302 exam 1 student resource quizzes
a. In a side-lying position. Side-lying position with legs flexed or prone position to keep hips elevated. Positions will reduce edema & pressure on surgical site.
The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping: a. In a side-lying position. b. On her back with a pillow under her knees. c. With the head of the bed elevated. d. On her abdomen.
d. The woman's weight gain is appropriate for this stage of pregnancy. During the first trimester, the average total weight gain is only 1 to 2.5 kg. The desirable weight gain during pregnancy varies among women. Weight gain should take place throughout the pregnancy. The optimal rate depends on the stage of the pregnancy. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman's BMI is within the normal range, and she has gained the appropriate amount of weight for her size at this point in her pregnancy. Although the statements in A through C are accurate, they do not apply to this client.
A 22-year-old woman pregnant with a single fetus had a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this finding? a. This weight gain indicates possible gestational hypertension. b. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). c. This weight gain cannot be evaluated until the woman has been observed for several more weeks. d. The woman's weight gain is appropriate for this stage of pregnancy.
d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy. In addition to hemorrhoids, compression of the iliac veins and inferior vena cava by the uterus also leads to varicose veins in the legs and vulva. The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, each blood pressure measurement should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases.
A group of maternity nurses are providing education to pregnant clients about changes in blood pressure. What information should the nurses include? a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. b. Shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. c. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.
d. Increased plasma levels in correlation to expected gestational age A substantial increase in plasma levels that is inconsistent with gestational age indicates presence of genetic disorders and/or malformations and as such should warrant further investigation. Following implantation, one would expect to see an increase in levels up to 7 to 8 days. Decreases in plasma levels are seen during the end of pregnancy, with the peak seen between 60 and 70 days, and then the lowest levels at about 100 to 130 days gestation.
A group of student nurses are reviewing human chorionic gonadotropin (hCG) levels as it relates to pregnancy. Which finding if observed by the student nurses would indicate a potential problem? a. Increase in levels 7 to 8 days after implantation b. Expected peak between 60 and 70 days into the pregnancy c. Decrease in plasma levels at the end of pregnancy d. Increased plasma levels in correlation to expected gestational age
b. 10 lunar months, 9 calendar months, 40 weeks, 280 days Pregnancy lasts approximately 10 lunar months, 9 calendar months, 40 weeks, 280 days. Length of pregnancy is computed from the first day of the last menstrual period (LMP) until the day of birth. Nine lunar months is just short of a term pregnancy, and 294 days is longer than the average length of a pregnancy and would be considered postterm. Because conception occurs approximately 2 weeks after the first day of the LMP, the length described in D represents the postconception age of 266 days or 38 weeks. Postconception age is used in the discussion of fetal development.
A group of student nurses are reviewing length for a normal pregnancy. Which time span should the student nurse identify as being appropriate? a. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days b. 10 lunar months, 9 calendar months, 40 weeks, 280 days c. 9 calendar months, 10 lunar months, 42 weeks, 294 days d. 9 calendar months, 38 weeks, 266 days
d. Constipation is common with iron supplements. Constipation can be a problem with iron supplements. Milk, coffee, and tea actually inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die.
A maternity nurse is counseling a pregnant client about getting enough iron in her diet. What information should the nurse provide? a. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron. b. Iron absorption is inhibited by a diet rich in vitamin C. c. Iron supplements are permissible for children in small doses. d. Constipation is common with iron supplements.
a. The father goes through three phases of acceptance of his own.
A maternity nurse is working with a father of a pregnant client to assist with acceptance of the pregnancy and preparation for childbirth. What should the nurse understand related to the father's role in pregnancy? a. The father goes through three phases of acceptance of his own. b. The father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth. c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. d. Typically men remain ambivalent about fatherhood right up to the birth of their child.
b. Increased pulse rate Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. In the first trimester blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.
A nurse is reviewing cardiovascular system changes that occur during pregnancy. Which finding would the nurse consider to be normal for a woman in her second trimester? a. Less audible heart sounds (S1, S2) b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production
b. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for mature or immature women, young or older. Conflicts about desire to perform childrearing and career-related concerns, however, need to be resolved; the baby's arrival ends the pregnancy but not all the issues.
