not place the pregnancy at high risk. Maternal mortality during the prenatal period is not increased in the presence of a multiple gestation.
Why is it important for the nurse in the prenatal clinic to provide nutritional counseling to all newly pregnant women?
Different cultural groups favor different essential nutrients. RATIONALE: The nurse would become informed regarding the cultural eating patterns of clients so that food containing the essential nutrients that are part of these dietary patterns may be included in the diet. Fluid retention is only 1 component of weight gain. Dietary allowances and the need for calories and nutrients increases during pregnancy. Pregnancy diets are not specific; they are composed of essential nutrients.
Which physiological changes are expected during the first trimester of pregnancy?
Fatigue Morning sickness Breast enlargement RATIONALE: Fatigue, morning sickness, and breast enlargement are observed through the first trimester of pregnancy. Increased libido is observed during the second trimester of pregnancy. Braxton Hicks contraction are observed during the third trimester of pregnancy.
After speculum examination in the first trimester of pregnancy, the nurse states that the client's cervix is bluish purple, which is known as the Chadwick sign. Which explanation of this sign would the nurse provide?
'It is caused by increased blood flow to the uterus during pregnancy.' RATIONALE: Stating that the Chadwick sign is caused by increased blood flow to the uterus during pregnancy underscores the normalcy of Chadwick sign and provides a simple explanation of the cause; women often need reassurance that the physical changes associated with pregnancy are expected. Stating that the Chadwick sign helps confirm pregnancy answers part of the question, but fails to explain why it occurs. The Chadwick sign is a probable sign of pregnancy; it is not seen in nonpregnant women. There is no free blood circulating in the uterus during pregnancy.
Which are presumptive signs of pregnancy that the nurse would expect when assessing a client at 10 weeks' gestation?
Amenorrhea Breast changes Urinary frequency RATIONALE: The key to answering this question is understanding the difference between presumptive versus probable signs of pregnancy. Presumptive signs of pregnancy are less specific subjective changes that are reported by the client during an assessment interview. Probable signs of pregnancy are more objective changes that can be measured in the reproductive organs during a physical assessment. The absence of menstruation (amenorrhea) is a presumptive sign of pregnancy that is recognized at 4 weeks' gestation. Breast changes, related to increased levels of estrogen and progesterone, are presumptive sign of pregnancy that is recognized at 3 to 4 weeks' gestation. Urinary frequency, related to pressure of the enlarging uterus on the urinary bladder, is a presumptive sign of pregnancy that is recognized at 6 to 12 weeks' gestation. Abdominal enlargement relate to the enlarging uterus is a probable sign of pregnancy that is recognized when the enlarging uterus rises out of the pelvis at 14 to 16 weeks' gestation. positive urine pregnancy test result, indicating an increase in human chorionic gonadotropin (hCG), is a probable sign of pregnancy that can be detected 26 days after conception
The nurse is teaching a class of expectant parents about changes that are expected during pregnancy. Which changes would the nurse explain result from melanocyte-stimulating hormone?
Cholasma Linea nigra RATIONALE: Melanocyte-stimulating hormone during pregnancy causes pigmentation over the bridge of the nose and cheeks (cholasma, mask of pregnancy). The concentration of melanocyte-stimulating increases from the end of the second month of pregnancy until term, causing in some women a line of pigmentation on the abdomen from the umbilicus to the symphysis pubis (linea negra). Effacement of the cervix is a result of the effects of labor or descent of the presenting part of the fetus in late pregnancy. A high level of chorionic gonadotropin in early pregnancy is associated with nausea and vomiting. Cervical softening occurs in early pregnancy due to increased vacularity, hypertrophy, and hyperplasia of the cervix. It is also noted in late pregnancy as a pre-labor change. Urinary frequency is related to growth and pressure of the uterus on the bladder in early pregnancy and to descent of the presenting fetal part in late pregnancy.
A client at 10 weeks' gestation tells the nurse in the maternity clinic that she is worried because she is voiding frequently. How would the nurse respond?
Explain why this is expected in early pregnancy. RATIONALE: The client should be give accurate information. Urinary frequency is caused by the pressure of the enlarging uterus on the bladder. Until 12 to 14 weeks of pregnancy the uterus is in the pelvic cavity. It then rises into the abdominal cavity, after which urinary frequency diminishes. It is unnecessary to refer the client to the health care provider. Urinary frequency is an expected adaptation during the first and last trimesters of pregnancy. Telling the client not to worry is demeaning because it implies that the client is not capable of understanding an explanation. It is not necessary to plan for a culture and sensitivity testing because the routine point-of-care urinalysis performed at each visit will indicate whether an infection is present and whether culture and sensitivity are necessary.
Which inference would the nurse draw when crackles are heard while auscultating the lungs of a client admitted with severe preeclampsia?
Pulmonary edema may have developed RATIONALE: Pulmonary edema is associated with severe preeclampsia; as vasospasms worse, capillary endothelial damage results in capillary leakage into the alveoli. Crackles are not an indication of an impending seizure; signs of an impending seizure include hyperreflexia, developing or worsening clonus, severe headache, visual disturbances, and epigastric pain. Pregnancy does not precipitate bronchial constriction, although the hormones associated with pregnancy can cause nasal congestion. Impaired diaphragmatic function is a discomfort associated with pregnancy that may result in shortness of breath of dyspnea, not crackles.
A pregnant woman continues to consume alcohol during pregnancy. Which teratogenic effects might the nurse expect to see in the fetus or neonate?
Stillbirth Spontaneous abortion Intellectual disabilities RATIONALE: Prolonged fetal exposure to alcohol may cause a stillbirth. A spontaneous abortion may occur if the pregnant woman consumes alcohol in excess amounts. Intellectual disabilities may be seen in the neonate if it is exposed to alcohol in the fetal stage. Ebstein anomaly is caused by lithium exposure during pregnancy. Neural tube defects may be due to exposure to anti-seizure medications during pregnancy.
