Antepartum

A patient at 28 weeks of gestation states, "I frequently have leg cramps that are horribly uncomfortable." Which contributing factor should the nurse suspect led to the patient's leg cramps? A) Increased pressure of the uterus on the nerves B) Circulatory congestion of the lower extremities C) Prolonged standing D) The specific causative factors are unknown

A) Increased pressure of the uterus on the nerves Rationale: The contributing factor to the leg cramps the patient is experiencing is the increased pressure of the uterus on the nerves. Other possible contributing factors include the imbalance of calcium-phosphorus ratio, fatigue, poor circulation to lower extremities, and pointing the toes. Prolonged standing and circulatory congestion of the lower extremities contribute to other discomforts of pregnancy.

The nurse caring for a pregnant client with diabetes interprets the results of the client's nonstress test (NST) as nonreactive. Which intervention should the nurse anticipate? A) Administer oxytocin B) Arrange for a biophysical profile C) Prepare client for urgent cesarean birth D) Provide ordered supplemental oxygen

B) Arrange for a biophysical profile Rationale: If the NST is nonreactive a biophysical profile may be performed. A biophysical profile is indicated when there is a risk of placental insufficiency or fetal compromise. Indications for a biophysical profile include material diabetes mellitus and nonreactive NST. Oxytocin is used to induce or augment labor in a pregnant client. It is not standard practice to administer oxygen in this case. There is no indication of fetal distress in the case​ presented, so it is not reasonable to anticipate a cesarean birth delivery.

The nurse is caring for a 36yo pregnant woman. She has two children, ages 15 and 13, from a previous marriage, and this is her first child from her second marriage. The client has indicated that her two older children seem very upset by her pregnancy and have been increasingly belligerent the closer she gets to delivery. What can the nurse say to support this family? A) "It may help to remind your older children that you will still make time for them and that you won't expect them to be responsible for the baby unless they want to." B) "You could tell your older children that the stress and anxiety that comes with a new baby will help improve your family relationships." C) "They are probably just embarrassed because you are pregnant. They'll get over it one you have the baby." D) "Your older children probably just want to know what their new roles will be once the baby is born. You should tell them what their responsibilities will be in caring for the baby."

A) "It may help to remind your older children that you will still make time for them and that you won't expect them to be responsible for the baby unless they want to." Rationale: Adolescent children, especially children from a previous marriage, may feel jealous that the new baby will take all the attention of the parent or fear that they will be asked to contribute to the newborn's care. The nurse should help the mother understand these feelings and encourage the mother to address these feelings with her older children. Telling the mother that the older children are just embarrassed and will get over it is inappropriate. Encouraging the mother to give newborn care responsibilities to the older children may make the issue worse. Discussing the role of stress and anxiety in improving relationships is more appropriate for a spouse, not older children

The nurse is caring for a client who asks, "Why do I need an ultrasound and all of these tests while I am pregnant?" Which response by the nurse provides the most appropriate explanation for antenatal testing to the client? A) "Tests such as ultrasounds can help screen for birth defects." B) "Ultrasounds are painless and your insurance will pay for it." C) "I will ask the doctor to explain theses tests to you later." D) "These tests ensure your baby is healthy."

A) "Tests such as ultrasounds can help screen for birth defects." Rationale: Antenatal testing helps ascertain fetal​ well-being, growth, and development during the prenatal period and allows for screening and detection of congenital abnormalities. Antenatal testing does not ensure a baby will be healthy. The​ statements, "These tests ensure your baby is​ healthy," "I will ask the doctor to explain these tests to you​ later," and​ "Ultrasounds are painless and your insurance will pay for​ it" do not address the​ client's question.

A client at 16 weeks gestation is diagnosed with TB. Which statement by the nurse is appropriate when instructing the client regarding the needs for both the client and fetus? A) "You have been prescribed isoniazid; therefore, you must also take pyridoxine (Vitamin B6)." B) "Your contact with the baby will be limited for several months after delivery." C) "You will not be able to breastfeed your baby because of this diagnosis." D) "You are free to have contact with anyone as TB is not contagious when diagnosed during pregnancy."