A maternity nurse's role is to help guide a woman's acceptance of pregnancy. What information should the maternity nurse understand related to potential effects of maternal feeling as they relate to acceptance of pregnancy? a. Nonacceptance of the pregnancy very often equates to rejection of the child. b. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. c. Ambivalent feelings during pregnancy are usually seen only in emotionally immature or very young mothers. d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth.
B, C, D, E The impact of bariatric surgery on pregnancy can be substantial in that surgical procedures can lead to deficiencies of both macro and micro nutrients. It is important to monitor this client with regard to iron levels, B vitamins (folate, vitamin B12), calcium and vitamin D. It is also important to monitor weight gain during pregnancy for these clients are at risk to have preterm and small for gestational age infants. Although, the amount of weight loss is important, it would not be considered to be the highest nutritional concern.
A nurse is assessing a pregnant client who has had bariatric surgery. Which assessment factors would pose the highest nutritional concerns for this client based on her surgical history? (Select all that apply.) a. Amount of weight loss that has occurred post procedure. b. Monitoring of iron levels c. Monitoring of B vitamins d. Monitoring of calcium levels e. Amount of weight gain during pregnancy
c. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Typically, running should be replaced with walking around the seventh month of pregnancy. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises, to prepare the joints for more strenuous exercise.
A nurse is assessing a pregnant woman at 10 weeks of gestation who jogs three or four times per week. The client expresses concern about the effect of exercise on the fetus. How should the nurse respond? a. "You don't need to modify your exercising any time during your pregnancy." b. "Stop exercising, because it will harm the fetus." c. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." d. "Jogging is too hard on your joints; switch to walking now."
a. Many protein-rich foods are also good sources of calcium, iron, and B vitamins. Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.
A nurse is counseling a pregnant client about protein intake. Which information should the nurse provide? a. Many protein-rich foods are also good sources of calcium, iron, and B vitamins. b. Many women need to increase their protein intake during pregnancy. c. As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. d. High-protein supplements can be used without risk by women on macrobiotic diets.
c. 33% HCT; 11 g/dL HGB 38% HCT; 14 g/dL HGB and 35% HCT; 13 g/dL HGB are within normal limits in a nonpregnant woman. 33% HCT; 11 g/dL HGB represents the lowest acceptable values during the first and the third trimesters, and 32% HCT; 10.5 g/dl HGB represents the lowest acceptable values for the second trimester, when the hemodilution effect of blood volume expansion is at its peak.
A nurse is monitoring lab results for a client in the third trimester of pregnancy. Which hematocrit (HCT) and hemoglobin (HGB) results should the nurse identify as being the lowest acceptable value? a. 38% HCT; 14 g/dL HGB b. 35% HCT; 13 g/dL HGB c. 33% HCT; 11 g/dL HGB d. 32% HCT; 10.5 g/dL HGB
a. Rates of twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. If the parents-to-be are older and have taken fertility drugs, they would be very interested in this information. Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference; fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender. Identical twins are the same gender.
A nurse is planing to teach a pregnancy class to expectant parents and discuss multiple births. What information should the nurse include? a. Rates of twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. b. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. c. Identical twins are more common in Caucasian families. d. Fraternal twins are same gender, usually male.
b. Modesty A concern for modesty is a strong deterrent to many women seeking prenatal care; for some women, exposing body parts, especially to a man, is considered a major violation of modesty. There are other deterrents. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group or religion to which she belongs. For many cultural groups a physician is deemed appropriate only in times of illness. Because pregnancy is considered a normal process and the woman is in a state of health, the services of a physician are considered inappropriate. Many cultural variations are found in prenatal care, so ignorance is not likely to be a deterrent to women seeking prenatal care.
A nurse is reviewing barriers to prenatal care. What type of cultural concern should the nurse identify as being the most likely deterrent? a. Religion b. Modesty c. Ignorance d. Belief that physicians are evil
b. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.
A nurse is reviewing maternal nutritional needs during lactation. Which statement should the nurse identify as being accurate? a. The mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. b. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. c. Critical iron and folic acid levels must be maintained. d. Lactating women can go back to their prepregnant calorie intake.
c. Iron and folate Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Zinc is sometimes supplemented; most women get enough calcium.
A nurse is reviewing nutritional supplementation for pregnant women. Which minerals and vitamins should the nurse identify as being recommended? a. Fat-soluble vitamins A and D b. Water-soluble vitamins C and B6 c. Iron and folate d. Calcium and zinc
a. Several glasses of fluid If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid, possibly contributing to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient without trying to replace sodium.
A nurse is reviewing physical activity pattern for a pregnant woman who reports that she is still playing tennis at 32 weeks of gestation. Which recommendation would be most important relative to nutritional requirements for an active pregnant woman who exercises? a. Several glasses of fluid b. Extra protein sources, such as peanut butter c. Salty foods to replace lost sodium d. Easily digested sources of carbohydrate
a. It serves as a source of oral fluid and as a repository for waste from the fetus. Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. Its volume changes constantly; too little fluid (oligohydramnios) is associated with renal abnormalities, and too much fluid (polyhydramnios) is associated with gastrointestinal and other abnormalities.
A nurse is reviewing physiological concepts related to amniotic fluid. Which statement should the nurse identify as being accurate? a. It serves as a source of oral fluid and as a repository for waste from the fetus. b. The volume remains about the same throughout the term of a healthy pregnancy. c. A volume of less than 300 ml is associated with gastrointestinal malformations. d. A volume of more than 2 L is associated with fetal renal abnormalities.
c. Goodell sign cervical polyps Goodell sign might be the result of pelvic congestion, not polyps. Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Chadwick sign might be the result of pelvic congestion.
A nurse is reviewing presumptive and probable signs of pregnancy. Which finding should the nurse identify as not being correlated to a possible etiology? a. Amenorrhea stress, endocrine problems b. Quickening gas, peristalsis c. Goodell sign cervical polyps d. Chadwick sign pelvic congestion
d. Main blood vessels form by 8 weeks. The heart starts beating by 4 weeks, the lungs take shape by 12 weeks, and brain configuration is complete by 12 weeks.
A nurse is reviewing the concept of fetal growth. Which finding should the nurse identify as being within normal range of development? a. Heart starts beating at 12 weeks. b. Lungs take shape by 8 weeks. c. Brain configuration is complete by 8 weeks. d. Main blood vessels form by 8 weeks.
B, C, D A client being treated with an anticonvulsant or lithium is at risk for toxic effects during pregnancy. Warfarin (Coumadin) can put a client at risk during pregnancy. Although acetaminophen (Tylenol) can have toxic effects on the liver, the reported frequency is not a concern at this time. Taking multivitamins is a healthy recommended option.
A nurse is reviewing the history of a woman who wants to become pregnant. Which medication profile would indicate to the nurse a potential concern relative to toxic exposure? (Select all that apply.) a. Tylenol OTC occasionally for a headache; twice last week b. Anticonvulsant for seizure disorder c. Lithium for bipolar disorder d. Coumadin for atrial fibrillation e. Multivitamins once a day
b. Intrauterine growth restriction. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain; an adequate amount of folic acid has been shown to reduce the incidence of this condition. Diabetes mellitus is not related to inadequate weight gain. A mother with gestational diabetes is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of trisomy 21, not inadequate maternal weight gain.
A nurse is reviewing the impact of inadequate weight gain during pregnancy. Which finding should the nurse anticipate as being at highest risk based on inadequate weight gain? a. Spina bifida. b. Intrauterine growth restriction. c. Diabetes mellitus. d. Down syndrome.
d. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus.
A nurse is working with a pregnant client and providing information about weight gain. Which suggestion should the nurse identify as not being appropriate? a. Underweight women should gain 12.5 to 18 kg. b. Obese women should gain at least 7 kg. c. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. d. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.
a. She keeps all prenatal appointments. The goal of prenatal care is to foster a safe birth for the infant and mother. Keeping all prenatal appointments is a good indication that the woman is indeed seeking "safe passage." Eating properly, driving carefully, using proper body mechanics, and wearing appropriate footwear during pregnancy are healthy measures that all pregnant women should take.