A) "You have been prescribed isoniazid; therefore, you must also take pyridoxine (Vitamin B6)." Rationale: When teaching a pregnant client diagnosed with TB, the nurse will include information regarding medication administration. Isoniazid, which does cross the placenta but most studies show is not teratogenic, is often the drug of choice to treat TB during pregnancy. When taking isoniazid, the client will also need to take pyridoxine. If TB is active at delivery, the newborn should not have direct contact with the mother while she is infectious. This is not likely going to be the case, as the client is diagnosed early in the pregnancy. If maternal TB is inactive, the mother may breastfeed and care for her infant. Extra rest and limited contact with others are required until the disease becomes inactive.

A patient diagnosed with gestational diabetes is scheduled for induction of labor because the baby is large for gestational age (LGA). Which statement is the most likely interpretation of the contributing factor to the diagnosis of LGA for a baby born to a patient with gestational diabetes A) High levels of fetal insulin B) Inadequate amounts of fetal insulin C) Inability of the fetus to produce insulin D) High levels of maternal insulin

A) High levels of fetal insulin Rationale: Characteristically, newborns of mothers with diabetes are large for gestational age (LGA) as a result of high levels of fetal insulin production stimulated by the high levels of glucose crossing the placenta from the mother. High levels of maternal insulin, the inability of the fetus to produce insulin, and inadequate amounts of fetal insulin are not contributing factors to a newborn that is LGA.

The nurse is caring for an ob client during her first visit who states that she is experiencing nausea and vomiting. the nurse should identify which hormone is responsible for this change? A) Human chorionic gonadotropin (hCG) B) Human placental lactogen (hPL) C) Progesterone D) Estrogen

A) Human chorionic gonadotropin (hCG) Rationale: Increased levels of hCG are attributed to the​ client's nausea and vomiting. During​ pregnancy, estrogen enlarges the​ uterus, and causes breast tenderness and nasal stuffiness. Progesterone is essential for maintaining the pregnancy. Human placental lactogen assists in maintaining the​ fetus's glucose levels. Human chorionic gonadotropin preserves the corpus luteum.

The nurse is teaching childbirth exercises to a pregnant client with a history of back pain. Which is most appropriate for this client? A) Perform the pelvic rock exercise only in the standing position B) Exercise in the supine position throughout the pregnancy C) Perform the pelvic rock exercise while in the hands and knees position D) Soak in a hot tub for approximately 30 minutes after exercise

A) Perform the pelvic rock exercise only in the standing position Rationale: The pelvic tilt or pelvic rock exercise helps prevent or reduce back strain, as it strengthens the abdominal muscles. The client with a history of back pain should be instructed to perform the exercise in the standing position only. Doing the exercise on the hands and knees may aggravate back strain and cause pain. Pregnant clients should be instructed to avoid exercising in the supine position after the first trimester because it could hinder uterine blood flow and harm the fetus. Pregnant clients should be instructed to avoid hot tubs because of the possible teratogenic effects of hyperthermia on the developing fetus.

The nurse is caring for a 14yo client who is pregnant. What will the nurse need to consider that may affect this client more than older adolescents? A) The client may be more concerned about modesty B) The client may be more concerned with state marriage laws C) The client. may be more concerned about parents finding out about the pregnancy D) The client may be more concerned about finding a support person

A) The client may be more concerned about modesty Rationale: A younger client may be more concerned about modesty than older clients, especially as her body changes and grows rapidly. Older adolescents who are pregnant may be more concerned about state marriage laws, parents finding out about the pregnancy, and finding a support person. Younger clients are more likely to involve parents in the early stages of pregnancy for both emotional and financial support.

The nurse is caring for a client who is at 38 weeks gestation who is positive for group B strep (GBS). Which information should the nurse provide the client? A) "No treatment is necessary because you are asymptomatic." B) "You will be given an antibiotic treatment during labor." C) "You will be taking an antibiotic for the remainder of your pregnancy." D) "Your baby will receive treatment after it is born."

B) "You will be given an antibiotic treatment during labor." Rationale: The client who is GBS positive will be treated with an antibiotic during labor. GBS is one of the major causes of early onset neonatal infection that can be transmitted by vertical transmission from the mother during birth or by horizontal transmission from colonized nursing personnel or colonized babies. If the maternal infection is not resolved prior to​ delivery, IV antibiotics will be prescribed during labor. Treatment is not delayed until after birth. The client will not be prescribed a prophylactic antibiotic throughout the pregnancy.