A nurse is working with a pregnant client. Which behavior if observed by the nurse indicates that a woman is "seeking safe passage" for herself and her infant? a. She keeps all prenatal appointments. b. She "eats for two." c. She drives her car slowly. d. She wears only low-heeled shoes.
b. Eat small, frequent meals (every 2 to 3 hours). Eating small, frequent meals is a correct suggestion for a pregnant woman experiencing nausea and vomiting. She should avoid consuming fluids early in the day or when nauseated, but should compensate by drinking fluids at other times. She should also reduce her intake of fried foods and other fatty foods.
A nurse observes a pregnant woman experiencing nausea and vomiting. What intervention should the nurse suggest to the client? a. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. b. Eat small, frequent meals (every 2 to 3 hours). c. Increase her intake of high-fat foods to keep the stomach full and coated. d. Limit fluid intake throughout the day.
b. Fetal movement palpated by the nurse-midwife. Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat and palpating fetal movement. A positive pregnancy test result and Braxton Hicks contractions are probable signs of pregnancy. Quickening is a presumptive sign of pregnancy.
A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: a. A positive pregnancy test result. b. Fetal movement palpated by the nurse-midwife. c. Braxton Hicks contractions. d. Quickening.
B, C, E Facial edema is a concern because it can represent toxemia of pregnancy. Superficial thrombophlebitis is a concern because it can represent a risk factor for development of a DVT during pregnancy. The presentation of allodynia (pain upon normal touch) is considered to be a significant finding and requires additional investigation. Melasma (also known as the mask of pregnancy or chloasma), linea nigra (a hyperpigmentation line extending from the fundus to the symphysis pubis), and the presence of vascular spiders are all considered to be normal abnormal findings in pregnancy.
A pregnant client is experiencing some integumentary changes and is concerned that they may represent abnormal findings. Which of the following findings should the nurse provide to the client that would be considered "normal abnormal" findings during pregnancy so that she should not be alarmed? (Select all that apply.) a. Facial edema b. Melasma c. Linea nigra d. Superficial thrombophlebitis e. Vascular spiders f. Allodynia
c. Fetus with possible renal problems Oligohydramnios reflects a decrease in the amount of amniotic fluid and is associated with renal abnormalities in the fetus and compromised fetal well-being. The position of the fetus is due to gestational age and the maternal uterine environment. Oligohydramnios places stress on the fetus, thus one would not anticiapte that the FHR would be within normal range. An increase in fundal height would be associated with polyhydramnios and/or advanced gestational age assessment.
A pregnant woman has been diagnosed with oligohydramnios. Which presentation would the nurse suspect to find on physical examination? a. Fetus is in a breech position b. FHR baseline is within normal range c. Fetus with possible renal problems d. Increased fundal height
c. The lungs are mature. The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. This result is unrelated to Down syndrome and in no way indicates risk for preterm labor. Meconium should not be present in the amniotic fluid.
A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. Which finding does the nurse identify? a. The fetus is at risk for Down syndrome. b. The woman is at high risk for developing preterm labor. c. The lungs are mature. d. Meconium is present in the amniotic fluid.
c. 3-1-0-1-0 According to the GPTAL system, this woman's gravidity and parity information is calculated as follows:G: Total number of times the woman has been pregnant (she is pregnant for the third time)T: Number of pregnancies carried to term (only one pregnancy resulted in a fetus at term)P: Number of pregnancies that resulted in a preterm birth (none)A: Abortions or miscarriages before the period of viability (she has had one)L: Number of children born who are currently living (she has no living children)3-1-0-1-0 is the correct calculation of this woman's gravidity and parity
A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. How would the nurse document her gravidity and parity according to the GTPAL system? a. 2-0-0-1-1 b. 2-1-0-1-0 c. 3-1-0-1-0 d. 3-0-1-1-0
b. "A baby in utero does respond to the mother's voice." Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice, and the nurse should instruct the mother so. Although statement A is accurate, it is not the most appropriate response. Statement D is not appropriate because it gives the mother impression that her baby cannot hear her and belittles her interpretation of her fetus's behaviors.
A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? a. "Many women imagine what their baby is like." b. "A baby in utero does respond to the mother's voice." c. "You'll need to ask the doctor if the baby can hear yet." d. "Thinking that your baby hears will help you bond with the baby."
d. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."
A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know whether it is safe for her to have a drink with dinner now. How should the nurse respond? a. "Because you're in your second trimester, there's no problem with having one drink with dinner." b. "One drink every night is too much. One drink three times a week should be fine." c. "Because you're in your second trimester, you can drink as much as you like." d. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."
c. "They occur between the third and fifth weeks of development." The nurse would be aware of when such defects occur. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week.
A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? a. "We don't really know when such defects occur." b. "It depends on what caused the defect." c. "They occur between the third and fifth weeks of development." d. "They usually occur in the first 2 weeks of development."
d. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.
An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. How should the nurse respond? a. Intercourse should be avoided if any spotting from the vagina occurs afterward. b. Intercourse is safe until the third trimester. c. Safer-sex practices should be used once the membranes rupture. d. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.
c. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." The statement in C is the most appropriate response because it gives an explanation and a time frame for when the mood swings may stop. The statement in A is an appropriate response but it does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. The statement in D is judgmental and not appropriate.
An expectant father confides in the nurse that his pregnant wife, at 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" What is the nurse's best response? a. "This is normal behavior and should begin to subside by the second trimester." b. "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know." c. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." d. "You seem impatient with her. Perhaps this is precipitating her behavior."
a. Hegar sign. At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The Chadwick sign is a blue-violet cervix caused by increased vascularity; it is seen around the fourth week of gestation. Softening of the cervical tip, which may be observed around the sixth week of pregnancy, is called the Goodell sign. (The McDonald's sign indicates a fast-food restaurant.)
During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. How should the nurse document this finding? a. Hegar sign. b. McDonald sign. c. Chadwick sign. d. Goodell sign.
a. Primipara A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.
How would the nurse document a woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability? a. Primipara b. Primigravida c. Multipara d. Nulligravida
c. Extends her leg and dorsiflexes her foot during the cramp. Extending the leg and dorsiflexing the foot are the appropriate relief measure for a leg cramp. Pointing the toes can aggravate rather than relieve the cramp. Application of heat is recommended. Bearing weight on the affected leg can help relieve the leg cramp, so it should not be avoided.
The nurse has given information about relief of leg cramps to a pregnant client. Which client action if observed by the nurse indicates that the client has understood the instructions? a. Wiggles and points her toes during the cramp. b. Applies cold compresses to the affected leg. c. Extends her leg and dorsiflexes her foot during the cramp. d. Avoids weight bearing on the affected leg during the cramp.
b. Alteration in the pattern of fetal movement An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. Heart palpitations are a normal change related to pregnancy; they are most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.
The nurse is reviewing danger signs of pregnancy with a client who is 32 weeks pregnant. What information should the nurse tell the client to observe for? a. Constipation b. Alteration in the pattern of fetal movement c. Heart palpitations d. Edema in the ankles and feet at the end of the day
d. She must be having a low-risk pregnancy. Midwives usually see low-risk obstetric clients. Nurse-midwives must refer clients to physicians for complications. Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer clients to physicians for complications, but clients are not required to see an obstetrician otherwise. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care; this does not imply that medications for pain control are prohibited.
Which information should the nurse provide to the woman who wants to have a nurse-midwife provide obstetric care? a. She will have to give birth at home. b. She must see an obstetrician as well as the midwife during pregnancy. c. She will not be able to have epidural analgesia for labor pain. d. She must be having a low-risk pregnancy.
b. Twin pregnancies come to term with the same frequency as single pregnancies. Twin pregnancies often end in prematurity; serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often experiences anemia because of the increased demands of two fetuses; this issue should be monitored closely throughout her pregnancy. The client may need nutrition counseling to ensure that she gains more weight than what is needed for a singleton birth. The considerable uterine distention in multifetal pregnancy is likely to cause backache and leg varicosities; maternal support hose should be recommended.
Which statement should the nurse identify as not being accurate regarding multifetal pregnancy? a. The expectant mother often experiences anemia because the fetuses have a greater demand for iron. b. Twin pregnancies come to term with the same frequency as single pregnancies. c. The mother should be counseled to increase her nutritional intake and gain more weight. d. Backache and varicose veins are often more pronounced.
a. Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. The statement in A is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.
With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that during pregnancy: a. Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. b. The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. c. Killed-virus vaccines (e.g., tetanus) should not be given, but live-virus vaccines (e.g., measles) are permissible. d. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.