A regnant client asks the nurse when the 1-hour oral glucose tolerance test (OGTT) will be performed to screen for gestational diabetes. Which response by the nurse is the most accurate? A) "You will only need to be screened if you have any risk factors." B) "You will be screened between 24 and 28 weeks gestation." C) "Your screening is generally prescribed between 20 and 24 weeks gestation." D) "Screening is initiated between 16 and 20 weeks gestation."

B) "You will be screened between 24 and 28 weeks gestation." Rationale: The​ 1-hour OGTT screening test for gestational diabetes is performed at between 24 and 28​ weeks' gestation. All clients are screened for gestational diabetes.

The nurse is caring for a client who is at 10 weeks gestation and experiencing "some gastrointestinal problems." Which symptom should the nurse anticipate specifically in the client? A) Decreased salivation B) Diarrhea C) Ptyalism D) Urinary frequency

B) Diarrhea Rationale: Ptyalism, or increased​ salivation, may occur during pregnancy. Urinary frequency is a genitourinary change that occurs during pregnancy. Diarrhea is an abnormal symptom and is not an expected change in the gastrointestinal system during pregnancy.

The nurse is teaching smoking cessation to a newly pregnant client who still smokes. Which fetal complication of cigarette smoking should the nurse include? A) Congenital abnormalities B) Prematurity C) Large for gestational age D) Postterm gestation

B) Prematurity Rationale: The nurse will teach the client about the risk of prematurity associated with smoking. Postterm​ gestation, congenital​ anomalies, and newborns who are large for gestational age are not risk factors associated with maternal smoking.

The nurse is providing care to a pregnant client who is experiencing ptyalism. Which will the nurse include in the plan of care for this client? A) Use a cool-mist vaporizer B) Suck on hard candy C) Avoid use of nasal sprays and decongestants D) Use low-sodium antacids

B) Suck on hard candy Rationale: Ptyalism is excessive, often bitter salivation that can occur during pregnancy. Appropriate interventions for this client include using astringent mouthwashes, chewing gum, or sucking on hard candy. A cool-mist vaporizer and avoiding nasal sprays and decongestants are appropriate interventions for nasal stuffiness and nosebleed (epistaxis). The use of low-sodium antacids is appropriate for pyrosis, or heartburn.

A client who recently learned of being pregnant tells the nurse that she stopped eating meat years ago and started eating fish daily because it's healthier. Which teaching points are appropriate for this client based on her current diet? SATA A) Avoid shrimp, salmon, and catfish because these have higher mercury levels. B) eat up to 12 ounces a week of a variety of fish and shellfish C) Don't eat more than 6 ounces per week of albacore tuna D) eat plenty of fish such as king mackerel while pregnant E) Follow a complete vegetarian diet while pregnant as an alternative to eating fish

B, C Rationale: Nearly all fish contain traces of mercury. Mercury can place the developing nervous system of the fetus at risk and cause negative effects on cognitive functioning. The nurse should instruct the client to eat up to 12 ounces a week of a variety of fish and shellfish. The nurse should advise the client to eat no more than 6 ounces of albacore tuna each week because it has more mercury than other canned tuna. King mackerel should be avoided because it contains high levels of mercury. The nurse should not suggest that the client consume a complete vegetarian diet because this could lead to other nutritional deficiencies. The nurse should encourage the client to consume shrimp, salmon, and catfish, because these fish have the least amount of mercury.

The nurse is providing care to a client with a history of rheumatoid arthritis (RA) who is 5 months pregnant. Which nursing actions are appropriate when providing care to this client? SATA A) Telling the client there isa n increased risk for preterm delivery because of salicylate therapy B) Monitoring the client for anemia due to salicylate therapy C) Suggesting the client begin supplemental pyridoxine D) Educating the client that medication therapy may be discontinued due to remission E) Teaching the client that RA may be contracted by the fetus during pregnancy

B, D Rationale: When providing care to a client with RA during pregnancy, the nurse will monitor the client for anemia due to salicylate therapy and educate the client that medication therapy may be discontinued if the client experiences remission during the pregnancy. Salicylate therapy is associated with prolonged gestation and labor. Supplemental pyridoxine is required for clients being treated with isoniazid for TB during pregnancy. RA cannot be contracted by the fetus during pregnancy.

The nurse is caring for a client at 32 weeks gestation who asks, "Why do I waddle when I walk?" Which explanation by the nurse provides the client with accurate information?" A) "A low calcium intake can cause you to walk differently." B) "I am concerned you have an underlying musculoskeletal disorder." C) "A hormone causes the pelvic joints to relax." D) "You are experiencing a change in the center of gravity."

C) "A hormone causes the pelvic joints to relax." Rationale: The joints of the pelvis relax due to hormonal​ influences, resulting in a waddling gait. A change in the center of gravity results in lordosis. A low calcium intake will not result in a waddling gait. The changes in the​ client's gait are due to​ hormones, not an underlying musculoskeletal disorder.

The nurse is caring for a pregnant client beginning her second trimester of pregnancy. Which question is the most appropriate for the nurse to ask? A) "Have you considered enrolling in childbirth classes?" B) "Are you aware we will test you for Group B strep today?" C) "How are you getting relief from your lower back pain?" D) "What is your labor plan?"

C) "How are you getting relief from your lower back pain?" Rationale: The​ nurse's role in the second trimester includes providing teaching about the common discomforts of​ pregnancy, such as lower back pain. Questions about childbirth classes and birth plans are appropriate questions for later in the​ pregnancy, during the third trimester. Testing for Group B strep occurs during the third trimester.

The nurse is caring for a client who is at 28 weeks gestation and diagnosed with gestational diabetes. The client expresses fear that the baby will not be healthy. Which response by the nurse provides the necessary reassurance to the client? A) "You should make an appointment in a few days to talk to the midwife about that." B) "The test for diabetes is done primarily to determine your risk of diabetes lager in life and has a minimal effect on the pregnancy." C) "We will help you to modify your diet to keep your blood sugar at normal levels to maintain a healthy pregnancy and baby." D) "Your pregnancy will be considered high risk from now on and you should be prepared for potential complications."

C) "We will help you to modify your diet to keep your blood sugar at normal levels to maintain a healthy pregnancy and baby." Rationale: The response by the nurse that provides the most reassurance to the client​ is, "We will help you to modify your diet to keep your blood sugar at normal levels to maintain a healthy pregnancy and​ baby." Gestational diabetes mellitus is controlled by diet and exercise. Referring the client to the midwife negates the​ client's concern for her baby. Telling the client to be prepared for complications is not good therapeutic​ communication, nor does it provide reassurance to the client. Gestational diabetes can have a significant effect on the pregnancy and may be associated with serious outcomes for the​ fetus, which include intrauterine growth​ restriction, macrosomia, symptomatic neonatal​ hypoglycemia, and fetal demise if left untreated.

The nurse is caring for a couple attending their first prenatal visit. The client states, "I have had trouble with anemia in the past." Which response by the nurse reflects the most appropriate plan of care in managing the pregnancy? A) "A healthy dietary intake should provide you with the iron and vitamins you need." B) "You will be taking an iron supplement throughout your pregnancy." C) "You will be instructed to take iron and folic acid throughout the pregnancy." D) "The results of your blood work will determine what supplements will be recommended."

C) "You will be instructed to take iron and folic acid throughout the pregnancy." Rationale: The goal of healthcare for the client is to prevent anemia so the client will be instructed to take an iron supplement and a folic acid supplement. If the results indicate the client has iron deficiency anemia or megaloblastic anemia caused by a folate​ deficiency, further treatment may be required. Folic acid supplementation also prevents neural tube defects. All pregnant clients are encouraged to take prophylactic supplementation of iron and vitamins in addition to their diets. Iron and folate supplementation is not deferred for laboratory results.

A pregnant patient with placenta previa has had an episode of active bleeding. Which antenatal tests should the nurse anticipate to be prescribed to evaluate fetal well-being? A) Contraction stress test B) Vibroacustic stimulation test C) Biophysical profile D) Nonstress test

C) Biophysical profile Rationale: The biophysical profile test is indicated when there is risk of placental insufficiency or fetal compromise. A nonstress test is used to evaluate fetal oxygenation. The vibroacustic stimulation test is used with the NST with the intention of inducing fetal movement and associated accelerations of the fetal heart rate with a nonreactive NST and in fetuses with decreased variability of the FHR during labor. The contraction stress test is a means of evaluating the respiratory function (oxygen and carbon dioxide exchange) of the placenta. It enables the healthcare team to identify the fetus at risk for intrauterine asphyxia by observing the response of the FHR to the stress of uterine contractions (spontaneous or induced). A contraction stress test is contraindicated in a patient with a placenta previa.

The nurse is conducting a dietary assessment for a pregnant adolescent. Assessment of dietary intake of which nutrient should be a priority? A) Vitamin B12 B) Magnesium C) Calcium D) Vitamin K

C) Calcium Rationale: Inadequate intake of calcium is frequently a problem for this age group. Adequate calcium is important to continue to support the growth and calcium maintenance of the adolescent as well as the growth and development of the fetus. Vitamin K and magnesium are not found to be deficient in the adolescent. Vitamins B6​, ​A, and D are found to be deficient in this age​ group, not vitamin B12.

The nurse is caring for a client who is at 28 weeks gestation and diagnosed with heart disease. Which condition should prompt the nurse to contact the HCP immediately? A) Emotional stress on the job B) Mild ankle edema C) Increased dyspnea at rest D) Weight gain of 1 pound in a week

C) Increased dyspnea at rest Rationale: Increased dyspnea at rest must be reported immediately because it may be an indication of congestive heart failure. Mild ankle edema and weight gain of 1 pound a week are expected physical findings during the third trimester. Emotional stress on the job can increase cardiac demand and should be reported only if the client experiences symptoms such as palpations or an irregular heart rate.

The nurse is caring for a pregnant client who has asthma. The client has a cold and has an exacerbation of asthma symptoms, including mild wheezing. To help avoid hypoxia-related complication in the fetus, which medication prescription does the nurse anticipate? A) IV corticosteroid (ie: prednisone) B) Oral pseudoephedrine (ie: Sudafed) C) Inhaled beta2-agonist (ie: albuterol) D) Oral acetylsalicylic acid (ie: aspirin)

C) Inhaled beta2-agonist (ie: albuterol) Rationale: Albuterol, a beta2-agonist, is the medication recommended to treat asthma exacerbations during pregnancy. Steroids, decongestants such as pseudoephedrine, and aspirin should be avoided in pregnancy because of potential harmful effects to the fetus.

*Possible Exam Question* A client who is at 12 weeks gestation is experiencing nausea, breast tenderness, and fatigue. She tells the nurse her husband is upset with her constant complaints. Which is the priority nursing diagnosis based on this data? A) Ineffective Breastfeeding B) Dysfunctional Family Processes C) Nausea D) Fatigue

C) Nausea Rationale: Of the three physiologic complaints, the one that has the highest priority is nausea because it could directly impact the developing fetus. Breast tenderness does not mean that the client will experience ineffective breastfeeding. Fatigue is a common symptom of pregnancy and would not negatively impact the developing fetus. The husband being upset with the client's complaints does not necessarily mean that she and her husband have dysfunctional family processes.

The nurse is caring for a client who is 36 weeks gesatation and diagnosed with gestational diabetes mellitus. Which maternal complication will the client be monitored for? A) Oligohydraminios B) Preterm labor C) Preeclampsia D) Anemia

C) Preeclampsia Rationale: Preeclampsia or eclampsia occurs more often in pregnant women with​ diabetes, especially when​ diabetes-related vascular changes already exist. Clients with gestational diabetes are​ 4-5 times more likely to develop gestational hypertension. Gestational diabetes does not place the client at an increased risk for anemia or preterm labor. The client with diabetes is at risk for hydramnios

The nurse is caring for a client who is at 31 weeks gestation and admitted for preterm labor. The client expresses concern for her baby and missing work. Which is a nursing priority? A) Restricting family visitors B) Contacting her employers to secure work release C) Providing emotional support D) Administering anti-anxiety medications

C) Providing emotional support Rationale: Based on the​ client's concerns, the​ nurse's priority is to provide the client emotional support. Clients experiencing preterm labor may have a difficult time coping with their concerns regarding the diagnosis. The​ nurse's role does not include restricting family visitors or contacting the​ client's employers. Concern for the unborn baby is a normal response and is not an indication for anti-anxiety medication.

The nurse is providing dietary counseling for a newly pregnant patient whose diet preference is lactovegetarian. Which information should the nurse include to ensure the patient is getting enough dietary calcium to support the pregnancy? A) Instruct the patient to increase the consumption of eggs B) Encourage the patient to increase dietary intake of dairy products C) Recommend a dietary calcium intake of 1200-1500 mg/day D) Increase the dietary intake of riboflavin to 1.4 mcg/day

C) Recommend a dietary calcium intake of 1200-1500 mg/day Rationale: Information that should be included in the dietary teaching is the specific recommendation of calcium. This enables the patient to understand how to monitor their dietary intake of calcium when choosing foods. The patient is encouraged to increase their dairy intake, but should also understand the recommendation of calcium intake to ensure an adequate amount of calcium-rich foods are consumed. Lactovegetarian diets do not include the consumption of eggs, and eggs are not a food source high in calcium. Riboflavin is a B vitamin.

A patient with gestational diabetes as 32 weeks gestation is scheduled for a nonstress test and asks, "How can this test tell if my baby is doing okay?" Which statement by the nurse reflects the purpose of a nonstress test? A) "the test allows for the measurement for the amniotic fluid volume." B) "The test is an assessment for fetal tone and breathing." C) "The test is reflective of your baby's oxygen status and intact nervous system." D) "Your baby's well-being is determined by the amount of movement during the test."

C) The test is reflective of your baby's oxygen status and intact nervous system." Rationale: The nonstress test is a widely used method for fetal evaluation, which is based on the knowledge that when the fetus has adequate oxygenation and an intact central nervous system (CNS), accelerations of the fetal heart rate (FHR) occur with fetal movement. Measurement of an amniotic fluid index, fetal movement, fetal tone, and breathing are components of a biophysical profile.

*Possible Exam Question* A client with type 2 DM requiring insulin has just discovered that she is pregnant. The nurse is teaching the client about insulin requirements during pregnancy. Which guideline should the nurse provide? A) "Insulin requirements increase greatly during the first trimester." B) "Insulin requirements do not change during pregnancy." C) "Insulin requirements increase greatly during labor." D) "Insulin requirements increase during the last two trimesters."

D) "Insulin requirements increase during the last two trimesters." Rationale: Maternal insulin requirements fluctuate throughout​ pregnancy; decreasing during the first​ trimester, then increasing during the second and third trimesters. During the second half of​ pregnancy, fetal growth accelerates and there is an increased utilization of glucose by the fetus. In response to​ this, the placental​ hormone, human placental lactogen​ (hPL), creates insulin resistance in the maternal tissues to have sufficient glucose available for the fetus. This increased insulin resistance may result in an increase in maternal insulin requirements. During​ labor, insulin requirements diminish due to the increased maternal energy expenditure.

The nurse is providing care to a pregnant client and her spouse. the client requires an amniocentesis. Which client statement indicates appropriate understanding of the information presented? A) "The test has to be done before the 14th week of pregnancy." B) "If the test determines our baby has Down syndrome, we will not need to take childbirth classes." C) "It is not unusual for amniocentesis to misdiagnose a problem with the baby." D) "The results of the amniocentesis will take up to 2 weeks."

D) "The results of the amniocentesis will take up to 2 weeks." Rationale: For couples having an amniocentesis, the first few months of pregnancy can be difficult because the test cannot be performed until the 14th week of pregnancy, and not before. The results of the amniocentesis will not be available for up to 2 weeks, which is evidence that instruction regarding the test has been understood by the client and spouse. Childbirth classes are important in promoting adaptation to the event of childbirth for expectant couples of any age or situation. The results of an amniocentesis are 99% accurate in diagnosing genetic abnormalities.

The nurse caring for a client who is at 35 weeks gestation is planning to teach the client about the premonitory signs of labor. Which statement is appropriate to include in the teaching? A) "Expect to see bleeding each day from now on." B) "Your swelling will start to go away now." C) "You may notice you need to urinate less frequently as you get closer to labor." D) "You may notice that you breathe easier when the baby drops down into your pelvis."

D) "You may notice that you breathe easier when the baby drops down into your pelvis." Rationale: The​ client's session should include the​ statement, "You may notice that you breathe easier when the baby drops down into your​ pelvis." As lightening​ occurs, the pregnant client may experience easier breathing. As the pregnancy​ continues, the client may experience increased dependent​ edema, backache, leg​ pain, urinary​ frequency, and vaginal discharge. Bloody show is the loss of the​ blood-tinged cervical mucus plug. Vaginal bleeding is abnormal and should be reported to the healthcare provider.

Which pregnant client would have the greatest need for a nutritional assessment and individualized meal plan? A) A client who is lactose intolerant B) A client who is a vegetarian C) A client who requires a Kosher diet D) A client with anorexia nervosa

D) A client with anorexia nervosa Rationale: Although all of these clients will need special considerations related to diet and nutritional requirements, the client with anorexia nervosa, an eating disorder, is at highest risk for inadequate nutrition. When a pregnant woman has an eating disorder, education and individualized meal plans can help the patient increase her dietary intake while maintaining a sense of control.

The nurse is reviewing exercises with a pregnant woman to help the client maintain physical fitness and appropriate weight gain throughout the pregnancy. After the teaching session, the client tells the nurse that she was taught never to reach over the head because this will harm the baby. Based on this data, which action by the nurse is appropriate? A) Provide dietary instruction instead to ensure the client does not gain excessive weight. B) Tell the client to just perform the exercises that don't require her to reach over her head. C) Provide alternative activities to do instead of exercise D) Assure the client that reaching over the head will not harm the baby.

D) Assure the client that reaching over the head will not harm the baby Rationale: Clients of European, African, and Mexican descent may believe that reaching over the head during pregnancy can harm the baby. The nurse should assure the client that this is not accurate. Providing activities to do instead of exercise or telling the client to avoid the exercises that require her to reach over her head will not address the misconception that reaching over the head will harm the baby. Dietary instruction during pregnancy is important to ensure a healthy weight gain for a healthy baby, not to ensure the client does not gain excessive weight because of lack of exercise.

*Possible exam question* The nurse is providing a prenatal class instruction on different exercises that can be done to prepare for child birth. Which exercise should the nurse include that specifically helps redu e back strain? A) Partial situps B) Kegel C) Tailor sitting D) Pelvic tilt

D) Pelvic tilt Rationale: The pelvic tilt can reduce back strain as it strengthens the abdominal muscles. Kegel exercises strengthen the pelvic floor muscles. Tailor sitting is used to stretch the inner thighs. Partial​ sit-ups strengthen abdominal muscle tone.

The nurse is caring for a client who has had a positive pregnancy test. The nurse reviews the client's history and notes the client smokes half a pack of cigarettes a day. Which information should the nurse include in the plan of care? A) Provide information on a 12-step rehab program B) Inform her that less than 10 cigarettes per day has not been proven harmful to the baby. C) Encourage her to chew gum instead of smoke D) Refer her to a smoking cessation program

D) Refer her to a smoking cessation program Rationale: The information that is important to include in the plan of care for the client that smokes half a pack of cigarettes a day is a referral to a smoking cessation program. Chewing gum is not a replacement for smoking cessation. A​ 12-step rehabilitation program is for drug or alcohol abuse. Any smoking adversely affects the fetus.

The nurse is reviewing the histories of four new prenatal clients. Which maternal risk factor indicates the need for antenatal testing? A) Maternal age of 25 B) Maternal history of depression C) Vegan dietary preference D) Twin gestation pregnancy

D) Twin gestation pregnancy Rationale: Obstetrical​ factors, such as multifetal gestation and previous fetal​ loss, are indicators for antenatal testing. Demographic factors such as age younger than 17 or older than 35 years may indicate the need for antenatal testing. Mothers who are vegans may have special nutritional​ needs, but this factor alone does not indicate the need for fetal antenatal testing. A maternal history of depression is not an indicator for antenatal testing.